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PEDICULOSIS CAPITIS WITH COMPLICATION SEPSIS AND ANEMIA

IN ELDERLY PATIENT

A CASE REPORT

Riyana Noor Oktaviyanti, Rahmadewi
Department of Dermatology and Venereology
Faculty of Medicine, Airlangga University / Dr. Soetomo General Hospital Surabaya

ABSTRACT
Background: Pediculosis is an ectoparasitic infestation of human scalp. Feed on the
human blood. Infestation is characterized by intense itching, secondary infection and
anemia in cases of severe infestation and inadequate diet. Treatment of head lice
includes physical methods, topical pediculicides, and oral agents.
Case: A Women, 80 years old, body weight 45 kilograms, came to Emergency room
of Dr. Soetomo General Hospital with complaint about malaise, low appetite and
sometime fever since 1 week ago. Patient also complaint about Itchy sensation on her
scalp appeared since 3 month ago . There are many lice on her scalp. Itchy sensation
felt all day long. Patient just take a bath once daily, and spent her time on bed because
patient had a hemiparese since 6 month ago. There are history of the same disease in
the family, her grandson also has the same complain (lice on scalp). No history of
bleeding or gastrointestinal bleeding. Patient has a low appetite. There were so many
lice on her scalp, with erosion and crustae. patient treated with systemic antibiotic Inj.
Ceftriaxone 2x1 gr, metronidazole drip 3x500 mg, transfusi PRC 2 kolf/day until
HB>10, permetrin 1 % ( Peditox) give a good result.
Discussion: This is a case of pediculosis capitis in a adult , 80 years old, with anemia
and sepsis.. Head-to-head contact is by far the most common route of lice transmission.
We therefore suppose that the infestation could stem directly from hairto- hair contact,
or indirectly, e.g. towels, which may have been already used by infected people.The
source of contagious of this case could be from her grandson also has the same
complain (lice on scalp). Treatmen of pedikulosis are permetrim 1%, other options if
these treatments don’t work include malathion, benzyl alcohol, spinosad, and topical
ivermectin.
Key words: pediculosis capitis, permetrim 1%, itchy

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PEDIKULOSIS KAPITIS DENGAN KOMPLIKASI SEPSIS DAN ANEMIA

PADA PASIEN USIA TUA

LAPORAN KASUS

Riyana Noor Oktaviyanti, Rahmadewi
Departemen Kulit dan Kelamin
Fakultas Kedokteran, Universitas Airlangga / RSUD Dr. Soetomo Surabaya

ABSTRAK
Latar Belakang: Pedikulosis adalah infestasi ektoparasit pada kulit kepala manusia.
Infestasi yang banyak dari kutu ditandai dengan gatal yang sangat kuat, infeksi
sekunder dan anemia pada keadaan diet yg kurang. Pengobatan kutu meliputi metode
fisik, topikal, dan agen oral.
Kasus: Seorang Wanita, 80 tahun, berat badan 45 kilogram, datang ke ruang Gawat
Darurat Rumah Sakit Umum Dr. Soetomo dengan keluhan lemas, kurang nafsu makan
dan terkadang demam. Keluhan dirasakan sejak 1 minggu yang lalu. Pasien mengeluh
tentang gatal pada kulit kepalanya muncul sejak 3 bulan yang lalu. Terdapat banyak
kutu di kulit kepalanya. Sensasi gatal terasa sepanjang hari. Pasien hanya mandi satu
kali sehari, dan menghabiskan waktunya di tempat tidur karena pasien mengalami
hemiparese sejak 6 bulan yang lalu. Ada riwayat penyakit yang sama dalam keluarga,
cucunya juga memiliki keluhan yang sama (kutu pada kulit kepala). Tidak ada riwayat
perdarahan atau perdarahan pencernaan, nafsu makan berkurang. Dari hasi
pemeriksaan fisik terdapat banyak kutu di kulit kepala, dengan luka dan sisik. Pasien
di terapi dengan antibiotik sistemik Injeksi ceftriaxone 2x1 gr, metronidazole drip
3x500 mg, transfusi RRC 2 kolf / hari sampai HB> 10, permetrin 1%. Terapi
memberikan hasil yang baik dan tidak didapatkan efek samping pada pasien.
Diskusi: Pada kasus pediculosis kapitis ini mengenai pada orang dewasa, 80 tahun,
dengan anemia dan sepsis. Kontak secara langsung adalah jalur transmisi kutu yang
paling umum. Oleh karena itu, kami menduga bahwa infestasi dapat berasal langsung
dari kontak rambut-rambut, atau secara tidak langsung seperti handuk, yang mungkin
sudah pernah digunakan oleh orang yang terinfeksi. Sumber penularan kasus ini dari
cucunya yang juga memiliki keluhan yang sama (kutu pada kulit kepala). Terapi
pedikulosis adalah permetrim 1%. pilihan lain jika perawatan ini tidak bekerja meliputi
malathion, benzyl alcohol, spinosad, dan ivermectin topikal.
Kata kunci: pedikulosis kapitis, permethrin 1%, gatal

