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Staphylococcus
Non-bullous Impetigo
70% of impetigo
Bullous Impetigo
30% of impetigo
G+ cocci in chains
Classic impetigo
Honey-crust near nose
impetigo = superficial pyoderma
Strep pyogenes
Larger bullae,
Systemic symptoms.
Subgranular blister
S. aureus phage II
type 71 toxin
Nikolskys sign + in
lesional & uninvolved skin;
Path: split @ granular layer.
Mortality: Kids 3%, Adults >50%.
S. aureus phage II
Subcorneal blister
No Fever, no Pastias lines,
pharyngitis, strawberry tongue
deep dermis & subcutis infection
blood cx: negative (except H.flu)
Folliculitis/Furunculosis
Scarletiniform Eruption
Staph Scarlet Fever
Botryomycosis
Granular bacteriosis
Bacterial pseudomycosis
Necrotizing Fasciitis
Endocarditis
Clostridial
Anaerobic Cellulitis
Myonecrosis
Gas Gangrene
S. aureus >
(3A,3C,55,71)
Exfoliative toxins
ET-A, ET-B
S.aureus
> P.aeruginosa, E.coli, Proteus
S.aureus
S.aureus,
Strep pyogenes
90% polymicrobial (type 1)
10% GAS (type 2): M-protein
Large, G+ rods; -toxin (destroys cell membranes, hemolysis), -toxin (hemolysis, muscle necrosis, & cardiac toxicity); Tx: PCN G (+ Clinda + Aminoglycoside as 50% polymicrobial
cellulitis with crepitus
C. perfringens
Clinical: dirty wound cellulitis w/ crepitus, + gas, foul-smell
spares deep fascia & muscle
(also Bacteroides,
Gram stain: short, plump, blunt-ended G+ rods, no spores, & variable # PMNs
>3d incubation
Peptostreptococcus, Prevotella)
deep anaerobic cellulitis
Epidermology: elderly w/ DM or PVD trauma >> post-op bowel or GB surgery
to muscle & fascia w/ toxemia
C. perfringens
Clinical: foul painful necrotic nodules; toxic, bronze skin, bullae w/ brown fluid
fast incubation <3d
ID for boards pg 2
Streptococcus
Strep Toxic Shock Synd
STSS
Toxic Strep Synd
G+ cocci in clusters
20-50 yo w/ any GAS infection,
PAINFUL skin early shock &
organ failure
Blood cx: + >50%; mortality
Super-Antigen Syndrome: M-protein
Ecthyma
Scarlet Fever
Scarletina
Erysipelas
St Anthony's fire
Purpura Fulminans
Blistering Distal Dactylitis
Erythrogenic toxins
A,B,C
Clinical: 20-50yo w/ severe pain in extremity; flu & CNS sx shock, organ failure
Patho: M-proteins bind MHC II (APCs) & V (TCR): T-cells cytokines shock
Morbidity: renal failure, DIC & ARDS; Mortality: 30-60%
Tests: bx, blood cultures + GAS; bandemia, Bun, Cr, Fibrin split products, LFTs
Tx: Clindamycin (inhibits toxins), IVFs/support, early surgical intervention
Clinical: vesicopustule enlarges/crusts punched-out, necrotic base (not
systemic) Tx: 10d Keflex (staph superinfection)
Prodrome: 1-2d sore throat, tender LNs, HA, N/V & high fevers, palatal petechiae.
Exanthem: blotchy neck/chest erythema sandpaper sunburn w/ goosebumps
Tongue: strawberrybeefy; Pastias lines: linear petechiae at folds
Resolution: fever gone in 1 week or 48h Abx; Peeling skin on day 6 x up to 6 weeks.
