Wednesday, October 12, 2016

A Case Of Scabies

A 10-year-old boy presents with his mother, complaining of intense itching, worse at night, since the
first week of school. He has numerous excoriations in the interdigital web spaces, wrists, and anterior axillary folds. His infant sister has recently developed intensely pruritic linear lesions on her palms,
soles, face, and scalp. Their mother works in a nursing home and has developed pruritus and reddish-brown nodular lesions in her axillae and perineum that have persisted several months after she treated herself with a lotion that was provided at her place of work. As you exam the patient, your skin begins to itch.

Q 1, The most likely ectoparasite affecting this family is:
A) Head lice (pediculosis).
B) Chiggers (mites).
C) Ticks.
D) Fleas.
E) Scabies.

Answer And Discussion
The correct answer is “E.” Scabies.

Scabies’ mites (Sarcoptes scabiei) burrow into the epidermis, lay eggs, and hatch larvae in cycles of 3–4 days. The most notable clinical symptom is intense pruritus that is worse at night.
The typical lesion is small, erythematous, and papular and may resemble eczema in quality and distribution.

                                                         Example of scabies rash 


About 7% of individuals develop a nodular variant(like the mother in this case). Transmission is typically by direct contact and infestations may appear as epidemics in institutions like nursing homes. The organism may be spread by fomites as well, although to a lesser extent. Young children and infants often have involvement of palms, soles, face, and scalp. A clinical diagnosis may be made in the setting of pruritic rash, typical distribution, and multiple family members affected.

Q 2 What is the next best step in this case (the infant child weighs 10 kg)?

A) Removal of the individual organisms.
B) Tetracycline 10 mg/kg divided TID for all affected family members
C) Single-dose oral ivermectin 200 g/kg, repeated in 2 weeks for all affected family members.
D) Symptomatic treatment with topical steroids and oral antihistamines.
E) Single-dose oral ivermectin 200 g/kg repeated in 2 weeks for the mother; one application of 5%
permethrin cream for all other family members for 8–14 hours, followed by showering.


Answer And Discussion
The correct answer is “E.”

Permethrin cream is the topical medication of choice. Ivermectin, an antihelmintic medication, is indicated for adults with nodular disease (like the mother in this case), in epidemic settings, and for treatment of scabies crustosa.
Answer “B” is incorrect because tetracycline is not helpful in this situation and should be avoided in children.
Answer “C” is incorrect because oral ivermectin should be avoided in infants weighing <15 kg due to
concerns about increased penetration of the blood– brain barrier.
Finally, “D” is incorrect because scabies should be treated with specific therapy rather than simply symptomatic therapy.

All family members should be treated, regardless of the presence or lack of symptoms. Microscopic exam of a skin scraping may identify the mite but has poor sensitivity.
Other viable treatment alternatives include crotamiton 10% solution precipitated sulfur in petroleum and lindane (but avoid lindane in children <2 years old).

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
    Have been totally convinced that HIV,and many others dangerous diseases can be best cured using the Herbal Medicine. Dr.Akpu the great and powerful herbalist cured me with his Herbal remedy. I'm Linda,15 years from Texas. I was born with HIV. I lost parents at my teenager age when I was 4th. I had to grew up with my mum only Sister, whom I loved so much. She was so worried about my life as my condition was her mature problem in life. I had taken lots of antiviral treatment to get ride of the virus not believing what there said HIV has no cure. I was on the internet when i came across blogs of testimony about a lady who where cured of a 7 years diagnose of Herpes by this powerful Herbalist, Dr.Akpu.I wrote down his mail @ Dr.akpupowerherbscenter@gmail.com
    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
    Dr.akpupowerherbscenter@gmail.com
    Is the solution

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