Pediculosis capitis among school-age students worldwide as an emerging public health concern: a systematic review and meta-analysis of past five decades.

Pediculosis by Pediculus humanus capitis is still an important health issue in school-age students worldwide. Although pediculicidal agents effectively kill head lice, the re-infestation rate is still high. This study was conducted to provide a summary of evidence about the prevalence of pediculosis capitis among school-age students worldwide. Different databases including MEDLINE/PubMed, Scopus, and Web of Science were searched for publications related to pediculosis capitis in school-age students from 1977 to 2020. All peer-reviewed original research articles describing pediculosis capitis among school-age students were included. Statistical heterogeneity of the different years among studies was assessed using the standard chi squared and I2 tests. Due to the significant heterogeneity, a random effect model was adopted to estimate the pooled, continent, and gender-specific prevalence of pediculosis. Two hundred and one papers met the inclusion criteria of this review and entered into the meta-analysis including 1,218,351 individuals. Through a random effect model, the prevalence of pediculosis capitis among school students was estimated as 19% (CI 95% = 0.18-0.20%, I2 = 99.89%). The prevalence of pediculosis capitis among boys was 7% (CI 95% = 0.05-0.10) compared to 19% (CI 95% = 0.15-0.24) in girls. The highest prevalence was in Central and South America (33%, CI 95% = 0.22-0.44, I2 = 99.81%) and the lowest was in Europe (5%, CI 95% = 4-6, I2 = 99.28%). Relatively high pediculosis capitis prevalence among school-age students observed in this study emphasizes the need for implementing screening and prophylaxis tailored to the local context.

A simplified protocol for in vitro rearing of human body lice.

Human body lice (Pediculus humanus) are neglected ectoparasites and pathogen vectors. Difficulties in raising and maintaining colonies of body lice in a laboratory setting remain a barrier to fundamental studies of physiology and vector-pathogen interactions in these insects. Several in vivo and in vitro rearing systems have been previously described and used by multiple research groups. However, these methods suffer from drawbacks that still complicate the rearing of body lice relative to many other commonly studied hematophagous insects. Here, a simplified protocol for raising and maintaining body lice in vitro using the commercially available Hemotek apparatus is described. This protocol draws from published methods for rearing body lice as well as other hematophagous insect species to further reduce labor, time, costs, and regulatory requirements typically associated with keeping human body lice in the laboratory. Using this protocol, the insects consistently fed on commercially available rabbit blood with little mortality, reached adulthood at a high rate, and produced a significant number of viable eggs, resulting in a 4.8-fold increase in population over a period of 40 days. The data suggest that the process described here can propagate modest populations for ongoing laboratory experiments and is a useful alternative to existing methods. The use and further optimization of in vitro rearing systems may facilitate dynamic studies of body lice by a wider range of investigators, enabling new progress in combating lice infestations, and louse-borne infections.

TITLE: Un protocole simplifié pour l'élevage in vitro des poux du corps de l'homme. ABSTRACT: Les poux du corps de l'homme (Pediculus humanus) sont des ectoparasites et des vecteurs de pathogènes négligés. Les difficultés à élever et à maintenir des colonies de poux du corps en laboratoire restent un obstacle aux études fondamentales en physiologie et des interactions vecteur-pathogène chez ces insectes. Plusieurs systèmes d'élevage in vivo et in vitro ont déjà été décrits et utilisés par plusieurs groupes de recherche. Cependant, ces méthodes souffrent d'inconvénients qui compliquent encore l'élevage des poux du corps par rapport à de nombreux autres insectes hématophages couramment étudiés. Ici, un protocole simplifié pour élever et maintenir des poux du corps in vitro en utilisant l'appareil Hemotek, disponible dans le commerce, est décrit. Ce protocole s'inspire des méthodes publiées pour l'élevage des poux du corps ainsi que d'autres espèces d'insectes hématophages pour réduire le travail, le temps, les coûts et les exigences réglementaires généralement associées à la conservation des poux du corps dans le laboratoire. En utilisant ce protocole, les insectes se nourrissent constamment de sang de lapin disponible dans le commerce avec peu de mortalité, atteignent l'âge adulte avec un taux élevé et produisent un nombre important d'œufs viables, entraînant une augmentation de 4,8 fois de la population sur une période de 40 jours. Les données suggèrent que le processus décrit ici peut propager des populations modestes pour des expériences de laboratoire et est une alternative utile aux méthodes existantes. L'utilisation et l'optimisation des systèmes d'élevage in vitro peuvent faciliter les études dynamiques des poux du corps par un plus large éventail de chercheurs, permettant de nouveaux progrès dans la lutte contre les infestations par les poux et les infections transmises par les poux.

