Infections and Infestations

Question 1

What are symptoms of threadworms?

Answer 1

Itching around the anus
Disturbed sleep
Actually seeing the threadworms

Question 2

How are threadworms contracted?

Answer 2

They are contracted when the patient swallows the female eggs. This can be contracted from eating undercooked meat, sharing bedding or toys with an infected person.

Question 3

Why are threadworms most commonly found with children?

Answer 3

Have poor personal hygiene. Often will scratch around the anus and then put their hands in their mouth which causes an reinfection and continuation of the cycle.

Question 4

What are some of the alarm symptoms of threadworms?

Answer 4

If the child is under 2 
Rectal bleeding 
Failure of OTC product 
Recently travelled abroad 
Repeated infestation
If the patient has any medical conditions

Question 5

What OTC product is available for threadworms?

Answer 5

Mebendazole

Question 6

What dose of Mebendazole is recommended?

Answer 6

100mg and then repeated 2 weeks later

All household members are required to have this

Question 7

Who is excluded from taking mebendazole?

Answer 7

Pregnant women and infants under 2

Question 8

Lifestyle advice for dealing with threadworms?

Answer 8

Rigorous cleaning measures for 6 weeks
Dust with a damp cloth and hoover daily
Washing hands before meals and after nappy changes (scrub under the nails)
Wear underwear and night to prevent scratching
Shower and wash the anus
Clean toys

Question 9

Do children need to be off school with nits or threadworms?

Answer 9

No but the school should be alerted

Question 10

What are the alarm symptoms for head lice?

Answer 10

The lice have not been seen 
Crusty, yellow scalp 
Patient has a skin condition 
Repeated infestation 
Failure of OTC product
Resistant to product is suspected 
Patient is asthmatic

Question 11

What are the three treatment options for head lice?

Answer 11

Malathion
Permethrin
Dimeticone

Question 12

How long is each treatment required to be on the hair?

Answer 12

Malathion: 12 hours
Permethrin: 8-12 hours
Dimeticone: 8 hours

Question 13

What counselling advice is required for head lice?

Answer 13

2-3 days after the treatment, wet combing is required to see if it is successful
Repeat treatment 7 days later

Question 14

How does scabies occur?

Answer 14

Scabies is caused by a parasite burrowing into the skin and laying eggs which hatch in 14 days after the parasite is first present under the skin.

It is passed on by close contact with an infected person.

Question 15

What are the main symptoms of scabies?

Answer 15

Intense itching particularly at night

A rash that usually appears firstly between the fingers

Question 16

What are the referral symptoms for scabies?

Answer 16

Child is under 2
Patient is receiving treatment for another skin condition
Long term health conditions are also present
Repeated infestations
Compromised immune system
Widespread rash
Scratching has led to broken skin

Question 17

What treatment options are available for scabies?

Answer 17

Permethrin 5% cream or Malathion

Question 18

How would you counsel a patient for treatment of scabies?

Answer 18

Apply the cream all over the body and leave on for 8-12 hours and then rinse with a bath or shower.
Ensure all household members do this.
Repeat in a weeks time

Question 19

What are the two types of Herpes Simplex?

Answer 19

Type 1: Cold sores

Type 2: Genital herpes

Question 20

Describe the timeline of a cold sore.

Answer 20

Prodromal phase: patient experiences tingling on their lip.
The cold sore then begins to appear firstly as a red patch and then it fills with fluid before it bursts and blisters over.

Question 21

What is the time scale of a cold sore?

Answer 21

7-10 days

Question 22

How is HSV1 spread?

Answer 22

Via the saliva of an infected person. Often contracted in childhood and then stays dormant until it is reactivated later in life.

Question 23

What are some of the referral symptoms of a cold sore?

Answer 23

The cold sore is not on the lips or they are inside of the mouth
The cold sore is weeping 
Very frequent reappearance 
Blisters are spreading 
Patient is on other medication 
Large number at once
Other symptoms 
No obvious cause

Question 24

How do aciclovir and penciclovir work?

Answer 24

Inhibit the enzymes involved in the virus and speed up the healing process.

Question 25

When should aciclovir and penciclovir be applied?

Answer 25

In the prodromal phase

Question 26

What triggers cold sores to reappear?

Answer 26

Menstrual cycle Spending lots of time in the sun Stress Feeling run down

Question 27

What two organisms cause fungal infections?

Answer 27

Dermatophytes or yeast

Question 28

What conditions are dermatophytes responsible for?

Answer 28

Athlete's foot, Ringworm and Fungal nail infections

Question 29

What are some of the symptoms of Athlete's foot?

Answer 29

The skin breaking and weeping Usually occurs between the crack between the fourth and fifth toe due to the warm, moist conditions Red, itchy and sore skin Skin may smell Can be spread across the foot and to the nail if left untreated

Question 30

When should you refer to the Pharmacist with Athlete's foot?

Answer 30

``` If the infection is producing pus, bleeding and weeping It is causing pain Elderly patient Young child Patient has other medical conditions Failure of OTC product ```

Question 31

What are the two treatments for Athlete's foot and give OTC examples.

Answer 31

Imidazoles: Miconazole, Clotrimazole and Ketoconazole Allylamines: Terbinafine

Question 32

What lifestyle advice would you provide to somebody with Athlete's foot? (Similar for Fungal Nail infection)

Answer 32

``` Avoid sharing towels Good foot hygiene (wash them daily) Breathable shoes Change socks daily Dusting powder in socks and shoes ```

Question 33

Are creams or ointments best for Athlete's foot?

Answer 33

Creams

Question 34

What are some of the symptoms of fungal nail infection?

Answer 34

The nail becomes thickened and changes colour It can be lifted from the nail bed, eventually crumbles away Nail changes shape Essentially it can change in colour, texture and shape. Normally this begins at the tip of the nail

Question 35

What are some of the referral symptoms for fungal nail infections?

Answer 35

``` Young child Toe is bleeding/ discharge from the nail Patient is on other medication Patient has a medical condition Repeated infection Spread to other toes Trauma to the nails Fingernails are affected More than 50% of the nail is affected OTC failure ```

Question 36

What treatment option is available for fungal nail infections?

Answer 36

Amorolfine laquer is used. Painted onto the affected toe like nail vanish once a week. May have to be used for up to 12 months.

Question 37

What are the key symptoms of ring worm?

Answer 37

A red rash that resembles a circular shape. Less red at the centre in comparison to the outside Rings may be feel raised to touch Patches can be itchy Patches can grow and merge together

Question 38

What symptoms of ring worm would you refer to a Pharmacist for?

Answer 38

If the rash is on the hands or face or torso If the rash is cracked or bleeding More than two patches of ringworm

Question 39

What treatments can be used for ringworm?

Answer 39

Imidazole cream or Terbinafine cream