Treating head lice: a case study.

People who are homeless are greater risk of infections than the general public because they are often in poor health and have difficulty maintaining hygiene. This article discusses the treatment of head lice and uses a case history to outline specific issues that may arise in a person who is homeless and how these can be managed.

Head Lice.

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. Since the 2015 clinical report on head lice was published by the American Academy of Pediatrics, new medications have been approved, and an algorithm for management of affected patients is included. This revised clinical report clarifies current diagnosis and treatment protocols.

A 12-Year-old Girl With Chronic Pediculosis Infestation Presenting With Severe Iron Deficiency Anemia.

Iron deficiency is the leading etiology of anemia worldwide. Excessive cow's milk intake and menorrhagia are the most common etiologies in the pediatric population in the United States, with parasitic infections a more common cause in lower-resource countries. Here we present a case of a 12-year-old female in the midwestern United States with severe iron deficiency anemia (hemoglobin 4.7 g/dL) and chronic pediculosis infestation. Anemia resolved with transfusion, iron supplementation, and eradication of the parasite. We believe this is the only reported case of a child in the United States with severe iron deficiency anemia secondary to chronic severe lice infestation.

A clinical review and history of pubic lice.

The ectoparasite Pthirus pubis (PtP), commonly known as the crab or pubic louse, has plagued primates from prehistoric apes to Homo sapiens. We combed the literature from antiquity to the present day, reviewing the pubic louse's origins, its evolution with mankind, and its presentation and management. MEDLINE and EMBASE provided the greatest yield of literature compared with other databases. Estimates for PtP incidence range from 0.3% to 4.6% and for prevalence around 2% in adults. War, disasters and overcrowding support lice transmission, but modern pubic hair grooming has reduced the incidence of PtP in recent years. PtP, is usually found on pubic hair, but may infest scalp and body hair, eyebrows and eyelashes. Reports suggest the possibility of PtP as a vector for Bartonella spp. and Acinetobacter spp., which require further study. Transmission of PtP is via close contact, so sexual abuse and concomitant sexually transmitted infections should be considered. Symptoms and signs of infestation include pruritus, red papules and rust/brown deposits from feeding or faecal matter. Visualization of live lice confirms the diagnosis. Traditional treatments include hand-picking and combing, but in modern times pediculicidal products may generate faster resolution. Permethrin or pyrethrins are the first-line recommendations. Resistance to pediculicides is common with head lice and is presumed likely with PtP, although data are lacking. Pseudoresistance occurs as a result of poor compliance, incorrect or ineffective dosing, and reinfestation. In true resistance, a different pediculicide class should be used, e.g. second-line agents such as phenothrin, malathion or ivermectin. Lice have existed long before humans and given their adaptability, despite habitat challenges from fashion trends in body hair removal, are likely to continue to survive.

Unilateral Phthiriasis Palpebrarum: A Case Study

Phthiriasis palpebrarum is a rare eyelid infestation caused by Phthirus pubis (pubic lice) that is often confused with other causes of blepharoconjunctivitis. In this study, we report the case of a 49-year-old male patient with phthiriasis palpebrarum who presented with itching and eye irritation in the left eye and had undergone treatment for conjunctivitis in the past month. Biomicroscopic examination revealed a dense population of motile and translucent lice and eggs, more intensely on the upper lid. For treatment, the lice were first cleaned mechanically, eyelashes were cut from the bottom, and eggs and lice were removed from the eye, after which petrolatum jelly (vsaseline) was applied to the lids for 10 days. In the control examination, no lice and eggs were observed.

[Parasitoses in childhood]. / Parasitosen im Kindesalter.

Parasitoses are a frequent occurrence in pediatric consultations in both hospitals and private practices. Responsible for this are parasites that permanently infest human skin, such as Sarcoptes scabiei hominis and Pediculus humanus capitis (persistent parasites) as well as those that only attack the skin for feeding, such as Pulex irritans, Cimex lectularius und Neotrombicula autumnalis (transient parasites). The main symptom of parasitoses is pruritus, which is caused by a delayed allergic reaction to proteins in the saliva of the parasites. In some parasitoses, such as scabies, the pruritus is typical, occurs particularly at night and is associated with a considerable impairment in the quality of life due to the resulting lack of sleep, whereas the pruritus is often absent in the case of pediculosis capitis. In this article persistent and transient parasitoses are characterized based on the patient history, morphology and symptoms.

What's eating you? human body lice (Pediculus humanus corporis).

Compared to head and pubic lice, body lice (Pediculus humanus corporis) carry increased morbidity in the form of greater body surface area involvement, possible infectious disease transmission, and the potential for secondary iron-deficiency anemia. They thrive in high-density urban populations in which hygiene is poor, such as among the homeless. Treatment includes washing of affected individuals, their possessions, and treatment with topical insecticides. Growing patterns of treatment resistance seen in body lice necessitate development of new strategies, with oral medications serving as a promising option.

Infestations, Bites, and Insect Repellents.

