From the Guidelines
I'll prepare a 5-slide presentation on hydatid disease, pediculosis, and scabies, focusing on clinical suspicion, diagnosis, treatment, and prevention. For hydatid disease, suspect this parasitic infection in patients with liver or lung cysts who have exposure to dogs or sheep in endemic areas, as suggested by 1. Diagnosis relies on imaging (ultrasound, CT, MRI) showing characteristic cystic lesions, confirmed by serology (ELISA, IHA). Treatment includes albendazole (10-15 mg/kg/day in two divided doses for 3-6 months) and surgical removal for accessible cysts, with PAIR (puncture, aspiration, injection, reaspiration) as an alternative for inoperable cases, as noted in 1. Prevention involves deworming dogs, proper meat inspection, and handwashing after dog contact.
Pediculosis
For pediculosis (lice infestation), suspect in patients with:
- Intense scalp itching
- Visible nits on hair shafts
- Crawling lice Diagnosis is clinical through visual identification. Treatment includes:
- Permethrin 1% cream rinse applied for 10 minutes then rinsed off, repeated in 7-10 days
- Ivermectin 200-400 mcg/kg as a single oral dose for resistant cases, as recommended by 1 and 1 Prevention requires avoiding head-to-head contact and not sharing personal items.
Scabies
For scabies, suspect in patients with:
- Intense nocturnal itching
- Characteristic burrows in web spaces and wrists
- Family members with similar symptoms Diagnosis is clinical, confirmed by microscopic identification of mites from skin scrapings. Treatment consists of:
- Permethrin 5% cream applied from neck down, left for 8-14 hours, then washed off, repeated in 7 days
- Oral ivermectin 200 mcg/kg, repeated in 7-14 days, as an alternative, as suggested by 1 and 1 Prevention includes treating all household contacts simultaneously and washing bedding and clothing in hot water. In cases of outbreaks in communities, nursing homes, and other institutional settings, ivermectin can be considered, especially if treatment with topical scabicides fails, as noted in 1.
From the FDA Drug Label
Hydatid Disease: Treatment of cystic hydatid disease of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm, Echinococcus granulosus . Scabies: Permethrin Cream, 5% is indicated for the treatment of scabies. Pediculosis: No information is available in the provided drug labels.
- When to Suspect:
- Hydatid disease: when a patient presents with symptoms such as abdominal pain, nausea/vomiting, or abnormal liver function tests, and has a history of exposure to the dog tapeworm, Echinococcus granulosus.
- Scabies: when a patient presents with intense itching, especially at night, and has a rash or blisters on the skin.
- Pediculosis: no information is available in the provided drug labels.
- Diagnosis:
- Hydatid disease: diagnosis is based on imaging studies, such as ultrasound or CT scans, and serological tests to detect antibodies against Echinococcus granulosus.
- Scabies: diagnosis is based on clinical presentation and microscopic examination of skin scrapings to detect the mite or its eggs.
- Pediculosis: no information is available in the provided drug labels.
- Treatment:
- Hydatid disease: albendazole tablets are indicated for the treatment of cystic hydatid disease, with a dosage of 400 mg twice daily for patients weighing 60 kg or greater, and 15 mg/kg/day in divided doses twice daily for patients less than 60 kg.
- Scabies: permethrin cream, 5% is indicated for the treatment of scabies, with instructions to apply the cream to the entire body, from the neck down, and leave it on for 8-14 hours before rinsing off.
- Pediculosis: no information is available in the provided drug labels.
- Prevention:
- Hydatid disease: prevention involves avoiding contact with contaminated soil, water, or animals, and practicing good hygiene.
- Scabies: prevention involves avoiding close contact with infected individuals, and washing clothing and bedding in hot water.
- Pediculosis: no information is available in the provided drug labels. 2 3
From the Research
Slide 1: Introduction to Hydatid, Pediculosis, and Scabies
- Hydatid disease is a life-threatening zoonotic disease caused by the larval stage of the Echinococcus granulosus worm 4
- Pediculosis is an infestation of lice on the body, head, or pubic region that occurs worldwide 5
- Scabies is an intensely itchy parasitic infection of the skin caused by the mite Sarcoptes scabiei 6
Slide 2: When to Suspect
- Hydatid disease: when a patient presents with a cystic lesion in the liver, lungs, or other organs, especially in endemic areas 4
- Pediculosis: when a patient presents with pruritus, especially in the head, body, or pubic region 5
- Scabies: when a patient presents with a pruritic, papular rash with excoriations in a typical distribution pattern 7
Slide 3: Diagnosis
- Hydatid disease: diagnosis is typically made by imaging studies such as ultrasound or CT scan, and confirmed by serological tests 4
- Pediculosis: diagnosis is made by visualization of live lice or nits (louse egg shells) 7
- Scabies: diagnosis is made by visualization of the mite, eggs, or feces in a skin scraping, or by a positive response to treatment 6
Slide 4: Treatment
- Hydatid disease: treatment typically involves surgical removal of the cyst, and may also include albendazole therapy to prevent recurrence 4, 8
- Pediculosis: treatment typically involves permethrin 1% lotion or shampoo, and may also include wet combing as a non-pharmacologic option 7
- Scabies: treatment typically involves topical permethrin 5% cream, and may also include oral ivermectin in severe cases 6
Slide 5: Prevention
- Hydatid disease: prevention involves avoiding ingestion of Echinococcus granulosus eggs, which can be found in contaminated food or water 4
- Pediculosis: prevention involves avoiding close contact with infested individuals, and washing clothing and bedding in hot water 7
- Scabies: prevention involves avoiding close contact with infested individuals, and washing clothing and bedding in hot water 6