SCABIES
History
• Persistent pruritus, worsen over 2–3 wk; sometimes multiple family members involved
• More common in fall & winter months, worse at night
Findings
• Skin eruption: Elevated thin pink or gray track in skin w/ small vesicle at tip
• Associated intense pruritus b/w web spaces of extremities, genital region, axilla, feet, buttocks, areola, nipples, abdomen, beneath breasts
• Secondary lesions include urticaria, impetigo, eczematous plaques, pyoderma, excoriations, cellulitis, & furuncles
Evaluation
• Clinical Dx; burrow ink test, tetracycline fluorescence test, skin scrapings, or shave biopsy
Treatment
• Symptomatic relief, treat secondary infections & household members, clean clothes
• Permethrin 5% cream most effective; if severe can also give ivermectin, lindane 1%
Disposition
• D/c w/ instructions for household to be treated, decontaminate clothing, bedding
• Exclude from school until treated, topical permethrin usually effective w/i 12 h
Pearls
• Caused by female human mite, S. scabiei
• Skin-to-skin contact, indirect contact through bedding or clothing
• Can lead to long-term colonization of skin by group A Strep
TOXOPLASMOSIS
History
• Immunocompromised (HIV), painless impaired vision
Findings
• Mainly neural & muscular tissue involvement, often asymptomatic
• Nontender isolated cervical or occipital LAD, 4–6 wk
• Congenital: Intracranial calcifications, neonatal hydrocephalus, chorioretinitis, blindness
• Immunocompromised: HA, confusion, sz, AMS, focal motor deficits, CN abnormalities, movement disorder
Evaluation
• IgG detection via ELISA
• MRI better than CT to see Toxoplasma brain lesions
Treatment
• Fluid resuscitation, sz tx, airway management
• Nonpregnant: Pyrimethamine + sulfadiazine OR spiramycin OR clindamycin OR azithromycin OR atovaquone + folic acid; corticosteroids for ocular toxoplasmosis
• Pregnant: Spiramycin + pyrimethamine + sulfadiazine
• AIDS: Pyrimethamine + sulfadiazine (tx & prophylactic)
Disposition
• Depends on sxs
Pearls
• Caused by Toxoplasma gondii, an obligate intracellular (in macrophage) sporozoan
• Intracellular parasite; cats are definitive host, mammals serve as intermediate host
• Transmitted via airborne spores or infected food (raw meat, unwashed vegetables, dairy)