Nocturnally pruritic rash
Quick thinking and fast reflexes during the physical exam led to an identification that confirmed the diagnosis.
Pulicosis results from bites caused by a variety of flea species including, but not limited to, human, dog, oriental rat, sticktight, mouse, and chicken fleas. Fleas are small brown insects measuring about 2.5 mm in length, with flat sides and long hind legs. Their bites are most often arranged in a zigzag pattern around a host’s legs and waist. Hypersensitivity reactions may appear as papular urticaria, nodules, or bullae.2
Pediculosis corporis is caused by body lice. The adult louse is 2.5 to 3.5 mm in size, has 6 legs, and is a tan to greyish white color.6 Lice live in clothing, lay their eggs within the seams, and obtain blood meals from the host. Symptoms include generalized itching. The erythematous blue- and copper-colored macules, wheals, and lichenification can occur throughout the body, but spare the hands and feet. Secondary impetigo and furunculosis commonly occur.2
Scabies is caused by an oval mite that is ventrally flat, with dorsal spines. The mite is < 0.5 mm in size, appearing as a pinpoint of white. It burrows into its host’s skin, where it lives and lays eggs, causing pruritic papular lesions and ensuing excoriations. The mite burrows with a predilection for the finger web spaces, wrists, axillae, areolae, umbilicus, lower abdomen, genitals, and buttocks.2
Treatment involves a 3-step process
The mainstay of treatment is removal of the infested bird, decontamination of bedding and clothing, and use of oral antihistamines and topical corticosteroids.1,3,5 Bedding and clothing should be washed. Carpets, rugs, and curtains should be vacuumed and the vacuum bag placed in a sealed bag in the freezer for several hours before it can be thrown away. Eggs, larvae, nymphs, and adults are killed at 55 to 60 °F. Because humans are only incidental hosts and mites do not reproduce on them, the use of scabicidal agents, such as permethrin, is controversial.
Our patient was treated with permethrin cream before definitive identification of the mite. Once the mite was identified, the chicken was removed from the home and the patient’s bedding and clothing were decontaminated. The patient continued to apply over-the-counter topical steroids and take oral antihistamines for several more days after the chicken was removed from the home.
ACKNOWLEDGEMENT
The authors would like to acknowledge Patrick Liesch of the University of Wisconsin-Madison’s Department of Entomology, Insect Diagnostic Lab, for his help in identifying the avian mite.