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INTRODUCTION Pediculosis is an ectoparasitic infestation of human scalp. unnecessary absenteeism from academics and difficult issue for school authorities to handle. especially in rural and developing areas owing to their hair length. which represents an active infestation and requires an appropriate treatment for its control (Mumcuoglu et al.5 3 . conjunctivitis. Head lice are blood-sucking insects that can cause pruritus. 2001).12 years. it can be cause of social embarrassment. This might take 2 to 6 weeks to develop with the first infestation.3% to 49%. Girls are 2 to 4 times more frequently infested than boys. Although pediculosis is not a major health problem (no vector-borne disease reported). unspecific generalized dermatitis. anaemia. capitis De Geer (Anoplura: Pediculidae). ethnicity. posterior neck adenopathy. An infestation is commonly encountered in pediatric population in the age group of 6 . secondary bacterial infection. In rural areas. pillows and hats. nymphs and/or viable eggs in the human head. peer-criticism.3 Transmission occurs mainly by direct person-to-person contact or by instruments such as shared combs. excoriation. prevalence rate ranges from in the age group of 3 . and subsequent infestations might take hours for symptoms to start. ranges varies from 13. feed on the human blood.2 The characteristic itch that is classic of head lice infestations is caused by irritation from saliva injected by the feeding louse.1 Its diagnosis is based on the detection of adults. isolation. The causative lice Pediculus humanus var. Climate.4. parental anxiety. local post-therapeutic dermatitis. geography. and hygienic conditions play a role in spreading lice.13 years. and allergic reactions resulting in nasal obstruction and rhinorrhea.

Ivermectin (400 µg/kg as a single dose and repeated in 7 days) is an anthelmintic agent resulting in 95% of patients being lice-free on day 15. These agents quickly immobilize and kill lice. and oral agents. secondary infection and anemia in cases of severe infestation and inadequate diet.7). Although the amount of blood ingested during a single feed is extremely small. Permethrin also has residual effects because it adheres to the hair shaft as long as conditioner or siliconebased shampoos are not used.3 Oral anthelmintics and antibiotics.8 as no pediculicide is completely ovicidal and in order to reduce the development of resistance. parasite resistance to insecticides. This might par.6. Treatment of head lice infestations with trimethoprimsulfamethoxazole remains controversial. genetic factors. Infestation is characterized by intense itching. louse resistance patterns particular to the local area. there has been increased interest in oral anthelmintic treatments. With increasing resistance to topical therapies.5% malathion topically (n = 812.ticularly be the case in an individual with poor nutrition or 4 . absolute difference 10. The physical removal of eggs has become an important part of treatment of louse infestations. Severe infestations are associated with low socioeconomic status. as compared with 85% of those receiving 0. 95% CI 4. hair characteristics.2 percentage points. and cultural habits.3 Treatment of head lice includes physical methods. Topical pediculicides require 2 applications 7 to 10 days apart.6 to 15. Choice of treatment is determined by age. topical pediculicides.3 These lice survive from a blood meal from their host. and potential toxicity. a heavily infested individual over an extended period of time might be expected to be susceptible to iron deficiency anemia.

