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Presented by :Dermatology
andParasitology
Departments
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A previously imprisoned, 30 years oldmale patient has been released from jail
since two weeks. He developed severenight itching, resulting in extensivescratching till bleeding specially in the
inter-digital spaces, peri-umbilicaland medial aspect of the thighs.
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Examination revealed the following lesions:Multiple linear scratch marks
Papules
Pustules
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Lesions were distributed in the following areas The web space between the fingers
Peri-umbilical region
Anterior axillary fold Medial aspect of the thigh
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What is the probablediagnosis?
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Scabies
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What is scabies?
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Scabies is a transmissible ectoparasiticskin infestation caused by infestation withand sensitization to adult female of
Sarcoptes scabiei. It is characterized bysuperficial burrows , intense pruritus(itching) and secondary bacterial infection
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What is Sarcoptes scabiei?
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Sarcoptes scabieiis a small arthropodebelonging to class ARACHNIDA; orderACARINA
It is a small mite having an unsegmentedrounded or oval body, 4 pairs of legs,and tegument covered with bristles.
ARTHROPODA
CRUSTACEA ARACHNIDA INSECTA
SCORPIONIDA ACARINA
TICKS MITES
S scabeii
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What is the life cycle
of Sarcoptes scabieimite ?
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When the impregnated female tunnels into thestratum corneum of the skin and deposits eggs
in the burrow , which hatch in 3-10 days, thelarvae move on the skin and then mature intoadult mites. The adult mites live 3-4 weeks inthe host's skin.
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What is the mode of
transmission ofinfection?
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Scabies is transmitted readily, often throughoutan entire household, by skin-to-skin contact
with an infected person
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In what special situations
could scabies spread?
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Scabies spreads among overcrowded
poor population, with poor hygienicconditions
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What are the usual sites
of infestation withSarcopetes scabeii
mite?
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The usual sites involved are theinter-digital spaces, ulnar, aspect of
the arm, elbows, axilla, groin, breast,umbilicus shoulder, back andbuttocks.
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What is the characteristiclesion for scabies?
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Itchy skin burrows (tunnels) are characteristic
for scabies.
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How are skin tunnels
formed?
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Sarcopetes scabeiipenetrates the horny layerof the skin and keeps on burrowing in the
epidermis, resulting in the formation oftunnels. As the mites feed on the tissues,they deposit minute faecal pellets believed to
provoke the characteristic vesiculations of theskin and the severe pruritis.
epidermis
Fecal pellets
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When does itchingoccur?
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Severe itching is intensified at night. It isenhanced by warmth and perspiration of the
affected area. Warmth initiates an acidicsecretion which intensifies the irritation.
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Why does itching occur?
(Factors reponsible foritching)
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mites wandering within the skin
Presence of the eggs and the mite excretaproduce a massive allergic response which, inturn, produces more itching.
Both type I and type IV hypersensitivity reactionsoccur which take about one month forsensitization after initial infestation yet upon re-infection only 24 hrs are needed to produceclinical symptoms of intense itching.
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What is the mostcommon complication?
P l d d b i l
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Pustules, due to secondary bacterialinfection introduced by intense skin
scratching caused by itching, oftencomplicate the lesion.
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If pus was seen oozing from the
previous lesion,what is the mostcommon complication that may occur?
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I-Secondary bacterial infections:
1-Impetigo.
2-Cellulitis. 3-Mixed bacterial infection.
II-Hypersensitivity& allergic reactionswhich complicated by secondary
bacterial infections
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What are the most
common organisms to be
involved ?
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1-Impetigo caused by Streptococcus group A.
2- Cellulitis caused by Streptococcus group A.
3-Mixed bacterial infection by : Gram positive cocci; Staphylococcus aureus.
Streptococcus group A.
Gram negative bacilli ; enterobacteriaceae eg.
Escherichia coli , proteus. Gram negative bacilli eg. Pseudomonas aeruginosa .
Anaerobic bacteria eg. Peptostreptococci .
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Describe the mainlines of laboratorydiagnosis of theseorganisms?
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1-Specimen: Pus swab( Precautions forspecimen collection should be regarded)
2-Smears : Gram stained smears to detect the
presence of bacteria and pus cells. 3-Culture & biochemical testing to identify the
organism.
4-Antibiotic susceptibility testing to detect theappropriate antibiotic to be prescribed
by the physician to treat such a condition.
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How can you reach a
proper diagnosis?
History: low hygienic conditions over crowdening contact with infected
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History: low hygienic conditions, over-crowdening, contact with infectedperson
Complaint: Characteristic nocturnal itching, vesiculations, papules.
Examination: Site of the lesion: inter-digital spaces, ulnar aspect of the arm, elbows, axilla,
groin, breast, umbilicus, shoulder, back and buttocks Character of the lesions: scratch marks, burrows, vesiculations, and sometimes
pustules.
Diagnosis confirmation:1. Skin scrapping: tunnels scrapping with a sharp needle. The scraped
material is cleared in 10% potassium hydroxide and examined
microscopically to detect the mite.2. Skin biopsy
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How can this case be
managed?
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MANAGEMENT
CAUSATIVETREATMENT
SYMPTOMATICTREATMENT
COMPLICATIONTREATMENT
SOOTHING CREAMMEDICATED SOAP
EURAXCREAM ANTIBIOTICS
PREVENTREINFESTATION
Topical treatment
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Topical treatment
Eurax (crotamiton)
Cream or lotion.
Acaricidal & inhibits the growth of bacteria. It has also antipruriticproparty.
Apply on the skin, paying particular attention to skin folds and webs inbetween the fingers and toes for 5 consecutive days.
Oral treatmentIvermectin
The drug is given orally.
It targetsthe parasite's CNS resulting in its paralysis.
Soothing cream for itching
Topical corticosteroides and antihistamines.
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Medicated Soap
Scrub the whole body using lifa and soapcontaining sulfur for 5 consecutive days.
AntibioticsIn severe cases of scabies wherepustules, antibiotic therapy may be
considered (after performing culture andsensitivity)
Prevent re-infestation
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How could we preventre-infection or cross
contamination?
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Maintenance of good personal hygiene
Patients' clothes and bed sheets should besterilized by boiling during the course oftreatment.
Avoidance of contact with infested persons.
All family and close contacts should be treated
at the same time . Treatment must be thorough and simultaneous .
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