Pediculosis Corporis


Article Author:
Jim Powers


Article Editor:
Talel Badri


Editors In Chief:
Rhonda Coffman
Lindsay Iverson
Heather Templin


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Frank Smeeks
Kristina Soman-Faulkner
Trevor Nezwek
Radia Jamil
Patrick Le
Sobhan Daneshfar
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
5/21/2019 12:08:02 PM

Introduction

Body lice are parasitic insects that feed on human blood. The three types of lice that feed on humans are the head louse, Pediculus humanus capitis, the pubic or crab louse, Pthirus pubis, and the body louse. There has been debate amongst entomologists regarding the proper taxonomy of head and body lice, some identify them as two different species, while others group them as a single species. Those considering them as two distinct species identify body lice as Pediculus humanus, while those who see them as one species identify them as Pediculus humanus humanus. In the medical literature, body lice are often referred to as Pediculus humanus corporis, but according to the rules of the International Commission on Zoological Nomenclature, this is an improper designation. [1]

Studies have identified that the head and body lice are closely related, with genetic studies demonstrating that body lice possess only one gene that is not also present in head lice. [2] 

Unlike head and pubic lice, body lice do not live on the skin but rather live and lay their eggs in stitchings of clothing or bedding, moving to the skin only to feed. The most significant difference between body and head lice is the distinct ability of body lice to transmit the bacterial diseases of trench fever, relapsing fever, and epidemic typhus to humans. [2]

Etiology

Body lice, which have a worldwide distribution, are ectoparasites that must feed on human blood to survive. They assume 3 forms across their life cycle starting with the egg, or nit, and progressing to the nymph and adult stage. As with head lice, nits are oval and appear yellow or white.  However, unlike head lice, which attach their eggs to the proximal hair shafts, body lice lay their eggs in the seams of clothing. A nymph is an immature louse, which except for its smaller size, has the same appearance as an adult louse. Adult lice have 6 legs, are tan to grayish-white in color, 2.5 to 3.5 cm in length, have no wings, and are flat in shape.

Body lice feed 1 to 5 times a day and can live up to 60 days. When separated from a human host, body lice will die within a week.

Epidemiology

As body lice cannot jump or fly, they spread primarily by direct contact, though transmission can also occur through clothing, bed linens, and towels. Infestations are strongly correlated with poor body hygiene, lack of access to clean clothing, and crowded conditions, which facilitate spread of the lice through direct physical contact. Outbreaks most commonly occur in situations where large groups of people live in unsanitary conditions such as prisons or camps of large groups of refugees from war, famine or natural disasters. In the United States and other developed countries, body lice infestations most commonly occur in homeless populations because of the lack of access to clean clothes or showers. Outbreaks of body lice infestations and louse-borne diseases continue to occur globally and have been documented in jails and refugee camps in central and eastern Africa, rural areas in the Peruvian Andes, and amongst rural populations in Russia. [2]

Pathophysiology

Body lice infestations can involve thousands of mites, each biting an average of 5 times per day. During feeding, body lice pierce the skin, inject a salivary anticoagulant, and then suck the blood meal into their digestive tract. Bites of the body louse can produce a variety of skin lesions, and severe pruritus thought to be due to an allergic and/or inflammatory reaction to the louse saliva. [3]Intense scratching of pruritic bites can result in skin excoriation, potentially leading to significant secondary bacterial infections.

The greatest medical impact of body lice is their ability to transmit bacterial diseases, most notably trench fever caused by Bartonella quintana, relapsing fever caused by Borrelia recurrentis, and epidemic (louse-borne) typhus caused by Rickettsia prowazekii. [4] Trench fever and epidemic typhus are not transmitted by louse bites but rather through infected feces. When feeding, the body louse often excretes its feces onto the skin, which can be inadvertently rubbed into the bite site, eyes, or mucous membranes. Transmission of Rickettsia prowazekii can also occur through inhalation of aerosolized fecal dust, which has been documented as a potential source of infection for clinicians. Unlike trench fever and epidemic typhus, transmission of relapsing fever, caused by Borrelia recurrentis, does not occur through contaminated feces. Infection occurs when a person crushes an infected louse, and the bacteria then invade the bite site or the skin of the fingers or hand that crushed the louse. [4] In addition, a person can acquire the infection if they rub their eye or put their fingers in their mouth after crushing the louse.

