A Rare Case of Chromoblastomycosis in a 12-year-old boy.

Chromoblastomycosis is a chronic fungal infection of the subcutaneous tissue. The infection usually results from a traumatic injury and inoculation of the microorganism by a specific group of dematiaceous fungi, resulting in the formation of verrucous plaques. The fungi produce sclerotic or medlar bodies (also called muriform bodies or sclerotic cells) seen on direct microscopic examination of skin smears. The disease is often found in adults due to trauma. We report a case of chromoblastomycosis in a 12-year-old child in whom the infection started when he was only 4 years old with secondary involvement of bones, cartilage, tongue and palatine tonsils. The child was not immunosuppressed.

Respiratory Allergic Disorders.

Allergic asthma refers to a chronic reversible bronchoconstriction influenced by an allergic trigger, leading to symptoms of cough, wheezing, shortness of breath, and chest tightness. Allergic bronchopulmonary aspergillosis is a complex hypersensitivity reaction, often in patients with asthma or cystic fibrosis, occurring when bronchi become colonized by Aspergillus species. The clinical picture is dominated by asthma complicated by recurrent episodes of bronchial obstruction, fever, malaise, mucus production, and peripheral blood eosinophilia. Hypersensitivity pneumonitis is a syndrome associated with lung inflammation from the inhalation of airborne antigens, such as molds and dust.

WITHDRAWN: Interventions for treating headlice.

BACKGROUND: Infection with head lice is a widespread condition in developed and developing countries. Infection occurs most commonly in children, but also affects adults. If left untreated the condition can become intensely irritating and skin infections may occur if the bites are scratched. OBJECTIVES: The aim of this review was to assess the effects of interventions for head lice. SEARCH STRATEGY: Cochrane Infectious Diseases Group specialized trials register (July 2002); The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2002); MEDLINE and TOXLINE (1966 to July 2002); EMBASE (1980 to May 2002); LILACS (July 2002); Science Citation Index (1981 to July 2002); BIOSIS (1985 to July 2002); reference lists of relevant articles; pharmaceutical companies producing pediculicides (published and unpublished trials); UK and US Regulatory Authorities. SELECTION CRITERIA: Randomised trials (published and unpublished) or trials using alternate allocation were sought which compared pediculicides with the same and different formulations of other pediculicides, and pediculicides with physical methods. DATA COLLECTION AND ANALYSIS: Of the 71 identified studies, only four met the inclusion criteria. Two reviewers independently assessed trial quality. One reviewer extracted the data. MAIN RESULTS: We found no evidence that any one pediculicide has greater effect than another. The two studies comparing malathion and permethrin with their respective vehicles showed a higher cure rate for the active ingredient than the vehicle. Another study comparing synergised pyrethrins with permethrin showed their effects to be equivalent. A comparative trial of malathion lotion vs combing, showed combing to be ineffective for the cureative treatment of head lice infection. Adverse effects were reported in a number of trials and were all minor, although reporting quality varied between trials. AUTHORS' CONCLUSIONS: Permethrin, synergised pyrethrin and malathion were effective in the treatment of head lice. However, the emergence of drug resistance since these trials were conducted means there is no direct contemporary evidence of the comparative effectiveness of these products. The 'best' choice will now depend on local resistance patterns. Physical treatment methods(BugBusting) were shown ot be ineffective to treat head lice. No evidence exists regarding other chemical control methods such as the use of herbal treatments, when used in the curative treatment of head lice. Future trials should take into account the methodological recommendations that arise from this review.

Widespread insecticide resistance in head lice to the over-the-counter pediculocides in England, and the emergence of carbaryl resistance.

