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When the Bugs Aren’t Real

Delusional parasitosis: when the bugs aren't real.

by James Hubbard, M.D., M.P.H.

I never heard of this in medical school, so when I saw my first patient with delusional parasitosis, I was quite bewildered. Here sat a well-dressed, anxious looking guy, scratching all over, who said he scabies and handed me the proof in a tissue. It was a flake of skin.

“And look, Doc. See the bites.” I looked and saw where he’d been scratching—digging and clawing actually—into his skin. But no bugs of any sort.

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Is It Really Scabies? Felt-Tip Markers and Other Diagnostic Tricks

Is it scabies?

Is it a scabies rash?

by James Hubbard, M.D., M.P.H.

The seven-year itch they used to call it, and if you’ve ever had it, you know the scabies rash itches like crazy—even worse at night.

As with head lice, I see more scabies cases when school starts back. It can also become a problem for shelters, nursing homes, even hospitals. Like head lice, the scabies mite feeds on the human body and likes to jump ship, so to speak, when people are in close contact.

But, in my opinion, tiny scabies mites aren’t as simple to diagnose as the bigger bugs.

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How to Check for Head Lice. Step 1: Brace Yourself.

Mayonnaise and plastic for head lice

A nit (egg). Those red spots are eyes. When you check for head lice, the nits look like white dandruff, but they don’t brush off easily.

by James Hubbard, M.D., M.P.H.

It’s back-to-school time. And soon afterwards, a young child’s rite of passage—the note from the teacher stating your little darling has head lice.

I can hear the collective “but we’re not a nasty family” now. For the umpteenth time, no one—not the teacher nor the principle nor the doctor—thinks you are. It’s not a question of cleanliness.

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The Parasitic GI Blues

Enlarged picture of a giardia parasite.

by James Hubbard, M.D., M.P.H.

I thought it might be fun to occasionally share email questions I get from you, my readers. Please let me know whether these types of topics interest you, and feel free to send me your own questions on general topics. I may use the question (a full or edited version), your first name and your state in a future post.

Here’s the first one.

Dr. Hubbard:

I have a topic I’ve never seen addressed by an MD in the preparedness community, and one I’d like to hear a doctor’s opinion on.

I’m interested in learning more about what types of intestinal parasitic infections may be common in travelers/wanderers/refugees during a lengthy emergency. Specifically, in people that may have been sheltering in close quarters in less than sanitary conditions (like the Louisiana Superdome during Katrina), had eaten spoiled/ill-prepared food (from garbage cans/dumpsters, or undercooked meat/fish), or drank from non-potable water sources (lakes, streams, puddles).

Any advice on correctly diagnosing and stocking a medicine cabinet to handle situation like this? Simple faecal tests a layman might be able perform at home with some modest equipment?

The only antiparasitics we currently have are permethrin 5% cream and flagyl. Thinking it may be prudent to add praziquantel, mebendazole, and/or albendazole.

Answer:

If you have giardia, this is what you'll see moving across a slide under a microscope. Giardia is [... continue reading]

How to Disinfect Water

river

The Russian River in Alaska.

by James Hubbard, M.D., M.P.H.

You can’t count on water anymore. No matter how pristine looking, a mountain stream is full of parasites, such as giardia from animal feces. Pond water, even rainwater, is loaded with bacteria just waiting to make you deathly ill. But what if that’s all there is?

It’s relatively simple to disinfect water manually so it becomes drinkable.

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