Case Definition

Papular pruritic rash with burrows (thin pencil-mark lines on skin)

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Affects interdigital web spaces and flexural areas, neck, axillae, areolae, genitals; may be more generalized or include palms and soles in young patients E,F,H,L,T

Consider impetiginous superinfection with S. aureus or b-hemolytic strepB

Red Flags

No relevant red flags for hospital referral

Management

Non-pharmacologic recommendations

Wash linen/bedding in hot water and place in sun (or dry on a tin roof) for 24 hours; trim fingernailsB,E,F,L,R,T

Plastic bag linens/clothes for 24-48 hrs to suffocate mites20

Pharmacologic management

Option 1:

Permethrin 5% cream: apply from chin to toes, leave on 6-10 hours, then shower off. Repeat treatment in one weekB,F,H,K, T

Option 2:

Ivermectin: (>5yo, >15kg): 200 mcg/kg (max 12mg) po on empty stomachI and repeat in 10-14 daysB,E,G,H,T. Avoid if pregnant, breast-feeding, or <15kg.

Other options:

Benzyl benzoate: mix 1:1 with water (1 part benzyl benzoate to 3 parts water in infants), apply and leave on for 24 hours then rinse offI,K,L,T

Lindane (only in age 2 and older)C,M

Other considerations:

Treat household contactsB

Rash will persist for several weeks but itching should cease after 2-3 weeksF. Consider symptomatic treatment with a medium strength steroid creamF, or with Itch Be Gone LiquidB

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Organization A

Locations: Nicaragua
Trips per year: 4
Format of trips: Mobile medical clinics and standing clinics
Setting: Rural
Type of Organization: Secular

Organization B

Locations: Guatemala
Trips per year: Variable
Format of trips: Clinics
Setting: Rural
Type of Organization: Secular

Organization C

Locations: Haiti
Trips per year: Variable
Format of trips: Clinic
Setting: Urban
Type of Organization: Faith-based

Organization D

Locations: Dominican Republic
Trips per year: 3
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

Organization E

Locations: Haiti
Trips per year: 7
Format of trips: Not mentioned
Setting: Rural
Type of Organization: Secular

Organization F

Locations: Honduras, Ecuador, Belize, Guyana, Guatemala
Trips per year: 5
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Faith-based

Organization G

Locations: Ecuador, Guatemala, Dominican Republic
Trips per year: 100 (spread over 6 sites)
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Secular

Organization H

Locations: Ecuador
Trips per year: 3
Format of trips: Mobile brigades in schools/Clinics in health centers
Setting: Rural
Type of Organization: Secular

Organization I

Locations: Honduras
Trips per year: 1
Format of trips: Mobile brigades in 20 villages
Setting: Rural
Type of Organization: Faith-based

Organization J

Locations: Jamaica, Haiti
Trips per year: 4
Format of trips: Mobile brigades, Permanent clinics/hospital medicine
Setting: Rural and urban
Type of Organization: Secular

Organization K

Locations: Haiti
Trips per year: 4
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

Organization L

Locations: Guatemala, Nicaragua
Trips per year: 3
Format of trips: Mobile clinics
Setting: Rural
Type of Organization: Faith-based

Organization M

Locations: Nicaragua, Honduras
Trips per year: 51
Format of trips: Mobile brigades, Hospital-based
Setting: Rural
Type of Organization: Faith-based

Organization N

Locations: Guatemala
Trips per year: 12
Format of trips: Hospital
Setting: Rural
Type of Organization: Secular

Organization O

Locations: Honduras
Trips per year: Up to 50
Format of trips: Mobile brigades in school and churches
Setting: Rural
Type of Organization: Faith-based

Organization P

Locations: Haiti
Trips per year: Variable
Format of trips: Mobile brigades and clinics
Setting: Rural and urban
Type of Organization: Secular

Organization Q

Locations: Dominican Republic, Haiti
Trips per year: 12 to 15
Format of trips: Mobile brigades
Setting: Rural
Type of Organization: Secular

Organization R

Locations: Honduras, Nicaragua, Panama
Trips per year: Hundreds
Format of trips: Mobile brigades in community centre or school
Setting: Rural
Type of Organization: Secular

Organization S

Locations: Honduras
Trips per year: 4
Format of trips: Mobile brigades, Specialty hospital services
Setting: Rural
Type of Organization: Secular

Organization T

Locations: Haiti
Trips per year: Approximately 40
Format of trips: Mobile clinics in 14 villages and Standing clinic
Setting: Rural
Type of Organization: Faith-based