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LICE – IDENTIFICATON & TREATMENT

LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation

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LICE – IDENTIFICATON & TREATMENT

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  1. LICE – IDENTIFICATON & TREATMENT

  2. PediculosisCapitis - head lice infection or infestation • PediculosisCorporis - body lice - usually associated with poor socio-economic conditions i.e. – homeless – infrequent change of clothing/poor hygiene

  3. Transmission • Usually head-to-head contact • Can be contracted through the sharing of brushes, hats, scarves, coats, bedding/linens, etc. • Obligate human parasite (a parasite organism that cannot complete its life cycle without dependence on its host)cannot be transferred through pets/animals

  4. Life Cycle • Mature female can lay 3 – 6 eggs/day and live for about 1 month • Eggs hatch within 6 – 10 days, maturity reached after another 10 days • nits may survive up to 3 weeks after removal from the host

  5. MALE FEMALE

  6. Facts • Most commonly affects children 3 – 11 years of age but anyone can be affected • Common to have outbreaks at schools, dormitories, etc • Prevalence - Female > Male • Likely many unreported due to stigma attached to infection • Lice prefer a clean environment

  7. Approx. 1 – 3 mm long • Flat • Wingless • 3 sets of legs - insect

  8. Signs & Symptoms • Most often found on the warmer areas of the head – behind the ears & back of head & neck • Itching common, especially at night • Excessive scratching can cause inflammation and secondary bacterial infection • Lice lay eggs or “nits”, cemented, close to the base of the hair shaft • Eyelashes (rarely) may be involved as well

  9. IDENTIFICATION • Live lice may be detected, but they move very quickly, and shy away from light so detection of live lice may be difficult –advantageous to use 2 people to check the infected person - many of those infected will have < 10 organisms present • Lice appear sluggish away from the warm scalp • Usually 24 hour survival off the host • Some recent data suggest for up to 55 hours

  10. IDENTIFICATION OF NITS • Important to distinguish nits from other possibilities • Dandruff, residues from gels/lacquers can look like nits • Recent, viable “un-hatched” eggs are creamy-yellow and very close to the scalp while older “nit shells” are further away from the scalp and white in colour • Oval in shape, slightly smaller than a sesame seed, never irregular in shape, fuzzy, or encircle the hair

  11. TREATMENT • A NIT REMOVAL COMB IS AN EFFECTIVE SCREENING TOOL • Manual removal may be the most important step, and it is possible to treat head lice with this method alone

  12. TREATMENT • Mainstay of treatment – insecticides

  13. Lice and other arthropods are killed by these medications blocking nerve impulses – causing paralysis and death of the parasite • Products should be applied to clean, dry hair in sufficient quantity to saturate the hair/scalp (especially behind the ears and the nape of the neck) and left on for 10 minutes, then rinsed. • Other treatments, petroleum jelly, kerosene, Tea-tree oil and others are either ineffective or unsafe

  14. Nit or egg removal should follow with a fine-toothed nit comb. • Soaking the hair and wrapping the scalp with a 50/50 solution of vinegar and water for at least 15 minutes • Machine wash (hot) and dry all hats, scarves, coats, bedding, if possible, and dry in dryer on the hot setting • For articles that cannot be cleaned this way, dry clean or seal up in a plastic bag for one week

  15. The nit comb, as well as other combs, brushes, barrettes, etc can be soaked in rubbing alcohol for 1 hour • Clean house room by room by thorough vacuuming (rugs, furniture, floors) • All close contacts should be thoroughly screened and treated only if necessary • After treatment, person should be checked regularly for any evidence of lice or nits • Re-treatment may be necessary and alternate agents may have to be used - resistance

  16. Itching, redness, and inflammation may persist for several days after successful treatment and may not necessarily mean re-application is required • Even the presence of live organisms several hours after treatment does not indicate that the treatment was unsuccessful; often these parasites take several hours to die after exposure to treatment

  17. ALTERNATE TREATMENT • Electric – battery-powered comb “zaps” lice • Some success • Price - $50

  18. REFERENCES • Centers for Disease Control and Prevention. Parasitic disease information: head lice infestation. Division of Parasitic Diseases. http://www.cdc.gov. • Hansen RC, et al. Guidelines for the treatment of resistant pediculosis. Contemporary Pediatrics 2000 Aug:S1-10. • Hipolito RB, Mallorca FG, Zunia-Macaraig ZO, et al. Head lice infestation: single drug versus combination therapy with one percent permethrin and trimethoprim/sulfamethoxazole. Pediatrics 2001;107(3):p.e30. • Burson, SC, Permethrin-Resistant Head Lice Pharmacist's Letter 1999;15(11):151116 • Clinical Pharmacology http://cpip.gsm.com

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