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The Human Louse and Disease
Recent Studies Support the Critical Need for Preparedness and Lice Prevention

"One of the greatest achievements in the war which the medical sciences have waged against epidemic diseases is the discovery that, during times of quiescence in interepidemic periods, the potential agents of disease may smolder in human carriers, in domestic animals - especially rodents, - and in insects." Hans Zinsser - Rats, Lice and History

As the threat of old and new communicable diseases emerge, it is critical to set public health standards that not only encourage, but also enable parents to send their children to school lice and nit free. http://www.headlice.org/downloads/nonitpolicy.htm

The following is a partial list of both classic and recent research studies involving louse-borne diseases. This list continues to grow so check back.

(Letter) Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
2014 May
"Bartonella quintana is a body louse–borne human pathogen that can cause trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy (1). Recently, B. quintana DNA was detected in lice collected from the heads of poor and homeless persons from the United States, Nepal, Senegal, Ethiopia, and the Democratic Republic of the Congo and in nits in France (2,3)."
Source: Rezak Drali, Abdoul Karim Sangaré, Amina Boutellis, Emmanouil Angelakis, Aurélie Veracx, Cristina Socolovschi, Philippe Brouqui, and Didier Raoult. Emerging Infectious Diseases. Volume 20, Number 5—May 2014.
The biology and taxonomy of head and body lice-implications for louse-borne disease prevention
2013 Nov
"ABSTRACT: Sucking lice (Phthiraptera: Anoplura) are obligate blood-feeding ectoparasites of placental mammals including humans. Worldwide, more than 550 species have been described and many are specific to a particular host species of mammal [1]. Three taxa uniquely parasitize humans: the head louse, body louse, and crab (pubic) louse. The body louse, in particular, has epidemiological importance because it is a vector of the causative agents of three important human diseases: epidemic typhus, trench fever, and louse-borne relapsing fever. Since the advent of antibiotics and more effective body louse control measures in the 1940s, these diseases have markedly diminished in incidence. However, due to 1) increasing pediculicide resistance in human lice, 2) reemergence of body louse populations in some geographic areas and demographic groups, 3) persistent head louse infestations, and 4) recent detection of body louse-borne pathogens in head lice, lice and louse-borne diseases are an emerging problem worldwide. This mini-review is focused on human body and head lice including their biological relationship to each other and its epidemiological relevance, the status and treatment of human louse-borne diseases, and current approaches to prevention and control of human louse infestations."
Source: Denise L Bonilla, Lance A Durden, Marina E Eremeeva, Gregory A Dasch Vector-Borne Disease Section, California Department of Public Health, Richmond, California, United States of America. PLoS Pathogens (Impact Factor: 8.14). 11/2013; 9(11):e1003724. DOI:10.1371/journal.ppat.1003724. PubMed. 2013 May.
Borrelia recurrentis in Head Lice, Ethiopia
2013 May
"Since the 1800s, the only known vector of Borrelia recurrentis has been the body louse. In 2011, we found B. recurrentis DNA in 23% of head lice from patients with louse-borne relapsing fever in Ethiopia."
Source: Boutellis A, Mediannikov O, Bilcha KD, Ali J, Campelo D, Barker SC, et al. "Borrelia recurrentis in head lice, Ethiopia." Emerg Infect Dis. 2013 May.
Plague Epidemics and Lice, Democratic Republic of the Congo
2013 Mar
"Our detection of B. quintana and the plague agent Y. pestis in modern head and body lice is similar to findings of a paleomicrobiological investigation at a medieval plague site near Paris."
Source: Centers for Disease Control and Prevention
Distinguishing body lice from head lice by multiplex real-time PCR analysis of the Phum_PHUM540560 gene
2013 Feb
"Body louse or head louse? Once removed from their environment, body and head lice are indistinguishable. Neither the morphological criteria used since the mid-18th century nor the various genetic studies conducted since the advent of molecular biology tools have allowed body lice and head lice to be differentiated. In this work, using a portion of the Phum_PHUM540560 gene from the body louse, we aimed to develop a multiplex real-time polymerase chain reaction (PCR) assay to differentiate between body and head lice in a single reaction."
Source: Drali R, Boutellis A, Raoult D, Rolain JM, Brouqui P.
PLoS One. 2013;8(2):e58088. doi: 10.1371/journal.pone.0058088. Epub 2013 Feb 28.
