C - Investigation: 1. Smear: amastigotes in macrophage by Giemsa-stain (Leishman-Donovan, LD bodies). 2. Biopsy: demonstration of LD bodies, and granuloma. 3. Culture: growth of promastigotes in NNN medium. 4. PCR: demonstration of leishmanial DNA. 5. Leishmanin test (Montenegro test): Injection of 0.1 ml suspension of cultured promastigotes in the forearm, and read after 48-72 h. It is unreliable in endemic areas. Treatment: CL is self-limited infection. The most important indications of treatment are: (1) Cosmetic concern. (2) Controlling the disease in population. (3) Failure of spontaneous healing. A - Intralesional infiltration: 1. Sodium stibogluconate solution (Pentostam) ® : is the treatment of first choice in CL. It is injected intradermaly in the borders of the lesions at 1-2 weeks intervals until cure. 2. Zinc sulfate solution (2%). 3. Hypertonic sodium chloride solution (7%). 4. Gamma Interferon: effective but expensive. B - Topical therapy: Topical paromycin, ketoconazole cream or podophyllin. C - Physical therapy: Infrared heat, cryotherapy, surgical excision or laser ablation (CO2 laser). D - Systemic therapy: I - Parentral: 1. Sodium stibogluconate (Pentostam) ® : the 1 st choice systemic agent in treatment of CL. Dose: 20 mg/ kg / day for 28 days in two divided daily doses i.v. or i.m.. Although uncommon, cardiotoxicity is the most serious side effect (it should be given under ECG monitoring). 2. Meglumine antimoniate. 3. Amphotericin B: may be used in antimonial-resistant cases. II - Oral: Zinc sulphate, dapsone, ketaconazole, rifampicin, itraconazole, or allopurinol. Indications of systemic therapy: 1. Multiple or large lesions. 2. Lesions in an immunocompromized patient. 3. Lesions in a critical area (around eyes), or in disfiguring or painful areas (nose & ears). 4. Leishmaniasis Recidivans.
3 Scabies Cause: Human scabies is a highly contagious infestation, caused by a mite ( sarcoptes scabiei var hominus ). Life Cycle: Adult mites are 0.3 mm long. The mite infestation begins when a fertilized female mite arrives to skin surface, then burrow through the stratum corneum at a rate of 3 mm per day, it lays about 3 eggs per day, eggs hatch within 3 days into larvae, which reach maturity in about 3 weeks. The mite can survive for about 3 days outside the human skin ( Role of 3 ). Transmission: Through prolong (5-20 min) close contact, some infections from exposure to fomites. Presentation: Scabies affects all races and all social classes. Occurs at any age, with equal sex incidence. The IP: weeks to months after the initial exposure to the mite. The IP is only few days in subsequent exposure, due to prior sensitization (the eruption caused by sensitization to the mites or their products). The itching: is severe and more at night ( nocturnal pruritus is characteristic). The lesions: the pathognomonic lesion is a burrow , which is a gray white, slightly elevated, tortuous or zigzag like linear lesion that is 1 to 10 mm in length. Scratching may destroy the burrows; therefore they don’t appear in some patients. Other types of lesions are vesicles and papules (red, excoriated, and urticarial).
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- Fall '13
- Head louse, Pediculosis, Cutaneous Leishmaniasis, Body louse, Crab louse, Louse