Head Lice Might Cause Infection and Anemia

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Photo source: unsplash.com
Photo source: unsplash.com

Pediculosis is a parasitic infection on the human scalp and caused by Pediculus humanis var. capitis. These lice survive from a blood meal from their host.

Generally, this infection affects children aged 6-12 years in rural areas — incidence rates from 13.3% to 49% in children aged 3-13 years.

Pediculosis is often experienced by girls, which is 2-4 times more frequent than boys. There are an estimated 2,400 new cases of pediculosis per 10,000 children each year. Pediculosis can be transmitted directly through contact with infected humans or indirectly through infected combs, pillows, towels, and hats.

Pediculosis infection is spread in almost all countries and a problem both in developed and developing countries. As many as 13% of children in Australia has head lice infections, while in Brazil 43% of children in urban areas, and 28% of children in rural areas have head lice infections.

In China, the prevalence of pediculosis reached 14%, while in Britain the prevalence was only 2%. Caucasoid races in Canada and United States have been shown to be more often affected by head lice infection compared to black people.

Pediculosis is established if lice, spleen, and or eggs grow on the human head. Pediculosis infection will provide persistent itching due to irritation from lice while they are sucking blood on the head.

The itching phase will appear 2-6 weeks after the first infection, but some other symptoms can appear several hours after the infection. Besides causing itching, pediculosis can also cause excoriation or rash, conjunctivitis (red eye), bacterial infections, dermatitis (red skin) after therapy, swollen lymph nodes / adenopathy, nonspecific dermatitis, anemia, and allergic reactions that are not specific causes obstruction of the nasal cavity and full nasal mucus / rhinorrhea fluid.

Anemia is generally rare except in severe lice infections and poor nutrition. Besides, iron deficiency anemia may occur in prolonged lice infections, poor nutrition, and in certain conditions such as gastrointestinal bleeding.

Severe pediculosis infection is usually associated with low socioeconomic, hygiene, and lack of nutrition, hair characteristics, parasites that are resistant to insecticides, genetic factors, and habits. Taking care of pediculosis infection is very important by eliminating the lice eggs that attach to a human head.

Pediculide (topical tick medicine) will make the parasite unable to move and eventually kill the tick. The use of pediculicides must be rinsed using cold water because using hot water will cause vasodilation or dilation of blood vessels, thereby increasing systemic absorption (absorption into the body). If not handled properly, complications that may occur are secondary bacterial infections, anemia, enlarged lymph nodes in the neck and back of the head, even sepsis (severe infections) that can cause death.

Although the age that is prone to pediculosis is children, it does not rule out pediculosis infection in the elderly / geriatrics. As one of the cases reports in Dr. Soetomo Surabaya, an 80-year-old female, the patient feels itchy on the head, decreased appetite, and sometimes fever.

Every day, the patient just lay on the bed due to hemiparesis (weakness of the limbs) since 6 months ago. Her grandson had also been exposed to pediculosis, which might be a source of transmission. Physical examination in patients also found an enlarged lymph node behind the ear, reddish spots, and erosion on the scalp. In addition, laboratory examination showed hypochromic microcytic anemia and an increase in the number of leukocytes.

This woman was diagnosed with pediculosis capitis with complications of severe infection (sepsis) and anemia. She has to consume antibiotics ceftriaxone, metronidazole, red blood cell transfusion, and permethrin 1%. After 1 week treatment, the clinical condition and laboratory examination showed good results and without side effects.

Pediculosis can affect all age groups ranging from children to the elderly. Therefore, education is needed so that everyone will clean their combs, pillows, and hats. We need to educate people about this because pediculosis can cause severe life-threatening infections. (*)

Author: dr. Rahmadewi, Sp.KK (K), FINS-DV, FAADV

Detail information from this research can be seen in our writing at: https://e-journal.unair.ac.id/BIKK/article/view/12393


Rahmadewi Rahmadewi, Riyana Noor Oktaviyanti

Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia


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