Complications: rheumatic fever, otitis/sinusitis, PNA, carditis, meningitis, hepatitis, GN
Tests: Culture NP for GAS, ASO, antihyaluronidase, antifibrinolysin, anti-Dnase B Abs
GAS
GAS
Other Gram-Positives
Anthrax
woolsorters disease
Bacillus cereus
Diptheria
Neutropenic pt w/
single necrotic bulla
Rare
Bacillus anthracis
G+ rod, spores
Bacillus cereus
G+ rod, spores
Corynebacterium
diphtheriae
G+ bacillus, no spores
Actinomycoses
Erysipeloid
Lumpy Jaw
Fisherman or butcher
Finger webs
Erysipelothrix
rhusiopathiae
G+, no spores
Actinomyces isralii
G+ rod, Non-acid-fast
(normal oral flora)
Nocardia brasilensis
Mycetoma
Nocardiosis
Other Nocardiosis
ID for boards pg 3
Corynebacterium
G +, catalase positive
Superficial localized, mild/chronic
infection @ moist areas
Woods: Coral-red fluorescence
Erythrasma
Interdigital Erythrasma
Disciform Erythrasma
Pitted Keratolysis (PK)
Trichomycosis Axillaris
Corynebacterium
minutissimum
Micrococcus sedentarius
or Corynebacterium spp
Corynebacteria tenuis
(NL flora)
Clinical: irregular, red patches w/ fine scales red fades to brown ( mildly pruritic)
Woods Lamp: porphyrins produced by C.minutissiumum bright coral-red
Treatment: AlCl, topical antibiotics, oral erythromycin
Chronic maceration & fissuring between toes
Associated with Diabetes Mellitus
Clinical: 1-7 mm crater punched-out depressions in stratum corneum on feet
Stain: methenamine silver stain;
Clinical: axillary hair shafts develop adherent yellow-brown concretions
Tx: shave affected area, antibacterial soaps, benzoyl peroxide
Gram-Negative Infections:
Meningococcemia
Neisseria meningitidis
(nasopharynx reservoir)
Ecthyma Gangrenosum
P. aeruginosa
P. aeruginosa
Malta fever
Cutaneous Malacoplakia
Tularemia
Rabbit Fever,
Pahvant Valley Plague
G - motile aerobe
P. aeruginosa
P. aeruginosa
P. aeruginosa
Clinical: large verrucous plaques with multiple pustules and elevated borders
Brucella spp.
Clinical: erythema nodosum, vasculitis; farcy buds= nodules along lymph drainage
Other clinical: ocular, pulmonary, GI, cardio, GI, CNS. Tx: doxy / rifampin
Michaelis-Gutmann bodies in
von Hansemann cells
E.coli
G neg rod
G -, non-motile coccobacillus
Blastomycosis-like Pyoderma
Undulant fever
septicemia
Epidemiology: young children & young adults, males 4:1, winter & spring
Dx: positive culture, tissue gram stain, latex agglutination of Neisseria antigens
Tx: high-dose IV PCN (chloramphenicol); Vaccinate military & co-eds
Clinical: red macule hemorrhagic bulla gangrenous ulcer w/ gray-black eschar
Location: anogenital or extremity. Tx: imipenem (amino
G neg rod
Francisella Tularensis
Burkholderia mallei
Glanders
Facial Cellulitis (<2 yo)
Plague
Rhinoscleroma
Rat bite fever
Enteric fever
Vibrio infection
Horse-handlers
Vaccinations!
Positive blood cultures
Vector: Oriental Rat Flea
(Xenopsylla cheopis)
or wild/domestic rodent contact
Haemophilus influenzae
high fevers, L shift WBC, positive blood cultures (unlike common cellulitis)
G- coccobacillus
Yersinia pestis
Klebsiella pneumoniae
rhinoscleromatis
Streptobacillus
moniliformis
Salmonella
Vibrio vulnificus
ID for boards pg 4
Rickettsial Diseases
Ehrlichiosis
Monocytic Ehrlichia
Granulocytic Ehrlichia
(HGE)
Babesiosis
Tick paralysis
Rickettsia-Like Infections
Cat-Scratch Disease
Bartonellosis = Carrions dz
Oroya Fever
Verruga peruana
Bacillary Angiomatosis
Disseminated cat-scratch dz
Trench Fever
Spirochetes
Lyme Disease
Relapsing Fever
Louse-Borne
Relapsing Fever
R. rickettsii
R. akari
R. prowazekii
R. typhi
Orientia tsutsugamushi
Clinical: Fever, malaise, Neutropenia, LFTs, rash (like RMSF but rarely palms/soles);
Vector: (monocytic) Amblyomma americanum = lone star tick; Cytoplasmic PMN
inclusions
Vector: Ixodes scapularis/daminii = black-legged tick; I.pacificus (West US)
Vectors: Dermacentor andersoni (West US); Dermacentor variabilis (East); hard ticks
Coxiella burnetii
Babesia microti
Dermacentor
Organisms appear adherent to RBCs, may be inside RBCs; Bartonella stain w/ Silver stains only (except Oroya Fever: Giemsa)
Tender lymphadenitis
Clinical: persistent tender regional lymphadenitis
Bartonella henselae
after cat scratch
Bartonella bacilliformis
(stains w/ Giemsa)
HIV pt
20% had cat contact
Vector: Human body louse
Pediculus humanus corporis
Bartonella henselae
Bartonella quintana
Bartonella quintana
Borrelia Burgdorferi
Vectors:
I. dammini/scapularis (NE US)
Ixodes pacificus (West US)
Borrelia recurrentis
Vector: Pediculus humanus
(human body louse)
1 stage (erythema migrans); 2 stage (e.m. resolved), 3 stage (>7 mos s/p e.m.)
