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dcnp > BITES, STINGS > Flashcards

BITES, STINGS Flashcards

1
Q

High Risk Wounds

A
  • Hand or foot bites
  • Extremity bite with underlying venous/lymphatic compromise
  • Puncture or crush injury
  • Cat bite (due to deep puncture)
  • Immunosuppression
  • Wounds w/delayed presentation ≥12 hrs old on extremity, ≥24 hrs on face
  • Bite near vascular graft or prosthetic joint`
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2
Q

Time from bite to signs/symptoms of infection

A

24 hrs for dogs/12 hrs for cats

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3
Q

Dog & Cat Bites - Management

A

• Do NOT close a puncture wound
• Do NOT close any high-risk wounds
Antibiotic Prophylaxis (3-5 days) & Empiric Treatment (5-14 days)
• Mupirocin ointment TID for minor wounds
• Amoxicillin-clavulanate (Augmentin)
• Adults - 875/125mg BID
• Peds - 7:1 formulation: 22.5mg/kg BID

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4
Q

Human Bites

A

≈ 25% become infected
• 2-24 hrs for infection onset
• Likelihood of infection: location, depth, host factors
• Relevant pathogens:
• Oral flora - group A Strep, Fusobacterium, Peptostreptococcus,
• Skin flora – staphylococci and streptococci

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5
Q

Human Bite mgmt - uninfected v infected

A

Uninfected – wound care, abx prophylaxis, tetanus, Hep B/C, HIV…. if infected, add imaging and a surgical consult

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6
Q

Human bite abx mgmt

A

Antibiotic Prophylaxis (3-5 days) & Empiric Treatment (5-14 days)
• Mupirocin ointment TID for minor wounds
• Amoxicillin-clavulanate (Augmentin)
• Adults - 875/125mg BID
• Peds - 7:1 formulation: 22.5mg/kg BID

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7
Q

Fleas

A
  • Wingless, 1-8mm, dark brown insect capable of jumping 2 feet
  • Live on livestock, pets & humans
  • Cat flea most likely to bite humans
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8
Q

Flea clinical presentation

A
  • Clusters of red papules
  • Legs, ankles, axillae, skin folds
  • Children more sensitive – papular urticaria
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9
Q

Flea clinical mgmt

A 
Management
• Home extermination, treat pets
• Pruritus relief is primary goal
• Topical corticosteroids
• Burow’s solution or calamine lotion
• Treat for secondary infection
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10
Q

Black Widow

A
  • Western 1⁄2 of US & Southeast (Maryland, Southern Ohio, and lower states)
  • Rarely indoors
  • Clutter around homes (sheds, garages, etc.)
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11
Q

Brown Recluse

A
  • Midwest & Southern extending Westward
  • Rarely outdoors, inside homes (basements, cupboards, attics) • If outdoors – cool, dark places other than live vegetation
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12
Q

Black Widow Bite

A
  • Asymptomatic to sharp sting
  • Systemic reaction (20 min – 2 hours after bite)
  • Spreading severe pain & localized diaphoresis at site of bite
  • Abdominal rigidity, muscle spasms, headache, nausea, vomiting • Infants & preschool children – seizures and tetany
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13
Q

Brown Recluse Bite

A

Typically painless bite
• Red papules or plaque with central pallor
Systemic reaction (1-2 days/rare)
• Expanding necrotic ulcer at site of bite
• Malaise, nausea, vomiting, fever, myalgia
• Rarely – acute hemolytic anemia, DIC, thrombocytopenia

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14
Q

Cutaneous Larva Migrans

A

• Infection with cat or dog hookworm larvae
• Parasitic infestation of epidermis
• Eggs passed through stool into sand
or soil, grow into larvae
• Larvae penetrate epidermis →
migration for weeks → trail of inflammation → spontaneous resolution

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15
Q

Cutaneous Larva Migrans

Clinical Presentation

A

• Begin with pruritic papules
• Within a few days; intensely pruritic serpiginous tracts • Larvae migrate from 2mm up to 2cm/day
• Can occur days to weeks after exposure
-Dermoscopy – brown, translucent, structureless areas (larva bodies) & dotted red vessels (burrow)

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16
Q

Cutaneous Larva Migrans mgmt

A

stromectal, topical steroids, antihistmaines, spontaneous resolution in 4-6 weeks

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17
Q

Pediculosis

A

Transmission through direct contact with infested persons or fomites Feed on human blood, can live up to 10 days without feeding

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18
Q

Pediculosis Capitis

A
  • School age children, girls > boys, whites > blacks
  • Occipital scalp, neck and postauricular skin most affected
  • Allergic reaction to lice saliva causes pruritus
  • Medication resistant
  • Eyelashes may be involved
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19
Q

Pediculosis Corporis

A
  • Pruritus is chief complaint
  • Linear excoriations on neck, trunk, axillary folds, and waist
  • Louse is visible with naked eye (2-4mm)
  • Lay eggs along clothing seams, feeds, then returns to clothing
20
Q

Pediculosis Pubis

A

STD, P. pubis is translucent, 1mm length, 4 of 6 legs are crab-like claws • Found at base of hair shaft

21
Q

Pediculosis - Diagnosis

A
  • Pruritus of any hair-baring area without evidence of other causes
    * Excoriations
  • Corporis - Linear on trunk, neck, waist, axilla • Capitis – postauricular & occipital scalp
  • Wet combing for live lice
  • Dermoscopy – lice and nits on body & clothing
  • Nits cemented securely to hair shaft
  • Wood’s lamp – nits fluoresce pale blue, can be gray or white
22
Q

Pediculosis Capitis- Management

A

OTC pediculicides – highly resistant, retreat in 8-10 days

• Pyrethrins w/piperonyl butoxide (RID, Pronto) - ≥ 2 years or older • Permethrin 1% (Nix) - ≥ 2 months or older