BACKGROUND: Increasing resistance to insecticides used for the control of head lice infestation has been documented over the last decade. Treatment failure and tolerance to insecticides have been validated in a number of studies undertaken in several U.K. centres. OBJECTIVES: To establish the extent of insecticide resistance in head lice and acetylcholinesterase activity in the presence of carbaryl in head lice. METHODS: Head lice were collected from school children in four centres across England (Exmouth, Loughborough, Leeds and South Shields), and tested in their response to the insecticides permethrin, phenothrin, malathion and carbaryl. Data were compared with information collected in Bristol and Bath in 1998 and with susceptible body lice. The activity of louse acetylcholinesterase was measured with and without carbaryl in head lice collected in Bristol, Leeds, Loughborough and in body lice. The efficacy of a 1% carbaryl lotion was compared in children in Bristol and Leeds. RESULTS: Compared with body lice, head lice from all six centres were significantly different in their response (P < 0.0001) to permethrin, phenothrin and malathion after 2-h exposure tests. There were significant differences in louse acetylcholinesterase activity in body lice, and head lice collected in Loughborough and Bristol in the presence or absence of carbaryl (P < 0.001), indicating enzyme inhibition. However, the difference for lice from Leeds was not significant (P = 0.363) suggesting that the enzyme was resistant to carbaryl. Eighty-nine per cent of children treated in Leeds with carbaryl were cured compared with 100% in Bristol. CONCLUSIONS: The data suggest head lice resistance is present in many parts of England to over-the-counter products containing synthetic insecticides (permethrin, phenothrin and malathion). They further suggest that resistance is starting to develop to carbaryl in head lice in Leeds and that extensive use of this product would lead to significant resistance.

Interventions for treating headlice.

BACKGROUND: Infection with head lice is a widespread condition in developed and developing countries. Infection occurs most commonly in children, but also affects adults. If left untreated the condition can become intensely irritating and skin infections may occur if the bites are scratched. OBJECTIVES: The aim of this review was to assess the effects of interventions for head lice. SEARCH STRATEGY: Trials register of The Cochrane Infectious Diseases Group; Medline; Embase; Science Citation Index; Biosis and Toxline; reference lists of relevant articles; pharmaceutical companies producing pediculicides (published and unpublished trials); UK and US Regulatory Authorities. SELECTION CRITERIA: Randomised trials (published and unpublished) or trials using alternate allocation were sought which compared pediculicides with the same and different formulations of other pediculicides, and pediculicides with physical methods. DATA COLLECTION AND ANALYSIS: Of the 71 identified studies, only four met the inclusion criteria. Two reviewers independently assessed trial quality. One reviewer extracted the data. MAIN RESULTS: We found no evidence that any one pediculicide has greater effect than another. The two studies comparing malathion and permethrin with their respective vehicles showed a higher cure rate for the active ingredient than the vehicle. Another study comparing synergised pyrethrins with permethrin showed their effects to be equivalent. A comparative trial of malathion lotion vs combing, showed combing to be ineffective for the cureative treatment of head lice infection. Adverse effects were reported in a number of trials and were all minor, although reporting quality varied between trials. REVIEWER'S CONCLUSIONS: Permethrin, synergised pyrethrin and malathion were effective in the treatment of head lice. However, the emergence of drug resistance since these trials were conducted means there is no direct contemporary evidence of the comparative effectiveness of these products. The 'best' choice will now depend on local resistance patterns. Physical treatment methods(BugBusting) were shown ot be ineffective to treat head lice. No evidence exists regarding other chemical control methods such as the use of herbal treatments, when used in the curative treatment of head lice. Future trials should take into account the methodological recommendations that arise from this review.

Interventions for treating head lice.

BACKGROUND: Infection with head lice is a widespread condition in developed and developing countries. Infection occurs most commonly in children, but also affects adults. If left untreated the condition can become intensely irritating and skin infections may occur if the bites are scratched. OBJECTIVES: The aim of this review was to assess the effects of interventions for head lice. SEARCH STRATEGY: Trials register of The Cochrane Infectious Diseases Group; Medline; Embase; Science Citation Index; Biosis and Toxline; reference lists of relevant articles; pharmaceutical companies producing pediculicides (published and unpublished trials); UK and US Regulatory Authorities. SELECTION CRITERIA: Randomised trials (published and unpublished) or trials using alternate allocation were sought which compared pediculicides with the same and different formulations of other pediculicides, and pediculicides with physical methods. DATA COLLECTION AND ANALYSIS: Of the 71 identified studies, only four met the inclusion criteria. Two reviewers independently assessed trial quality. One reviewer extracted the data. MAIN RESULTS: We found no evidence that any one pediculicide has greater effect than another. The two studies comparing malathion and permethrin with their respective vehicles showed a higher cure rate for the active ingredient than the vehicle. Another study comparing synergised pyrethrins with permethrin showed their effects to be equivalent. A comparative trial of malathion lotion vs combing, showed combing to be ineffective for the cureative treatment of head lice infection. Adverse effects were reported in a number of trials and were all minor, although reporting quality varied between trials. REVIEWER'S CONCLUSIONS: Permethrin, synergised pyrethrin and malathion were effective in the treatment of head lice. However, the emergence of drug resistance since these trials were conducted means there is no direct contemporary evidence of the comparative effectiveness of these products. The 'best' choice will now depend on local resistance patterns. Physical treatment methods(BugBusting) were shown ot be ineffective to treat head lice. No evidence exists regarding other chemical control methods such as the use of herbal treatments, when used in the curative treatment of head lice. Future trials should take into account the methodological recommendations that arise from this review.