The origin and distribution of human lice in the world
2013
"Two genera of lice parasitize humans: Pthirus and Pediculus. The latter is of significant public health importance and comprises two ecotypes: the body louse and the head louse."
Source: Amina Boutellisa, Laurent Abi-Rachedb, Didier Raoulta.
Neurological Manifestations of Bartonellosis in Immunocompetent Patients: A Composite of Reports from 2005-2012
2012
"It is important that the medical history include questions related to arthropod (lice, fleas, and ticks) and animal exposures."
Source: Journal of Neuroparasitology - Vol. 3 (2012), Article ID 235640, 15 pages - doi:10.4303/jnp/235640
E. B. Breitschwerdt,1 S. Sontakke,1,2 and S. Hopkins.
Evidence That Head and Body Lice on Homeless Persons Have the Same Genotype
2012
"These findings confirm that head and body lice are two ecotypes of the same species and show the importance of implementing measures to prevent lice transmission between homeless people in shelters."
Source: Aurélie Veracx, Romain Rivet, Karen D. McCoy, Philippe Brouqui, Didier Raoult
Evidence for an African cluster of human head and body lice with variable colors and interbreeding of lice between continents.
2012 May
"We identified two geotypes of Clade A head and body lice including one that is specifically African, that can be either black or grey and can live on the head or in clothing. We also hypothesized that lice from different areas are interbreeding"
Source: PLoS One. 2012;7(5):e37804. doi: 10.1371/journal.pone.0037804. Epub 2012 May 25.
"Evidence for an African cluster of human head and body lice with variable colors and interbreeding of lice between continents." Veracx A1, Boutellis A, Merhej V, Diatta G, Raoult D.
Bartonella quintana in head lice from Sénégal.
2012 May
"Head and body lice are strict, obligate human ectoparasites with three mitochondrial clades (A, B, and C). Body lice have been implicated as vectors of human diseases, and as the principal vectors of epidemic typhus, relapsing fever, and Bartonella quintata-associated diseases (trench fever, bacillary angiomatosis, endocarditis, chronic bacteremia, and chronic lymphadenopathy). Using molecular methods (real-time and traditional PCR), we assessed the presence of Bartonella quintana DNA in black head lice collected from three locations in Sénégal. DNA from B. quintana was identified in 19 lice (6.93%) collected from 7 patients (7%) in Dakar. B. quintana-positive lice collected from three subjects were identified as clades C and A."
Source: Vector Borne Zoonotic Dis. 2012 Jul;12(7):564-7. doi: 10.1089/vbz.2011.0845.
Boutellis A, Veracx A, Angelakis E, Diatta G, Mediannikov O, Trape JF, Raoult D.
Université de la Méditerranée, Faculté de Médecine, Marseille, France.
Bartonella quintana in Ethiopian lice.
2012 March
"The finding of B. quintana among head lice is important given the frequency of infestations seen among humans, especially children, around the globe. The perception among the general public is that head lice do not carry pathogens, a belief that should now be rectified. Whether all genetic lineages of head lice are equally competent for this pathogen under natural circumstances remains to be elucidated by comprehensive studies of head lice from diverse locations."
Source: Community-acquired infections
S. Cutler* (London, GB)
Brill-Zinsser Disease in Moroccan Man, France, 2011
2011 December
"Epidemic typhus is caused by Rickettsia prowazekii and transmitted by human body lice. For centuries, it has been associated with overcrowding, cold weather, and poor hygiene. Brill-Zinsser disease is a recurrent form of epidemic typhus that is unrelated to louse infestation and develops sporadically years after the primary illness."
Source: Faucher JF, Socolovschi C, Aubry C, Chirouze C, Hustache-Mathieu L, Raoult D, et al. "Brill-Zinsser disease in Moroccan man, France, 2011" [letter]. Emerg Infect Dis, 2012 Jan.
Detection of Acinetobacter baumannii in head lice from elementary schoolchildren in Paris
2011 December
"The human body louse is the only known vector of Bartonella quintana. However, the presence of this bacterium has recently been detected in the head lice of homeless individuals and Nepalese slum children. Previous studies have reported the isolation of Acinetobacter baumannii from the body lice of homeless individuals. An epidemiological survey including 74 schools was conducted between 2008 and 2009 in Paris. After a first visual examination, the hair of children with suspected pediculosis was combed with a fine-tooth comb to collect live adult head lice. Molecular studies were performed on randomly selected DNA samples to detect B. quintana and A. baumannii by specific quantitative real-time PCR. Among a collection of 288 DNA samples, B. quintana was not detected, but A. baumannii was detected in 95 DNA samples (33%). Further study is needed to determine the significance of the finding of A. baumannii in head lice."
