Page 36 - 2013-mar-apr

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36
MAR / APR 2013
I 
Healthcare Journal of NEW ORLEANS  
spread through prolonged skin-to-skin
contact, but scabies transmission can
also occur via prolonged contact with
bed linen, clothing, and other fabrics
from infested hosts. The mites are able
to survive 2-3 days at room tempera-
ture when the relative humidity is
more than 30%. The higher the rela-
tive humidity, the higher the survival
rate, so Southern cities like New
Orleans are at increased risk of sca-
bies transmission via routes other
than skin-to-skin contact. Child
care facilities are common sites of
scabies infections, and the Louisi-
ana DHH recommends that chil-
dren be excluded from school or
daycare until treatment has been
completed.
Rivaling lice in prevalence
(and parental horror) in New
Orleans children are Entero-
bius vermicularis, a.k.a. pin-
worms. These thin, white
roundworms (about the
length of a staple) live in the
colon and rectum of the child. At night, the
female worms emerge from the anus and
lay eggs around the outside of the open-
ing. This causes intense itching. When the
child scratches, the eggs get underneath
his or her fingernails. From there, they can
be transferred either directly to the child’s
own mouth, establishing a new cycle of
infection when they hatch in the stomach,
or to toys and other items, where they can
survive for as long as 2 to 3 weeks (ideal
conditions for egg viability are low heat
and high humidity) and be ingested by
other children. To prevent infection, chil-
dren should be encouraged to wash their
hands often. Nails should be kept trimmed,
and items from an infected child should
be washed. Treatment with anthelmin-
thics will kill the worms, but not the eggs,
and so must be repeated after two weeks
to kill any newly hatched worms. While
however, since the heat and humidity in
New Orleans can at times be high enough
tomimic the conditions of the human scalp,
there is concern that eggs could hatch away
from a scalp during particularly hot and
humid weather here. Sealing items tightly
in plastic bags for two weeks ensures that
no living lice will remain on the items, even
under the unique New Orleans conditions
that might theoreticallymake it possible for
the eggs to hatch.)
Another common ectoparasitic infesta-
tion of children, scabies, is caused not by
insects, but by an arachnid, themicroscopic
mite Sarcoptes scabiei. Scabies mites bur-
row into the upper layer of the skin where
they live and lay eggs, causing an intensely
itchy rash. Scabies is most commonly
Your child has
Enterobius
vermicularis...
Oh no!
But howcould this
happen doctor?