Interventions for treating headlice.

BACKGROUND: Infection with head lice is a widespread condition in developed and developing countries. Infection occurs most commonly in children, but also affects adults. If left untreated the condition can become intensely irritating and skin infections may occur if the bites are scratched. OBJECTIVES: The aim of this review was to assess the effects of interventions for head lice. SEARCH STRATEGY: Trials register of The Cochrane Infectious Diseases Group; Medline; Embase; Science Citation Index; Biosis and Toxline; reference lists of relevant articles; pharmaceutical companies producing pediculicides (published and unpublished trials); UK and US Regulatory Authorities. SELECTION CRITERIA: Randomised trials (published and unpublished) or trials using alternate allocation were sought which compared pediculicides with the same and different formulations of other pediculicides, and pediculicides with physical methods. DATA COLLECTION AND ANALYSIS: Of the 70 identified studies, only three met the inclusion criteria and one is awaiting assessment. Two reviewers independently assessed trial quality. One reviewer extracted the data. MAIN RESULTS: We found no evidence that any one pediculicide has greater effect than another. The two studies comparing malathion and permethrin with their respective vehicles showed a higher cure rate for the active ingredient than the vehicle. The third study comparing synergised pyrethrins with permethrin showed their effects to be equivalent. Adverse effects were reported in a number of trials and were all minor, although reporting quality varied between trials. REVIEWER'S CONCLUSIONS: Permethrin, synergised pyrethrin and malathion were effective in the treatment of head lice. However, the emergence of drug resistance since these trials were conducted means there is no direct contemporary evidence of the comparative effectiveness of these products. The 'best' choice will now depend on local resistance patterns. There is currently no evidence from trials to indicate the effectiveness of physical methods, such as combing/'BugBusting' or other chemical control methods such as the use of herbal treatments, when used in the curative treatment of head lice. Future trials should take into account the methodological recommendations that arise from this review.

What's eating you? Pediculus humanus (head louse and body louse).

Head lice remain a common problem worldwide. As resistance to available therapeutic agents can emerge rapidly, there is a need for continued research to find new and better agents. Until better agents are available, clinicians may find that rotational therapy, using different agents, may help to slow the emergence of resistance. Physical modalities, such as mechanical nit and louse removal and occlusive agents to asphyxiate the lice, should not be ignored, especially in light of our limited therapeutic armamentarium. All therapeutic agents are doomed to failure if infestation is allowed to recur. Classmates, playmates, and family members of infested children should be inspected for head lice. Efforts should be directed at fomite control and nit removal. Louse infestation must be addressed as a community-wide problem. Body lice remain important vectors of disease. War, natural disaster, and poverty favor the spread of body lice. As we work to solve these seemingly eternal problems, we must develop better agents to treat infestation and prevent the spread of body lice.

A comparison of two insecticidal shampoos in the treatment of head louse infection.

The efficacy and tolerability of a phenothrin liquid shampoo was compared with a carbaryl shampoo in 50 children with head lice infection. Twenty-five children were treated with a phenothrin liquid shampoo and 25 with a carbaryl shampoo. Each treatment was applied on three occasions at three-day intervals. Reinspection two weeks after initiation of treatment revealed two apparent treatment failures in the carbaryl group and one in the phenothrin group. No side effects were reported for either treatment. It is concluded that phenothrin liquid shampoo is a safe and effective treatment for head louse infection and is therefore a useful addition to those insecticides currently employed.

Phenothrin lotion, the latest recruit in the battle against headlice: the results of two controlled comparative studies.