Infestations and arthropod bite reactions in children are common reasons for presentation to pediatric health care providers. Infestations in children include head lice, scabies, and other mites. Fleas and bed bugs are common causes of bite reactions in children, and papular urticaria is a chronic, recurrent eruption resulting from delayed hypersensitivity to a variety of insect bites. Both infestations and bite reactions may result in severe pruritus with associated sleep disturbance and can be a source of significant distress for patients and families. In this review, we discuss infestations and bite reactions affecting pediatric patients, along with the approach to treatment and prevention of these conditions. [Pediatr Ann. 2020;49(3):e124-e131.].

Polyplax brachyrrhyncha (Anoplura: Polyplacidae) and Rhipicephalus turanicus (Ixodidae: Rhipicephalinae) in an Ancient Louse Comb.

A fine-toothed comb found in the Judean Desert and resembling an ancient louse comb was examined. Based on radiocarbon dating, it ranged between 1660 AD and 1950 AD. From the material accumulated between the teeth, an oribatid mite, a pseudoscorpion, exuviae of beetle larvae, a sucking louse (Polyplax brachyrrhyncha Cummings, 1915), as well as a fully engorged larva and a nymph of the ixodid tick Rhipicephalus turanicus Pomerantzev, 1936 were recorded. Additionally, the comb included numerous hairs of a spiny mouse (Acomys sp.). Although finding mites, beetle larvae, and a pseudoscorpion on a louse comb could be regarded as contamination, the findings of P. brachyrrhyncha, as well as of a larva and nymph of R. turanicus, are noteworthy. We hypothesize that the presence of animal lice and ticks could indicate some sort of pet grooming.

Ectoparasites: Pediculosis and tungiasis.

Pediculosis is an infestation of lice on the body, head, or pubic region that occurs worldwide. Lice are ectoparasites of the order Phthiraptera that feed on the blood of infested hosts. Their morphotype dictates their clinical features. Body lice may transmit bacterial pathogens that cause trench fever, relapsing fever, and epidemic typhus, which are potentially life-threatening diseases that remain relevant in contemporary times. Recent data from some settings suggest that head lice may harbor pathogens. The epidemiology, clinical manifestations, and management of body, head, and pubic louse infestation are reviewed. New therapies for head lice and screening considerations for pubic lice are discussed. Tungiasis is an ectoparasitic disease caused by skin penetration by the female Tunga penetrans or, less commonly, Tunga trimamillata flea. It is endemic in Latin America, the Caribbean and sub-Saharan Africa and seen in travelers returning from these regions. Risk factors for acquiring tungiasis, associated morbidity, and potential strategies for prevention and treatment are discussed.

Pthiriasis of the eyelashes.

Pthirus pubis, popularly known as crab louse, usually infests the pubis, groin, buttocks, intergluteal fold and perianal region. However, it can also infest, in particular in hairy males or when the infestation is longstanding, the thighs, abdomen, chest, axillae and face. The involvement of the scalp is very rare. Eyelashes may also be involved. We present a review of the literature about etiology, epidemiology, clinical features, complications and therapy of Pthiriasis of the eyelashes.

Severe pediculosis capitis in a nursery school girl / Pediculosis capitis grave en una niña inscrita en una guardería

Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.

La pediculosis capitis es la ectoparasitosis más frecuente a nivel mundial. La infestación es causada por Pediculus humanus capitis (piojo de la cabeza) y afecta el cabello, el cuero cabelludo y la piel. Rara vez se manifiesta con otro tipo de sintomatología y, por lo general, su curso es benigno si se trata adecuadamente. Se presenta el caso de una menor con pediculosis capitis de 18 meses de evolución, asociada con forúnculos, lesiones cutáneas, múltiples adenopatías y anemia, que no mejoró tras la aplicación del champú. Inicialmente, llamó la atención la presencia de forúnculos, alopecia y adenopatías. La persistencia de la pediculosis capitis y el rascado intenso alteraron la integridad de la epidermis y facilitaron las infecciones secundarias por bacterias patógenas y oportunistas que produjeron impétigo, forunculosis, excoriaciones, costras hemáticas, anemia, alopecia y linfadenopatías. La pediculosis capitis afectó notoriamente a la paciente al causarle problemas psicológicos y de salud, agudizados por su condición económica y social. La paciente presentó manifestaciones clínicas poco frecuentes (forunculosis, anemia, fiebre, alopecia y adenopatías), lo cual se vio facilitado por la persistencia de los factores de riesgo y el hecho de que no se le inspeccionaba la cabeza ni se removían los insectos. La educación sobre los factores de riesgo y el control sanitario es indispensable para controlar la infestación.

