Scabies

SCABIES
(see picture above) Immunocompromised individuals may experience Norwegian scabies, which involves extensive scaling and crusting.
Introduction : Scabies is a prevalent skin condition that effects people of all classes and ethnicities all over the world. Scabies is an ancient affliction, estimated to have infected humans for the last 2,500 years. The WHO considers scabies to be a water-related disease because of the connection between bathing and personal hygiene to prevention or control of its spread. The tick that causes scabies, however, is not dependent on water for transmission or for any part of its life cycle. Definition : Scabies is an old age skin infection caused by an itch mite ,which penetrates the skin ,forming burrows. (Burrows are tiny thread like projections ranging from 2-6 mm long that appear as thin gray, brown or red lines in affected areas. Etiologic Agent : Sarcoptes scabiei Incubation Period: The itch may burow under the skin and lay ova within 24 hrs.of the original contact. Usually between 2 to 6 weeks; can be as little as 1 to 4 days in people that have been sensitized by prior exposure. Pathognomonic Sign : Severe Itching Period of Communicability: This disease is communicable for the entire period that the host is infected.
Mode of Transmission: Direct through an infected individual Acquired sleeping on the infested bed or wearing infested clothing. Anyone may become infected or re-infected. Infestation with mites may also result from contact with dogs ,cats and other small animals. 5. Scabies on dogs is called mange. When canine of feline mites land on humanskin, they fail to thrive and produce only a mild itch that eventually disappear. 1. 2. 3. 4. Pathology
Signs and symptoms : 1. The disease is invariably accompanied by itching, characteristically more pronounced at night, when patient has retired ,since the increased warmth of the skin has a stimulating effect on the parasite. 2. For the first week ,the itch is subtle. It gradually becomes more intense that after a month or two, sleep becomes almost possible. 3. Secondary lesions like vesicles , papules,pustules, excoriations and crusts may be found on the affected site. 4. Bacterial superinfectionmay result from constant excoriation of burrows and papules. Diagnostic test : Skin scrapings after application of mineral oil to look for eggs under the microscope. Modalities of treatment : 1. Application of Pediculocide, such as permethrin cream or lindane lotion , as a thin layer over the entire skin surfaces, left on for 10-12 hrs. 2. Crotamiton cream is apllied for 5 consecutive nights. 3. Neosporin oitment is rubbed onto the affected skin 4-5 times a day. 4. Eurax and Kwell lotion also prove effective in some patient. 5. Antihistamine ,like diphenhydramine(benadryl) can be useful in giving relief from the itch. 6. All clothes used before and during the treatment period should be disinfected by dry cleaning or boiling. Nursing Management 1. Instruct the patient to apply the cream at bedtime,from the neck down to the toes, covering the entire body. 2. Contaminated clothing or bedclothes should be dry cleaned or boiled. 3. Advise the patient to report any skin irritation. 4. Suggestthe family members and other close contacts of the patient be checked for possible symptoms and treated if necessary. 5. If the patient is hospitalized, practice good handwashing technique or use gloves while performing nursing procedure. 6. Terminal disinfection should be carried out after the discharge of the patient. Nursing Diagnoses 1. Alteration in comfort; itchiness 2. Impaired skin integrity
3. 4. 5. 6.
Altered role performance Knowledge deficit Social isolation Body image disturbance
Prevention and Control 1. 2. 3. 4. Good personal hygiene. Avoid contact with infected persons. All members of the household, including close contacts,should be treated. After treatment, beddings and clothing worn next to the skin should be properly laundered.
SCHISTOSOMIASIS
Synonyms :Bilharziasis/ Snail Fever Definition ; Schistosomiasis, or bilharzia, is a parasitic disease caused by trematode flatworms of the genus Schistosoma. Larval forms of the parasites, which are released by freshwater snails, penetrate the skin of people in the water. In the body, the larvae develop into adult schistosomes, which live in the blood vessels. The females release eggs, some of which are passed out of the body in the urine or faeces. Others are trapped in body tissues, causing an immune reaction. In urinary schistosomiasis, there is progressive damage to the bladder, ureters and kidneys. In intestinal schistosomiasis, there is progressive enlargement of the liver and spleen, intestinal damage, and hypertension of the abdominal blood vessels. Control of schistosomiasis is based on drug treatment, snail control, improved sanitation and health education. Etiologic agent: Schistosoma japonicum Three major types of the organism: 1.Schistosoma japonicum a. this agent infects the intestinal tract (Katayama disease). b. It is found to be the only type that is endemic in the philippines. c. this is also known as oriental schistosomiasis 2. Schistosoma mansoni a. It also affects the intestinal tract. b. It is common in some parts of africa 3. Schistosoma haematobium a. It affects the urinary tract. b.It can be found in some parts of the middle east, like Iraq and Iran.
Incubation Period: at least 2 months. Pathognomonic sign : Swimmers itch Source of infection: 1. Feces of infected persons 2. Dogs, pigs,carabaos, cows, monkeys and wild rats have been found to be infected and, therefore,also serve as hosts. Modes of Transmission 1.The disease is transmitted through ingestion of contaminated water. 2. Skin pores 3. Intermediary host, a tiny snail called Oncomelania quadrasi. Characteristic of Oncomelania quadrasi. 1. The snail thrives best along riverbanks, fresh water streams, creeks, canals and swamps. 2. It can be found clinging to water hyacinths, grasses,decaying leaves and pieces of rotting wood,bamboo and coconut husks. 3. It also loves to stay in areas with sandy-loamy soil. 4. The adult snail is greenish brown in color and is as big as the smallest grain of palay. Clinical Manifestation 1. 2. 3. 4. 5. 6. 7. A pruritic rash known as the swimmers itch,develops in the site of penetration Thre is a low grade fever, myalgia, and cough. Abdominal discomfort due to hepatomegaly, spleenomegaly and lymphadenopathy. Bloody mucoid stool similar to dysentery Icteric and jaundice Weak , pale and marked muscle wasting Dizziness, severe headache,convulsion may lead if the parasite reach the brain.
Pathophysiology

Scabies

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SCABIES

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