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
Pediculosis capitis is the medical term for an infestation of head lice. It is itself an infectious disease.
Head lice are highly communicable parasites specific to humans. They require blood meals to survive and have been associated with various infections including rickettsial diseases. Newer technologies are validating research done by bench workers on this subject many decades ago.
Additional studies are required as new emerging or re-emerging pathogens occur.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.
The following is a partial list of both classic research studies involving louse-borne diseases. This list continues to grow so please check our comprehensive list of louse and disease articles.
|Refugee crisis and re-emergence of forgotten infections in Europe|
“Makeshift shelters are becoming increasingly evident in European cities as a consequence of the momentous influx of refugees seeking asylum in European countries. These individuals have endured long, gruelling journeys to reach their target countries, often having survived appalling living conditions (Fig. 1a). One of the routes chosen by migrants is that from East Africa, through Sudan and Libya, to North Africa and eventually Europe (Fig. 1b). Not unsurprisingly, this has led to the introduction of infectious diseases that are rarely encountered in developed nations, most notably louse-borne relapsing fever (LBRF).”
Source: Cutler, Sally J. (2015) ‘Refugee crisis and re-emergence of forgotten infections in Europe’, – Clinical Microbiology and Infection.
|Cytogenetic Features of Human Head and Body Lice (Phthiraptera: Pediculidae)|
“The genus Pediculus L. that parasitize humans comprise two subspecies: the head lice Pediculus humanus capitis De Geer and the body lice Pediculus humanus humanus De Geer. Despite the 200yr of the first description of these two species, there is still a long debate about their taxonomic status. Some authors proposed that these organisms are separate species, conspecifics, or grouped in clades. The sequencing of both forms indicated that the difference between them is one gene absent in the head louse. However, their chromosomal number remains to be determined. In this study, we described the male and female karyotypes, and male meiosis of head and body lice, and examined the chromatin structure by means of C-banding. In P. h. humanus and P. h. capitis, the diploid chromosome complement was 2n=12 in both sexes. In oogonial prometaphase and metaphase and spermatogonial metaphase, it is evident that chromosomes lack of a primary constriction. No identifiable sex chromosomes or B chromosomes were observed in head and body lice. Neither chiasmata nor chromatin connections between homologous chromosomes were detected in male meiosis. The meiotic behaviour of the chromosomes showed that they are holokinetic. C-banding revealed the absence of constitutive heterochromatin. Our results provide relevant information to be used in mapping studies of genes associated with sex determination and environmental sensing and response.”
Source: Bressa MJ1, Papeschi AG2, Toloza AC3. – Oxford University Press on behalf of Entomological Society of America.
|Head lice predictors and infestation dynamics among primary school children in Norway|
“With the exception of hair length, we have found that individual and household characteristics are of minor importance to predict head lice infestations in a low-prevalence country and that unnoticed transmissions in school classes and families are likely to be the major driver upon outbreaks.”
Source: Birkemoe T, Lindstedt HH, Ottesen P, Soleng A, Næss Ø, Rukke BA. – Fam Pract. 2015 Oct 28. pii: cmv081.
|A New Clade of African Body and Head Lice Infected by Bartonella quintana and Yersinia pestis-Democratic Republic of the Congo|
“The human body louse is a known vector for the transmission of three serious diseases-specifically, epidemic typhus, trench fever, and relapsing fever caused by Rickettsia prowazekii, Bartonella quintana, and Borrelia recurrentis, respectively-that have killed millions of people. It is also suspected in the transmission of a fourth pathogen, Yersinia pestis, which is the etiologic agent of plague. To date, human lice belonging to the genus Pediculus have been classified into three mitochondrial clades: A, B, and C. Here, we describe a fourth mitochondrial clade, Clade D, comprising head and body lice. Clade D may be a vector of B. quintana and Y. pestis, which is prevalent in a highly plague-endemic area near the Rethy Health District, Orientale Province, Democratic Republic of the Congo.”
