[Translated article] Spanish Academy of Dermatology and Venereology (AEDV) expert recommendations for the management of sexual transmitted parasitosis. Scabies, and pediculosis pubis.

Sexually transmitted infections are communicable diseases where the pathogen is transmitted through sexual contact. The Sexually Transmitted Infections Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) is engaged in the drafting of documents to guide dermatologists and health care personnel who treat Spanish patients with these infections. This document analyzes the epidemiological, clinical, therapeutic, and control characteristics of 2 sexually transmitted parasitosis: scabies due to Sarcoptes scabiei var. hominis, and pubic pediculosis due to Phthirus pubis. Both parasitoses share a sort of mixed spread through sexual and community transmission regardless of the route through which the infection was initially acquired. This specific feature creates particularities in the management and control of the infestation.

So happy together: juvenile crabeater seal behavior improves lice transmission.

Lice from family Echinophthiriidae are of the few insects that have successfully colonized marine environment living as ectoparasites of pinnipeds, i.e., sea lions, seals, and the walrus. They have developed unique adaptations to cope with the amphibious lifestyle of their hosts. Because eggs do not survive underwater, lice could only reproduce when their host remains on pack ice enough time. Consequently, lice generations per year are limited by host haul-out behavior. The objective of this work is to study the effect of host sex and age class, and the annual variation on the prevalence and mean abundance of Antarctophthirus lobodontis in crabeater seals from the Antarctic Peninsula. During three consecutive field-seasons, we collected lice from 41 crabeater seals (23 females, 16 males, 2 indeterminate, being 24 adults, and 17 juveniles). We investigated this effect on the prevalence and mean abundance by a generalized linear model formulation in a Bayesian framework. According to the lowest Deviance Index Criterion model, sex host does not affect prevalence nor mean abundance. We found that juveniles present greater abundance and prevalence than adults, possibly due to foraging habits. They spent more time on the ice than adults in groups of dozens of animals. This behavior would favor both egg development and lice transmission. We do not find adult females with lice, which suggests that transmission of A. lobodontis should be horizontal. The high mean abundance of lice in 2014 could be associated with an unusual increase in Lobodon carcinophaga population, probably related to the pack-ice availability and zooplankton abundance.

Insights About Head Lice Transmission From Field Data and Mathematical Modeling.

Head lice infest millions of school-age children every year, both in developed and developing countries. However, little is known about the number of lice transferred among children during school activities, because direct methods to study this are almost impossible to implement. This issue has been addressed following an indirect method, which consist in collecting data of real infestation from several children groups and using a mathematical model of lice colonies to infer how the infestation observed might have evolved. By determining the events that would most likely lead to infestations as those observed, we find that severe infestations are most likely initiated by a relatively large number of lice transferred at the same moment or within relatively short time spans. In turn, analysis of the data obtained from screenings of the same groups of children a few days apart shows evidence of such transmission events. Interestingly, only children with severe infestations could harbor the lice necessary for this type of transmission. Thus, they play the same role as 'superspreaders' in epidemiology. As part of our experimental study it is also shown that a simple procedure of combing can be very effective to remove all mobile lice, and thus could be used as an effective preventive measure against those severe infestations that are responsible for the spread of pediculosis.

European guideline for the management of pediculosis pubis.

Pediculosis pubis is caused by Phthirus pubis. The disease can be sexually transmitted. Patients main complain is of itch in the pubic area. The parasite can be spotted with the naked eye and blue macules can be observed in the pubic area. First line therapy consists of permethrin or pyrethrins with piperonyl butoxide. Second line therapy contains phenothrin, malathion and oral ivermectin. Partner management needs a look-back period of time of 3 months. Pubic lice incidence is increased in populations groups living in crowded spaces with scarce sanitary conditions as in time of war or disaster.

Walk or ride? Phoretic behaviour of amblyceran and ischnoceran lice.