Additional pathogenic bacteria found in body lice include Salmonella typhi, Serratia marcescens, and Acinetobacter baumannii. The DNA of Yersinia pestis, which causes bubonic plague, has been identified in body lice, and it is believed they may serve as supplementary vectors for the organism. [1]

History and Physical

Historical clues such as poor body hygiene, lack of access to clean clothing, homelessness, and residing in crowded, unsanitary conditions should prompt consideration for body louse infestation and louse-borne infections

The primary symptom of body lice infestations is severe pruritus.

The dermatologic findings in body lice infestation vary but include areas of pyoderma, erythematous macules, wheals, and hemorrhagic puncta. The severe pruritus associated with bites can cause intense scratching leading to excoriations and the development of secondary infections. In the setting of chronic body lice infestation, frequently bitten areas of the skin can develop notable thickening and discoloration, a condition known as “vagabond’s disease.” [CDC - https://www.cdc.gov/parasites/lice/body/disease.html] Dermatologic findings tend to be most prominent in areas where clothing seams are in contact with the skin, such as the waist, groin, thighs, and axillary folds. [3] Additional physical exam findings including cervical lymphadenopathy and conjunctivitis are often present.

Unlike head and pubic lice, infestation with body lice is typically diagnosed by finding eggs and lice in seams of clothing rather than on the skin. [2] Therefore, an important component of the exam in patients suspected of having body lice includes careful inspection of their clothing. In addition to lice, indirect findings such as blood stains or louse feces may be discovered.

Evaluation

While body lice may occasionally be found crawling on the patient’s skin, an infestation is typically diagnosed by finding eggs and lice in seams of clothing.

A PCR assay has been developed to differentiate between head and body lice but is primarily used for research purposes rather than to support clinical decision-making.

Treatment / Management

Treatment of body lice does not usually require the use of a pediculicide because improvements in hygiene, including showering and laundering clothing in hot water at least 50 C, will most often eradicate the infestation. [2] All clothing, bed linens and towels should be washed in hot water and machine dried on the hot cycle.

Itching can be treated with topical corticosteroids and systemic antihistamines. Secondary skin infections are managed with appropriate systemic antibiotics. While the use of pediculicides is not required for eradication of body lice infections, they are often utilized, especially if body lice or nits are found on body hair or if there is co-infection with head lice, pubic lice, or scabies. [3] In these cases, pharmacologic treatment employs same agents utilized for pubic and head lice, most commonly permethrin cream applied to the entire body for 8 to 10 hours. Additional treatments include 5% benzyl alcohol lotion, 0.5% ivermectin lotion, 0.5% malathion lotion, 0.9% spinosad topical suspension, and 1% lindane shampoo. [2] Lindane is not recommended for first-line treatment due to a number of potentially serious reactions including neurotoxicity and seizures. In some settings, such as refugee camps with large numbers of people, environmental application of chemical insecticides may be needed to prevent the spread of body lice and louse-borne infections.[5][6][7]

Differential Diagnosis

The differential diagnosis of dermatologic findings in body lice infestation includes scabies, contact dermatitis, atopic dermatitis, drug reaction, and viral exanthem. Co-infection with head lice, pubic lice, scabies, and fleas may be found, especially in refugee populations. [3]

A high index of suspicion should be maintained for trench fever, relapsing fever and epidemic typhus in patients with body lice infestation presenting with signs and/or symptoms of systemic infections. Other infectious diseases that may present with similar manifestations include babesiosis, brucellosis, Q fever, typhoid fever, leptospirosis, ehrlichiosis, and tularemia.

Prognosis

The prognosis for the eradication of body lice infestation is very good if patients are provided with regular access to showering and at least weekly access to laundered clothing and bedding.

Significant morbidity and mortality are associated with louse-borne diseases but can be reduced substantially with early recognition and appropriate antibiotic therapy.

Epidemic typhus can cause a vasculitis leading to limb ischemia, gangrene, central nervous system (CNS) dysfunction and multiorgan failure. Mortality ranges from 20% to 40% in untreated patients but decreases to 3% to 4% with appropriate antibiotic therapy.

Louse-borne, relapsing fever mortality rate is approximately 40% if untreated, while the mortality rate with treatment drops to around 4%.

Trench fever, caused by B. quintana, tends to be self-limited in immunocompetent people but can result in the development of endocarditis, which can lead to increased morbidity and mortality.

Pearls and Other Issues

Unlike head and pubic lice, body lice do not live on the skin but rather live and lay their eggs in seams of clothing or bedding, moving to the skin only to feed.