Source: Drali R, Shako JC, Davoust B, Diatta G, Raoult D2. – The American Society of Tropical Medicine and Hygiene. 2015 Sep 21. pii: 14-0686.
|Louse-borne relapsing fever (Borrelia recurrentis) in an Eritrean refugee arriving in Switzerland|
“Here we communicate a case of louse-borne relapsing fever (LBRF) in an Eritrean refugee after arrival in Switzerland in August 2015. Borrelia recurrentis, the causative agent of LBRF, was identified by 16S rRNA gene sequencing. In addition to diagnostic and therapeutic aspects, we discuss the epidemiology of this potentially re-emerging and serious disease in the context of a recent increase in refugees from East Africa travelling to Europe.”
Source: D Goldenberger, GJ Claas, C Bloch-Infanger, T Breidthardt, B Suter, M Martínez, A Neumayr, A Blaich, A Egli, M Osthof –Eurosurveillance. Vol. 20 | Weekly issue 32 | 13 August 2015.
|LOUSE-BORNE RELAPSING FEVER (BORRELIA RECURRENTIS) IN ASYLUM SEEKERS FROM ERITREA, THE NETHERLANDS|
“Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by Borrelia recurrentis was diagnosed. Treatment was complicated by severe Jarisch–Herxheimer reactions in both patients. Physicians should be aware of the possibility of B. recurrentis infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.”
Source: K R Wilting ()1, Y Stienstra2, B Sinha1, M Braks3, D Cornish4, H Grundmann1 – Eurosurveillance, Volume 20, Issue 30, 30 July 2015.
|Epidemiological comparative study of pediculosis capitis among primary school children in Fayoum and Minofiya governorates, Egypt.|
“Pediculosis is a frequent public health problem. The pattern and prevalence of Pediculosis is dependent on many socio-demographic and economic factors. It is common in schoolchildren especially primary level; it may affect their learning performance. This study aimed to determine the prevalence of head louse among primary students, in Fayoum and Bagor districts, and explore the predisposing factors of head louse infestation in both public and private schools. The study was a cross-sectional descriptive study, conducted in two governorates: Fayoum and Minofiya governorates which represent upper and lower Egypt respectively during the academic year of 2012-2013. The students were selected from different grades with a total of 10,935 students. The prevalence of head lice in the study group was 16.7 %.”
Source: Abd El Raheem TA1, El Sherbiny NA, Elgameel A, El-Sayed GA, Moustafa N, Shahen S. – J Community Health. 2015 Apr;40(2):222-6. doi: 10.1007/s10900-014-9920-0.
|The Distribution of Pediculus humanus capitis Among Primary School Pupils of the Turkish Chamber of Commerce and Stock Exchange Organisation in Van.|
“The infestation rates observed and the evaluation of the questionnaire showed that there is a statistically significant relationships between pediculosis capitis and sex, level of family income, education level of the mother, number of baths taken per weekly, number of family members living in the same home, room number per capita, and hair length (p<0.001). However, there was no significant relationship between pediculosis capitis and cleaning materials used to wash the head.”
Source: Karaaslan S, Yılmaz H. – Turkiye Parazitol Derg 2015 Mar;39(1):27-32. doi: 10.5152/tpd.2015.3673.
|Molecular survey of the head louse Pediculus humanus capitis in Thailand and its potential role for transmitting Acinetobacter spp.|
“This report is the first to describe Acinetobacter spp. in human head lice collected from school children in Thailand. The data obtained from this study might be used to develop effective planning for head louse control. The detection of pathogenic bacteria in head lice is useful for monitoring the possible head louse-borne pathogens in humans.”
Source: Sakone Sunantaraporn, Vivornpun Sanprasert, Theerakamol Pengsakul, Atchara Phumee, Rungfar Boonserm, Apiwat Tawatsin, Usavadee Thavara and Padet Siriyasatien. – Parasites & Vectors 2015, 8:127.
|“Collembola vs head lice: A puzzling case solved by videodermoscopy” (and it wasn’t head lice!)|
“A 65-year-old woman presented with a 4-month history of a recalcitrant pruritic scalp disorder unresponsive to repeated pediculicidal treatments. She exhibited self-collected specimens of presumed head lice entrapped in adhesive tape that she claimed to have recovered after combing her hair. At physical examination, several scratching marks were detectable on the scalp.”
