Bubonic Plague • Sudden onset of fever, headache, chills, and weakness • Swollen, tender and painful lymph nodes • Septicemic Plague – Fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs – Skin and other tissues may turn black and die, especially on fingers, toes, and the nose – Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague 14
Bubonic Plague • Consider in patients with clinical signs and recent travel or living in western US • Can lead to septicemic plague and/or pneumonic plague if left untreated • IV gentamicin and fluoroquinolones are typically first-line treatments – Duration of treatment is 10 to 14 days, or until 2 days after fever subsides. Oral therapy may be substituted once the patient improves. 15
16 Plague Types
Sarcoptes Scabiei • Scabies “the itch”; contagious, parasitic skin infection • Mites – Burrow up to 1cm in the stratum corneum and deposit eggs • Infestation sites – Interdigital spaces of fingers and surfaces of wrists – External male genitalia – Buttocks – Anterior axillary folds • Infection characterized by inflammation and intense itching • Requires prescription therapy 17
Sarcoptes Scabei • Rash and pruritus may last up to 2 weeks after treatment • Treat fellow household members and close contacts – All persons should be treated at the same time to avoid reinfestation • All bedding, clothing, towels, etc. used over 3 days before treatment need to be decontaminated 18
Therapeutic Treatment • Permethrin 5% cream applied from neck down and wash off after 8-14 hours • Ivermectin 200mg/kg oral dose once – Not FDA approved but widely used and literature supported – Use when topical therapy impractical or difficult • Crotamiton 10% cream or lotion; requires second application 24 hours later • Sulfur ointment safe in children less than 2 months old • Second line: Lindane 1% lotion or cream – Increasing resistance – Contraindications in pregnant women, children, infants, and elderly – Potentially neurotoxic – Single 60 ml application from neck down, leave on 8-12 hours, then rinse off • Hydrocortisone may be used topically for pruritus 19
Bedbugs • Hide and deposit eggs on objects during the day and bite at night • Increased infestation in the US due to worldwide travel – Hotels • Bites – Exposed areas of skin such as arms, neck, etc. – Clusters of twos and threes, straight line – Irritation at the site – Dermal hemorrhage 20
Bedbugs • Treatment is typically supportive • Local antiseptic or antibiotic creams for secondary infections • Corticosteroid creams and oral antihistamines for allergic reactions 21
Ticks • Attach mouthparts into the skin – If removal doesn’t include mouthpart intense itching and nodules requiring surgical excision can occur • Can remain up to 10 days before falling off – Itching papules disappear within 1 week • Removal – Use tweezers – Do not use heating methods, nail polish, or petrolatum 23
Ticks: Systemic Diseases • Certain species transmit systemic diseases •
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- Fall '19
- Head louse, Pediculosis, Body louse, permethrin