Phoresy is a behaviour where one organism hitches a ride on another more mobile organism. This is a common dispersal mechanism amongst relatively immobile species that specialise on patchy resources. Parasites specialise on patchily distributed resources: their hosts. Although host individuals are isolated in space and time, parasites must transmit between hosts or they will die with their hosts. Lice are permanent obligate ectoparasites that complete their entire life cycle on their host. They typically transmit when hosts come into direct contact; however, lice are also capable of transmitting phoretically. Yet, phoresy is rare amongst some groups of lice. Fundamental morphological differences have traditionally been used to explain the phoretic differences amongst different suborders of lice; however, these hypotheses do not fully explain observed patterns. We propose that a more fundamental natural history trait may better explain variation in phoresy. Species able to disperse under their own power should be less likely to engage in phoresy than more immobile species. Here we experimentally tested the relationship between independent louse mobility and phoresy using a system with four species of lice (Phthiraptera: Ischnocera and Amblycera) that all parasitize a single host species, the Rock Pigeon (Columba livia). We quantified the relative ability of all four species of lice to move independently off the host, and we quantified their ability to attach to, and remain attached to, hippoboscid flies (Pseudolynchia canariensis). Our results show that the most mobile louse species is the least phoretic, and the most phoretic species is quite immobile off the host. Our findings were consistent with the hypothesis that phoretic dispersal should be rare amongst species of lice that are capable of independent dispersal; however other factors such as interspecific competition may also play a role.

Serie parasitosis en dermatología: pediculosis / Parasitosis in dermatology: pediculosis

La enfermedad producida por Pediculus humanus capitis, conocida como pediculosis, es una parasitosis específica del ser humano de distribución mundial. El contagio puede ser directo por contacto con el cuero cabelludo de una persona afectada, o por fómites contaminados con parásitos, por lo que no distingue raza, sexo, edad ni nivel socioeconómico. Presentamos el caso de una paciente de 80 años con una forma típica de pediculosis. (AU)

The disease caused by Pediculus humanus capitis, known as pediculosis, is a human specific parasitosis. It has a worldwide distribution. Transmission can be by direct contact with the scalp of an affected person or by contaminated fomites with parasites. This infestation makes no distinction of race, sex, age, or socioeconomic status. We present a case of an 80 years old patient with a typical case of pediculosis. (AU)

Declines in large wildlife increase landscape-level prevalence of rodent-borne disease in Africa.

Populations of large wildlife are declining on local and global scales. The impacts of this pulse of size-selective defaunation include cascading changes to smaller animals, particularly rodents, and alteration of many ecosystem processes and services, potentially involving changes to prevalence and transmission of zoonotic disease. Understanding linkages between biodiversity loss and zoonotic disease is important for both public health and nature conservation programs, and has been a source of much recent scientific debate. In the case of rodent-borne zoonoses, there is strong conceptual support, but limited empirical evidence, for the hypothesis that defaunation, the loss of large wildlife, increases zoonotic disease risk by directly or indirectly releasing controls on rodent density. We tested this hypothesis by experimentally excluding large wildlife from a savanna ecosystem in East Africa, and examining changes in prevalence and abundance of Bartonella spp. infection in rodents and their flea vectors. We found no effect of wildlife removal on per capita prevalence of Bartonella infection in either rodents or fleas. However, because rodent and, consequently, flea abundance doubled following experimental defaunation, the density of infected hosts and infected fleas was roughly twofold higher in sites where large wildlife was absent. Thus, defaunation represents an elevated risk in Bartonella transmission to humans (bartonellosis). Our results (i) provide experimental evidence of large wildlife defaunation increasing landscape-level disease prevalence, (ii) highlight the importance of susceptible host regulation pathways and host/vector density responses in biodiversity-disease relationships, and (iii) suggest that rodent-borne disease responses to large wildlife loss may represent an important context where this relationship is largely negative.

Lice.

Pediculosis (capitis, corporis, and pubis) share well-known features: worldwide prevalence (involving millions of people annually); parasites inducing skin lesions directly, and indirectly as a result of itching and hypersensitivity to parasites; and treatment based on good entomological knowledge of the parasite and practical considerations (ie, most available treatments do not act on eggs and should be repeated, depending on the life cycle of the parasites). Infestations are spread most commonly by close contacts. Social stigma and persistent misconceptions complicate the implementation of appropriate management strategies. Head and pubic lice infestations are diagnosed by the visualization of insects or viable nits (eggs). Primary treatments are topical pediculicides (permethrin or malathion), used twice, but emergence of resistance against pediculicides has created the need of alternative treatments including topical or oral ivermectin. Pubic lice are treated the same as head lice, but this finding should prompt evaluation for other sexually transmitted diseases. Body lice infestation should be suspected when symptoms of generalized itching occur in persons who do not change or wash their clothing or bedding regularly; lice may be found in the seams of their clothing.Topically administered permethrin may help to eradicate body lice, but personal hygiene measures are essential for successful treatment. Environmental treatment is also necessary for the eradication of the infestation. Health care personnel who come into contact with this population need to be well informed of the facts in order to disseminate accurate information for diagnosis and management.

