PARASITIC INFESTATION

PARASITIC INFESTATION

Scabies
Pediculosis
SCABIES

 Scabies is an intensely pruritic rash caused by tiny burrowing mite

Causative agent

 Sarcoptes scabiei
 Crab shaped
Lifecycle

 The female digs into the skin and remain there for 30 days
 It lays eggs daily which hatch after 3 to 4 days
 The baby mite furrow their own burrow and become reproductive adults in 10 days
Transmission

 Person to person through close contact

 Fomite contact also seen
Pathogenesis

 Burrows are thin elevated skin tracts measuring about 5 to 10 mm

 It is caused by furrowing of mite
 Delayed type 4 sensitivity reaction to mites, eggs and faeces develops resulting in erythematous papules,
vesicles or nodules in association with burrows
 Sometimes secondary infection develop and hide these tracks
Clinical features

 It generally affects the flexr aspect of elbows and wrist, buttocks and the external genitalia.
 The patient suffers from intense itching which is more severe at night
 It may also present as papules, vesicles or burrows
Diagnosis

 Scraping across the burrow with a scalpel blade and mixing the fragments in immersion oil on microscopic
slide
 Identification of mites, eggs, egg fragments or faecal pellets is diagnostic
Treatment

 5% permethrin cream is the recommended agent. It is applied from neck downward with special attention to
pruritic areas, hands, feet and genital regions. 8 to 14 hours ater application, bath is taken to remove the
medication. Only one application is necessary.
 All family members must be treated with exception of children less the 2 years
 Another option – oral antihelminthic Ivermectin 200μg/kg once and repeated 2 weeks later
 Bed linens and recently worn clothes are washed to prevent reinfection
 Antihistamines – to reduce pruritus
 Antibiotic therapy if these lesions become linfected
PEICULOSIS

 Pediculosis pubis is one of the most contagious sexually transmitted disease

Causative agent

 Lices are small ectoparasite measuring about 1mm

 Phthris pubis – crab louse / pubic louse
 Other species – Pediculus humanus(body louse)
- Pediculus humanus capitis(head louse)
Lifecycle

 Lice attach to human hair with claws that vary in diameter which determines the infestation site.
 Crab louse is found on pubic hair and other hair of similar diameter such as axillary and facial hair.
 Lice depend on blood meals
 Each female lays 4 eggs per day which are glued to base of hair.
 Incubation is about 1 month.
 These attached eggs are termed as ‘nits’ which are seen attached to hair shaft away from skin line as hair
grows.
Transmission

 Pubic lice – sexually transmitted

 Head and body lice – sharing of personal objects such as combs, brushes and clothing
Clinical features

 The main symptom from louse attachment and biting is pruritus.

 Scratching results in erythema and inflammation causing vulvar rash.
 Patient may develop pyoderma and fever if bites become secondarily infected.
 Intense itching can cause insomnia, irritation and social embarassment.
Diagnosis

 Identification of nits and lice by magnifying glass.

 Microsopic examination of suspicious flecks on pubic hair to see the characteristic louse.
Treatment

 Local application of 5% permethrin cream – 2 doses 10 days apart. Single dose is usually effective but
second is recommended to kill new hatches.
 Cream rinses or shampoos containing 1% permethrin or pyrethrins with piperonly butoxide.
 0.5% malathion lotion apllied for 8 to 12 hours.
 Oral Ivermectin 250μg/kg once and repeated 2 weeks later.
 Bedding and infested clothing are washed and dried.
 To reduce pruritus – antihistamines, anti-inflammatory cream or ointment, or both.
VULVAR ABSCESS
Vulva

 Vulva is an ill-defined area which in gyncological practice comprise the whole of external genitalia and
includes the perineum.
Vulvar abscess

 It is the collection of bacteria and pus beneath the vulvar skin.

