Habif Chapter 15 Infestations And Bites

Front 1

scabies mite?

Back 1

sarcoptes scabiei var. hominis
obligate parasite humans

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scabies blacks?

Back 2

rare

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sarcoptes scabiei var. hominis

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1/3 mm
8 legs
30 day life cycle
burrow within 1 hr
eggs 2 or 3/day
scybala
larvae hatch maturity 14 to 17 days

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scabies type of rxn?

Back 4

hypersensitivity
elevated IgE
eosinophilia

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scabies layer of epi?

Back 5

stratum corneum

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norwegian scabies

Back 6

scaly thick skin develops in immunosuprpressed or elderly patients thoughsand of mites
urrows enter underlying epi

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scabies survive oil?

Back 7

7 days

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mites papules?

Back 8

rare

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scabies infants

Back 9

pustules and vesicles palms and soles
face and scalp
few burrows
nodules axillae and diaper

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elderly scabies

Back 10

fewer cutaneous signs (decrease immunity)

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Crusted Norwegian Scabies

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hands and feet
asymptomatic crusting
thick subungual keratotic nail dystrophy
wartliek formations digits and sites of truam
gray scales and thick crusts trunk and extremities
desquamation of the facial skin
shed hair
neuro or MR DOWN'S SYNDROME
itching absent or severe

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scybala

Back 12

scabies feces

Front 13

Permethrin

Back 13

Elimite cream
Acticin cream
synthetic pyrethrin
2% absorption/not significant absorption

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Lindane

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Kwell
gamman benzene hexachloride
scabies
CNS stimulant produces seizures and death to scabies
10% systemic absorption
attach to fat and brain tissue
no < 2 yrs, preg, HIV

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Ivermectin

Back 15

po scabies medicine
2 doses

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Scabies treatment

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1. Premethrin
2. Lindane
3. Ivermectin
4. Sulfer w petroleum jelly
5. Crotamiton (Eurax lotion)

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Nodular scabies
treatment?

Back 17

scrotum
intralesional scabies

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Pediculosis

Back 18

mites
obligate human parasites
10 days (adults) to 3 weeks (fertile eggs) off human
ectoparasites
insect
6 legs
3 types
2 mm flat wingless 3 pairs legs anterior directly behind head
3 types

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pediculosis types

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pediculus humanus var capitis
pediculus humanus var corporis
pthirus pubis

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pediculosis size?

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< 2mm

corporis > capitis > pubis

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pthirus pubis

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short oval body with claws

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lice
feed?
engoged?
color?
life cycle?

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5 x per day feed, not engorged, rust color, 30 days egg to eggs
6 eggs or nits/day, 18 days to maturity
Nits or eggs 0.8 mm firmly cemented to base hair shafts

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pediculosis capitis

Back 23

kids females
blacks rare back of the head and enck behind the ears
20 adult lice
sensiization 3 to 8 mths
posterior cervical adenopathy
eyelashes
lice survive off human 3 days
nits surive off human 10 days

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pediculosis corporis

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uncommon
typhus relapsing fever rench fever
lay eggs in seams of clothing skin only to feed

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eyelashes pediculosis

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kids

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pediculosis pubis

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most contagious STD
30% have other SD
Blacks = whites
hair around anus
iching
gray-blue macules (maculae ceruleae) 1 to 2 cm groin and sites distant from infestation
unkonwn cause alterd blood pigment

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gray-blue macules

Back 27

pediculosis pubis

Front 28

patient witout an apparent rash and localized itching

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r/o lice

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nits on exam? active infestation?

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nits persit for mths after successful treatment
does not indicate active infestation

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live eggs lice located?

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within a quarter inch of scalp

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lice comb

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0.2 to 0.3 mm
usually takes 1 min to find the first louse

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live nits? woods lamp

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live nits fluoresce
nits that contain an unborn louse flouresce white
empty nits flouresce gray

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only peculicide in US not less effective tx of lice

Back 33

ovide

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premethrin lice

Back 34

OTC treatment lic
paralyzes nerves that allow lice to breateh
lice can close down respiratory airways for 30 mins whe immersed in water
all insecticides are put on dry hair
developing eggs no CNS during first 4 days
medician must have residual activyt to be ovicidal
efficacy 95%
active for 2 weeks
do not use cream rinses 2 weeks

Front 35

pyrethrin

Back 35

not active for 2 weeks
lotions for body an dpubic hair

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lice tx

Back 36

treat once then in two weeks

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malathion

Back 37

ovide
only insectiside in US no loss of effectiveness
peidulicidal and ovididal
no infants

Front 38

ivermectin tx lice

Back 38

paralysis and death of lice
selective parasites
73% effective w one 12 mg dose adult

Front 39

bactrim lice tx?