Source: Comp Immunol Microbiol Infect Dis. 2011 Dec;34(6):475-7. doi: 10.1016/j.cimid.2011.08.007. Epub 2011 Oct 5.
Université Paris-Est Créteil Val de Marne and Department of Dermatology, Hospital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
Bouvresse S, Socolovshi C, Berdjane Z, Durand R, Izri A, Raoult D, Chosidow O, Brouqui P.
Altitude-dependent Bartonella quintana genotype C in head lice, Ethiopia.
2011 December
"To determine the presence of Bartonella quintana in head and body lice from persons in different locations in Ethiopia, we used molecular methods. B. quintana was found in 19 (7%) genotype C head lice and in 76 (18%) genotype A body lice. B. quintana in head lice was positively linked to altitude (p = 0.014)."
Source: Université de la Méditerranée, Marseille, France.
Angelakis E, Diatta G, Abdissa A, Trape JF, Mediannikov O, Richet H, Raoult D.
Bartonella quintana in Ethiopian lice.
2011 October
"The higher numbers of infected head lice pools compared with clothing lice suggests their competence for maintaining this infection within Ethiopia."
Source: Comp Immunol Microbiol Infect Dis 2011 Oct 21.
Cutler S, Abdissa A, Adamu H, Tolosa T, Gashaw A.
Bartonellosis: A hidden epidemic.
2011
"Physicians should be educated as to the large number of Bartonella spp. in nature, the extensive spectrum of animal reservoir hosts, the diversity of confirmed and potential arthropod vectors, current limitations associated with diagnosis and treatment efficacy, and the ecological and evolving medical complexity of these highly evolved bacteria."
Source: Bayer Animal Health Symposium.
Edward B. Breitschwerdt, DVM, DACVIM.
Bartonella quintana in head louse nits.
2011 July
"Bartonella quintana DNA has been detected exclusively in head lice collected from impoverished populations such as the homeless or Nepalese children living in slums or on the streets, who are usually infested by both head and body lice. ...the role of the head louse in the maintenance and transmission of B. quintana remains to be determined."
Source: FEMS Immunology & Medical Microbiology Volume 62, Issue 2, pages 244-246, July 2011
Emmanouil Angelakis, Jean-Marc Rolain, Didier Raoult, Philippe Brouqui.
Genotyping of Human Lice Suggests Multiple Emergences of Body Lice from Local Head Louse Populations
2010 March
While being phenotypically and physiologically different, human head and body lice are indistinguishable based on mitochondrial and nuclear genes. As protein-coding genes are too conserved to provide significant genetic diversity, we performed strain-typing of a large collection of human head and body lice using variable intergenic spacer sequences.
Rickettsial infections: Indian perspective
2010 March
Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician.
Source: Narendra Rathi, Akanksha Rathi. Indian Pediatrics. Volume 47, Issue 2, pp 157-164.
Body lice originate from head lice
2010 March
Until now, head lice and body lice were thought to be different species.
Beyond Anthrax: The Weaponization of Infectious Diseases Section 8.2.3
2009
"Of the 3,000 or so species of lice that have been characterized, only three are strictly human parasites, the clothing or body louse, P. humanus humanus; the head louse, P. humanus capitus; and the crab or pubic louse, Pthrius pubis."
Louse- and flea-borne rickettsioses: biological and genomic analyses
Source: Vet Res. 2009 Mar-Apr; 40(2): 12. Joseph J. Gillespie, Nicole C. Ammerman, [...], and Abdu F. Azad
Bartonella quintana in Body Lice and Head Lice from Homeless Persons, San Francisco, California, USA
June 2009
Apes, lice and prehistory
2009 by Robin A Weiss
Preventing and Controlling Emerging and Reemerging Transmissible Diseases in the Homeless.
2008 September
"Snapshot interventions have also identified the risk for the homeless of acquiring other louse-borne diseases such as epidemic typhus and relapsing fever, and enabled the first isolation of A. baumanii from lice (5,32,39)."
Source: Emerging Infectious Diseases Vol. 14, No. 9, September 2008
Emerging and re-emerging rickettsioses: endothelial cell infection and early disease events.
2008 Walker DH, Ismail N.
Feces of Pediculus capitis humanus as sign of viability of the louse.
2007 April
"When viable lice are not visible on the hair, to find on the hair species specific feces can indirectly confirm their existence. The feces can be barely visible to the naked eye as blackish dots. On the other hand, they can be more easily put in evidence by the dermosco- pe used with dry technique. The most typical appearance of the louse feces discharged from a short time is that of dark clustered globules, fixed to the hair or free on the surface of the scalp."