Extracutaneous: (tons) F/HA/cough, ophth, CNS, arrhythmias/CHF, arthritis, orchitis
Tx: Doxy 100mg po bid x 21d
Clinical: Paroxysmal fevers (>2), HA, lymphocytoma, myalgias, rash
Rash: Erythematous or petechial macules on trunk & extremities
Tx: Doxycycline
(Western US)
Tx: Doxy 100mg BID x 7d
Yaws
Treponema pallidum
subspecies pertenue
red painless papule ulcerates on LEs of kids < 15 coalesce into tracts bone dz
Pinta
Symmetric vitiligo-like
Treponema carateum
Treponema pallidum
subspecies endemicum
Tick-Borne
Vector: Ornithodoros
ID for boards pg 5
Mycobacterial Infections
LEPROSY
Hansen's disease
Lepromatous
Borderline Lepromatous
Mid-borderline
Borderline Tuberculoid
Indeterminate
Solitary lesion
No sensory loss
TUBERCULOSIS
Lupus Vulgaris
Scrofuloderma
Tuberculous Gumma
Tuberculosis Cutis
Orificialis
Miliary Tb of the skin
Tuberculids
3 lesions
Tuberculosis Verrucosa
Cutis
Tuberculoid
Tuberculous Chancre
(intracytoplasmic parasite of
macrophages & Schwann cells)
1 exogenous inoculation
in non-sensitized host
Exogenous RE-infection
(sensitized host w/ strong immunity)
Hematogenous, lymphatic, or
contiguous spread of Distant Tb
Contiguous spread onto skin from
Underlying Tb focus
(sensitized host w/ low immunity)
Hematogenous spread
( Immunosuppressed host)
Autoinouclation from underlying
advanced visceral Tb
(sensitized host, immunity)
Hematogenous spread from
fulminant Tb of lung/meninges
(immunosuppressed HIV, infant)
cutaneous immune reactions to
M. tuberculosis
Clinical: Painless red-brown papule ulcerates Gohn complex (lung), regional lymphadenopathy 3-8 wk p infection
Pauci- or Multi-bacillary (depends on stage of infection & strength of immune response).
Clinical: Slowly growing verrucous plaques w/ irregular borders on hand
Pauci-bacillary
Clinical: Brownish-red plaque; Apple-jelly diascopy; Head/neck involvement in 90% of cases
Pauci-bacillary
Clinical: Subcut draining nodules sinuses & ulcers w/ granulating bases; mostly over cervical lymph nodes
Pauci- or Multi-bacillary
Clinical: Subcut abscesses fistulas & ulcers; typically on trunk, head or extremities
Multi-bacillary
Clinical: Punched-out ulcers w/ undermined edges; Mucocutaneous junctions of mouth, genitalia.
Multi-bacillary
Clinical: Disseminated erythematous macules, papules, nodules, or purpuric lesions.
Anergic (tuberculin test negative)
#1. papulonecrotic eruption (small dusky red papules w/ necrosis on extremities & buttocks)
#2. erythema induratum of Bazin (women, like nodular vasculitis), #3. lichen scrofulosorum
ATYPICAL MYCOBATERIOSES Most culture in 2-3 weeks; Rapid Growers in 5d (M. fortuitum, M. chelonae, M. abscessus). ACID-FAST
Swimming Pool Granuloma
Buruli ulcer
Bairnsdale ulcer
Searles ulcer
Turtle Tubercle Bacillus
Scrofuloderma-like
AIDS: Mult Purulent LE ulcers
Mycobacterium Marinum
(skin exposed to water)
Mycobacterium ulcerans
Mycobacterium kansasii
Clinical: aquarium, pool, lake small papule nodule granulomatous verrucous plaque
Sporotrichoid spread; Tx: Minocycline
Tx: excision, heat, hyperbaric O2; rifampin, bactrim, minocycline
fortuitum complex
M. fortuitum = M. chelonei
M. scrofulaceum
M. avium, M. intracellulare
ID for boards pg 6
Leishmaniasis
New World Cutaneous
New - Mucocutaneous
Old World Cutaneous
oriental sore, Baghdad sore
Old - Mucocutaneous
Visceral Leishmaniasis
kala-azar (India, Kenya)
American Trypanosomiasis
Chagas disease
African Trypanosomiasis
African Sleeping Sickness
Lymphatic Filariasis
L. mexicana
L.braziliensis complex
L. major or L. tropica
L.aethiopica, L.infantum
L.aethiopica
L.donovani
L. chagasi, L.infantum (kids)
T. cruzi
(Central, S. America, Texas)
(Tom Cruise is American)
Tsetse fly
Glossina spp.