First Determination of Pyrethroid Knockdown Resistance Alleles in Human Head Lice (Phthiraptera: Pediculidae) From Chile.

The infestation with the human ectoparasite, Pediculus humanus capitis (De Geer), is a common public health problem affecting schoolchildren worldwide. In Chile, the main active ingredients present in the over-the-counter pediculicides contain pyrethroids. Despite the extended use of these products, there is no evidence of the insecticide resistance status of the head lice geographically located in Chile. The most extended resistant mechanism of pyrethroids consists of the target site insensitivity (Kdr) determined by the presence of mutations linked to insecticide-binding sites in the voltage-sensitive sodium channel. T917I is recognized as the main mutation in head lice, and detection is considered to be a biomarker of resistance. The goal of the present study was to detect the presence and distribution of T917I mutation in five geographic locations of Chile. All five geographically selected louse populations had a frequency of pyrethroid resistance genes that ranged from 36 to 77%, and 94.9% of the collected head lice had one or two T917I mutant alleles. Moreover, the frequency of the aggregate resistant alleles was 50.5%. This is the first evidence that head lice in Chile had the mutations commonly associated with the resistance to pyrethroids. Moreover, the overrepresentation of heterozygotes in the studied populations suggests that head lice in Chile are currently under active selective pressure.

The Presence of Acinetobacter baumannii DNA on the Skin of Homeless People and Its Relationship With Body Lice Infestation. Preliminary Results.

The presence of Acinetobacter baumannii was demonstrated in body lice, however, little is known about the mechanism of natural lice infection. In 2013 and 2014, cross-sectional one-day studies were therefore performed within two Marseille homeless shelters to assess the presence of A. baumannii DNA on human skin, blood and in body lice collected from the same homeless individuals. All 332 participants completed questionnaires, were examined for dermatologic signs, and provided four skin samples (hair, neck, armpits, and pelvic belt), blood samples and body lice (if any). We developed a new real-time PCR tool targeting the ompA/motB gene for the detection of A. baumannii for all collected samples. Blood culture was also performed. Body lice were found in 24/325 (7.4%) of subjects. We showed a prevalence of A. baumannii DNA skin-carriage in 33/305 (10.8%) of subjects. No difference was found in A. baumannii DNA prevalence according to body sites. A strong association between body lice infestation (OR = 3.07, p = 0.029) and A. baumannii DNA skin-carriage was noted. In lice, A. baumannii DNA was detected in 59/219 arthropods (26.9%). All blood cultures and real-time PCR on blood samples were negative for A. baumannii. Lice probably get infected with A. baumannii while biting through the colonized skin and likely transmit the bacteria in their feces. We found no evidence that lice facilitate the invasion of A. baumannii into the blood stream. Further investigations are needed to compare phenotypic and genotypic features of A. baumannii isolates from human skin and lice from the same individuals.

Molecular Markers of Pesticide Resistance and Pathogens in Human Head Lice (Phthiraptera: Pediculidae) From Rural Georgia, USA.

Although the head louse, Pediculus humanus capitis De Geer, and body louse, Pediculus humanus humanus L., both have a worldwide distribution, the occurrence of head louse pediculosis appears to be more prevalent in modern societies despite systematic use of various pediculicides. This study tested head lice collected in rural Georgia and body lice collected in Russia for the prevalence of a kdr-biomarker that is associated with permethrin resistance. This study also screened lice for the presence of DNA from Bartonella quintana and Acinetobacter species. The kdr-permethrin resistance biomarker for the T917I mutation was detected by RFLP and PCR in 99.9% of head lice tested from Georgia, whereas only 2.9% of body lice from Russia tested positive for this kdr biomarker. DNA of B. quintana was detected in 10.3% of head lice from Georgia, whereas 84.8% of body lice from Russia tested positive. Acinetobacter DNA was detected in 80.8% (95% CI, 68-89%) of head lice from Georgia and all body lice from Russia tested.

