Scabies and pediculosis

Ziad Elnasser, MD, Ph.D

Scabies
Sarcoptes
Burrows

scabiei or the itch mite.

resides in human skin.

Eggs,

Larvae, adult (Incomplete

metamorphoses)

Arachnid,

4 pairs of legs, 0.35mm.

Epidemiology
Worldwide,

Sexual promiscuity, poverty,

poor hygiene overcrowding, and
malnutrition.
Intimate personal contact, casual
contact or dust samples.
Extent of clinical manifestation is
related to level of cleanliness.

Clinical manifestations
Intense

itching especially at night.

Erythematous papules, excoriations and
occasionally vesicles.
Interdigital web spaces, wrists, axillary
folds, periumbilical skin, pelvic girdle,
penis and ankles.
Classic linear burrows.

Diagnosis

Clinical
Skin

presentation.

scraping and demonstration of the

mite microscopically.

Complications
Secondary

impetiginization.

Eczematous

eruption.

Scabies

incognito if corticosteroids are

Delayed

hypersensitivity reaction.

used.

Norwegian scabies
Severe

variant.

Institutionalized

persons, down
syndrome, and AIDS patients.

Hyperkeratotic
Secondary

crusted nodules.

bacterial infections,
septicemia and death.

Treatment
1%

solution of Lindane not for infants,

pregnant women or after a bath.
5 % cream Permethrin safer.
6% 10% precipitated sulfur in petrolium
daily for 3 days.
Antipruritic drugs.
Treat secondary infections.
Ivermectin in severe cases.
Treat all contacts and linen.

prevention
Gloves.

Prophylactic

contacts.

Isolation

items.

treatment for close

and the use of disposable

Pthirus pubis
Crab

louse.
Could be found other than genital region.
2mm in length, powerful legs, hair attachment,
moves slowly.
Incomplete metamorphosis, eggs, nymph and
adult.
Eggs operculated, shiny, stick to hair (nits)

Clinical manifestations
Pruritis.
Maculopapular

rash.

Excoriation.
Eye

lashes scaling.
Skin thickening, macular swellings,
hyperpigmentations, Subcutaneous
hemorrages (Vagabonds disease).

Diagnosis
Clinical

Nits,

manifestation.

nymphs or adult louse.

Treatment

Lindane.
Permethrin.
Antipruritic

drugs.

Gardnerella vaginalis
Hemophilus

vaginalis, Corynebacterium

vaginalis.
Gram variable, although amino acids and
fatty acids analysis shows gram positive,
oxidase and catalase negative
Enriched media, beta hemolytic colonies
on human blood.
Endotoxin but no lipid A.

Epidemiology
69%

No

presence in the vagina.

signs or symptoms.

100%

Bacterial vaginosis, male urethra.

Pathogenesis
Pili

and adherence to McCoy cells.

Hemolysin (Cytolytic toxin).
Normal flora with phospholipase
activity.
Associated with premature rupture of
the membranes.
Serum resistant.

Clinical manifestations
Bacterial

vaginosis:

Present

with mixed anaerobic flora.

Predispose to bacterial vaginitis.
Fishy odor discharge.
Vulvar burning or pruritis.
Gram stain of vaginal fluid rather than by culture.
Urinary

tract infection: Infrequent, difficult to

diagnose.
Bacteremia: obstetrics events.
Neonatal infection.

Diagnosis
Small
Beta

pinpoint colonies.

hemolysis on human blood.

Blood

culture in SPS free bottles.

Catalase

positive.

and oxidase neg, Na hippurate

Treatment

Penicillin.
Ampicillin
Gentamycin.
Metronidazole.
Clindamycin.