Parasites

Question 1

Jellyfish sting

Answer 1

Most patients do not see the jellyfish but do feel immediate pain. Usually, patients will notice a linear red or urticarial lesion that develops a few minutes after the exposure. The pain associated with the envenomation is described as burning pain and sometimes as pruritus. The pain may last anywhere from several hours to several days. Moderate to severe symptoms include muscle ataxia, seizure, anaphylaxis, hypotension, bronchospasm, pulmonary edema, nausea, vomiting, diarrhea, muscle cramps, conjunctivitis, and corneal ulcers.
Treatment is manual removal of stings and warm compresses (cold or vinegar only used in Australia/Indic Ocean)

Question 2

Irukandji syndrome

Answer 2

This syndrome is caused by a tiny jellyfish which is usually one centimeter by one centimeter in diameter. Symptoms of this syndrome include pain at the site of envenomation followed by generalized back, chest, abdominal pain, hypertension, and tachycardia. The signs are a result of a catecholamine release. Treatment is with opioids and benzodiazepines

Question 3

Portuguese Man-Of-War

Answer 3

Not a true jellyfish, but a colony of hydroids. Envenomation causes pain, scarring, paresthesias — other symptoms include nausea, headache, chills, and possibly even cardiopulmonary arrest.

Question 4

Swimmer’s itch

Answer 4

Cercarial dermatitis (swimmer’s itch) is caused by the penetration of human skin by cercariae of schistosome parasites that develop in and are released from snail hosts. Cercarial dermatitis is frequently acquired in freshwater habitats, and less commonly in marine or estuarine waters. Treatment is with antihistaminics, calamine, topical steroids

Question 5

Seabather’s eruption

Answer 5

Annoying pruritic dermatitis that appears on the areas covered by the bathing suit as an erythematous macular or papular dermatitis, with or without urticaria. It occurs sporadically in Florida, the Caribbean, and as far north as Bermuda. It is caused by nematocysts of larval-stage thimble jellyfish (Linuche unguiculata), sea anemones (eg, Edwardsiella lineata), and larval cnidarian

Question 6

Jiggers

Answer 6

Tungiasis

Question 7

Chiggers

Answer 7

Chigger bites are due to infestations due to the larval form of trombiculid mites encountered in grasslands, forests and around lakes and streams. Lesions are papulovesicualr and intensely pruritic. Tx is symptomatic with antipruritics and topical steroids

Question 8

Insect bite reactions in CLL

Answer 8

Exuberant papulovesicular lesions develop in patients with CLL apparently as an exaggerated response to arthropod bites. Prominent eosinophil infiltration and degranulation within these lesions likely contribute to the severity of symptoms.

Question 9

Demodex folliculitis

Answer 9

Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may,be implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentration

Question 10

Facial spinulated demodicosis

Answer 10

Caused by Demodex and treated with ivermectin

Question 11

Walking dandruff

Answer 11

Caused by mites, looks like moving dandruff and treatment is with oils

Question 12

Fire ants

Answer 12

Fire ants do not need to be provoked to attack, and their venom is capable of causing a painful local reaction and, in some instances, result in life-threatening anaphylaxis. TX is topical steroids and antipruritics

Question 13

Lepidopterism

Answer 13

“Lepidopterism” refers to various skin and systemic reactions secondary to contact with moth and butterfly larvae or caterpillars (order Lepidoptera). It is worth noting that the adult forms of moths and butterflies do not sting. Treatment is symptomatic

Question 14

Snake bite manifestations

Answer 14

• Local pain and edema
• Venom induced consumption anticoagulation
• Thrombocytopenia or altered platelet function
• Thrombosis
• Neurotoxicty with descending flaccid paralysis
• Myotoxicity, cardiotoxicity and hypotension
• Nephrotoxicity

Question 15

Prehospital care of snake bites

Answer 15

• Get away from the snake and identify it, if possible
• Loosely splint the bitten body part, with a default of heart-neutral positioning
• Anticipate swelling (e.g., remove jewelry)
• Obtain transport (with personnel competent in advanced life support) to a capable health care facility.
• A compressive bandage or a blood pressure cuff placed proximal to the bite and inflated to sufficient pressure (approximately 50 mm Hg [upper extremity] or 70 mm Hg [lower extremity]) may be considered

Question 16

Scorpion bites

Answer 16

The majority of scorpion stings are either dry or result in low amounts of injected venom, thus explaining why up to 95% of scorpion stings ensue only in local signs.
In severe cases there is a massive release of neurohormonal mediators, with systemic vasoconstrictor effects eliciting a sharp increase in systemic arterial pressure and LV-filling pressure and decreased cardiac output. This early phase is followed by a severe cardiomyopathy, a form of Takotsubo cardiomyopathy, involving both ventricles and reversible in days to weeks. T
The standard intensive-care treatment (when available) overcomes envenomation’s consequences such as acute pulmonary edema and cardiogenic shock.

Question 17

Lacttodectism

Answer 17

Latrodectism results from bites by widow spiders (Latrodectus spp) and causes local, regional, or generalised pain associated with non-specific symptoms and autonomic effects.

Question 18

Lactrodectism

Answer 18

Latrodectism results from bites by widow spiders (Latrodectus spp) and causes local, regional, or generalised pain associated with non-specific symptoms and autonomic effects. Antivenoms are an important treatment for spider envenomation but have been less successful than have those for snake envenomation.

Question 19

Loxoscelism

Answer 19

Loxoscelism is caused by Loxosceles spp, and the cutaneous form manifests as pain and erythema that can develop into a necrotic ulcer. Systemic loxoscelism is characterised by intravascular haemolysis and renal failure on occasion. Antivenoms are an important treatment for spider envenomation but have been less successful than have those for snake envenomation.