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Derm Phys Lectures > Stings, Bites, and Bugs > Flashcards

Stings, Bites, and Bugs Flashcards

1
Q

What two organisms cause Trypanosomiasis?

A

T. Brucei(African) and T. cruzi (american)

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2
Q

Where is Chagas dz found?

A

Central and South America

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3
Q

How is T cruzi transmitted?

A

Through infected reduviid bugs and occasionally infected blood

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4
Q

What bug is the kissing bug?

A

Raduviid bug

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5
Q

What’s unique about the life cycle of Raduviid?

A

It bites you and then defecates in it

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6
Q

What is chagas dz?

A

Serious systemic disease that primarily affects the autonomic nervous system, heart and GI tract.

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7
Q

What is the Romana sign?

A

Edema of the palpebral and periocular tissue due to entry through the conjunctiva

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8
Q

Describe the acute phase of Chagas dz?

A

Localized erythema ,swelling regional lymphadenopathy (chagoma)
Romana Sign- Painless edema of palpebrae occurs in 80% of cases infected this route
Fever, malaise, anorexia, edema of face and lower extremities

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9
Q
A

Acute Phase Chagas disease

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10
Q

Describe the chronic phase of chagas dz

A

Occurs many years to decades later. Cardiac manifestations including Cardiac failure, arrythmias, heartblock and Gastrointestinal manifestations: Megacolon, Megaesophagus

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11
Q
A

Chronic chagas dz

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12
Q

Tx for Chagas dz?

A

Nifurtimox (acute phase) and Benzimidazole (more effective acute phase)

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13
Q

How are T. bruceii transmitted?

A

Tsetse flies

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14
Q

What are the names of the two African Trypanosomiasis causing species?

A

West Africa- T. brucei gambiense
East Africa- T. brucei rhodesiense

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15
Q

What are the clinical manifestations of trypanosomiasis?

A

Trypanosome Chancre, enlargement of lymph nodes, neurologic manifestations include: irritability, personality changes and day time somnolence, restlessness, insomnia

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16
Q
A

Trypanosome Chancre

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17
Q

African TrypanosomiasisTreatment?

A

Suramin=DOC for early stages; Pentamidine; other organic arsenicals; and Eflornithine which is effective for both hemolymphangitic and CNS involvement

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18
Q

What are synonyms for Onchocerciasis?

A

River blindness, Enfernedad de robles, Erysipelas de la costa

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19
Q

What is onchoceriasis?

A

Filarial infestation that predominantly affects cutaneous and ocular tissue. Caused by Onchocerca volvulus

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20
Q

How is the dz onchocerciasis transmitted?

A

Simulium black fly

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21
Q

Where is onchocerciasis found?

A

Exclusively in humans living in tropical African belt and south America

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22
Q

What is the clinical picture of onchocerciasis?

A

Subcutaneous nodules that are located over bony prominences. Intermittent intensely pruritic dermatitis. Microfilariae in conjunctivae move through cornea into the anterior and posterior chambers of the eye. Conjunctivitis, sclerosing keratitis, uveitis ,optic atrophy and glaucoma. Blindness in severe cases

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23
Q

What does chronic onchocerciasis look like?

A

Thickened , wrinkled skin with hyperpigmentation (lizard or elephant skin)

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24
Q
A

Onchocerciasis

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25
Q
A

Onchocerciasis

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26
Q

OnchocerciasisTreatment?

A
  1. Ivermectin: in 1 week microfilariae disappear from skin
    and 3 months microfilariae disappear from eye
  2. Nodulectomy
  3. Older drugs : suramin and DEC associated with severe hypersensitivity and dangerous toxic reactions
    (Mazzotti reaction)
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27
Q

What dz is know as Tunga penetrans, Chigoe flea, jiggerflea, burrowing flea, sand flea, Pique, Nigua?

A

Tungiasis

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28
Q

Where is tungiasis found?

A

Endemic in Central and South America, the Caribbean Islands, Africa, Pakistan and India

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29
Q

Tungiasis dz?

A

Impregnated female flea burrows into skin causing 1 cm nodule and erythema. Rarely associated with gangrene, tetanus and auto amputations

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30
Q
A

Tungiasis

31
Q

Tungiasis Tx?

A

May spontaneously resolve. For early lesions
you removal gravid female with a needle. For late lesions use surgical curettage, electrodessication, excision.
Topicals=Chlorophenothane, 4% formaldehyde, chloroform, turpentine. You can also use Niridazole, and Tetanus prophylaxis.

32
Q

How do you prevent tungiasis?

A

Wear shoes, avoid sitting directly on beaches

33
Q

What are the synonyms for cutaneous myiasis?

A

Maggots, screw worm, blowflies, fleshflies and tumbu fly

34
Q

Myiasis dz?

A

Infestation of skin by fly larvae. The larvae inhabit skin wound or burrow into the dermis causing boil-like lesions. It usually causes minimal morbidity unless they involve nasal cavity and sinuses

35
Q

Dermatobia hominis clinical presentation?

