Parasitic infestations

1. PARASITIC INFESTATIONS

2. PAPULAR URTICARIA
• Syn lichen urticatus,prurigo simplex
• Acquired specific sensitivity to antigens in
insects
• 2-7 years
• Immigrants
• Cancer patients
• Mosqitoes,bed bugs ,fleas,mites
• seasonal

3. • Wheals,papules,wheals surmounted by
papules
• Central h’gic punctum
• Pruritic-excoriated,crusted
• Sec. Infection
• Rec. crops
• Site depend on insect

5. SCABIES
• By sarcoptes scabiei var hominis
• F-0.4x 0.3mm.
• 2-3 eggs/d. 10-25eggs. Lives 30 d.
• M- 0.2x0.15
• Burrow 2mm. moult thrice.

7. Clinical features
• Itching –more at night
• Typical distribution of lesions-finger
webs,flexor wrist,elbow, ant.axillary
fold,umbilicus,periumbilical,genitalia,upper
thighs,knees &ankles
• Family history
• Burrow-thread like,grayish or dark line

10. • Nodular scabies
• Crusted scabies
• Scabies incognito
• Scabies in clean
• Scabies in infants
• Animal transmitted scabies
• Complications…..

14. TREATMENT
• Permethrin5%
• GBH 1%
• Benzyl benzoate 25%
• Others-crotamiton 10%, malathion 0.5%
• Oral- ivermectin 12mg tab

15. PEDICULOSIS
• Pediculus humanus var capitis
• Pediculus humanus var corporis
• Phthirius pubis
• Dorsoventrally flattened
• Head,thorax,abdomen
• Legs-3 pairs with claws

16. • Body louse-larger ,grey,300 eggs/d, eggs
glued to clothing
• Head louse- smaller,darker,100 eggs/d,
eggs to hair
• 2-3 blood meals/d

18. PEDICULOSIS CAPITIS
• Mainly scalp
• Louse pit
• No- rarely>20
• Nits laid close to scalp
• Itching-sec. Infection&LNE

22. TREATMENT
• Permethrin 1%
• GBH 1%, .5% malathion
• Repeat 10-14 d later
• Antibiotics esp cotrimoxazole

23. PEDICULOSIS CORPORIS
[Vagabond’s disease]
• Ery.macules or urticarial wheals ,excoriated
papules and parallel linear scratch marks
• Pararallel linear scratch marks&
hyperpigmentaton over upper back-
vagabonds dis.
• Clothes-Laundering,hot iron
• Pt- scrub bath
• Vector –epidemic typhus,relapsing
fever,trench fever

25. PEDICULOSIS PUBIS
• Crab louse
• Pubis,abd, thighs,axillae,beard,areolar hair,
eyebrow eyelash
• May be STD
• Maculae cerulae,bluish grey macules upper
thighs,abdomen
• Rx- permethrin GBH, petrolatum
over eyelash, flourescien e/d, ivermectin

27. MYIASIS
• Infestation of tissues of living vertebrates with
larvae of dipterous flies
• Cutaneous
• Ophthalmic
• Nasopharyngeal
• Intestinal

28. • Creeping myiasis-hypoderma bovis ,
gastrophilus
• Furuncular/true cutaneous
• Traumatic/ wound
• Rx-furuncular-inscise&pick out,
creeping-+antihelmintics, wound-
use turpentine/chloroform&pick out

29. PULICOSIS
• By flea
• Human flea-pulex irritans
• Wheal/.papule with a central hgic
punctum
• Grouped lesions
• Where cloth fit tightly

30. TUNGIASIS-
• By sandflea
• Tunga penetrans/burrowing flea
• Flourish best in sandy soil
• fertilised female burrows into feet-under the
nail,toe webs and medial side of foot
• Genital and perineal regions
• Black dotulcer
• Extract with a pin,turpentine

31. CIMICOSIS
• By bed bug
• Cimex hemipterus& cimex lectularis
• Exposed parts
• Bites painless, non pruritic in non sensitised
individuals , Sensitised-irritable papules with
hgic punctum, wheal
• Back of trunk &buttocks-in bed
• Insecticides like BHC

32. BLISTER BEETLE DERMATITIS
• Lytta vesicatoria (spanish fly)-cantharadin
• Epicauta solani
• Paederus(rove beetles)-pederin

33. • Alarmed on waking up
• Burning,pain,itching
• Wheal……rapidly blisters in 12 hrs
• Linear whiplash dermatitis patchy
,herpetiform,bizarre
• Kissing lesions
• Exposed parts
• Residual hyperpigmentation

35. SPIDER BITE
• LACRODECTISM-L.mactans-black widow spider
• Local reaction with 2 punctae
• Neurotoxic-vomiting,cramps,delirium, partial
paralysis
• Recover in 2-3 d
• Morphine,calcium gluconate

36. • LOXOSCELISUM-L reclusa-brown recluse spider
• Necrotic cutaneous loxoscelism-localised type
• Viscero-cutaneous loxoscelism –hemotoxic,
joint pain
• Ice bag,elevation,rest,antibiotics

37. DEMODICIDOSIS
• Follicle mites
• D folliculorum in hair follicle&D brevis-
sebaceous and meibomian glands
• Usually in older children and adults
• Forehead,cheeks,nasolabial folds,chin
,scalp,external ear,upper chest

38. • Burning &itching with diffuse erythema of
face with dryness and follicular scales
• Addl rosacea like lesions
• Benzoyl peroxide,Benzyl benzoate,
permethrin,ppt sulphur

39. CUTANEOUS LARVA MIGRANS
• Hookworms-A braziliense,A canium, A
ceylonicum
• S stercoralis
• F hepatica

40. • Itchy red papule-vesicular
• Itchy,skin coloured.tortuous,3mm wide tract
• Ankylostoma-1-2cm/d
• Larva migrans-10cm/d
• Self limiting
• Albendazole 400mg/dx3
• Mebendazole 100mg tid x7d

42. LEISHMANIASIS
• Old world leishmaniasis-oriental sore, delhi
boil
• L major,L tropica,L aethiopica,L infantum
• P papatasi,P sergenti
• L major-nodule-crust-ulcer-heal in 2-6months
with scar. Satellite lesons

43. • L tropica-nodule,plaque,ulcer with crust , heal
in 8-12 months with scar
• Rx-sodium stibogluconate, pentamaidine

46. NEW WORLD leishmaniasis
• L mexicana-chiclero ulcer ..face,
retroauricular areas
• L brasiliensis
• Primary lesion-pruritic nodule.. ulcerate

47. • Mucosal lesions - espundia
• 2-10 yrs after primary infection-due to
hematogenous spread
• mainly affect nose mucosa …ulceration and
destruction of cartilage ….tapir nose deformity

48. • POST KALA AZAR leishmaniasis
• Following visceral leishmaniasis
• In india 2yrs later
• Ery. bat wing rash over face
• Hypopigmented….then nodular
• May involve mucosa
• May resemble LL

49. LYMPHATIC FILARIASIS
• By Wuchereria bancrofti, Brugia Malayi, Brugia timori.
• Rec. episodes of lymphangitis and lymphadenitis occur.
• Lead to elephantiasis - Skin thickened, subcutaneous
tissue hypertrophic. Fissuring, nodular and papillomatous
to verrucose changes also occur.
• Mainly lower limbs.
• Rx. - DEC, ivermectin

51. THANK YOU