Flammability testing of 22 conventional European pediculicides.

Lice have been parasitizing humans for at least 10,000 years. Since then, humans have tried to rid themselves of these unpleasant and potentially disease-carrying insects. Despite various plant extracts and chemical compounds being used to combat recurring infestations to this date, several lice populations have developed resistance to some of the abundantly used compounds. This resulted in the development of anti-louse products that physically kill the different lice stages. Today, a widely used group of delousing agents are dimethicones (polydimethylsiloxane PDMS) which function by suffocating the lice. However, many dimethicones and related products are highly flammable which makes them potentially dangerous for treatment. In the present study, we tested the flammability of 22 delousing agents in order to shed some light onto this currently unresolved problem in the product design of pediculicides. Thirteen products were easily ignitable, some even by distant contact with a sparkler.

Ovicidal Efficacy of Abametapir Against Eggs of Human Head and Body Lice (Anoplura: Pediculidae).

Studies were undertaken to determine the ovicidal efficacy of 5,5'-dimethyl-2,2'-bipyridyl (abametapir) against eggs of both human head and body lice. Head lice eggs of different ages (0-2, 3-5, and 6-8-d-old eggs) were exposed to varying concentrations of abametapir in isopropanol and concentration-dependent response relationships established based on egg hatch. One hundred percent of all abametapir-treated eggs failed to hatch at the 0.74 and 0.55% concentrations, whereas 100% of 6-8-d-old head louse eggs failed to hatch only at the 0.74% concentration. The LC50 value for abametapir varied, depending on the age of the head lice eggs, from ∼0.10% recorded for 0-2-d-old eggs and increasing to ∼0.15% for 6-8-d-old eggs. Abametapir was also evaluated once formulated into a lotion referred to as Xeglyze (0.74% abametapir) and serial dilutions made. Ovicidal efficacies were determined against head lice eggs 0-8-d-old. Results indicated 100% ovicidal activity at the 0.74, 0.55, 0.37, and 0.18% concentrations. Additional studies undertaken using body lice eggs also demonstrated that abametapir was 100% ovicidal against eggs of all ages when evaluated at a concentration of 0.37 and 0.55%. Given that ovicidal activity is a critical component of any effective treatment regime for louse control, the data presented in this study clearly demonstrate the ability of abametapir to inhibit hatching of both head and body louse eggs as assessed in vitro.

The History of Epidemic Typhus.

Epidemic typhus caused by Rickettsia prowazekii is one of the oldest pestilential diseases of humankind. The disease is transmitted to human beings by the body louse Pediculus humanus corporis and is still considered a major threat by public health authorities, despite the efficacy of antibiotics, because poor sanitary conditions are conducive to louse proliferation. Epidemic typhus has accompanied disasters that impact humanity and has arguably determined the outcome of more wars than have soldiers and generals. The detection, identification, and characterization of microorganisms in ancient remains by paleomicrobiology has permitted the diagnosis of past epidemic typhus outbreaks through the detection of R. prowazekii. Various techniques, including microscopy and immunodetection, can be used in paleomicrobiology, but most of the data have been obtained by using PCR-based molecular techniques on dental pulp samples. Paleomicrobiology enabled the identification of the first outbreak of epidemic typhus in the 18th century in the context of a pan-European great war in the city of Douai, France, and supported the hypothesis that typhus was imported into Europe by Spanish soldiers returning from America. R. prowazekii was also detected in the remains of soldiers of Napoleon's Grand Army in Vilnius, Lithuania, which indicates that Napoleon's soldiers had epidemic typhus. The purpose of this article is to underscore the modern comprehension of clinical epidemic typhus, focus on the historical relationships of the disease, and examine the use of paleomicrobiology in the detection of past epidemic typhus outbreaks.

High Ancient Genetic Diversity of Human Lice, Pediculus humanus, from Israel Reveals New Insights into the Origin of Clade B Lice.

