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SCABIASCABIA
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- Sarcoptes scabiei- Sarcoptes scabiei, varietatea hominis, parazit uman obligator , varietatea hominis, parazit uman obligator (supravietuire 1-2 zile in afara omului)(supravietuire 1-2 zile in afara omului)
-contaminare prin contact direct; rar indirect prin haine, asternuturi, -contaminare prin contact direct; rar indirect prin haine, asternuturi, prosoapeprosoape
femela adulta 0,4/0,3mm, 4 perechi picioare scurte, femela adulta 0,4/0,3mm, 4 perechi picioare scurte, anterior rostru cu dinti, dorsal spinianterior rostru cu dinti, dorsal spini
masculul mai mic (1/2din lungimea femeii)masculul mai mic (1/2din lungimea femeii)
-speciile adaptate la animal dau rar boala la om-speciile adaptate la animal dau rar boala la om
-incubatie 2-3 sapt. in primoinfectie; 24 ore la reinfectie-incubatie 2-3 sapt. in primoinfectie; 24 ore la reinfectie
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Femela sapa tunel in care are loc copularea; il Femela sapa tunel in care are loc copularea; il prelungeste cu 2-3 mm/zi, timp de 1-2 luni; in urma ei prelungeste cu 2-3 mm/zi, timp de 1-2 luni; in urma ei raman oua (40-50) si fecaleraman oua (40-50) si fecale
La capatul distal – vezicula perlataLa capatul distal – vezicula perlata
In 3-4 zile din oua ies larve cu 6 picioare – taie In 3-4 zile din oua ies larve cu 6 picioare – taie acoperisul tunelului - nimfe – acarieni adultiacoperisul tunelului - nimfe – acarieni adulti
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Manifestari cliniceManifestari clinice
Obiective: Obiective:
- patogn:- - patogn:- sant acariansant acarian
- vezicula perlata- vezicula perlata
- - nespecificenespecifice: prurigo, lez grataj, placi urticariene, : prurigo, lez grataj, placi urticariene, veziculo-bule palmoplantare (copii)veziculo-bule palmoplantare (copii)
Localizare: Localizare: sp interdig, artic pumni, coate, genunchi, sp interdig, artic pumni, coate, genunchi, axilar, periombilical, fese, perimamelonar, teaca penis, axilar, periombilical, fese, perimamelonar, teaca penis, scrotscrot
copii palme, plante, fata, scalpcopii palme, plante, fata, scalp
Subiective:Subiective: prurit exacerbat nocturnprurit exacerbat nocturn
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Forme cliniceForme clinice
NormoergiceNormoergice
clasicaclasica
incognita (la cei tratati cu dermatocorticoizi)incognita (la cei tratati cu dermatocorticoizi)
atenuata/ a oamenilor curatiatenuata/ a oamenilor curati
HiperergiceHiperergice
Hipo-/anergiceHipo-/anergice
Scabia persoanelor imune Scabia persoanelor imune cei din arii endemice de scabie cei din arii endemice de scabie sau la care boala evolueaza de multa vremesau la care boala evolueaza de multa vreme
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Scabia norvegiana (Scabia norvegiana (scabiascabia crustoasa) crustoasa)
Imunodeprimati, pacienti tratati cu dermatocorticoiziImunodeprimati, pacienti tratati cu dermatocorticoizi
Nr. f. mare de parazitiNr. f. mare de paraziti
Scuamocruste groase, predominant pe extremitatiScuamocruste groase, predominant pe extremitati
Prurit redus sau absentPrurit redus sau absent
Majoritatea adenopatie generalizata si eozinofilieMajoritatea adenopatie generalizata si eozinofilie
Foarte contagioasaFoarte contagioasa
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Scabia nodularaScabia nodulara
Hipersensibilitate fata de antigenele parazitareHipersensibilitate fata de antigenele parazitare
Noduli rosii-bruni,infiltrati, pruriginosi; fese, flancuri, Noduli rosii-bruni,infiltrati, pruriginosi; fese, flancuri, organe genitale, coapseorgane genitale, coapse