Source: Journal of the American Academy of Dermatology: Volume 72, Issue 1, A1-A10, S1-S78.
|A ghost covered in lice: a case of severe blood loss with long-standing heavy pediculosis capitis infestation.|
“This case highlights the link between head lice (pediculosis capitis) infestation and iron-deficiency anaemia.”
Source: US National Library of Medicine National Institutes of Health
|Lice-borne Diseases in the Homeless Population|
“Lice were prevalent in a sample of 203 homeless people in San Francisco, as were Bartonella quintana infections, which cause trench fever, according to a recent study (Bonilla DL et al. Emerg Infect Dis. 2014;20:1645-1651).
Lice are vectors of B quintana, which they transmit by excreting bacteria-laden feces onto human skin. The bacteria enter the body through mucous membranes or a louse bite. Trench fever causes symptoms such as severe headache, conjunctival congestion, lymphadenopathy, and relapsing fever, as well as potentially life-threatening endocarditis and bacillary angiomatosis. Lice also can cause pruritus, infections from scratching, and anemia. Dirty clothing and close contact with others create an ideal environment for lice infestations and transmission, making homeless people an especially vulnerable population.”
Source: Journal of the American Medical Association. 2014;312(19):1962. doi:10.1001/jama.2014.14764.
|Faster the better: a reliable technique to sample anopluran lice in large hosts|
“Among Anoplura, the family Echinophthiriidae includes those species that infest mainly the pinnipeds. Working with large hosts implies methodological considerations as the time spent in the sampling, and the way in that the animal is restrained. Previous works on echinophthiriids combined a diverse array of analyses including field counts of lice and in vitro observations. To collect lice, the authors used forceps, and each louse was collected individually. This implied a long manipulation time, i.e., ≈60 min and the need to physically and/or chemically immobilize the animal. The present work described and discussed for the first a sample technique that minimized the manipulation time and also avoiding the use of anesthesia. This methodology implied combing the host’s pelage with a fine-tooth plastic comb, as used in the treatment of human pediculosis, and keeping the comb with the lice retained in a Ziploc® bag with ethanol. This technique was used successfully in studies of population dynamic, habitat selection, and transmission pattern, being a reliable methodology. Lice are collected entirely and are in a good condition to prepare them for mounting for studying under light or scanning electron microscopy. Moreover, the use of the plastic comb protects from damaging taxonomically important structures as spines being also recommended to reach taxonomic or morphological goals.”
Source: Laboratorio de Parasitología, Centro Nacional Patagónico, CENPAT-CONICET, Boulevard Brown 2915, PC U9120ACV, Puerto Madryn, Argentina, email@example.com. Parasitol Res. 2014 Jun;113(6):2015-8. doi: 10.1007/s00436-014-3890-0. Epub 2014 Apr 22.
|[Epidemiological study of Pediculosis in elementary schools of Arica, northern Chile]|
“Pediculosis is an ectoparasitosis infestation that has not received much attention in northern Chile despite it is a common reoccurring condition among school-age children. The objective of this study is to determine the prevalence of Pediculus humanus capitis infestation in elementary schools of Arica… The school population of Arica is significantly affected by Pediculosis and its prevalence is similar to other regions.”