Images below appear with permission from Dr. Gaetano Scanni


Pediculus & Feces

Dr. Gaetano Scanni



Pediculus & Feces

Dr. Gaetano Scanni



Pediculus & Feces

Dr. Gaetano Scanni


Supergroup F. Wolbachia bacteria parasitise lice.
2007 March
"This is first report of an infection of supergroup F. Wolbachia in lice."
First Molecular Evidence of Bartonella quintana in Pediculus humanus
capitis (Phthiraptera: Pediculidae), Collected from Nepalese children

2006
“B. quintana DNA sequences were detected in both head and body lice from two children as well as in body lice derived from two other children. These results demonstrate that head lice may also play a role in the transmission of trench fever.”
Toshinori Sasaki; Shree Kanta S. Poudel; Haruhiko Isawa; Toshihiko Hayashi; Naomi Seki; Takashi Tomita; Kyoko Sawabe; Mutsuo Kobayashi
Symbiotic Bacteria Associated with Stomach Discs of Human Lice †
2006, September
The symbiotic bacteria associated with the stomach disc, a large aggregate of bacteriocytes on the ventral side of the midgut, of human body and head lice were characterized. Molecular phylogenetic analysis of 16S rRNA gene sequences showed that the symbionts formed a distinct and well-defined clade in the Gammaproteobacteria. >>>
Multispacer typing of Rickettsia prowazekii enabling epidemiological studies of epidemic typhus.
September 2005
"Currently, there is no tool for typing Rickettsia prowazekii, the causative agent of epidemic typhus, currently considered a potential bioterrorism agent, at the strain level."
Zhu Y, Fournier PE, Ogata H, Raoult D.
Excretion of living Borrelia recurrentis in feces of infected human body lice.
2005 June
"We conclude that, similar to epidemic typhus and trench fever, transmission of LBRF may be caused by lice feces."

Houhamdi L, Raoult D.
Drugs used in treatment of pediculosis
2005 March
"This having been said, the two are so closely related that it is naive to believe that head lice will never be shown to spread disease."
Elston DM.
Lice and lice-borne diseases in humans
2005 March
Rickettsia prowazekii, Borrelia recurrentis, Bartonella quintana, Acinetobacter baumannii