Lousy mums: patterns of vertical transmission of an amphibious louse.

In this study, we document patterns of vertical transmission of the amphibious louse Antarctophthirus microchir (Echinophthiriidae) in pups of South American sea lion, Otaria flavescens, from Patagonia. Vertical transmission is fundamental for the long-term stability of A. microchir populations because only pups stay long enough (1 month) on land for the louse to reproduce. A total of 72 pups ≤7 days old from a single rookery were captured and examined for lice. Infection parameters and population structure of A. microchir did not differ among pups collected at the beginning, middle, and end of the reproductive season, suggesting that patterns of early vertical transmission are not affected by the increase of rookery size during this period. Over 60% of 1-day-old pups were infected with A. microchir, and recruitment increased in pups up to 3 days old and then leveled off. In 1-day-old pups, significantly more adults than nymphs were found, but the pattern was reversed in older pups. The number of first-stage nymphs was significantly smaller than that of second- and third-stage nymphs, as it was the number of males vs. females, particularly in 1-day-old pups. Three non-exclusive hypotheses could account for these patterns, i.e., recruitment merely reflects the population structure of A. microchir is cows; the relative ability of lice to pass from cows onto pups increases in advanced instars; and/or natural selection favors transmission of adults, especially females, because they accrue greater fitness. The importance of latter hypothesis should not be underestimated in a species with a tight reproductive schedule.

Effect of households' social networks on lice infestation among vulnerable Mexican children: a qualitative comparative analysis.

The prevalence of pediculosis is high among elementary and secondary school children, which favors the belief that infestation occurs more often in schools than in homes. This study explored the role of households' social networks in the transmission of head lice. Seventeen school children and their social networks (n = 22) from Acatlipa (Morelos, Mexico) participated in a prospective observational study during school vacation. The hair of all the school children was washed with shampoo containing permethrin at the beginning of the study and the incidence of pediculosis (O) was evaluated at the beginning of the school term (follow-up at 1.5 months). The sets included in the qualitative comparative analysis were sex (S), length of hair (H), baseline diagnostic of pediculosis (I) and degree (D) and infestation index (N) obtained through the analysis of social networks. The prevalence of pediculosis was the same at the beginning and the end of follow-up (17.6%). The degree of the school children's networks ranged between 2 and 14. There were 8 configurations, the most frequent being F*i*d*n*h. The most parsimonious configuration associated with the incidence of pediculosis was F*I*d*H (female, previous infestation, low degree and long hair), with a coverage of 0.344 and a consistency of 0.941. Indicators of social networks made it possible to identify the role of households' social networks in the transmission of lice. Individual actions such as the use of shampoo containing insecticides are temporary and, therefore, structural actions should be favored.

Pediculosis capitis: an update.

Head louse infestation, or pediculosis capitis, caused by Pediculus humanus var. capitis, is a common health concern in pediatric age group. An itching of the scalp is the chief symptom, whereas presence of viable nits confirms the diagnosis of head louse infestation. Secondary bacterial infection with impetignization with cervical and occipital lymphadenopathy can complicate the clinical scenario with physician misdiagnosing pediculosis to a primary bacterial infection. Screening and treatment of all close contacts is necessary for an adequate management of pediculosis. Medical management of head louse infestation requires proper application of topical pediculicidal agents', chiefly permethrin lotion and wet combing with a fine toothcomb. Severe cases with high parasitic load justify the use of either oral cotrimoxazole or Ivermectin. Other described technique involves a single application of hot air for 30 minutes. Radical but culturally unacceptable method would be shaving of scalp in resistant cases. Environmental fogging with insecticides is neither necessary nor recommended.