Mosquitoe vector
Cutaneous Filariasis
Loiasis
Loa Loa
Onchocerciasis
River Blindness
Onchocerca volvulus
Cyclops copepods
Dracunculus medinensis
Dracunculiasis
Larva Currens, Ground Itch
Cutaneous Strongyloides
Disseminated Strongyloides
Cercarial Dermatits
Swimmers itch
Seabathers Eruption
Fishtank Granuloma
(aquatic arthropod)
Strongyloides stercoralis
Strongyloides stercoralis
Schistosomatidae (cercarial flatworms)
Edwardsiella lineata (sea anemone); Linuche unquiculata (thimble jellyfish)
Mycobacterium marinum (deep fungal infection)
Transmit: contaminated water; worm emerges from skin (wrap around a stick)
Clinical: Serpiginous urticarial plaques on buttocks, groin, trunk
FAST: 5-15 cm per hour
Periumbilical thumbprint purpura w/ widespread truncal petechiae
Pruritic papules & papulovesicles on uncovered skin;
Northern US & Canada; Tx: prazinquantel
Pruritic erythematous papules/wheals under swimsuit; Saltwater only;
Southern US, Caribbean, Long Island coast.
Ulcerated papule/nodule; Tx: Bactrim, Biaxin, Doxy
ID for boards pg 7
STDs
Disease
1 syphilis
2 syphilis
Micro-organism
Clinical lesion
2-4 weeks incubation (lasts 3-12 weeks)
Diagnosis
6 weeks after onset of 1 chancre lasts 4-12 weeks followed by LATENT phase
Early: non-pruritic PR-like rash; Late: copper-colored maculopapular rash, +lymphadenopathy
Palm/soles: symmetric split-papules w/ Biett scale (collarette), moth-eaten alopecia (tel eff)
Condyloma tala (local treponemes); 'corona veneris' @ hairline, prodromal sx;
3 syphilis
DTH response: Late benign no cardio or CNS gummas; Cardiovascular or Neurosyphilis. Dx: CSF IgG
Congenital
1st 3 mos: marasmic syphilis, snuffles (bullous/erosive 2 syphilis). Hutchinson triad: keratitis, teeth, deafness
Haemophilus ducreyi 3-10d incubation Purulent, painful, 1 ulcers, soft ragged edges.
Culture
School of fish on Giemsa stain
Chancroid
Granuloma
Inguinale
Donovanosis
G bacillus
LGV
Chlamydia trachomatis
Tx
2.4 million U
Benzathine IM
PCN
1, 2 - 1 dose
3 - q week x3
Jarisch-Herxheimer:
treatment fever due
to TNF release.