Back 39

kills essential bacteria in lice gut? lice fall off and die
need additional tx in one week for eggs
one tab po BID x 3 days then repeat in one week

Front 40

when can kid go back to school after pediculosis capitis?

Back 40

after first topidal treatment or wet combing
even if nits

Front 41

pomades tx lice?

Back 41

petrolatum, manyonnaise, an dpomades
kill lice in 10 mins
must use a lot and repeat weekly for 4 weeks
eggs hatch in 8 to 10 days

Front 42

eyelid lice

Back 42

petrolatum, forceps, fluorescein immediate toxic effect lice
oral ivermectin resistant cases

Front 43

caterpillar dermatitis

Back 43

papules and vesicles on posterior neck
setae (hairs)
seasonal
mechanical stim or release of irritating substances on the hairs
windblown setae

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brown tail moth

Back 44

NE US

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gypsy moth

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NE US
hang from trees wit long threads
setae wind land on clothes hung out to dry

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puss caterpillar

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wooly slug
SE US
1 inch long
back and sides coveredd with fine bristles

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Io moth

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east of rocky mountains
2 to 3 inches
pale green wit red dish stripes
each body segment with tufts of sines

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saddleback caterpillar

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est of Texas and south of Massachusetts
1 inch long
green and fleshy
brown or purple saddle shape on midback
stout spines at end and along sides
spines hollwo and contain toxin

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type of immune response with gypsy moth

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closed patchy delayed hypersenstitivity response
type 4
similar to poison ivy

Front 50

caterpillar dermatitis clinical

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linear
vesicles and pustules on posterior neck
puss catapiller grid-like pattern

Front 51

puss catapiller clinical?

Back 51

grid-like pattern
sharp severe pain

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assoc sx with caterpillar dermatitis

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rhinitis, conjunctivitis, and wheezing
no deaths in US

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caterpillar dermatitis tx?

Back 53

resolve few days to 2 weeks
topical steroids
puss caterpillar analgesics

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wooly slug

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puss caterpillar
SE US

Front 55

spider venom

Back 55

enzyme spreading factor hyaluronidase and a toxin that is distributed by spreading factor
harmless
pain, swelling inflammation
hives satellite hives

Front 56

Black Widow

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Lactrodectus mactans
shoe button spider
no Alaska
lots in rural south
4 cm

Front 57

lactrodectus mactans envenomation
toxin?
mechanism?
clinical sx?

Back 57

only spider capable of envenomation
neurotoxin alpha-latrotoxin
binds to receptors at neuromuscular motor end plate of both sypathetic and parasympatheitc nerves increased synapti catecholamines
migratory muscle cramps and spasm nausea vomiting, HTN, maliase, treomors dayst to a week

Front 58

black widow web?

Back 58

crinkling crackling haphazard randomly arranged

don't bite when away from web because need stability of web
come inside w cold weather

Front 59

black widow clinical

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immediate sharp pain or no pain
immediate rxn minimal slight swelling small red fang marks
lymphatic absorption and vascular dissemination of lactrotoxin = LACTRODECTISM
GENERALIZED ABDOMINAL PAIN, BACK, AND LEG PAIN
15 mins to 2 hrs afte bite DULL MUSCLE CRAMPING OR SDEVERE PAIN WITH NUMBNESS gradually spreads from inoculation site to entire torso
MOST SEVERE IN ABDOMEN AND LEGS
SKELETAL MUSCLES
SURGICAL ABDOMEN without ttp and distension
INCREASE DTRs
dizziness, ha, sweating, n/v
increase severity up to 24 hrs
decrease 2 to 3 days
residual sx weakness, tingling, nervouse ness , transient muslce spams wks to mths

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lactrodectism

Back 60

lymphatic absorption and vascular dissemination of lactrotoxin

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immunity to black widow?

