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BITES, STINGS Flashcards

(45 cards)

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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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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
Scabies Presentation
* 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
Scabies – Management
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
Crusted (Norwegian) Scabies mgmt
• 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
Lyme Disease
Borrelia burgdorferi, New England states, west coast, and upper Midwest, Transmission takes 24-48 hrs once tick attaches and feeds
29
Early Localized Lyme
Days to Weeks • Erythema migrans (EM) | • Nonpainful, expanding erythema w/central clearing (≈ 80% of patients) & flu-like symptoms with no cough
30
Early Disseminated Lyme
Weeks to Months • Mult EM lesions and/or neuro/cardiac findings • ≈ 10% develop neuro symptoms • motor/sensory radiculoneuropathy
31
Late Disease lyme
Months to Years • Arthritis one or few large joints, knee common • Neuropathies, mild encephalopathy, acrodermatitis chronica atrophicans
32
Lyme Disease – Serologic Testing
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
Lyme 2 tiered testing
ELISA, if + then western blot -- Detects IgM & IgG antibodies to multiple components of the spirochete
34
Considerations in early lyme testing
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
Considerations (later disease lyme)
Seropositive titers persist for years, despite resolution with treatment • Retesting not useful, interpret future positive test carefully
36
Lyme Disease – Management | Prophylaxis – within 72 hrs of bite
Doxycycline 200mg PO, single dose
37
early lyme tx
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
Suspect Lyme if patient presents with
flu-like symptoms and no | cough during summer months
39
Primary EM lesions are
> 5cm & slowly expanding | • Rarely pruritic or burning, lack scaly, typically asymptomatic
40
Rocky Mountain Spotted Fever
• 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
Clinical Presentation RMSF
* 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
RMSF Rash
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
Clinical Presentation & Diagnosis RMSF
* Headache, fever, myalgia w/wo petechial eruption on palms/soles * Labs – norm WBC at presentation, then thrombocytopenia
44
RMSF Dx
* 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
RMSF - Management
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

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