Azithromycin,
Ceftriaxone,
Cipro, Erythro
TMP-SMX,
Doxy, Cipro,
Erythro
Doxy
Acyclovir
Single dose:
Ceftriaxone
ID for boards pg 8
Herpesvirus: core of linear ds-DNA, icosahedral capsid, envelope w/ surface glycoprotein spikes;
Orolabial herpes
HSV-1 ALPHA
Eczema herpeticum =
Kaposis varicelliform eruption
gG-1 glycoproteins
Herpes gladiatorum
contact sports, ie. Wrestling (arms > H&N)
Erythema multiforme
Western Blot (gold standard)
HSV folliculitis
DIF, Viral culture, Tzank
HSV keratoconjunctivitis
#2 cause of corneal blindness
Herpes encephalitis
1 sporadic fatal encephalitis; temporal lobes; 70% mortality); CSF cx & PCR, EEG, MRI
replication at mucosal site
Genital
herpes
HSV-2 ALPHA
gG-2 glycoproteins
Neonatal herpes
risk of transmission highest (33-50%) w/ 1 eruption near time of delivery; <3% in recurrent herpes
Tx 1 HSV: Valtrex (2g PO BID x10d); HSV Recurrence: Valtrex (500 bid x 3-5d); HSV Supression: 500-1000 qd;
Acyclovir: guanosine analoge inhibits viral DNA polymerase (after thymidine kinase phosphorylation) & 2 viral kinases. (Acyclovir & Famivir require viral TK)
Acyclovir resistance: Foscarnet/Cidofovir (not dependent on viral thymidine kinase)
90% of 10yo; airborne; 11-20d incubation; LNs replication 2 viremia, liver/spleen replicate vesicles
rash: scalp/face rosepetal dewdrops over 12h; enanthem
Varicella
VZV (HHV-3)
Congenital Varicella Synd (1st 20 wks): hypoplastic limbs, ocular & CNS abnormalities
ALPHA
Neonatal Varicella (5d pre-, 2d post-delivery): inadequate transplacental Ab (Tx: VZIG + IV-acyclovir)
20% of healthy adults, 50% of immunocompromised
st
DIF (best), Tzank (1 )
Herpes zoster
disseminated: >20 vesicles outside primary or adjacent dermotomes; more common in immune suppressed
Viral Culture (most specific)
Clinical: Ipsilateral facial paralysis + tinnitus or auditory symptoms
Ramsay Hunt Syndrome
VZV infection of geniculate ganglion (vesicles on external ear or tympanic membrane)
VZV-Ig - w/in 96h passive prophylaxis of immunocompromised, pregnant, neonates; VZV vaccine (Oka) - 95-100% effective in preventing severe disease
Tx VZV: Valtrex w/in 72h of 1st vesicle improves course
1 EBV infxn in 50% of 17-25yo (pharyngitis, fever, lymphadenopathy, spleenomegaly x2-3 weeks)
EBV (HHV-4)
Ampiciliin rash: Mono + Amp = copper macular extensor rash 7-10d later spreads to trunk
Infectious Mononucleosis
GAMMA
desquamates 1 wk later
Epstein Barr Virus
Replicates in B cells
+ monospot or
heterophile Ab >1:40
HHV-8 GAMMA
Lymphoproliferative disorders (solid organ transplants or HIV +), Nasopharyngeal Carcinoma, ?Hodgkins lymphoma, African Burkitts lymphoma;
Gianotti-Crosti synd (infantile papular acrodermatitis), EM, EN, urticaria, acrocyanosis, EAC, pityriasis lichenoides, palmar dermatitis
#1 cause of congenital deafness & mental retardation (TORCH synd); #1 congenital virus.
Clinical: SGA, microcephaly, retinitis, colobomas, intracranial calcifications.
Congenital CMV
dermal erythropoiesis purpuric papules ('blueberry muffin lesions)
#1 cause of blindness in AIDS pts.
CMV Retinitis
Roseola Infantum =
Infant toddler febrile illness (6 mos to 3 yrs) high fevers & 48h rash as fever remit.
Rash: rose-red maculopapules 2-5mm, occasionally surrounded by white halo.
Exanthem sibitum = 6th disease
HHV-6B > -6A, -7
CD4+ lymphotropic viruses; Transmitted through saliva
Castlemans syndrome
>60 yo Mediterranean or Ashkenazi Jew; HIV+
Kaposis sarcoma
1. classic KS spongy feel (early) purplish-red plaques on LEs of elderly Mediterranean men (slow progression)
