Infestations PDF

Infestations 1. Scabies 2. Lice Scabies Parsitic Scabies (Sarcoptes scabiei): The most common infestation worldwide. Causes intense itching that characteristically keeps those affected awake at night. The female mite burrows into the epidermis and lays eggs. Holl Scabies: child onlyin the around _n...

Infestations 1. Scabies 2. Lice Scabies Parsitic Scabies (Sarcoptes scabiei): The most common infestation worldwide. Causes intense itching that characteristically keeps those affected awake at night. The female mite burrows into the epidermis and lays eggs. Holl Scabies: child onlyin the around _n Sparing face (in adults) and back Transmission: Transmission occurs because of close personal contact (at least 15 min of skinto-skin contact) with an infected individual. The first symptoms of itching occur 2 weeks later when the immune system reacts to the proteins in the mites, eggs, and feces in the skin. After 2 weeks PrimaryInfestation 24 48hrs After Infestation Serandary M 2 Jay Diagnosis: History Taking: - Several individuals in the same household/institution/ classroom/ward are being affected simultaneously by a rash that is intensely itchy at night. - Severe itching, more at night, classic distribution. Physical Examination: 1. Burrows: Hollis - Clinically, burrows can be seen, especially in the finger-web spaces and on the genitals - Burrows are linear palpable ridges on the skin with a black speck indicating the position of the mite, which can be teased out of its burrow using a sterileMmm needle and MMM mounted onto a microscope slide. immune response 2. Patients often have a widespread papular rash, which is due to a reaction to the infestation, with multiple excoriation marks which can become secondarily infected with staphylococcus. Scabies burrows: Tx Permathrin ridgeson theskin Linear Palpable with Black speak Linear palpable ridges on the skin with a black speck indicating the position of the mite Scabies in children: Babies and young children infested with scabies characteristically present with erythematous cutaneous papules and nodules in the axillae and on the soles of the feet. severreaction at Lesions might blister. Classic burrows are rarely seen in this age group. Scabies in an infant: me Yates vesicae Edy.gg m multible artumas papal over Trunk eat off Scabies nodules in a child fad nodules Axilla multible Papule Mfume Crusted scabies: Crusted scabies can look similar to dry scaly skin rashes such as psoriasis and eczema, and consequently can be misdiagnosed. Patients are usually immunosuppressed or elderly and do not complain of itching, as their immune cells are not reacting against The mite proteins. Consequently, mite numbers are usually in the hundreds. Crusted scabies clinical findings: Crusted fine superficial scaling on the skin. Mar Very little erythema (unlike psoriasis and eczema) If the diagnosis is missed then many close contacts such as nurses and caregivers develop classic scabies, and Small outbreaks can occur. Crusted scabies: Management: All scabies A full explanation of how to use topical therapy is essential. (m.c.c of e treatment failure is incorrect use) e Important The lotions should be applied from the neck downwards.(although thenotz head and neck of babies should also be treated) Patients should be told that they and all their close personal contacts need to be treated at the same time. (to prevent reinfestation) Towels, bedding, and underwear should be washed. under Heat Go e Management: The asas treatment should be left overnight and then repeated after 7 days. (i.e. D1 and D8 applications) ease can mite mite easy They should pay particular attention to the web spaces and genital areas. They should reapply the lotion after washing their hands. Management: Patients should be warned that the skin itching will take 6–8 weeks to subside. Persistent itching often leads patients to conclude that the mites are still active and they subsequently treat themselves repeatedly, leading to an irritant dermatitis (Post scabies dermatitis) The itching resolves when the mites, eggs, and feces have been removed from the skin by the host’s immune cells. Management: 1. Permethrin cream 5%: - First-line treatment - Should be left overnight, two applications 7 days apart, adults apply from the neck downwards; babies/infants apply to all the skin. 2. Malathion lotion 0.5% - Second line - Applied as permethrin. 3. Ivermectin: - Dose: 200 μg/kg - Two doses 7 days apart - Can be given to immunocompromised patients and those with crusted scabies (avoid in patients < 15 kg and in pregnancy). __ 0 Management: If permethrin and malathion are not available, then >> 10% sulphur in yellow soft paraffin is effective and safe. 25% benzyl benzoate emulsion may also be used. For severe pruritus >>> Topical anti pruritic agents e.g. crotamiton. Lice - Head Lice - Body Lice - Pubic Lice Head lice: They have a worldwide distribution and can affect anyone. Children are the most common hosts. Lice are transmitted by head-to-head contact, and on combs, brushes, and hats Girls are more commonly affected than boys Head lice: Mic Posterior scalb IIE Mild itching may be the only symptom of head lice. Inspection of the hair close to the scalp may reveal adult lice and nits (white empty egg cases) in infested individuals. Patients may develop an itchy irritantlooking dermatitis on their upper back and neck area. Fine-toothed combs can aid detection. to Nite 0 adherent to shaft diaonosis EE Hair Brown Lary Management: Only treat individuals with live lice visible on the scalp. Fine-toothed combs can be used to comb out lice and eggs. An application of hair conditioner usually allows the comb to pass more easily through the hair. Combinations of insecticides and Fine-toothed combs (bug-busting) are effective. Management: First-line treatment is permethrin 1–5% crème rinse applied to dry hair and left on overnight. Alternative agents include phenothrin 0.5% or malathion 0.5% Body lice: Body lice are the vectors of several human pathogens including: - Bartonella Quintana (agent of trench fever, bacillary angiomatosis, and endocarditis). - Rickettsia Prowazekii (agent of typhus). Body lice tend to affect individuals from poorer economic backgrounds Body lice: The lice live in the host’s clothes and bite imma the skin. Close inspection, especially of the clothing 23seams, reveals the adults and eggs. Infested individuals have a widespread papular eruption with excoriations. Body lice: Infested individuals have a widespread papular eruption with excoriations. multible linear excoriation artumatus poster with upper papulesoverand upperBack arm multibi arthesmtus Papale Management Wash clothing in hot water OR place them in a sealed plastic bag for 2 weeks to kill adults and eggs. Treat the skin reactions with a moderately potent topical steroid, plus topical antibiotic if secondarily infected with bacteria. Take blood for culture and serology if louse-borne systemic disease is suspected. (e.g. if the patient has a fever or constitutional symptoms) Pubic lice These lice prefer the sparser hair-bearing sites on the skin such as the pubic, axillary, and eyelash area. The so-called crab lice are slow-moving and are spread by close personal contact. Check the patient for other sexually transmitted diseases. Pubic lice on eyelashes. Pubic lice on the Pubic area Management: Use topical permethrin 5% cream or 0.5% malathion to the skin from the neck downwards, left on overnight, repeated after 7 days. If the eyelashes are involved use petrolatum only, as insecticides can I damage the eyes. vasteline Thank You