Source: Gazmuri B P, Arriaza T B, Castro S F, González N P, Maripan V K, Saavedra R I. Rev Chil Pediatr. 2014 Jun;85(3):312-8. doi: 10.4067/S0370-41062014000300007.
|(Letter) Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France|
“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.
|Differential gene expression in laboratory strains of human head and body lice when challenged with Bartonella quintana, a pathogenic bacterium|
“Human head and body lice are obligatory hematophagous ectoparasites that belong to a single species, Pediculus humanus. Only body lice, however, are vectors of the infectious Gram-negative bacterium Bartonella quintana. Because of their near identical genomes, yet differential vector competence, head and body lice provide a unique model system to study the gain or loss of vector competence. Using our in vitro louse-rearing system, we infected head and body lice with blood containing B. quintana in order to detect both differences in the proliferation of B. quintana and transcriptional differences of immune-related genes in the lice. B. quintana proliferated rapidly in body lice at 6 days postinfection, but plateaued in head lice at 4 days postinfection. RNAseq and quantitative real-time PCR validation analyses determined gene expression differences. Eight immunoresponse genes were observed to be significantly different with many associated with the Toll pathway: Fibrinogen-like protein, Spaetzle, Defensin 1, Serpin, Scavenger receptor A and Apolipoporhrin 2. Our findings support the hypothesis that body lice, unlike head lice, fight infection from B. quintana only at the later stages of its proliferation.”
Source: D. Previte, B. P. Olds, K. Yoon, W. Sun, W. Muir, K. N. Paige, S. H. Lee. Insect Mol Biol. 2014 April ; 23(2): 244–254. doi:10.1111/imb.12077..
|Drought and epidemic typhus, central Mexico, 1655-1918|
“Epidemic typhus is an infectious disease caused by the bacterium Rickettsia prowazekii and transmitted by body lice (Pediculus humanus corporis). This disease occurs where conditions are crowded and unsanitary. This disease accompanied war, famine, and poverty for centuries. Historical and proxy climate data indicate that drought was a major factor in the development of typhus epidemics in Mexico during 1655-1918. Evidence was found for 22 large typhus epidemics in central Mexico, and tree-ring chronologies were used to reconstruct moisture levels over central Mexico for the past 500 years. Below-average tree growth, reconstructed drought, and low crop yields occurred during 19 of these 22 typhus epidemics. Historical documents describe how drought created large numbers of environmental refugees that fled the famine-stricken countryside for food relief in towns. These refugees often ended up in improvised shelters in which crowding encouraged conditions necessary for spread of typhus. KEYWORDS: Mexico; Pediculus humanus corporis; Rickettsia prowazekii; bacteria; body lice; drought; epidemics; tree rings; typhus.”
Source: Burns JN, Acuna-Soto R, Stahle DW. PMID: 24564928 PMCID: PMC3944858 DOI: 10.3201/eid2003.131366.
|The biology and taxonomy of head and body lice-implications for louse-borne disease prevention|
“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 . 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|
“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|
“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
|UP kids’ killer disease spread through lice, expert panel finds|
“The mystery deaths of hundreds of children in eastern Uttar Pradesh last year was likely caused by a bacterial infection that is transmitted through head lice, an expert group has concluded.”
Source: The Indian Express
|Distinguishing body lice from head lice by multiplex real-time PCR analysis of the Phum_PHUM540560 gene|
“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.
|First report of family infestation with pubic louse (Pthirus pubis; Insecta: Anoplura: Pthiridae) in Iran – a case report|
“The sucking lice including the head, body and pubic louse infest humans and so they are of high hygienic importance. Pubic lice are transmitted during sexual contact in adults. Thus, infestation of children with pubis louse is very rare. A case of infestation with pubic louse (Pthirus pubis) in a family in Kashan was seen. On examination of family members, the parasites were collected and observed under the light microscope. Infestation of eyelashes with P. pubis lice was confirmed. Since this parasite can be observed on the skin, infestation with this louse has always been one of the concerns of human communities. Pthiriasis has frequently been reported in many parts of the world; however, there are few reports on this infestation in Iran, especially familial infestation with this louse. Hence, this article could be the first report on the familial infestation with P. pubis in Iran and it can be suggested that infestation with pubic lice occurs in sporadic form in all over the country”
Source: Dehghani, R., Limoee, M. and Ahaki, A.R.3
Tropical Biomedicine 30(1): 152–154 (2013)
|The origin and distribution of human lice in the world|
“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|
“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|
“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.|
“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.|
“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.
|Mapping the social network: tracking lice in a wild primate (Microcebus rufus) population to infer social contacts and vector potential|
“Using a simple method, we were able to visualize exchanges of lice in a population of cryptic wild primates. This method not only provided insight into the previously unseen parasite movement between lemurs, but also allowed us to infer social interactions between them. As lice are known pathogen vectors, our method also allowed us to identify the lemurs most likely to facilitate louse-mediated epidemics. Our approach demonstrates the potential to uncover otherwise inaccessible parasite-host, and host social interaction data in any trappable species parasitized by sucking lice.”