Leziunile pot persista luni dupa o scabie tratataLeziunile pot persista luni dupa o scabie tratata
Reactie granulomatoasa la resturi ale artropodelor sau la Reactie granulomatoasa la resturi ale artropodelor sau la ouale acestoraouale acestora
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Diagnostic Diagnostic
Context epidemiologic sugestivContext epidemiologic sugestiv
Prurit cu exacerbare nocturnaPrurit cu exacerbare nocturna
Leziuni cu aspect si topografie Leziuni cu aspect si topografie caracteristicecaracteristice
Examen parazitologic directExamen parazitologic direct
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Tratament Tratament
Benzoat de benzil 25-30%Benzoat de benzil 25-30%
Crotamiton 10%Crotamiton 10%
Permetrina 5%Permetrina 5%
Malathion 0,5% (CI gravide , copii)Malathion 0,5% (CI gravide , copii)
Sulf pp 10% adulti, 3-5% copiiSulf pp 10% adulti, 3-5% copii
Lindan 1% (CI gravide, copii, supraf mari Lindan 1% (CI gravide, copii, supraf mari erodate)erodate)
SistemicSistemic- ivermectina ( imunodeprimati)- ivermectina ( imunodeprimati)
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Special population recommendationsSpecial population recommendations
Infants - Permethrin 5% cream (>2 months age) Infants - Permethrin 5% cream (>2 months age) (Ivermectin and lindane contraindicated)(Ivermectin and lindane contraindicated)
Children - Permethrin 5% cream, benzyl benzoate 12.5%Children - Permethrin 5% cream, benzyl benzoate 12.5%
Pregnant and breastfeeding women - 6% sulfur Pregnant and breastfeeding women - 6% sulfur (Ivermectin, permethrin, and lindane contraindicated)(Ivermectin, permethrin, and lindane contraindicated)
Crusted or Norwegian scabies - Oral ivermectin (may Crusted or Norwegian scabies - Oral ivermectin (may require 3-7 doses, or in combination with a topical require 3-7 doses, or in combination with a topical scabicide depending on the severity of the infectionscabicide depending on the severity of the infection[5] [5] ); ); hyperkeratosis treated with a keratolytic agent (5-10% hyperkeratosis treated with a keratolytic agent (5-10% salicylic acid in petrolatum) improves penetration of the salicylic acid in petrolatum) improves penetration of the topical agenttopical agent[5] [5]
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PEDICULOZAPEDICULOZA
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- paduchii sunt paraziti hematofagipaduchii sunt paraziti hematofagi
- 3 specii parazitare pentru om:3 specii parazitare pentru om:
- pediculus humanus capitis (P.capitis)- pediculus humanus capitis (P.capitis)
- pediculus humanus corporis (P.vestimentorum; P.corporis)- pediculus humanus corporis (P.vestimentorum; P.corporis)
- pediculus pubis (P.inguinalis; phtirius pubis; latei)- pediculus pubis (P.inguinalis; phtirius pubis; latei)
ClinicClinic -scalp (spatele urechii); prurit; papule ,escoriatii, eczema, -scalp (spatele urechii); prurit; papule ,escoriatii, eczema, suprainfectie cu aglutinare fire par, adenopatie; paraziti si oua atasate suprainfectie cu aglutinare fire par, adenopatie; paraziti si oua atasate firului de parfirului de par
-corp: prurit, papulopustule, leucomelanodermia vagabonzilor-corp: prurit, papulopustule, leucomelanodermia vagabonzilor
-transmit: tifos, febra butonoasa, febra recurenta-transmit: tifos, febra butonoasa, febra recurenta
-ftiriaza: prurit, pete albastrii= macule cerulee-ftiriaza: prurit, pete albastrii= macule cerulee
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Tratament Tratament
Lindan1%Lindan1%
Malathion 0,5-1%Malathion 0,5-1%
Piretrine si permetrinaPiretrine si permetrina
Crotamiton Crotamiton
Gene- ocluzie cu vaselina albaGene- ocluzie cu vaselina alba