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Vellore, Tamil Nadu, India
I'm a frood who knows where his towel is.

Tuesday, July 12, 2011

Scabies scare

Date: 07/12/2011

I was pretty foxed by the skin lesions the boy's mother thrust into my face. Finally, I consulted Gemlyn and Kartik. In a few minutes,we had diagnosed a boy and his family with scabies, an appalling and rather infectious mite (Sarcoptes scabei) borne disease. Kartik prescribed some permethrin ointment to them and we sent them on their way before they infected anyone. It was probably a really lucky thing for the young man that we caught it before his mother took him to a local quack.

We found similar lesions in his mother and treated his sister prophylactically as well.
I like the fly.

Many quacks that lurk in rural India give gratuitous injections to their patients. The patients naively believe that this is the best standard of care. Usually, these injections are simply B12 or saline injections. However, some actually give intravenous steroids. Steroids tend to put you in a really good mood when you take them so the poor patients leave on cloud nine singing the quack’s praises. Injudiciously administered steroids have the potential to make some diseases (like tuberculosis) worse. Topical steroid application can actually throw scabies infections into overdrive. I’m not 100% confident if steroid injections would do the same, but we do know that steroids suppress our immune systems. Immunosuppressed patients (such as HIV/AIDS patients) can develop a particularly severe form of scabies called Norwegian scabies (don't google it). In any case, I am glad we caught him before he infected all his classmates.

Two nights later, I woke up at 3 am:

3.00.00: Huh, my fingers are itching.
3.00.05 : Which ones?
3.00.10: Right hand. Above the distal and proximal phalanges. Differential diagnosis time!
3.00.25: You ass! You worked with the family with scabies without gloves.
3.00.30: Ah, but I used turpentine and spirit to clean my skin afterwards.
3.00.35: Oh yeah because turpentine and spirit kill everything! Let’s embalm everyone in the malaria zone with turpentine and spirit. That’s a nobel prize worth idea right there. Wake up and check the bite pattern, moron!
3.00.40: Fine, fine, no need to get sassy. I’ll get permethrin in the morning in any case. Just let me sleep now.
3.00.45: Not so fast, what else could it be?
3.00.50: Ants raiding my overripe mango? Allergy to that odd soap I used? Polycythemia Vera? Cutaneous T-cell Lymphoma? Doxycycline dermatitis? Mosquitoes? I don’t know and I don’t care. I wanna sleep!
3.01.00: Man, you’re gonna suck as a doctor.

A few minutes later, I heard an annoying buzz in my ear. I quickly swatted it and I don’t think I’ve ever felt more pleased to feel a mosquito’s crushed corpse between my fingers. How’s that for a diagnosis?

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