The most significant difference between body and head lice is the distinct ability of body lice to transmit the bacterial diseases trench fever, relapsing fever, and epidemic typhus to humans.

Infestations are strongly correlated with poor body hygiene, lack of access to clean clothing, and crowded conditions, and most commonly occur in situations where large groups of people live in unsanitary conditions such as prisons or camps of large groups of refugees from war, famine or natural disasters.

In the United States and other developed countries, body lice infestations most commonly occur in homeless populations who lack access to clean clothes or showers.

Bites of the body louse can produce a variety of skin lesions and severe pruritus which is thought to be due to an allergic and/or inflammatory reaction to the louse saliva.

Infestation with body lice is typically diagnosed by finding eggs and lice in seams of clothing rather than on the skin.

Treatment of body lice does not usually require the use of a pediculicide because improvements in hygiene, including showering and laundering clothing in hot water, will most often eradicate the infestation. [8][9]

Enhancing Healthcare Team Outcomes

Body lice are often encountered by the nurse practitioner, primary care provider, internist, emergency department physician and the pharmacist. the treatment of body lice requires education of the patient on maintenance of good personal hygiene and laundering clothes in hot water. The symptoms like pruritus are managed with antihistamines and topical corticosteroids

While the use of pediculicides is not required for eradication of body lice infections, they are often utilized, especially if body lice or nits are found on body hair or if there is co-infection with head lice, pubic lice, or scabies. [3] 

The most significant difference between body and head lice is the distinct ability of body lice to transmit the bacterial diseases trench fever, relapsing fever, and epidemic typhus to humans.

The outcomes for patients who remain compliant with good body hygiene are good.


  • Image 6098 Not availableImage 6098 Not available
    CDC image - public domain https://www.cdc.gov/parasites/lice/body/index.html
Attributed To: CDC image - public domain https://www.cdc.gov/parasites/lice/body/index.html

Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Pediculosis Corporis - Questions

Take a quiz of the questions on this article.

Take Quiz
What is the best location to detect pediculus corporis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A resident of a large refugee camp in the Middle East presents complaining of severe pruritis which has been progressively worsening over the past week. He denies any exposure to possible irritants and does not recall any insect bites or stings. He has no systemic symptoms or other complaints. His vital signs are normal, and the physical exam reveals large areas of pyoderma, most prominent in the axilla, trunk, and groin. While no obvious arthropods are noted on his physical, inspection of his clothing reveals the presence of lice and eggs in the seams of his clothing. Surveillance of camp residents should be undertaken for the presentation of what disease?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following diseases is not transmitted by the body louse?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In the United States, which populations are most likely to be afflicted by body lice infestations?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most prominent symptom of patients with body lice infestations?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the cause of vagabond’s disease, a condition where areas of the skin develop notable thickening and discoloration?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the primary treatment for body louse infestation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Pediculosis Corporis - References

References

Management and Treatment of Human Lice., Sangaré AK,Doumbo OK,Raoult D,, BioMed research international, 2016     [PubMed]
The biology and taxonomy of head and body lice--implications for louse-borne disease prevention., Bonilla DL,Durden LA,Eremeeva ME,Dasch GA,, PLoS pathogens, 2013     [PubMed]
Pediculosis., Ko CJ,Elston DM,, Journal of the American Academy of Dermatology, 2004 Jan     [PubMed]
Epidemic typhus., Bechah Y,Capo C,Mege JL,Raoult D,, The Lancet. Infectious diseases, 2008 Jul     [PubMed]
Dadabhoy I,Butts JF, Parasitic Skin Infections for Primary Care Physicians. Primary care. 2015 Dec;     [PubMed]
Do-Pham G,Monsel G,Chosidow O, Lice. Seminars in cutaneous medicine and surgery. 2014 Sep;     [PubMed]
El-Bahnasawy MM,Abdel FE,Morsy TA, Human pediculosis: a critical health problem and what about nursing policy? Journal of the Egyptian Society of Parasitology. 2012 Dec;     [PubMed]
Feldmeier H,Heukelbach J, Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bulletin of the World Health Organization. 2009 Feb;     [PubMed]
Nutanson I,Steen C,Schwartz RA, Pediculosis corporis: an ancient itch. Acta dermatovenerologica Croatica : ADC. 2007;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of NP-Adult Acute Gerontology. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for NP-Adult Acute Gerontology, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in NP-Adult Acute Gerontology, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of NP-Adult Acute Gerontology. When it is time for the NP-Adult Acute Gerontology board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study NP-Adult Acute Gerontology.