A

Causes boil-like lesions usually on scalp, face ,forearms and legs. 24 hours after penetration pruritic papules form 1-3 cm in diameter. Lesions may be painful, tender and may become crusted and purulent. Sensation of movement may be observed

36
Q
A

Cutaneous Myiasisd

37
Q
A

Cutaneous Myiasis

38
Q

Dermatobia hominis Tx?

A

Myiasis is a self limiting infestation Do not remove forcibly. Occlusion/suffocation. Bacon, petroleum jelly beeswax , nail polish Injection of lidocaine at base of lesion. Surgical removal

39
Q

Human botfly preventive measures?

A

Avoid activities which increase risk of myiasis. Do not wear wet clothes. Do not rest on sandy areas. Use insect repellents. Avoid trips to Belize

40
Q

What are bedbugs (Cimicids)?

A

They are true bugs with flat oval body; about the same size as a tick; red brown in color; blood sucking, feed at night. The bites are often in linear groups of three. They hide in cracks and crevices and behind peeling paint during day

41
Q
A

Multiple bedbugs

42
Q
A

Bed bug bites

43
Q
A

Bed bugs: breakfast, lunch and dinner!

44
Q

What is the clinical picture of bed bugs?

A

Linear bites in groups of three (Breakfast, lunch and dinner). Maybe vectors for hepatitis B\ Chagas disease.
Bedbug dung may play a role in asthma

45
Q

Bedbug tx?

A

Elimination of cracks and crevices. Removal of roosting bats or birds. Use of insecticides (dichlorvos). Use of insect repellents. Cannot starve them, survive 1 year without feeding

46
Q

What are Reduviid Bugs?

A

AKA kissing bug due to predilection to bite on or near the lips. Spread T. cruzi the causative agent of Chagas disease. Kissing bug takes blood meal then turn around and defecate immediately after feeding. Trypanosomes spread by victim scratching

47
Q
A

Reduviid Bug

48
Q

What is Pediculosis capitis?

A

Head Lice

49
Q

Pediculosis corporis?

A

Body Lice

50
Q

Phthiriasis Pubis?

A

Pubic lice

51
Q

Lice facts?

A

Range from 1.5 -4.5 mm in length. Female may lay up to 300 eggs (nits). Live for approximately 30 days. Pierce skin every few hours to receive blood meal. Can live off human host for 2 days

52
Q

How is head lice transmitted?

A

Direct contact or through fomites ( combs, brushes, hats bedding)

53
Q

How do you tx head lice?

A

1% permethrin cream rinse
Leave on 10 min. Thoroughly rinse.
Fine tooth comb to remove nits
0.5% malathion lotion in resistant cases

54
Q

Is lice re-infection common?

A

Re-infection is more common than resistance

55
Q
A

Head lice

56
Q

Is body lice as common as head lice?

A

Nope

57
Q

What are the symptoms of body lice?

A

Pruitis may be the only symptom. Can see red papules under arms, upper shoulders, and neck. Maculae ceruleae are bluish/brown hemosiderin laden macules (intradermal hemorrhage at lice feeding sites)

58
Q
A

Body louse

59
Q

Body lice can be a vector for what dz’s?

A

Epidemic typhus (Rickettsia prowazekii), Trench fever (Bartonella quintana), and Relapsing fever (Borrelia recurrentis)

60
Q

How is pubic lice transmitted?

A

Usually transmitted by sexual contact but can be obtained through contact with clothing or infested hairs

61
Q

Is pubic lice limited to the pubic area?

A

No. May effect eyebrows, eyelashes, hair and scalp. Can also cause maculae ceruleae

62
Q
A

Pubic lice

63
Q

Pubic lice Tx?

A

Same as head lice: permetherin 1 % lotion for 10 min.
For eyelids, use occlusive ophthalmic ointment applied to eyelid margins for 10 days. Treat sexual partners too!

64
Q

What else is Scabies called?

A

Itch mite infestation, Pruritic eruption, infectious eczema, seven year itch

65
Q

What causes scabies? Vector?

A

Caused by female mite sarcoptes scabiei var. hominis. There is no known vector

66
Q

Where is scabies found?

A

Everywhere in the world

67
Q

Where does scabies live?

A

Spends entire life in the epidermis

68
Q

What does scabies look like clinically?

A

Severe pruritus that’s often worse at night. Burrow is the primary lesion. Most commonly found in interdigital web space wrist, flexor surfaces of the elbows, areola and penis, scrotum, and umbilicus belt line. Secondary papules, pustules vesicles more prominent than burrows
Involvement of head and face in infants

69
Q
A

Scabies

70
Q
A

Scabies

71
Q
A

Scabies

72
Q

Dx of scabies?

A

Skin Scraping demonstrating: Mites, Scybala, Eggs.
Be sure to scrape a lot and deep enough

73
Q

Tx for scabies?

A

Permethrin 5% overnight to all skin surfaces. Wash cream off in morning. Treat all family members. Repeat in 1 week. Wash all clothing and bedding after treatment in hot water. Patients may itch for 1 month after treatment. 5-10% precipitated sulfur in petrolateum (overnight for 3 nights)/ Lindane overnight out of favor due to potential toxicity. Crotamitin. Ivermectin repeat in 1 week

74
Q
A

Derm Phys Lectures (8 decks)

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