Threadworm & Scabies

Question 1

How are eggs transmitted?

Answer 1

faecal-oral transmission

Question 2

What are clinical features of threadworm?

Answer 2

1. Night-time perianal itching - caused from mucous produced by females when laying eggs
2. Local tickling sensation to acute pain
3. Eggs and worms may be visible and in the excrement after going to the toilet
4. Intense perianal itching especially in the morning

Question 3

When to refer pts suspected of threadworm?

Answer 3

1. Recent abroad travel
2. Failed treatment
3. Children under 2 years

Question 4

What OTC medication is given for threadworm?

Answer 4

Ovex - mebendazole
100mg as a single tablet or 5ml suspension
one dose is usually sufficient but can repeat after 2 weeks

Question 5

Should tx be given to all family members for threadworm?

Answer 5

Yes as it is likely that other family members will have been infected

Question 6

Can mebendazole be used in children?

Answer 6

only >2 years

Question 7

What are the S/E of mebendazole?

Answer 7

Abdominal pain, rash, diarrhoea

Question 8

What drugs can interact with mebenazole?

Answer 8

phenytoin, carbamazepine - decreases mebendazole plasma levels so the dose may need to be increased

Question 9

Can mebendazole be given in BF or pregnancy?

Answer 9

no data so avoid BF

Avoid in P

Question 10

What are hygiene measures the pt should take?

Answer 10

Keep nails short and clean
Careful washing and nail scrubbing before meals and after each visit to the toilet to prevent autoinfection
bed linen, towels and sleepwear should be washed on the first day of tx
Shower daily

Question 11

What are scabies?

Answer 11

mites burrowed beneath the skin surface causing allergic reaction to their coat and exudates resulting in intense itching (prutius)

Question 12

What are symptoms of scabies?

Answer 12

itching especially at night, appearance of the burrows are smalll thread-like grey lines, most visible in the webs of the fingers and toes

Question 13

What questions may you ask a pt who may have scabies?

Answer 13

visible signs of mites?
Location of the rash? - finger webs and wrists
History of presenting complaint

Question 14

Do all members of the household need to be treated for scabies?

Answer 14

yes and close contacts and clothes and bed linen should be washed at temperatures above 50 at time of tx

Question 15

What tx preps are available OTC for scabies?

Answer 15

1. Aqueous preps
2. Permethrin (Lyclear cream) or Malathion products can be used, 2 tx are recommended 7 days apart
3. Applications should be applied to the entire body and left on for 8-12 hours (for permethrin cream) or 24 hours before bathing (malathion lotion)

Question 16

How long will the itch last for for scabies? What can you recommend for this?

Answer 16

2-3 weeks even after insecticide tx as the allergens still remain but symptoms will eventually fade. 
Crotamiton cream (Eurax) can be recommended

Question 17

How are scabies transmitted?

Answer 17

By close contact with an infected individual so infected pts should be alerted to avoid contact with others.

Question 18

How long may symptoms not show once a pt is infected with scabies?

Answer 18

up to 8 weeks after infestation

Question 19

What are other counselling advice you can give for a person with scabies?

Answer 19

wash clothing and bedding at temperatures above 50 degrees

Question 20

What children use permethrin, benzyl benzoate and malathion?

Answer 20

Permethrin - > 2 years
Benzyl B > 12 years
MAlathion > 6 months

Question 21

What are the S/E that can occur with tx of scabies?

Answer 21

burning, stinging or tingling, irritation

Question 22

How often is permethrin used?

Answer 22

The whole tube is used for adults and children over 12 as a single application
1/4 tube those 2months-5 years
1/2 tube those 6-12 years
wash the whole body thoroughly 8-12 hours after tx.
repeat after 7 days

Question 23

How often should Malathion be used?

Answer 23

leave on for 24 hours - reapply to hands if washed

repeat after 7 days