Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Scabies: diagnosis and treatment

Abstract: Scabies is an intensely itchy dermatosis caused by the mite Sarcoptes scabiei . A patient with ordinary scabies may have an average of 12 mites; however, those with crusted scabies may have thousands of mites. The infestation occurs at all ages, but particularly in children. It is a common public health problem in poor communities and is widespread in many underdeveloped countries. Scabies is highly contagious, and person to person spread occurs via direct contact with the skin. Transfer from clothes and bedding occurs rarely and only if contaminated by infested people immediately beforehand.1 Infestation occurs when the pregnant female mite burrows into the skin and lays eggs. After two or three days, the larvae emerge and dig new burrows. They mature, mate, and repeat this cycle every two weeks. A history of itching in several family members over the same period is almost pathognomonic. However, lack of a history of itching in family members does not exclude scabies. It can be notoriously difficult to get family members to admit to a history of possible scabies, and some people with scabies genuinely seem not to itch. If left untreated, scabies can continue for many months. It is important to remember that recurrence of symptoms after attempted treatment does not exclude the diagnosis of scabies because patients may not have treated themselves correctly or may have been reinfested by an untreated contact. ### What are the symptoms and signs? The main symptoms of scabies are probably a result of the host immune reaction to the burrowed mites and their products.2 Scabies presents within two to six weeks of initial infestation, but reinfestation can provoke symptoms within 48 hours. Pruritus is the hallmark of scabies regardless of age. #### Summary points A high index of suspicion is needed to diagnose scabies correctly Consider scabies in any adult with widespread eczema …

Examination of insulin injection sites: an unexpected finding of localized amyloidosis.

Abstract: A 34-year-old man with a 17-year history of Type 1 diabetes mellitus attended an annual review clinic in December 1999 and complained of a lump on his right thigh. His diabetic control was moderate (HbA 1c 8.3%), and he displayed no long-term complications of diabetes. A firm well-defined 7-cm mass clinically distinct to adjacent areas of lipohypertrophy was found in the anterior aspect of his right thigh, an area that represented his current insulin injection site. Numerous smaller lesions of similar consistency were noted at other regular injection sites in his upper limbs and the contra-lateral thigh. No other clinical abnormalities were present and routine biochemical tests were unremarkable. Surgical excision was performed at a later date under general anaesthesia, revealing that the lesion was composed entirely of a waxy grey material. Histological examination showed the majority of the tissue to be amorphous acellular eosinophilic material possessing a mild chronic inflammatory cell infiltrate. The acellular matrix, when stained with Congo red and viewed through cross-polarized light, demonstrated the classical apple-green birefringent properties of amyloid (Fig. 1). This finding was corroborated by the appearance of non-branching fibrils on transmission electron microscopy. The association between the unusual and apparently localized soft tissue amyloid deposits and the insulin injection sites was considered and investigated further. Although parenteral drug abuse may occasionally result in reactive systemic (AA) amyloidosis by virtue of producing