Lifestyle Recommendations for Management of Pediculosis from the Viewpoint of Persian Medicine

Introduction: Pediculosis Capitis (head lice infestation) is the most common disease of the bloodsucking insect which affects approximately six to twenty million cases and results considerable economic burden annually. In this study we aim to investigate some medieval Persian views on the role of non-pharmacological treatment strategies for prevention and control of pediculosis and compare their prescriptions with current findings. Materials and methods: In this qualitative study, we reviewed some well-known Persian medicine (PM) textbooks based on the selected keywords (Shepesh, Reshk, Ghamal and Seyban) to collect the viewpoint of PM scholars for pediculosis and its treatments. Also, we searched in the databases such as PubMed, Science direct and Scopus about the topic. Results: Persian medicine scientists believed that there are six essential health principles (SetteZaroorieh), which can affect human health and prevent diseases including air, nutrition, exercise, sleep and wakefulness, exertion of unnecessary materials from the body and finally psychological concepts. Proper management of these essential factors can improve lifestyle of people affected with pediculosis and also play a key role in prevention of head lice infestation. Conclusion: There are several suitable recommendations for prevention and control of pediculosis according to essential health principles in PM which can consider beside current drug treatments and the individual health recommendations for complete control of the disease

Combined treatment modality for phthiriasis palpebrarum.

Phthiriasis palpebrarum (PP) is the infestation of eyelids caused by the ectoparasite Phthirus pubis, frequently misdiagnosed as allergic conjunctivitis, blepharitis or dermatitis. There is no standard treatment of choice although various treatment modalities have been described. A 6-year-old male child with PP was successfully treated with local application of 20% fluorescein solution over the eyelashes and eyebrows of both the eyes, followed by the mechanical removal of all parasites and trimming of the eyelashes from the base and application of ophthalmic ointment.

Actualización en pediculosis capitis / Update on human head lice

Los piojos de la cabeza o pediculosis capitis son una patología muy prevalente que causa mucha angustia, sobre todo en los padres de niños afectos. En los últimos años se ha demostrado la aparición de muchas resistencias a los tratamientos existentes, debido principalmente al uso indiscriminado de estos. Presentamos una revisión de la infestación por piojos y de los tratamientos existentes actualmente

Head lice is a common condition, and it causes great concern in parents of the affected child. Resistance to the most common treatment has been reported recently, due to an indiscriminate use. A review is presented on this condition and its available treatments

Where Are We With Human Lice? A Review of the Current State of Knowledge.

Pediculus humanus is an obligate bloodsucking ectoparasite of human that includes two ecotypes, head louse and body louse, which differ slightly in morphology and biology, but have distinct ecologies. Phylogenetically, they are classified on six mitochondrial clades (A, B, C, D, E, and F), head louse encompasses the full genetic diversity of clades, while body louse belongs to clades A and D. Recent studies suggested that not only body louse, but also head louse can transmit disease, which warrants greater attention as a serious public health problem. The recent sequencing of body louse genome confirmed that P. humanus has the smallest genome of any hemimetabolous insect reported to date, and also revealed numerous interesting characteristics in the nuclear and mitochondrial genomes. The transcriptome analyses showed that body and head lice were almost genetically identical. Indeed, the phenotypic flexibility associated with the emergence of body lice, is probably a result of regulatory changes, perhaps epigenetic in origin, triggered by environmental signals. Current lice control strategies have proven unsuccessful. For instance, ivermectin represents a relatively new and very promising pediculicide. However, ivermectin resistance in the field has begun to be reported. Therefore, novel opportunities for pest control strategies are needed. Our objective here is to review the current state of knowledge on the biology, epidemiology, phylogeny, disease-vector and control of this fascinating and very intimate human parasite.

Head lice infestations in rural Honduras: the need for an integrated approach to control neglected tropical diseases.

BACKGROUND: Pediculosis capitis is a neglected tropical disease (NTD) that receives little attention in countries where it continues to be endemic. This study aimed to understand the impact of Pediculus humanus capitis infestations in the lives of Honduran children living in extreme poverty. METHODS: A qualitative study on head lice infestation was conducted in June 2016 in a rural community in Honduras. Parents were invited to bring their children for head lice inspection using a dry-combing technique with a stainless steel-toothed comb with suction power. A semistructured questionnaire was administered to participants. Questions were broadly grouped into knowledge about transmission, control practices, barriers to treatment, and the overall impact of these infestations in children's wellbeing. Responses were coded, categorized, and organized through a theme-based approach. RESULTS: In total, 52 children aged 2-14 years (42 girls) and their mothers were enrolled in the study. The overall proportion of children with an infestation was 83%. Response analysis revealed a lack of understanding regarding lice transmission and stigmatization of infested children and the widespread belief that head lice were acquired during bathing in the slow-flowing river running through the village. An agricultural plaguicide was commonly used to rid children of head lice. CONCLUSIONS: The study underscores the dire situation of the rural poor, their physical and mental health affected by pediculosis capitis as well as other NTDs. These results highlight the need to reassess approaches and action towards combating NTDS under an integrated framework.

[Update on human head lice]. / Actualización en pediculosis capitis.

Head lice is a common condition, and it causes great concern in parents of the affected child. Resistance to the most common treatment has been reported recently, due to an indiscriminate use. A review is presented on this condition and its available treatments.