 They usually originate as simple infection that develop in the vulvar skin or subcutaneous tissue.
 Spread of infection and abscess formation in the vulvar area is facilitated by the loose areolar tissue in the
subcutaneous layers and the contiguity of the vulvar fascial planes with the groin and anterior abdominal
wall.
Causes

 An ingrown hair from shaving or waxing

 A blocked sweat gland
 Bacteria that gets inside a wound or opening
Risk factors

 Diabetes
 Obesity
 Perineal shaving
 Immunosuppression
 Unprotected sex
 Poor hygiene
 Genital piercing
Common isolates

 Staphylococcus aureus
 Group B Sterptococcus
 Enterococcus
 E. coli
 Proteus mirabilis
Clinical features

 Pain
 Itching
 Redness, warmth, and swelling
 A bump or rash
 Discharge of pus
 Fever and chills
Management

 In early cases, surrounding cellulitis may be the prominent finding and only a small or no abscess is
identified. In these cases Sitz bath and oral antibiotics are the reasonable treatment.
 When abscess is present,
* Smaller are treated by incision & drainage, abscess packing if indicated and oral antibiotics to treat
surrounding cellulitis.
 Antibiotic therapy
*Trimethoprim-sulfamethoxazole may be used alone.
*Two drug therapy with clindamycin or doxycycline combined with second-generation cephalosporin or
fluoroquinolone.
 Larger abscess require admission for drainage under anaesthesia. This provides adequate pain control for
abscess drainage and for abscess cavity exploration to disrupt the loculated area of pus.
BARTHOLIN GLAND DUCT
ABSCESS
Bartholin’s gland

 There are two Bartholin’s glands, each about the size of a pea. The glands sit on either side of the opening of
the vagina. They provide lubrication to the vaginal mucosa.
Bartholin’s abscess

 A Bartholin’s abscess can occur when one of the Bartholin’s glands, located on either side of the vaginal
opening, develop an infection. When the gland is blocked, a cyst will usually form. If the cyst becomes
infected, it can lead to a Bartholin’s abscess.
 Bacteria, such as E. coli, and sexually transmitted diseases (STDs) , such as chlamydia or gonorrhea, may
cause the infections that can lead to a Bartholin’s abscess. If bacteria get into the gland, swelling, infection,
and an obstruction may occur.
 When fluid builds up in the gland, pressure increases on the area. It may take years for fluid to build up
enough to form a cyst, but an abscess can form quickly after.
 If the infection and swelling advance, the gland may abscess, which breaks open the skin. A Bartholin’s
abscess tends to be very painful. It usually only occurs on one side of the vagina at a time.
Clinical features

 A Bartholin’s abscess usually causes a lump to form under the skin on one side of the vagina. A Bartholin’s
abscess will often cause pain during any activity that puts pressure on the area, such as walking, sitting
down, or having sexual intercourse.
 A fever may also accompany the abscess. The area of the abscess will likely be red, swollen, and warm to
the touch.
Treatment

 This infection is primarily managed by drainage.

 Antibiotics are added to treat surrounding cellulitis.
Actinomyces infection
Causative organism

 Actinomyces israelii is a gram-positive, slow-growing, anerobic bacterium found to be part of indigenous

genital flora of healthy women.
 It is found more frequently in vaginal flora of IUD users and rate of colonization increase with duration of
IUD usuage.
 Actinomyces is also found in pap smear.
Clinical features

 Fever
 Weight loss
 Abdominal pain
 Abnormal vaginal bleeding or discharge
 Pelvic infection and abscess are rare
Management

 In absence of symptoms, incidental finding on cytology may be managed by

1) expectant management
2) extended oral antibiotic treatment with IUD in place
3) IUD removal
4) IUD removal followed by antibiotic treatment
 If signs or symptoms develop in women who harbour actinomyces, the IUD is removed and antimicrobial
thrapy is instituted.
 Actinomyces is sensitive to anitmicrbials with gram positive coverage, notably the penicillinns.