NPA Note: These aren’t human head lice but it is trail-blazing and provides insights and relevance to human lice and disease. Source: BMC Ecology
Sarah Zohdy, Addison D Kemp, Lance A Durden, Patricia C Wright and Jukka Jernvall
|Bartonella quintana in Ethiopian lice.|
“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)
|Human louse-transmitted infectious diseases.|
“Several of the infectious diseases associated with human lice are life-threatening, including epidemic typhus, relapsing fever, and trench fever, which are caused by Rickettsia prowazekii, Borrelia recurrentis, and Bartonella quintana, respectively. Although these diseases have been known for several centuries, they remain a major public health concern in populations living in poor-hygiene conditions because of war, social disruption, severe poverty, or gaps in public health management. Poor-hygiene conditions favour a higher prevalence of body lice, which are the main vectors for these diseases. Trench fever has been reported in both developing and developed countries in populations living in poor conditions, such as homeless individuals. In contrast, outbreaks of epidemic typhus and epidemic relapsing fever have occurred in jails and refugee camps in developing countries. However, reports of a significantly high seroprevalence for epidemic typhus and epidemic relapsing fever in the homeless populations of developed countries suggest that these populations remain at high risk for outbreaks of these diseases. Additionally, experimental laboratory studies have demonstrated that the body louse can transmit other emerging or re-emerging pathogens, such as Acinetobacter baumannii and Yersinia pestis. Therefore, a strict survey of louse-borne diseases and the implementation of efficient delousing strategies in these populations should be public health priorities.”
Source: Clinical Microbiology and Infection 2012 – European Society of Clinical Microbiology and Infectious Diseases, CMI, 18, 332–337.
S. Badiaga, and P. Brouqui
|Brill-Zinsser Disease in Moroccan Man, France, 2011|
“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|
“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.
|Severe iron deficiency anemia and lice infestation|
“This is the first published evidence of a provocative association of louse infestation and severe iron deficiency anemia in humans.”
Source: J Emerg Med. 2011 Oct;41(4):362-5. doi: 10.1016/j.jemermed.2010.05.030. Epub 2010 Jul 24.
|Altitude-dependent Bartonella quintana genotype C in head lice, Ethiopia.|
“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.|
“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.|
“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.|
“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.
|Evidence of a louse-borne outbreak involving typhus in Douai, 1710-1712 during the war of Spanish succession.|
Anaemia due to head lice is unlikely, in an otherwise healthy child. However untreated, prolonged and severe infestation might lead to anaemia in the long term.
Source: Nguyen-Hieu T1, Aboudharam G, Signoli M, Rigeade C, Drancourt M, Raoult D. PLoS One. 2010 Oct 27;5(10):e15405. doi: 10.1371/journal.pone.0015405. (2010)
|Human Pediculosis and Anaemia: A “Lousy” Association|
Anaemia due to head lice is unlikely, in an otherwise healthy child. However untreated, prolonged and severe infestation might lead to anaemia in the long term.
