Scabies and pediculosis

Ziad Elnasser, MD, Ph.D

Scabies
Sarcoptes scabiei or the itch mite.

Burrows resides in human skin.

Eggs, Larvae, adult (Incomplete
metamorphoses)

Arachnid, 4 pairs of legs, 0.35mm.

Epidemiology
Worldwide, Sexual promiscuity, poverty,
poor hygiene overcrowding, and
malnutrition.
Intimate personal contact, casual
contact or dust samples.
Extent of clinical manifestation is
related to level of cleanliness.
Clinical manifestations
Intense itching especially at night.
Erythematous papules, excoriations and
occasionally vesicles.
Interdigital web spaces, wrists, axillary
folds, periumbilical skin, pelvic girdle,
penis and ankles.
Classic linear burrows.

Diagnosis
Clinical presentation.

Skin scraping and demonstration of the
mite microscopically.

Complications
Secondary impetiginization.

Eczematous eruption.

Scabies incognito if corticosteroids are
used.

Delayed hypersensitivity reaction.
Norwegian scabies
Severe variant.

Institutionalized persons, down
syndrome, and AIDS patients.

Hyperkeratotic crusted nodules.

Secondary bacterial infections,
septicemia and death.
Treatment
1% solution of Lindane not for infants,
pregnant women or after a bath.
5 % cream Permethrin safer.
6% 10% precipitated sulfur in petrolium
daily for 3 days.
Antipruritic drugs.
Treat secondary infections.
Ivermectin in severe cases.
Treat all contacts and linen.
prevention
Gloves.


Prophylactic treatment for close
contacts.


Isolation and the use of disposable
items.

Pthirus pubis
Crab louse.
Could be found other than genital region.
2mm in length, powerful legs, hair
attachment, moves slowly.
Incomplete metamorphosis, eggs, nymph and
adult.
Eggs operculated, shiny, stick to hair (nits)
Clinical manifestations
Pruritis.
Maculopapular rash.
Excoriation.
Eye lashes scaling.
Skin thickening, macular swellings,
hyperpigmentations, Subcutaneous
hemorrages (Vagabonds disease).
Diagnosis
Clinical manifestation.


Nits, nymphs or adult louse.
Treatment
Lindane.

Permethrin.

Antipruritic drugs.

Gardnerella vaginalis
Hemophilus vaginalis, Corynebacterium
vaginalis.
Gram variable, although amino acids and
fatty acids analysis shows gram positive,
oxidase and catalase negative
Enriched media, beta hemolytic colonies
on human blood.
Endotoxin but no lipid A.
Epidemiology
69% presence in the vagina.


No signs or symptoms.


100% Bacterial vaginosis, male urethra.

Pathogenesis
Pili and adherence to McCoy cells.
Hemolysin (Cytolytic toxin).
Normal flora with phospholipase
activity.
Associated with premature rupture of
the membranes.
Serum resistant.
Clinical manifestations
Bacterial vaginosis:
Present with mixed anaerobic flora.
Predispose to bacterial vaginitis.
Fishy odor discharge.
Vulvar burning or pruritis.
Gram stain of vaginal fluid rather than by culture.
Urinary tract infection: Infrequent, difficult to
diagnose.
Bacteremia: obstetrics events.
Neonatal infection.
Diagnosis
Small pinpoint colonies.

Beta hemolysis on human blood.

Blood culture in SPS free bottles.

Catalase and oxidase neg, Na hippurate
positive.
Treatment
Penicillin.
Ampicillin
Gentamycin.
Metronidazole.
Clindamycin.