[Management of lice infestations, recommendations for 2012]. / Prise en charge des pédiculoses en 2012.

Pediculosis is the most frequent and contagious ectoparasitic infestation in human, particularly in children from 3 to 8 years of age. Epidemics are observed from time to time, in schools or in adults in prisons. Even though benign, these infections remain unpleasant and can have an important psyco-social impact. Since a few years, caregivers have to face increasing problems while treating lice: appearance of insecticide resistances, lindane's withdrawal from the market and the marketing of new products which are not always well evaluated. This article offers first recalls about pediculoses and then a sum up of the different available treatments with an evidence based management strategy.

Head lice in Norwegian households: actions taken, costs and knowledge.

INTRODUCTION: Head lice infestations cause distress in many families. A well-founded strategy to reduce head lice prevalence must shorten the infectious period of individual hosts. To develop such a strategy, information about the actions taken (inspection, treatment and informing others about own infestations), level of knowledge and costs is needed. The present study is the first to consider all these elements combined. MATERIALS AND METHODS: A questionnaire was answered by 6203 households from five geographically separated municipalities in Norway. RESULTS: 94% of the households treated members with pediculicides when head lice were discovered. Nearly half of the households checked biannually or not at all. Previous occurrence of head lice and multiple children in a household improved both checking frequency and method. More than 90% of the households informed close contacts about their own pediculosis. Direct costs of pediculosis were low (less than €6.25 yearly) for 70% of the households, but the ability to pay for pediculicides decreased with the number of head lice infestations experienced. One in three households kept children from school because of pediculosis. Other widespread misconceptions, such as that excessive cleaning is necessary to fight head lice, may also add unnecessary burden to households. School affiliation had a significant effect on checking frequency and method, knowledge and willingness to inform others about own pediculosis. CONCLUSIONS: Increased checking frequencies appear to be the most important element to reduce head lice prevalence in Norway and should be a primary focus of future strategies. National campaigns directed through schools to individual households, might be an important tool to achieve this goal. In addition to improving actions taken, such campaigns should also provide accurate information to reduce costs and enhance the level of knowledge about head lice in households.

Why infest the loved ones--inherent human behaviour indicates former mutualism with head lice.

Head lice transmit to new hosts when people lean their heads together. Humans frequently touch their heads to express friendship or love, while this behaviour is absent in apes. We hypothesize that this behaviour was adaptive because it enabled people to acquire head lice infestations as early as possible to provoke an immune response effective against both head lice and body lice throughout the subsequent periods of their life. This cross-immunity could provide some defence against the body-louse-borne lethal diseases like epidemic typhus, trench fever, relapsing fever and the classical plague. Thus the human 'touching heads' behaviour probably acts as an inherent and unconscious 'vaccination' against body lice to reduce the threat exposed by the pathogens they may transmit. Recently, the eradication of body-louse-borne diseases rendered the transmission of head lice a maladaptive, though still widespread, behaviour in developed societies.

In vitro comparison of four treatments which discourage infestation by head lice.

Products which discourage the transmission of head lice are appealing; however, few studies have tested this concept. This study aims to test the efficacy of four commercial products which claim to discourage infestation by head lice; MOOV Head Lice Defence Spray (MOOV), Wild Child Quit Nits Head Lice Defence Spray (Wild Child), 100% Natural Head Lice Beater (Lice Beater) or Lysout Natural Anti-Lice Spray (Lysout). An in vitro challenge test was used. Briefly, one half of a filter paper lining the base of a petri dish was treated with the test product. Lice were then introduced to the centre of the dish, which was covered and placed in the dark at 20°C for 30 min. The number of lice on the treated and untreated sides of the filter paper was then counted after 2, 4 and 8 h post-application. MOOV was significantly more effective at discouraging the transmission of lice than the water control (p < 0.01), while Wild Child and Lysout were not at all time points. Lice Beater was significantly worse than the water control after 2 h (p < 0.01), while there was no difference after 4 and 8 h. MOOV was found to perform significantly better than Wild Child (p < 0.05) and Lice Beater (p < 0.05) at all time points. It also performed significantly better than Lysout at 2 (p < 0.05) and 8 h (p < 0.05), but not 4 h. MOOV offers the best efficacy and consistency of performance of the four products tested to discourage the transmission of head lice.