Source: Pediatric Research (2010) 68, 636–636; doi:10.1203/00006450-201011001-01284.
|Genotyping of Human Lice Suggests Multiple Emergences of Body Lice from Local Head Louse Populations|
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|
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|
Until now, head lice and body lice were thought to be different species.
|Beyond Anthrax: The Weaponization of Infectious Diseases Section 8.2.3|
“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.”
|Epidemiology of Pediculosis capitis in elementary schools of Buenos Aires, Argentina.|
“The infestation with the human obligate ectoparasite Pediculus humanus capitis De Geer is a common public health problem affecting mainly schoolchildren worldwide. The aim of the present study was to investigate the infestation levels of head lice in elementary schools from Buenos Aires with resistant levels to permethrin >100. A total of 1,856 children aged 3-13 years old from eight selected elementary schools were examined for head lice. Pediculosis was observed in all the studied schools. The overall infestation rate was 29.7%. Girls were statistically significant more infested than boys, with infestation rate values of 36.1% and 26.7%, respectively (P < 0.0001). Only 42 of the infested girls (12%) and 23 of the infested boys (11.4%) had >10 lice on their hair. The proportions of infested children-both girls and boys-in each age group were not found to differ significantly from one another. The infestation rate among schools varied from 19.12% to 42.74%. This indicated that pediculosis is relatively common in elementary schools from Buenos Aires, and those levels are of epidemic importance. The differences of pediculosis among the studied schools could be explained by the different control strategies applied by parents or advisors to eradicate head lice.”
Source: Toloza A1, Vassena C, Gallardo A, González-Audino P, Picollo MI. Parasitol Res. 2009 Jun;104(6):1295-8. doi: 10.1007/s00436-008-1324-6. Epub 2009 Jan 16.
|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|
|Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues.|
2009 February – World Health Organization – by Hermann Feldmeier & Jorg Heukelbach
“Epidermal parasitic skin diseases (EPSD) occur worldwide and have been known since ancient times. Despite the considerable burden caused by EPSD, this category of parasitic diseases has been widely neglected by the scientific community and health-care providers. This is illustrated by the fact that in the recent edition of The Communicable disease control handbook, a reference manual for public health interventions, only one EPSD (scabies) is mentioned. EPSD fulfil the criteria defined by Ehrenberg & Ault (2005) for neglected diseases of neglected populations, but are not listed on national or international agendas concerning disease control priorities. This probably explains why efforts to control EPSD at the community level have very rarely been undertaken.”Six EPSD are of particular importance: scabies, pediculosis (head lice, body lice and pubic lice infestation), tungiasis (sand flea disease) and hookworm-related cutaneous larva migrans (HrCLM). They are either prevalent in resource-poor settings or are associated with important morbidity. In this paper we focus on these diseases, summarize the existing knowledge on the epidemiology and the morbidity in resource-poor settings and focus on the interactions between EPSD and poverty.”
|Apes, lice and prehistory|
2009 by Robin A Weiss
|Preventing and Controlling Emerging and Reemerging Transmissible Diseases in the Homeless.|
“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.
|Headlice: a precursor to Group A Streptococcal infection in remove Indigenous children.|
2007 November – Head Lice
“Indigenous children living in remote Australia are suffering from infections with sequelae that are causing devastating effects that will continue into adulthood. Impetigo, also known as school sores, is a contagious, superficial pyogenic skin infection; the causative organism is commonly Group A beta-haemolytic streptococci (GAS) also known as Streptococcus pyogenes1. GAS infections have been reported to be endemic in some Northern Territory communities, with 70% of children having impetigo as a result of infected scabies and other infestation lesions2.A known post-infection sequelae of GAS is rheumatic heart disease; GAS is also believed to contribute to adult renal disease subsequent to post streptococcal glomerular nephritis2. Because of this prevention, early detection and aggressive management of skin infections experienced by remote Indigenous children is essential. An understanding the social determinates of health is also needed to provide comprehensive care for Indigenous children. This case study will describe the care of a small Indigenous child suffering from impetigo secondary to head louse infestation.”
