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Loaiasis
Aka Loa Loa, Calabar Swelling, Fugitive Swelling, Tropical Swelling Asymptomatic localized subQ swellings, size of a hens egg Prediliction for loose tissues such as eyes, frenulum of tongue, genitalia Transmitted by the Mango fly Chrysops dimidia or silacea Tx: Diethylcarbamazine
Onchocerciasis
River Blindness Central & South America, Mexico Pretibial depigmentation: leopard skin Thickened skin: elephant skin May develop into subQ nodules Mazzoti test + if edema, pruritis, fever & arthralgias w/50mg diethylcarbamazine Tx: Ivermectin 150mg single dose
Trichinosis
Inadequately cooked pork, bear or walrus meat Puffy eyelid edema, red conjunctiva and sometimes urticaria, fever, HA, muscle pains, neurologic S&S. 20% have maculopapular rash, very itchy, responsive to corticosteroids. Diagnosis confirmed by muscle biopsy Tx: Albendazole 400mg bid for 2w.
Insecta
Caterpillar Moth
Arachnida
Scolopendra sp.
Saddleback
GOAT MOTH
GYPSY MOTH
Anoplura
Pediculosis (Phthiriasis): Pediculosis Capitis Pediculosis Corporis Pediculosis Pubis (Crabs)
Pediculosis (Phthiriasis)
Pediculus humanus (head & body) Phthirus pubis (pubic or crab louse) Attach and suck blood, saliva is antigenic and creates dermatitis Lice may transmit endemic typhus, relapsing fever or trench fever.
Pediculosis Capitis
MC in children, scalp usually pruritic Diagnosis straightforward. Peripilar hair casts easily differentiated b/c moveable, but the breaks of trichorrhexis nodosum may mimic nits Tx: Apply Permethrin 1% Cream Rinse (Nix) to DRY hair, then rinse out after 3060 minutes. Do not shampoo for 24 hours afterwards.
Pediculosis Capitis
Pediculosis Corporis
Aka: Pediculosis Vestimenti or Vagabonds Dz. Likes pressure areas beneath collar, belt or in bedding. LICE RARELY FOUND ON SKIN. Dx: Generalized itching, parallel scratch marks, hyperpigmentation, LSC & red macules Tx: Laundering clothing and bedding, 1% Malathion powder or 10% DDT may be dusted onto inner surface of underwear Best to discard clothing as lice may live in clothing for 1 month without a blood meal
Ked itch
Sheep ked = Melophagus ovinus Feeds with mouth and sucks blood Woolsorters and sheepherders Pruritic often hemorrhagic papules, nearly always with a central punctum Deer keds attack people in a similar way, MC hips and abdomen, last 12m
Myiasis
Invasion of tissues by fly larvae, eggs hatch, burrow into skin. Furuncle with maggots in the center. Cochliomyia hominivorax (Screw worm) MC cause wound myiasis in USA Phormia regina (Black Blowfly, USA) Dermatobia hominis (botfly, New World) Cordylobia anthropophaga (Tumbu Fly, Africa)
Solenopsis saevissima
Flea Control
Malathion, Chlordane in kerosene, Lindane dusts or sprays time to call the Orkin man. Insect repellants OFF!, other DEET and pyrethrum preparations.
Tungiasis
Tunga penetrans Aka nigua, chigoe, sand flea, jigger. Reddish brown flea 1mm long Africa, Central & S. America, India, Pakistan Pregnant females burrow into skin of ankles, soles, feet and toes. Lesions become infected and painful
Tunga penetrans
Scabies
Distribution: Circle of Hebra Imaginary circle intersecting sites of prediliction areolae, axillae, elbow flexures, wrists, finger webs, umbilicus, lower abdomen, genitalia
Scabies
Papular and burrow-type lesions Face and scalp spared in adults, but not in infants or immunosuppressed. Burrows may be barely visible Dull red nodules persist in groin, called nodular scabies, may persist after cure, histo = pseudolymphoma Norwegian heavy crusting, scaling most common in malnourished, immunosuppressed or pts with neurologic dz.
Sarcoptes scabiei
Scybala
Scabies Treatment
Norwegian: Ivermectin 200mg/kg weekly x 3. Permethrin 5% cream from head to toe at night, rinse off in AM x 3. May repeat weekly. Lindane rarely neurotoxic to infants Infants and Pregnant women 6-10% precipitated sulfur in petrolatum applied nightly x 3 nights Treat family members
Animal Scabies
Milder course than human scabies Dogs, cats, poultry, birds, camels or horses Self limited, no burrows or mites found.
Cheyletiella Dermatitis
Non-burrowing mites that are parasitic for dogs, cats, rabbits May bite humans leaving an itchy dermatitis resembling scabies Mites easily seen on pets. Treatment of pet by veterinarian is the only necessary treatment
Chigger Bite
Eutrombicula alfreddugesi MC legs and belt line and other sites where clothing causes constriction Grass and bushes typically infested in summer or fall aka Mowers mites Pruritic hemorrhagic puncta surrounded by red swellings TX: TS, Prophylaxis: (DMP) demethylphthalate solution
Gamasoidosis
Persons who handle canaries, pigeons and poultry MC arms & hands, papular, urticarial Diagnosis of urticaria is usually made Ornithonyssus and Dermanyssus mites infest feathers, bite humans Take about 1 week longer to resolve than most bug bites, Tx: malathion
Grocers Itch
Pruritic dermatitis of forearms Carpoglyphus passularum fournd on dates, prunes, figs. Acarus siro and Tyrophagus longior found on cheese.
Grain Itch
Pyemotes tritici Lives in grain, attacks harvesters of wheat, hay, barley, oats and other cereals or other farmhands who work around straw. Urticaria papule with vesicle hemorrhagic punctum TX: malathion Mite may not be demonstrable in skin.
Scorpion Sting
Hide during daytime in closets, shoes, folded blankets, childrens sandboxes. Any sting by a large scorpion should be considered dangerous because venom is hemolytic and neurotoxic MC US is Centruroides sculpturatus Numbness, laryngeal edema, profuse sweating & salivation, cyanosis, nausea and paresthesia of the tongue Tx: tourniquet, antivenin, phentolamine, atropine, barbituates
Lactrodectus mactans 13mm long, coal black with an orange red hourglass on abdomen
Loxoscelism Therapy
1) Rest, Ice, Compression, Elevation 2) No hot packs or surgery 3) Dapsone 100mg BID 4) Aspirin 5) Surgery, if any should be delayed 4 to 6 weeks. 6) No benefit to surgical excision, actually increases complications.
Snake Bite
Rattlesnake, Cottonmouth, Copperhead Venom = hydrolases, 30 enzymes, anticoagulant, hemolytic, increased capillary permeability If treatment center cannot be reached within 1 hour, tourniquet, incision and suction in first 15 to 30 minutes, antivenin, antibiotics, tetanus toxoid, possibly surgical intervention
Lizard Bite