SCABIES IN HIV/AIDS PATIENT

Rizki Juniarti Nober C111 07 144

Irfan Adi Saputra C111 07 182

Glendy Daniel C111 06 050

PATIENT IDENTITY∞Name : Mr. A∞Gender : ♂∞Age : 25 years old∞Address : Palopo∞Came to the hospital at : December 31st, 2010

HISTORY TAKINGA man, 25 years old, came to the hospital with the prime complaint itchy skin in all of the body. He had intermittent episodes of dry skin and pruritus that began from June 2010 and developed a widespread erythematous, papular rash that covered his back, abdomen, arms, and legs, without apparent predilection for genital or intertriginous areas. The rash was hyperkeratotic .

CONT...The pruritus was worse at night. History of HIV/AIDS (+). Family members who live in the same house also complained of similar symptoms, but the most severe symptoms experienced by patient.

CONT...Physical Exams:

- Dermatoveneorology state:Loc : R. Truncus + ekstremitas superior et inferior

dextra et sinistra, R. Inguinal, R. genitaliaEff : plaque hiperpigmentation, papules, skuama,

crusting

D/ B20 + Scabies (Norwegian/Crusted Scabies)

DRUGS HISTORYIVFD RLInj. Ceftazidin / 8 hoursInj. Ranitidine / 12 hoursCotrimoxazole 1x2Fluconazole 1x1

PRESENT STATUSGeneral

Compous MentisModerate SicknessUnder nutritions

Vital SignsBlood Pressure : 120/80 mmHgPulse Rate : 100x/minRespiration Rate : 20x/minTemperature : 36,9 oC

PICTURES

PICTURES

DIFFERENTIAL DIAGNOSEPsoriasis, eczema, Darier’s disease, contact

dermatitis, ichthyosis, or an adverse drug reaction

Papular or psoriasiform rash on a patient with AIDS

LABORATORIUM EXAMINATION

Microscopic examination of material scraped from the lesion (and from beneath the nails), using mineral oil and not KOH, confirms the diagnosis. A hand-held magnification device can be utilized for identification of the mites, eggs or scybala

THERAPYScabimite creamCTMTopical (permethrins) and systemic (ivermectin)

therapyClothing, towels, and bedding should be changed

and washedKeratolytic agents or physical debridement to

removal the lesion.

PROGNOSISNorwegian scabies may become a difficult

management problem, requiring multiple courses of treatment.

PREVENTIONStrict barrier contact precautions should be

instituted for hospitalized patients. Serious institutional epidemics have resulted

from failure to recognize the disease and use such precautions.

To prevent reinfestations, bedding and clothing should be washed in hot water and dried in a heated dryer.

Close contacts, even if asymptomatic, should be treated simultaneously.

DISCUSSION

Depression of cellular and humoral immunity can result in an overwhelming infection with the mite Sarcoptes scabiei. Infections in which the densities of mites are very high are known as Norwegian or crusted scabies. Crusted scabies is a psoriasiform hyperkeratotic dermatosis of the hands and feet with involvement of the nails and an erythematous scaly eruption on the face, neck, scalp, and trunk. Crusted scabies may be localized, affecting only the scalp, face, fingers, toenails, or soles. The lack of pruritus and itching may be indicative of the absence of appropriate immune response.

The immune response to infection with the mite that causes scabies is both humoral and cellular. Patients with AIDS have diminished ability to respond to new antigens because of abnormal humoral immunity and lose the ability to suppress chronic infections because of depressed cellular immunity. It is logical, therefore, that an infection with mites may not be effectively controlled by the immune system of a patient with AIDS and that its cutaneous manifestations may differ from the localized intertriginous and genital burrows usually associated with scabies.

Because of the very large number of mites, crusted scabies is highly contagious, including through indirect transmission; it causes outbreaks among family members and among patients in hospital wards when no preventive measures are instituted. It may go undiagnosed.

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