23
Q

Pediculosis Corporis- Management

A

Bathe thoroughly, heat wash/dry infested linen and clothing, • Permethrin 5% cream to entire body for 8-10 hrs – single application
• Low- to medium-potency topical corticosteroid for symptom relief

24
Q

Pediculosis Pubis - Management

A

Pyrethrins w/piperonyl butoxide (RID, Pronto): ≥ 2 years or older
Permethrin 1% (Nix): ≥ 2 months or older • Ensure skin is cool/dry
• Apply to all suspect areas
• Wash after 10 minutes
• Remove nits with nit comb, tweezers, or fingernails • Retreat in 10 days

25
Q

Scabies Presentation

A
  • Pruritus – severe, worse at night
  • Small erythematous papules with excoriation
  • Burrows – thin serpiginous lines, can be red, gray or brown
  • Distribution, rarely localized
  • Web spaces, wrists, axillary folds, waist, buttocks, male genitalia, periareolar skin, extensors
26
Q

Scabies – Management

A

Permethrin 5% cream, ≥ 2months and older
• Apply neck down, wash after 8-14 hrs, repeat in 1 week
Ivermectin 200 mcg/kg PO single dose, repeat 1-2 weeks
clothing, linen, furniture
Treat all household members
Advise patients itching may persist several weeks after treatment

27
Q

Crusted (Norwegian) Scabies mgmt

A

• Permethrin 5% cream – full body application, wash after 8-14 hrs • Repeat daily for 7 days, then 2X/week until symptom resolution
AND
• Oral ivermectin 200 mcg/kg/dose on days 1, 2, 8, 9, and 15

28
Q

Lyme Disease

A

Borrelia burgdorferi, New England states, west coast, and upper Midwest, Transmission takes 24-48 hrs once tick attaches and feeds

29
Q

Early Localized Lyme

A

Days to Weeks • Erythema migrans (EM)

• Nonpainful, expanding erythema w/central clearing (≈ 80% of patients) & flu-like symptoms with no cough

30
Q

Early Disseminated Lyme

A

Weeks to Months
• Mult EM lesions and/or neuro/cardiac findings • ≈ 10% develop neuro symptoms
• motor/sensory radiculoneuropathy

31
Q

Late Disease lyme

A

Months to Years
• Arthritis one or few large joints, knee common
• Neuropathies, mild encephalopathy, acrodermatitis chronica atrophicans

32
Q

Lyme Disease – Serologic Testing

A

early - nothing, false negatives. weeks-mo: Detectable IgM & IgG antibodies to B. burgdorferi, late: IgG Western blot should be positive
IgM antibodies take 1-2 wks, IgG take 2-6 wks following onset of EM

33
Q

Lyme 2 tiered testing

A

ELISA, if + then western blot – Detects IgM & IgG antibodies to multiple components of the spirochete

34
Q

Considerations in early lyme testing

A

IgM antibodies take 1-2 wks, IgG take 2-6 wks following initial EM
• In early EM, seronegative (treatment initiated based on clinical findings)
• Early treatment with antibiotics may prevent seroconversion

35
Q

Considerations (later disease lyme)

A

Seropositive titers persist for years, despite resolution with treatment
• Retesting not useful, interpret future positive test carefully

36
Q

Lyme Disease – Management

Prophylaxis – within 72 hrs of bite

A

Doxycycline 200mg PO, single dose

37
Q

early lyme tx

A

Early Disease – treat for 2-3 wks (Adults), 2 wks (Peds)
• Doxycycline – 100mg BID adults, 2.2 mg/kg BID children
• Amoxicillin – 500mg TID adults, 50mg/kg/day in 3 divided doses
• Preferred for pregnancy

38
Q

Suspect Lyme if patient presents with

A

flu-like symptoms and no

cough during summer months

39
Q

Primary EM lesions are

A

> 5cm & slowly expanding

• Rarely pruritic or burning, lack scaly, typically asymptomatic

40
Q

Rocky Mountain Spotted Fever

A

• Gram-negative bacterium Rickettsia rickettsii
• Transmitted via Brown dog tick, Rocky Mountain
wood tick, American dog tick
• High fatality if not treated (20%-30%)
• > 90% of cases occur April – Sept
• Southeast and Central states of US

41
Q

Clinical Presentation RMSF

A
  • 3-12 days after infection
  • Fever, headache, and myalgia (almost always present) • Abdominal pain (esp. in children), nausea, and vomiting
  • 3-5 days after onset of fever, rash appears
42
Q

RMSF Rash

A

Papular rash starts on wrists, forearms, ankles & spreads to trunk • Papules progress to petechiae in 5-6 days
• Palms/soles affected later in disease
• Hand/pedal (especially children) and periorbital edema

43
Q

Clinical Presentation & Diagnosis RMSF

A
  • Headache, fever, myalgia w/wo petechial eruption on palms/soles
  • Labs – norm WBC at presentation, then thrombocytopenia
44
Q

RMSF Dx

A
  • Indirect immunofluorescence (IIF) for IgM & IgG antibodies
  • Antibodies appear 7-10 days after onset of symptoms
  • IgG antibodies titers persist for years
  • Do not use IgM alone to make dx of acute RMSF (false positives)
  • Direct immunofluorescence (DIF) for R. rickettsii
  • Before or within 12 hrs of antibiotics
45
Q

RMSF - Management

A

Doxycycline – treat at lest 3 days after fever resolves (1-2 weeks)
• Adults & children > 45kg: Doxycycline 100mg BID
• Children < 45kg: Doxycycline 2.2mg/kg/dose BID (daily max 200mg )
• Pregnant women: Doxycycline at adult dose

dcnp (6 decks)

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