One hundred and one subjects with head louse infestation were entered into two separate studies, in which a phenothrin aqueous/alcoholic lotion was compared to a carbaryl lotion and a malathion lotion. Fifty subjects were treated with a single application of the phenothrin lotion, 28 with the carbaryl lotion and 23 with the malathion lotion. In the comparative study of the phenothrin and malathion lotions an inspection on the day following treatment showed no live lice remained, but that six of the subjects treated with malathion lotion still had evidence of viable eggs (p less than 0.05). In one subject viable eggs were still evident at two weeks post-treatment. There were no cases, however, of live lice or viable eggs at four weeks post-treatment. Mild cutaneous side-effects were reported in five subjects, the incidence of which was not significantly different by treatment group. One subject in the phenothrin and carbaryl lotion comparative study had evidence of live lice at one week post-treatment with phenothrin lotion. This subject received no further treatment and was clear of both live lice and viable eggs at subsequent visits. A separate case of live lice infestation was found at two weeks post-treatment in a subject treated with phenothrin lotion and at four weeks post-treatment in two subjects treated with carbaryl lotion. As these subjects were free of live lice infestation at previous follow-up visits it was highly probable that these were cases of re-infestation from another source.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of a single occasion treatment of head louse infestation with phenothrin liquid shampoo or a carbaryl lotion.

Fifty subjects with head louse infestation were recruited into a controlled trial to compare a phenothrin liquid shampoo with a carbaryl lotion. Twenty-seven subjects were treated with phenothrin and 23 with carbaryl, each formulation being applied only on a single occasion. Subjects were inspected for evidence of live lice and eggs at 24 hours and 3 to 4 weeks after application of treatment. The results showed that both the phenothrin liquid shampoo and the carbaryl lotion were effective in killing adult lice and viable eggs. No statistically significant difference in treatment efficacy was observed between the two groups. Fewer side-effects, however, were observed with the phenothrin liquid shampoo than with the carbaryl lotion. These results indicate that, when applied as a single treatment, a phenothrin liquid shampoo was as effective as a carbaryl lotion in eradicating head lice and eggs.

Pediculosis capitis: why prefer a solution to shampoo or spray?

Two hundred and sixty-eight children with pediculosis capitis took part in a comparative study to test the efficacy of five different pediculocides commonly used in Israel. The preparations used were pyrethrin shampoo, pyrethroid spray, malathion solution, carbaryl shampoo and carbaryl lotion. Carbaryl lotion and malathion solution were much more efficient when compared to the shampoo and spray preparations.

Scabies and lice.

Scabies and pediculosis, two commonly encountered infestations both having an incidence that is on the rise, are discussed in detail in this article with special emphasis given to their symptomatology, pathogenesis, and treatment.

Residues of carbaryl and two of its metabolites in eggs of laying hens treated with Sevin for northern fowl mite control by dipping.

White Leghorn laying hens were treated with carbaryl [Sevin, 1-naphthyl-N-methylcarbamate] by dipping in a .5 or 1.0% (active ingredient) water suspension of an 80% commercially available wettable powder formulation. Residues of carbaryl and two of its metabolites, 1-naphthol and N-hydroxymethyl carbaryl, were detected in eggs within 1 day and reached maximum levels 5 to 7 days after dipping. After that time residues steadily declined but were still detectable 56 days posttreatment in the eggs of the high-dose hens. At no time during the study did total residues in eggs exceed the current .5 ppm egg tolerance for carbaryl and its metabolites.

Effectiveness of Ectiban, egg oil, Rabon, or Sevin for control of northern fowl mites on laying hens.

Two field trials were conducted on different ranches to compare acaricides for control of northern fowl mite (NFM) on White Leghorn hens. In Trial 1 Ectiban spray and dust treatments were compared to Rabon and Sevin spray-treatments; egg oil, Rabon, and Sevin sprays were tested in Trial 2. Concentration and rates of application followed label recommendations for the registered compounds. In Trial 1 Ectiban spray gave excellent NFM control; Ectiban dust, Rabon, and Sevin spray treatments resulted in poor NFM control. Egg oil and Rabon sprays gave effective NFM control in Trial 2. Sevin, as in Trial 1, gave poor NFM control. The failure of Sevin to control mites both times suggests the possibility of NFM resistance to this chemical.