|Feces of Pediculus capitis humanus as sign of viability of the louse.|
“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.|
“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
“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
|Quantification of blood intake of the head louse: Pediculus humanus capitis.|
“Although head lice, Pediculus humanus capitis, are globally prevalent blood-sucking ectoparasites, the amount of blood imbibed by head lice has not been determined. This study investigated this parameter, as regular loss of a small quantity of blood may lead to an iron deficiency and anaemia. Adult female lice (66), adult males (46), and nymphs (152) were weighed before and after feeding in groups of 17-109 lice. The average amounts of blood imbibed at a single feed were: adult female louse (0.0001579 ml), adult male (0.0000657 ml) and nymph (0.0000387 ml). Assuming three feeds per day by an average infection of 30 lice (10 females, 10 males, and 10 nymphs), the average child with active pediculosis would loose 0.008 ml of blood per day. This amount of blood loss is of no clinical significance even in iron-deficient children. The most heavily infected child observed with 2657 lice could be expected to loose 0.7 ml/day or 20.8 ml/month, which may be of clinical importance in a child on an adequate diet, and would be significant in an iron-deficient child. However, if head lice feed more often than three times a day, a heavy infestation would have a greater potential to lead to iron deficiency. The frequency of feeding of head lice on the head of the human host needs to be determined.”
Speare R1, Canyon DV, Melrose W. Int J Dermatol. 2006 May;45(5):543-6.
|Transmission potential of the human head louse, Pediculus capitis (Anoplura: Pediculidae).|
“Adult lice were the most likely to disperse. Neither population density nor hunger significantly affected dispersal tendencies. Lice were dislodged by air movement, combs and towels, and passively transferred to fabric within 5 min. Females oviposited on a variety of substrates and 59% of eggs incubated for 8 h/night hatched after 14-16 days. There was no survivorship difference between lice artificially fed on female vs. male blood… Adult lice are the most mobile, indicating that they are most likely to initiate new infestations. Although head-to-head contact may be the primary route of transmission, less direct routes involving fomites may play a role and need further evaluation. Blood-borne factors do not appear to cause any gender-biased host preference.”
Takano-Lee M, Edman JD, Mullens BA, Clark JM. Int J Dermatol. 2005 Oct;44(10):811-6.
|Symbiotic Bacteria Associated with Stomach Discs of Human Lice †|
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.|
“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. |
“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|
“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.”
|Lice and lice-borne diseases in humans |
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|
“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|
“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|
Cecilia M. Alsmark * , A. Carolin Frank * , E. Olof Karlberg * , Boris-Antoine Legault *, David H. Ardell * , Björn Canbäck * ¶, Ann-Sofie Eriksson *, A. Kristina Näslund *, Scott A. Handley * ||, Maxime Huvet *, Bernard La Scola * **, Martin Holmberg and Siv G. E. Andersson *,
|Potential role of head lice, Pediculus humanus capitis, as vectors of Rickettsia prowazekii.|
“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 |
C. Foucault, K. Barrau, P. Brouqui, and D. Raoult
|Human Pathogens in Body and Head Lice|
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|
Rong Fang, Linda Houhamdi and Didier Raoult*
|Detection of Bartonella quintana from body lice (Anoplura: Pediculidae) infesting homeless people in Tokyo by molecular technique. |
Sasaki T, Kobayashi M, Agui N.
|Experimental Model of Human Body Louse Infection Using Green Fluorescent Protein-Expressing Bartonella quintana |
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 |
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 |
Raoult D, Roux V.
|Rickettsial Pathogens and Their Arthropod Vectors |
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 |
|Seroprevalence to Bartonella quintana among patients at a community clinic in downtown Seattle|
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 |
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|
Armed Forces Pest Management Board
|Report to the Department of Defense – Armed Forces Pest Management Board |
1992Deborah Z. Altschuler
|Zinsser, Lice And History |
1990Deborah Z. Altschuler
Progress, National Pediculosis Association®
|Phoretic relationships between sucking lice (Anoplura) and flies (Diptera) associated with humans and livestock |
1990L. A. Durden
The Entomologist – 109
|National Committee to Abolish Nit-Picking and ‘Fine-Tooth Combing’ |
Pediatrics. Vol. 65, No. 2, 1980.
|UNDERSTANDING AND TREATING INFESTATIONS OF LICE ON HUMANS |
May 1971 – Benjamin Ken and John H. Poorbaugh, Ph.D.
|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.”