The human head louse, Pediculus humanus capitis, is subdivided into several significantly divergent mitochondrial haplogroups, each with particular geographical distributions. Historically, they are among the oldest human parasites, representing an excellent marker for tracking older events in human evolutionary history. In this study, ancient DNA analysis using real-time polymerase chain reaction (qPCR), combined with conventional PCR, was applied to the remains of twenty-four ancient head lice and their eggs from the Roman period which were recovered from Israel. The lice and eggs were found in three combs, one of which was recovered from archaeological excavations in the Hatzeva area of the Judean desert, and two of which found in Moa, in the Arava region, close to the Dead Sea. Results show that the head lice remains dating approximately to 2,000 years old have a cytb haplogroup A, which is worldwide in distribution, and haplogroup B, which has thus far only been found in contemporary lice from America, Europe, Australia and, most recently, Africa. More specifically, this haplogroup B has a B36 haplotype, the most common among B haplogroups, and has been present in America for at least 4,000 years. The present findings confirm that clade B lice existed, at least in the Middle East, prior to contacts between Native Americans and Europeans. These results support a Middle Eastern origin for clade B followed by its introduction into the New World with the early peoples. Lastly, the presence of Acinetobacter baumannii DNA was demonstrated by qPCR and sequencing in four head lice remains belonging to clade A.

How long do louse eggs take to hatch? A possible answer to an age-old riddle.

There are no rigorous data on how long eggs of the head louse, Pediculus capitis (Phthiraptera: Pediculidae), take to hatch. Pediculicide users often report reinfestations after apparently successful treatments in the absence of infective contacts. This study aimed to resolve the question of whether some louse eggs hatch after the completion of treatment, thereby giving rise to a new infestation. Data were extracted from the records of lice collected after treatments in 20 clinical intervention trials. All datasets were eliminated except those in which only newly hatched louse nymphs were found prior to the final assessment. This excluded the possibility that new eggs were laid after the first treatment and thus any young lice found must have originated from eggs laid before the start of treatment. This identified 23 of 1895 (1.2%) records with evidence of louse nymphs emerging at 13 days or more after the first treatment, 3­6 days longer than previous estimates. Current treatment regimens for pediculicides of two applications 7­10 days apart appear inadequate, which may explain continuing infestation in the community. Therefore, it is suggested that a revised approach using three treatments applied at intervals of 1 week should prevent the survival of any nymphs and their development into a new generation of adults.

[Pyrethroid resistance mechanisms in the body lice Pediculus humanus humanus L.: detoxification enzyme systems].

Synergists (piperonyl butoxide, MGK-264 (N-octyl bicycloheptene dicarboximide), DEF (S, S, S, tributyl phosphorotrithioate), and diethylmaleate) were used to investigate the metabolic resistance of body lice to permethrin. Instances of the synergistic activity ofpermethrin when combined with enzyme system inhibitors have been identified. The synergic ratios were 3.3 to 52.0 for monooxygenase inhibitors; 5.2 to 7.4 for esterases, and about 4 for glutathione-S-transferases. Since the use of the synergists did not lead to full inhibition of resistance, it was concluded that the lice had also a kdr-like type of resistance.

[Comparative activity of different groups of insecticides against permethrin-resistant lice (anoplura: pediculidae)].

The activity of insecticides (CK50, CK95 ) from different chemical classes against permethrin-resistant body and head lice was investigated. Having developed resistance to pyrethroids (permethrin, d-phenothrin, cypermethrin, and deltamethrin), the lice remain susceptible to organophosphorus compounds, phenylpyrazoles, neonicotinoids, and avermectins. The susceptibility of lice to the insecticides having a mechanism of action that is different from that of pyrethroids does not depend on the level of their resistance to permethrin.

Study of archaeological nits/eggs of Pediculus humanus capitis by scanning electron microscopy.

This paper presents and discusses archaeological samples of Pediculus humanus capitis nits/eggs in Arica, northern Chile, dating between 2000 B.C. and A.D. 500. Eight samples of nits/eggs taken directly from seven mummified bodies of both the valley and the coast of Arica, were collected and studied. Samples were analysed with scanning electron microscopy (SEM), uncoated, using low and variable pressure modes. The aim was to study the morphology of the nits/eggs, the different degrees of preservation and their research potential. All samples were in good external condition and due to manipulation before SEM analysis, the oldest ones were fractured allowing the observation in situ of the hatching ad portas of an embryo. This inside view of the egg allowed observation and identification of microstructures of the embryo such as abdominal and thoracic spiracles and claws. In the most recent and best preserved samples, external structures characteristic of the egg such as aeropyles and operculum were observed. SEM can contribute significantly to the study of ectoparasites that affected ancient American populations and in this particular case to illustrate the stages and morphology of Andean archaeological specimens of P. humanus capitis.

