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Itching may be very intense in body louse infestations, and scratching may result in deep excoriations, especially over the upper shoulders, posterior flanks, and neck In some cases, only itching is present, with few excoriations seen Pyoderma may be the presenting sign in any of these infestations Head lice can be found on the scalp or may be manifested as small nits resembling pussy willow buds on the scalp hairs close to the skin They are easiest to see above the ears and at the nape of the neck Pubic louse infestations are occasionally generalized, particularly in hairy individuals; the lice may even be found on the eyelashes and in the scalp

Head louse infestation must be distinguished from seborrheic dermatitis, body louse infestation from scabies, and pubic louse infestation from anogenital pruritus and eczema

Here are the parameters received: 5, 3.14

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The diagnosis may be difficult when the patient has not noticed the initial attack but suffers a delayed reaction Individual bites are often in clusters and tend to occur either on exposed parts (eg, midges and gnats) or under clothing, especially around the waist or at flexures (eg, small mites or insects in bedding or clothing) The reaction is often delayed for 1 24 hours or more Pruritus is almost always present and may be all but intolerable once the patient starts to scratch Secondary infection may follow scratching Urticarial wheals are common Papules may become vesicular The diagnosis is aided by searching for exposure to arthropods and by considering the patient s occupation and recent activities The principal arthropods are as follows: 1 Fleas: Fleas are bloodsucking ectoparasites that feed on dogs, cats, humans, and other species Flea saliva produces papular urticaria in sensitized individuals To break the life cycle of the flea, one must treat the home and pets, using quick-kill insecticides, residual insecticides, and a growth regulator 2 Bedbugs: In crevices of beds or furniture; bites tend to occur in lines or clusters Papular urticaria is a characteristic lesion of bedbug (Cimex lectularius) bites 3 Ticks: Usually picked up by brushing against low vegetation 4 Chiggers or red bugs: These are larvae of trombiculid mites A few species confined to particular regions and locally recognized habitats (eg, berry patches, woodland edges, lawns, brush turkey mounds in Australia, poultry farms) attack humans, often around the waist, on the ankles, or in flexures, raising intensely itching erythematous papules after a delay of many hours The red chiggers may sometimes be seen in the center of papules that have not yet been scratched 5 Bird and rodent mites: Larger than chiggers, bird mites infest pigeon lofts or nests of birds in eaves Bites are multiple anywhere on the body Room air conditioning units may suck in bird mites and infest the inhabitants of the room Rodent mites from mice or rats may cause similar effects Pet gerbils may be infested with bird mites The diagnosis of bird mites or rodent mites may easily be overlooked 6 Mites in stored products: These are white and almost invisible and infest products such as copra, vanilla pods, sugar, straw, cottonseeds, and cereals Persons who handle these products may be attacked, especially on the hands and forearms and sometimes on the feet Infested bedding may occasionally lead to generalized dermatitis 7 Caterpillars of moths with urticating hairs: The hairs are blown from cocoons or carried by emergent moths, causing severe and often seasonally recurrent outbreaks after mass emergence The gypsy moth is a cause in the eastern United States 8 Tungiasis: Tungiasis is due to the burrowing flea known as Tunga penetrans and is found in Africa, the.

West Indies, and South and Central America The female burrows under the skin, sucks blood, swells to 05 cm, and then ejects her eggs onto the ground Ulceration, lymphangitis, gangrene, and septicemia may result, in some cases with lethal effect Ethyl chloride spray will kill the insect when applied to the lesion, and disinfestation may be accomplished with insecticide applied to the terrain Simple surgical excision is usually performed

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fying or confirming the site of bone infection Plain bone films early in the course of infection are often normal but will become abnormal in most cases even with effective therapy Spinal infection (unlike malignancy) traverses the disk space to involve the contiguous vertebral body CT is more sensitive than plain films and helps localize associated abscesses MRI is slightly less sensitive than bone scan but has a specificity of 90% It is indicated when epidural abscess is suspected in association with vertebral osteomyelitis

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