Houhamdi L, Parola P, Raoult D.
Ectoparasitism and vector-borne diseases in 930 homeless people in Marseilles
2005 January
"The uncontrolled louse infestation of this population should alert the community to the possibility of severe re-emerging louse-borne infections."
Brouqui P, Stein A, Dupont HT, Gallian P, Badiaga S, Rolain JM, Mege JL, La Scola B, Berbis P, Raoult D.
On the ubiquity and phylogeny of Wolbachia in lice
2004 November
"Here we document the apparent ubiquity and diversity of Wolbachia in the insect orders Anoplura (sucking lice) and Mallophaga (chewing lice), by detecting single or multiple infections in each of 25 tested populations of lice."
Louse-borne human pathogen Bartella quintana is a genomic derivative of the zoonotic agent Bartonella henselae
2004 February
Cecilia M. Alsmark * {dagger}{ddagger}, A. Carolin Frank * {dagger}, E. Olof Karlberg * {dagger}, Boris-Antoine Legault *, David H. Ardell * §, Björn Canbäck * ¶, Ann-Sofie Eriksson *, A. Kristina Näslund *, Scott A. Handley * ||, Maxime Huvet *, Bernard La Scola * **, Martin Holmberg {dagger}{dagger} and Siv G. E. Andersson *, {ddagger}{ddagger}
Potential role of head lice, Pediculus humanus capitis, as vectors of Rickettsia prowazekii.
2003 June
"This review of the epidemiology of head louse and body louse infestations, and of LBET, indicates that head lice are potential vectors of R. prowazekii in the field."
Robinson D, Leo N, Prociv P, Barker SC.
Head Lice and body lice: (pdf) 2003 May
shared traits invalidate assumptions about evolutionary and medical distinctions
Bartonella quintana Bacteremia Among Homeless People
2002
C. Foucault, K. Barrau, P. Brouqui, and D. Raoult
Human Pathogens in Body and Head Lice
2002 November
Pierre-Edouard Fournier,* Jean-Bosco Ndihokubwayo,*† Jo Guidran,‡ Patrick J. Kelly,§ and Didier Raoult*
Detection of Rickettsia prowazekii in Body Lice and Their Feces by Using Monoclonal Antibodies
2002 September
Rong Fang, Linda Houhamdi and Didier Raoult*
Detection of Bartonella quintana from body lice (Anoplura: Pediculidae) infesting homeless people in Tokyo by molecular technique.
2002 May
Sasaki T, Kobayashi M, Agui N.
Experimental Model of Human Body Louse Infection Using Green Fluorescent Protein-Expressing Bartonella quintana
2001 March
Pierre-Edouard Fournier,1 Michael F. Minnick,2 Hubert Lepidi,1,3 Eric Salvo,1 and Didier Raoult1,*
Serodiagnosis of Louse-Borne Relapsing Fever with Glycerophophodiester Phosphodiesterase (GlpQ) from Borrelia recurrentis
2000 October

Stephen F. Porcella,1 Sandra J. Raffel,1 Merry E. Schrumpf,1 Martin E. Schriefer,2 David T. Dennis,2 and Tom G. Schwan1,*
The body louse as a vector for reemerging human diseases
1999 October

Raoult D, Roux V.
Rickettsial Pathogens and Their Arthropod Vectors
1998

Source: [Emerging Infectious Diseases] [Volume 4 No. 2 / April - June 1998]. Abdu F. Azad* and Charles B. Beard†.
*University of Maryland School of Medicine, Baltimore, Maryland, USA; and †Centers for Disease Control and Prevention, Atlanta, Georgia, USA
The neglected saliva: medically important toxins in the saliva of human lice
1998

D. Jones
Seroprevalence to Bartonella quintana among patients at a community clinic in downtown Seattle
1996 April
Jackson LA, Spach DH, Kippen DA, Sugg NK, Regnery RL, Sayers MH, Stamm WE.
Body Lice as Tools for Diagnosis and Surveillance of Reemerging Diseases
1999 March
Veronique Roux and Didier Raoult*
Emergence of Bartonella quintana Infection among Homeless Persons
Emerging Infectious Diseases * Volume 2 * Number 2            April-June 1996
Head lice as vectors of disease
L. Lance Sholdt, PhD
Disease Vector Ecology Profile
1994 September
Armed Forces Pest Management Board

Report to the Department of Defense - Armed Forces Pest Management Board
1992 Deborah Z. Altschuler

Zinsser, Lice And History
1990 Deborah Z. Altschuler
Progress, National Pediculosis Association
®

Phoretic relationships between sucking lice (Anoplura) and flies (Diptera) associated with humans and livestock
1990 L. A. Durden
The Entomologist - 109

Infection of Head Lice with Rickettsia Prowazeki
May 1966 - U.S. Army Biological Laboratories
The Louse
1939 PATRICK A. BUXTON, C.M.G., F.R.S.
Two chapters of a true classic.
Nobel Prize Speech on Typhus and the Louse
1928 Charles Nicolle
"The contagious agent was therefore something attached to his skin and clothing, something which soap and water could remove. It could only be the louse. It was the louse."

 

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