Ovicidal response of NYDA formulations on the human head louse (Anoplura: Pediculidae) using a hair tuft bioassay.

Using the in vitro rearing system in conjunction with the hair tuft bioassay, NYDA and NYDA without fragrances formulations (92% wt:wt dimeticones) were 100% ovicidal (0% of treated eggs hatched) after an 8-h exposure of the eggs of the human head louse (Pediculus humanus capitis De Geer) following the manufacturer's instructions. Comparatively, 78 and 66% of eggs similarly exposed hatched after distilled deionized water or Nix (1% permethrin) treatments, respectively. NYDA and NYDA without fragrances formulations were also statistically and substantially more ovicidal than either distilled deionized water or Nix treatments after 10, 30 min, and 1 h exposures. Only the 10 min exposure of eggs to NYDA and NYDA without fragrances formulations resulted in hatched lice that survived to adulthood (5-8% survival). Of the lice that hatched from eggs exposed to NYDA formulations for 10 min, there were no significant differences in the time it took them to become adults, female fecundity or the viability of eggs laid by surviving females. The longevity of adults, however, was reduced after the 10 min treatments of eggs with NYDA and NYDA without fragrances formulations compared with either the distilled deionized water or Nix treatments.

An ex vivo, assessor blind, randomised, parallel group, comparative efficacy trial of the ovicidal activity of three pediculicides after a single application--melaleuca oil and lavender oil, eucalyptus oil and lemon tea tree oil, and a "suffocation" pediculicide.

BACKGROUND: There are two components to the clinical efficacy of pediculicides: (i) efficacy against the crawling-stages (lousicidal efficacy); and (ii) efficacy against the eggs (ovicidal efficacy). Lousicidal efficacy and ovicidal efficacy are confounded in clinical trials. Here we report on a trial that was specially designed to rank the clinical ovicidal efficacy of pediculicides. Eggs were collected, pre-treatment and post-treatment, from subjects with different types of hair, different coloured hair and hair of different length. METHOD: Subjects with at least 20 live eggs of Pediculus capitis (head lice) were randomised to one of three treatment-groups: a melaleuca oil (commonly called tea tree oil) and lavender oil pediculicide (TTO/LO); a eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO); or a "suffocation" pediculicide. Pre-treatment: 10 to 22 live eggs were taken from the head by cutting the single hair with the live egg attached, before the treatment (total of 1,062 eggs). TREATMENT: The subjects then received a single treatment of one of the three pediculicides, according to the manufacturers' instructions. Post-treatment: 10 to 41 treated live eggs were taken from the head by cutting the single hair with the egg attached (total of 1,183 eggs). Eggs were incubated for 14 days. The proportion of eggs that had hatched after 14 days in the pre-treatment group was compared with the proportion of eggs that hatched in the post-treatment group. The primary outcome measure was % ovicidal efficacy for each of the three pediculicides. RESULTS: 722 subjects were examined for the presence of eggs of head lice. 92 of these subjects were recruited and randomly assigned to: the "suffocation" pediculicide (n = 31); the melaleuca oil and lavender oil pediculicide (n = 31); and the eucalyptus oil and lemon tea tree oil pediculicide (n = 30 subjects). The group treated with eucalyptus oil and lemon tea tree oil had an ovicidal efficacy of 3.3% (SD 16%) whereas the group treated with melaleuca oil and lavender oil had an ovicidal efficacy of 44.4% (SD 23%) and the group treated with the "suffocation" pediculicide had an ovicidal efficacy of 68.3% (SD 38%). CONCLUSION: Ovicidal efficacy varied substantially among treatments, from 3.3% to 68.3%. The "suffocation" pediculicide and the melaleuca oil and lavender oil pediculicide (TTO/LO) were significantly more ovicidal than eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO) (P < 0.0001). Ranking: 1. "Suffocation" pediculicide (68.3% efficacy against eggs); 2. Melaleuca oil and lavender oil (44.4%) pediculicide; 3. Eucalyptus oil and lemon tea tree oil (3.3%) pediculicide. The "suffocation" pediculicide and TTO/LO are also highly efficacious against the crawling-stages. Thus, the "suffocation" pediculicide and TTO/LO should be recommended as first line treatments.