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yes after severe attack

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convulsions, shock, and death % of black widows?

Back 62

5%

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black widow tx

Back 63

ice (limiit spread neurotoxin)
antivenin (horse)
muscle relaxants
analgesics

Front 64

black widow antivenem
animal serum?
only lactrodectus mactans?
route?
test to preform before giving?
relieves sx within time?
not effective after?
who is higher risk needs antivenem?

Back 64

horse
can use on all species of lactrodectans
IM or IV for severe/< 12 yrs
eye sensitivity test
1 to 2 hrs reieves sx
give even after 90 hrs
< 16 yrs old and > 60 yrs old

Front 65

muscle relaxants black widow

Back 65

calcium gluconate?
IV opioids and benzodiazepines
valium
diazepam
methocarbamol

Front 66

analgesics black widow

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ASA
morphine careful because toxin may affect resp muscles

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Brown Recluse

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loxoscelidae reclusus
fiddle back spider
1.5 cm (smaller than black widow)
violin back (broad head point towards abdomen)
Southern US

Front 68

loxoscelidae reclusus clinical

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sharp pain bee bite
initial mild inflammation
fatty acids buttocks and thighs more cutaneous rxn
bites mc EXTREMITIES
NECROSIS WITHIN 4 HRS SEVERE BITES
LOXOSCELISM

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loxoscelism

Back 69

nectrotic arachnidism
rapid expansion of blue-gray macular halo aroudn puncture site
local hemolysis
violaceous skin bad = necrrosis = start early tx
severe pain
SINKING INFARCT center sinks in blue cgray macule
DEEP INDOLENT ULCER WITH RAGGED EDGES
wks to mths SCARRING

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brown recluse severe progressive rxn

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severe
initial erythema to pallor
within 12 to 14 hrs f/c, n/v, weakness, joingt and msuscle pains, hives or measle-liek rashes, THROMBOCYTOPENIA or HEMOLYTIC ANEMIA, GENERALIZED HEMOLYSIS, DIC, RENAL FAILURE, death
sx rxns rare
KIDS

Front 71

brown reculuse preg?

Back 71

no affect on fetus

Front 72

most brown reculuse bites
tx?
apply ice or heat?

Back 72

mild minimal swelling and erythema
rice, ASA (prevents platelet aggregation and throbosis)
TETANUS
NO HEAT MAKES LESION WORSE

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mod to severe brown reculse therapy?

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within 24 to 48 hrs sx
NO SURGERY
atnibiotics CEPHALOSPORINS infection prophyhlaixs ulcerating lesions
analgesics
DAPSONE (give even if after 48 hrs)

Front 74

Dapsone brown recluse?
order which test?
mechanism?

Back 74

order 6GPD
prevent venom induced perivasculitis with PMNs infiltration that occurs w extensive necrosis

Front 75

Brown Reculuse spider progressive hemolytic anemia
size of lesion?

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> 1 cm test for hemolytic anemia (free serum hg or thromocytopenia)

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sx severe loxoscelism tx?

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prednisone

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surgery brown reculuse?

Back 77

no

Front 78

brown recluse spider antivenom?

Back 78

yes

Front 79

spider?
toxin?
MOA toxin?
area of body?

Back 79

latrodectus mactens
alpha-latrotoxin
neurotoxin (increase catecholamine release)
abdomen lactodectism

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spider?
toxin?
tx?

Back 80

loxoscleles reclusa
sphingomyelinase-D (phyospholipase D)

tx RICE, ASA, tenanus
dapsone/antivenem used quickly
hyperbaraic O2

Front 81

spider bite?

Back 81

loxosceles reclusa
toxin sphingomyelinase-D (phospholipase-D)

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dx?

Back 82

scabies

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organism?
life cycle?
how many eggs/day?
how long until the eggs marture?
incubation?

Back 83

sarcoptes scabeii var hominis
30 days
2 - 3 eggs/day
2 - 4 days off of host and up to one week in oil
incubation days to months

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dx?

Back 84

scabies

Front 85

dx?

Back 85

scabies