Human pediculosis: a critical health problem and what about nursing policy?

Lice infestation on the human body (also known as pediculosis) is very common. Cases number in the hundreds of millions worldwide. Three distinct presentations of lice infection exist and each is caused by a unique parasite. Head lice (Pediculus humanus capitis) is by far and away the most common infestation and favors no particular socioeconomic group. A genetically close "cousin," Pediculus humanus corporis, is responsible for body lice and is more commonly associated with poverty, overcrowding, and poor hygiene. Pubic lice (crabs) are caused by Pthirus pubis and is transmitted by intimate and/or sexual contact. No doubt, human lice infestation is an increasing problem worldwide, Apart from being an irritating and a shaming human ecto-parasite, they transmit serious infectious diseases; epidemic or classical typhus, epidemic relapsing fever as well as Trench fever. Eradication of lice infestation prevents transmission of infectious diseases. People who live and work in close proximity to louse-infested individuals may secondarily acquire lice even if they regularly wash their clothes and have good hygiene. Thus, all louse-infested persons and workers in close contact with such persons should periodically inspected and use long-acting safe insecticides. Human lice can be treated with agents such as DDT, malathion, and lindane, but reports of resistance to one or more of them have recently appeared. Pyrethroid permethrin when applied as a dust or spray to clothing or bedding is highly effective against lice and is the delousing agent of choice. Fabric treated with permethrin retains toxicity to lice even after 20 washings, thereby offering significant long-term passive protection against epidemic typhus. Itching may continue even after all lice are destroyed. This happens because of a lingering allergic reactionto their bites. Over-the-counter cortisone (corticosteroid) creams or calamine lotion may help.

Tratamiento eficaz con tintura de añil 5 por ciento de una paciente infestada por Pediculus capitis / Effective treatment of a patient infested with pediculus capitis by using 5 percent Indigofera suffruticosa Mill tincture

Introducción: en Cuba se reportaron altas frecuencias de pediculosis capitis desde finales de los años noventa, particularmente en algunos grupos de escolares y sus convivientes. Estos últimos se involucran en la cadena de transmisión de esos insectos y pueden desempeñar, en la actualidad, una función importante como reservorios del parásito. Objetivo: reportar la eficacia del tratamiento con añil cimarrón en una paciente infestada de Pediculus capitis. Métodos: se describe un caso de infestación persistente con pediculosis capitis en una paciente de 55 años de edad, tratada con solución de permetrina 1 por ciento y posteriormente con tintura de añil cimarrón 5 por ciento. Resultados: la identificación microscópica de adultos y estadios pre-adultos del parásito confirmaron la presencia de Pediculus capitis. El tratamiento del cabello con permetrina 1 por ciento no fue eficaz en 2 aplicaciones realizadas. Como alternativa de tratamiento, se aplicó tintura de añil 5 por ciento, lo que permitió disminuir la población de ectoparásitos adultos y logró eliminar la infestación después de una segunda aplicación, con la constante extracción de las liendres realizada por el personal paramédico encargado del caso. Conclusión: la aplicación de este procedimiento inocuo podría servir como alternativa terapéutica para esta afección(AU)

Introduction: pediculosis capitis was very frequently reported in Cuba since the end of the 90's, particularly in some groups of school children and their relatives. The latter are involved in a chain of transmission of these insects and may play an important role at present as parasite reservoirs. Objective: to report on the efficacy of the treatment of one female patient suffering from Pediculus capitis by using 5 percent Indigofera suffruticosa Mill (añil cimarrón) tincture. Methods: a case of persistent infestation with pediculosis capitis was described in which a 55 years-old patient was firstly treated with 1 percent permethrin solution and later with 5 percent Indigofera suffruticosa Mill tincture. Results: the microscopic identification of adult parasites and pre-adult stages of the parasite confirmed the presence of pediculus capitis. The hair treatment with 1 percent permethrin was not effective after two applications. As an alternative, 5 percent Indigofera suffruticosa Mill tincture was used and then the population of adult ectoparasites was reduced and the infestation was eliminated after the second application, with the paramedical staff continuously taking the nits out from the patient's hair. Conclusion: the use of this innocuous method may become a therapeutic alternative to treat this illness(AU)