7- 13 November 2014 #731

Bugs free

A few topical treatments exist to decrease the inflammation of scabies, lice, bedbugs and flea bites.
Dhanvantari by Buddha Basnyat, MD

In the olden days when people were infected by scabies or Luto as is called in Nepali, they burnt firewood and hurled them as far as they could with the hope that doing so would magically cure them of the disease. While such silly superstitious treatments are no longer the norm, it helps to be wary of scabies and other skin bugs infestation.

Scabies patients suffer from intense chronic scratching leading to discomfort and added bacterial infection in the affected region of the body. Scabies infestation can also lead to underlying bone infection (osteomyelitis), blood infection, and kidney infection. The elderly, sexually active young adults and unhygienic people are especially susceptible to scabies. Scabies is also known to spread through pet dogs.

Other common skin bugs are bedbugs, fleas and lice which like scabies cause excessive scratching. These bugs (except lice) are usually not visible on physical examination as they do not live on the skin. They thrive in impoverished areas where there is overcrowding and living conditions are poor. Bed bugs for example are generally found in places of shared accommodation such as hostels, hotels, hospital or a dorm room. Patients with bedbug bites typically have 3 or more lesions in a row on the forearm or legs.

Lice (jumra) appear on the scalp and are easily identifiable with a magnifying glass. Besides head lice there are body lice and pubic lice. Body lice are uncommon in the Western world with the exception of few cases in shelters, refugee camps and jails. These bugs are susceptible to cold so they stick to areas where the temperature is warmer like in the waistband. Lice can also transmit systemic diseases such as typhus. However, limited studies conducted on fever patients in Nepal show that body lice have not been a common transmitter of any systemic illness here.

Like bed bugs, fleas are also not found on skin during examination. The diagnosis is made by discussion of the patient’s history of exposure to animals. The ankle area is a common flea bite area. Out of all the skin infestations (scabies, bedbugs, fleas, and lice), rat fleas (C. felis) are particularly dangerous and can cause fever and pneumonia. Rat fleas carry a special kind of typhus bug (murine typhus) which can get transmitted to humans through a bite.

After typhoid fever, the second most important, documented common cause of non- viral fever in Kathmandu is murine typhus. The best drug to treat murine typhus is doxycycline. But this drug is not commonly prescribed to patients in Nepal, and doctors tend to suggest use of stronger antibiotics which is not able to contain fever.

The topical treatment for scabies and lice is permethrin based medicine which is available in Nepal. Bedbugs and flea bites do not have specific treatments except to use some mild topical cream to decrease the inflammation. Since house pets may carry fleas and mites, it is important to keep them clean and treat their infections so that they do not transmit the diseases to humans.

Read also:

Mystery fevers, Buddha Basnyat

Solving mysterious fevers, Buddha Basnyat