- Barzilai A, Shpiro D, Goldberg l, et al [ Sheba Med Ctr, Tel-Hashomer, Israel; Wolfson Med Ctr, Holon, Israel; Tel Aviv Univ, Israel; et al]
Insect Bite-Like Reaction in Patients With Hematologic Malignant Neoplasms
Arch Dermatol 135: 1503-1507, 1999
Skin eruptions are not unusual accompaniments of hematologic malignancy, and need not represent metastases. The present report of 8 such cases simulating insect bites is described. Hematologic neoplasia comprised chronic lymphocytic leukemia, acute monocytic leukemia, mantle cell lymphoma, large cell lymphoma, and myelofibrosis. Dermatologic reference arose from an itchy papular or vesico-lobullous eruption on exposed and covered parts of the skin. A history of insect bites was denied, as was outdoor activity. All were treated for scabies. 13 skin biopsies were examined.
The hall mark was failure to obtain relief with systemic antihistamines, topical steroids, antiscabetics and a partial response to 40 mgm of prednisone with rapid relapse on tapering the dose . A single subject was relieved by natural phototherapy in the Dead Sea. One cleared with remission of leukemia.
Biopsy specimens revealed a superficial and deep perivascular infiltrate of small lymphocytes and eosinophils extending into the surrounding connective tissue.
Arthropod assault can give the above picture in patients with lymphomas -Hodgkin’s and others. After exclusion a group of nondescript rashes remains. They are expected to disappear with treatment of the malignant process.
- Pollack RJ, Kiszewski A, Armstrong P, et al [Harvard School of Public Health, Boston; Idaho Division of Health, Boise; Sabah Dept of Health, Kota, Kinabalu, Malaysia]
Differential Permethrin Susceptibility of Head Lice Sampled in the United Status and Borneo
Arch Pediatr Adolesc Med 153: 969-973, 1999
This paper compares the results of treatment of head lice in Sabah where the infestation is common with a similar condition in the U.S. Pediculus infestation of the scalp was recorded in 59 boys between the ages of 6 and 13 years in Sabah and treated and cleared with permethrin. No effect was observed in the chronically infested scalp of boys between 5-8 years of age in American children.
The difference represents previous usage of permethrine in the US hence development of resistance. In children from Sabah the compound had not been used before. Disk assay test confirmed the different susceptibilities.
- Marliere V, Roul S, Labreze C, et al [Hopital Pellegrin -Enfants, Bordeaux, France]
Crusted [Norwegian] Scabies Induced By Use of Topical Corticosteroids and Treated Successfully with Ivermectin
J Pediatr 135: 122-124, 1999
Misdiagnosis of a 2 years boy as Eczema resulted in application of a corticosteroid ointment for 6 weeks. Lesions worsened to cover the trunk, legs, and dorsa of the feet. Permethrin application was ineffective. Scrapings from the feet showed large numbers of Sarcoptic mites and eggs. 200 mg/Kg given orally combined with keratolytic ointments and emollients, antiseptic baths with triclocarban cleared the lesions in a week.
Immunosuppresion was induced by corticosteroid ointment hence the severe picture of scabies. Though Ivermectin is an ideal ectoparaciticidal; dose monitoring is important as severe effects on neural transmitters, gamma-aminobutyric acid and glutamate may occur in the rare event of its crossing the hemato-encephalic barrier. The drug is available as 6mgm scored tablets.
- Chouela EN, Abeldano AM, Pellerano G, et al [ Hosp General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina]
Equivalent Therapeutic Efficacy and Safety of Ivermectin and Lindane in the Treatment of Human Scabies
Arch Dermatol 135: 651-655, 1999
53 patients suffering from scabies comprise this highly scientific clinical study. They received single oral dose of ivermectin [ 150 to 200 mg/Kg] or a single topical application of 1% lindane. Those not cured in 15 days repeated their respective treatments. 43 subjects completed the treatments. At the end of 15 days 74% of those on ivermectin showed healing; by the 29th day the percentage was 95%. With Lindane the figures were 54 and 96 respectively.
Results of the two treatments are the same but ivermectin has the advantage of being simpler to use.
- deShazo RD, Williams DF, Moak ES [Univ of Mississippi, Jackson, USDAARS Ctr for Med, Agricultural and Veterinary Entomology, Gainesville, Fla; Brookhaven, Miss]
Fire Ant Attacks on Residents in Health Care Facilities : A Report of Two Cases
Ann Intern Med 131: 424-429, 1999
Fire ants [Solenopsis invicta] have spread from South America to colonize South Eastern United States. Living in ground nests especially near new construction they are capable of stinging human beings. Anaphylaxis to stings have caused 80 deaths.
The usual sting sequence is an erythematous papule with burning and itching followed by pustulation and necrotic ulcers lasting a few days. The recorded
case involves a 67 year female with mental deterioration, congestive cardiac failure and respiratory tract disease. An ant trail from the ground to the bed was found. This was in a nursing home. Though she recovered from the effects of ant stings, she died of cardiac failure.
Patients without neurologic disease have also been affected. The facility is legally endangered.