Of lice and math: using models to understand and control populations of head lice.

In this paper we use detailed data about the biology of the head louse (pediculus humanus capitis) to build a model of the evolution of head lice colonies. Using theory and computer simulations, we show that the model can be used to assess the impact of the various strategies usually applied to eradicate head lice, both conscious (treatments) and unconscious (grooming). In the case of treatments, we study the difference in performance that arises when they are applied in systematic and non-systematic ways. Using some reasonable simplifying assumptions (as random mixing of human groups and the same mobility for all life stages of head lice other than eggs) we model the contagion of pediculosis using only one additional parameter. It is shown that this parameter can be tuned to obtain collective infestations whose characteristics are compatible with what is given in the literature on real infestations. We analyze two scenarios: One where group members begin treatment when a similar number of lice are present in each head, and another where there is one individual who starts treatment with a much larger threshold ("superspreader"). For both cases we assess the impact of several collective strategies of treatment.

Prevalence of head lice and hygiene practices among women over twelve years of age in Sindh, Balochistan, and North West Frontier Province: National Health Survey of Pakistan, 1990-1994.

BACKGROUND: Head lice infestation is an infection of the scalp and skin which causes blood loss, discomfort, and social and psychological distress with the possibility of secondary bacterial infections occurring at scratch sites. In Pakistan, although some small scale studies have been conducted to investigate prevalence of head lice in school children and the general population, no population based estimates have been reported. The National Health Survey of Pakistan (NHSP 1990 - 94) was a nationally representative health examination survey of the Pakistani population. The NHSP is the first population based household survey to collect data on the prevalence of head lice in adult women in Pakistan. In this paper we use data from the NHSP to present an epidemiological profile of personal hygiene practices and head lice infestation among women aged 12 years or older in three provinces of Pakistan; Balochistan, Sindh and North West Frontier Province (NWFP). RESULTS: Overall about 7% women aged 12 years and older suffered from head lice infestation. Multivariable logistic regression analysis identified factors independently associated with presence of head lice. Age less than 16 years and crowding at home were associated with higher infestation-rates. The impact of household socio-economic status on infestation rates among women was different in urban and rural settings; urban women with low socio-economic status were more vulnerable than similar women in rural settings. Bathing infrequently in summer was associated with higher prevalence rates only in Sindh, possibly due to the fact that among the three provinces Sindh has a hotter and more humid summer. CONCLUSIONS: The results of our analysis of NHSP indicate high levels of head lice infestation among girls and women in the three Provinces. The epidemiological profile of hygienic practices of women indicated that NWFP and Balochistan as compared to Sindh, and rural as compared to urban areas were less developed with respect to access to water supply and soap for maintaining personal hygiene. Simple and cost-effective measures such as provision of water and soap, and improving awareness regarding maintaining personal hygiene can contribute significantly towards improving public health status of the women in Pakistan.

Do nit removal formulations and other treatments loosen head louse eggs and nits from hair?

Eggs of the head louse, Pediculus capitis De Geer (Phthiraptera: Pediculidae), are difficult to remove because the female louse fixes them to hairs using a proteinaceous secretion that hardens within seconds. The persistent eggshells are harmless but unsightly and are often mistaken for an active infestation. Combing with a fine comb (nit comb) does not readily remove the eggs or empty eggshells because of the resilience of the fixative and both folk remedies and medical products have claimed to facilitate their removal. Measurement of the force required to initiate sliding of the egg fixative using a slip-peel tester was unable to detect evidence that any of three products which claimed to have egg-loosening properties (Step 2 Nit Removal System, Clear Lice Egg Remover, RID Lice Egg Loosener Gel) had any activity or exerted any effect on the egg fixative beyond the lubricating effects conveyed by water or conventional hair conditioner.