2. HIV/AIDS KS small macules, plaques become exophytic & ulcerative involves oral & perioral, genital, GI tract
3. Immunosuppressed KS similar to AIDS-KS with rapid dissemination
4. African endemic KS -- nodular (benign), lymphadenopathic, florid, infiltrative (aggressive).
Herpangina
Coxsackievirus Group A
Measles / Rubeola
Paramyxovirus
Paravaccinia virus
(Parapoxvirus)
Milkers Nodule
Orf
Orf virus
(Parapoxvirus)
Contagious Pustular
Dermatitis
Contagious Ecthyma
6 stages (each last 6 days): 1. Papular (red papule), 2. Target (erythematous w/ white ring); 3. Acute (weeping)
4. Regenerative (crusts w/ black dots); 5. Papillomatous (small papillomas); 6. Regressive (crusts, flat)
Fifth Disease
Erythema Infectiosum
Parvovirus B19
(ss-DNA)
Molluscum contagiosum
Variola (Poxvirus)
Smallpox
Smallpox complications:
ID for boards pg 9
Erythematous papules w/ grayish vesicle & surrounding red areola
Transmission: oral-oral & oral-fecal
Fever, Headache, Cervical Lymphadenopathy
Gray-white papulovesicles on tonsillar fauces, palate ulcerate
3d prodrome of: High Fever + 3 Cs (cough, coryza, conjunctivitis); Kopliks spots
Rash: Erythematous macules & papules begins on forehead, then generalizes (fades on 5th day)
Complications: otitis, PNA, encephalitis, myocarditis, subacute sclerocing panencephalitis (sz, coma)
Transmit: infected cows humans
Single 1cm erythematous targetoid nodule on finger/forearm (may be multiple); Self-limited
Endemic: sheep, goats, musk oxen (nodules on nose/mouth) transmitted to shepherds, farmers, vets
Clinical: Papule/nodule on dorsal index finger;
EM-like eruptions
Bacterial Superinfection
Accidental inoculation
Congenital vaccinia
Generalized vaccinia
Progressive vaccinia
S.aureus, GAS
Eczema vaccinatum p innoculation onto dermatitic skin
Following vaccination of a pregnant woman
Children w/ isolated IgM deficiency are especially prone (ie. Wiscott-Aldrich Synd)
Impaired immunological response to vaccinia (in normal or immunodeficient hosts)
HPV type
1
2,4
3,10
7 (2)
13,32
3, 5,8 > 9,12,14,15,17,19-26
6,11
16 >18,31,33-35
DNA Viruses:
H-H-A-P-P-P-y
RNA Viruses:
P-P-R-R-T
herpes, hepadna,
adeno,
papova, ss-parvo, pox
Paramyxovirus (measles, mumps);
Picornavirus (Enterovirus: coxsackie)
Retrovirus (HIV, HTLV);
Rhabdovirus (rabies);
Togavirus (rubella);
ID for boards pg 10
Lactodectus mactans
Brown recluse
Loxosceles
Wolf spider
Jumping spider
Sac spider
Hobo spider
Green Lynx spider
Tarantulas
Scorpions
Catepillars
Bee, wasp, hornet, ant
Fire ants
Black flies
Horseflies, Deerflies, Mangoflies
Sand flies
Mosquitoes: Malaria
Mosquitoes: Yellow Fever & Dengue
Bedbugs
Fleas: Typhus & Plague
Centipedes
Millipedes
Lycosidae
Phidippus
Chiracanthium
Tegenaria agrestis
Peucetia viridans
Centuroides sculpturatus/gertschi
Lepidoptera
Hymenoptera
Solenopsis (invicta)
Tabandae
Anopheles
Aedes
Cimicidae
Pulex irritans
Chilopoda
Diploda
White hourglass on abdomen; painful bites, but no necrosis. Antivenin helpful <90 hrs after bite.
Venom: Lactrotoxin neurotoxins F/C/N/V, cramps, paralysis, acute abd.
Tan w/ violin on abdomennecrosis; red-white-blue sign (erythema, ischemia, necrosis).
systemic rxns in kids (f/c/v/hematuria/t-penia/anemia/thrombosis).
Venom: Sphingomyelinase-D (necrosis/hemolysis).
Venom: Histamine (exceedingly painful bites lymphangitis/eschar)
Venom: Hyaluronidase; Aggressive: #1 biting spider in US (esp in South), pain, no systemic sx.
Venom: lipase
Herringbone abdomen; Pacific northwest (#1 necrotic spider bite)
Southern US; Bright green w/ red spots, black leg spines;
Southwest US; urticating hairs penetrate into reticular dermis or cornea (ophthalmia nodosa)
Venom: neurotoxin; pain / numbness /ecchymosis CNS symptoms arrhythmias, HTN
tram track purpura , erythematous papules
Honeybee leaves barbed ovipositor (needs removed QUICKLY) bee dies; tx: ice & lidocaine
Venom: hemolytic factor, solenospin D (causes histamine release); may attack in groups
blood suckers (vectors for onchocerciasis & tularemia)
Blood suckers
transmit Depetalonema perstans
Transmits: Malaria
Transmits: Yellow Fever & Dengue
Flat & broad; Nocturnal feeders; bites in linear purpuric macules
Transmits: typhus, plague; Extremely pruritic red papules on Lower legs
Nocturnal carnivores (painful venom wounds)
Harmless vegetarians (emit toxic substance that may produce blistering & pigmentation, eye irrit)