and no contagious person was reported. came to Emergency room of Dr. Sepsis is a lift-threatening condition in which the body if fighting a severe infection that has spread via bloodstream. 80 years old. and servical.No History of food or drug allergy.ilar effect in humans. No History of asthma and sneezing in the morning in her family. humanus capitis and corporis could have a sim. Itchy sensation felt all day long. it is not unexpected that blood. Complication of pediculosis capitits are secondary infection.6. occipital lymphadenopathy. Patient come to emergency room with complaint about malaise. There are many lice on her scalp. Patient just take a bath once daily. Considering the animal reports of iron deficiency anemia consequent to heavy louse infestation.7. low appetite and sometime fever since 1 week ago. History 5 . No history of bleeding or gastrointestinal bleeding. malaise. Case Report A Women.additional risk factors for iron deficiency anemia such as slow gastrointestinal bleeding. anemia. decrease appetite and sometimes fever. Patient has a low appetite. Soetomo General Hospital with main complaint Itchy sensation and there are some lice on her scalp. and spent her time on bed because patient had a hemiparese since 6 month ago.sepsis. body weight 45 kilograms. There are history of the same disease in the family. Anemia is a medical condition in which the red blood cell count or hemoglobin is less then normal. Patient also complaint about Itchy sensation on her scalp appeared since 3 month ago .8 We report a case of tinea capitis in child with poor compliance and need prolonged treatment but fortunately give good result either clinical and laboratory at the end of treatment period. her grandson also has the same complain (lice on scalp).sucking P.

heart rate 82 times per minute. No history of transfusion before. compos mentis. and pubis (Figure 1). The dermatological examination on regio capital of his scalp there was there were macule erythematous. No lice on regio eyebrows. There were so many lice on her scalp. The Blood pressure 100/60. unsharplymarginated with multiple papules. On general examination. body temperature 36.7 degree celcius. eyelashes. There were enlargement of retroauricular lymphonodes. No icteric or cyanosis. She never had different sexual partner and never had genital complaint before. patient look not well. respiration rate 20 times per minute. 6 .of DM (-) and HT (+).there were anemic in his eyes. No abnormality in thorax and abdomen examination. with erosion and crustae.

Figure 1. electrolyte. Figure 2. increase on leucocyt number (15. Urinary test. liver and renal function test when she admitted were within normal limit.1 g/dl). there was low level of haemoglobin (7. The Scapping examination 7 . HIV Rapid Test non reaktif. Result from blood smear with anemia hypochromic microcytic. no lice in eyebrow. eyelash and pubis From the blood examination.450/mm3). The Scapping examination there were lice (figure 2). So many lice in scalp.

and scrapping examination. permetrin 1 % (Peditox) applie to all over the scalp and hair. physical examination. It showed good result from clinical also laboratory examination for 1 weeks treatment. accept secondary infection area and cover it with bath cap and let stand in 10 menit and then rinsed it and compress with Nacl in erosion area. Education to the patients not to share combs. Monitored about the symptom (itchy) and progression of the lesion. metronidazole drip 3x500 mg. Diagnose was made from anamnesis. Ceftriaxone 2x1 gr. caps with other person and keep scalp hygine with wash the hair daily. pillows. The diagnosis in this patient was pediculosis capitis with complicatin sepsis and anemia. transfusi PRC 2 kolf/day until HB>10. Before treatment 8 . This patient treated with systemic antibiotic Inj. Figure 3. laboratory examination.

After 7 days treatment 9 . After 2 days treatment Figure 5. Figure 4.

450 9730 Assessment Pediculosis capitis with sepsis and anemia Therapy : Permetrin 1% + . - Inj. Ceftriaxone 2x1gr + + + Drip metronidazole + + + 3x500mg + + - Transf.8 • leukosit 15. The progression of the patient Progression 10 Mei 2017 12 Mei 2017 17 Mei 2017 of Clinical Manifestation Subjective : • Itchy ++ + - • malaise ++ + - • Fever ++ ± - • Low appetite ++ + Objective : • Macula ++ + + erythematous • Erythematous ++ + - papule • erosion + + - • Crustae + + - • Anemic conjungitiva + + - • Blood examination: • Hb 7.Table 1.1 9.450 15.1 7. PRC 2kolf/day + + - 10 .

has worldwide distribution. In Brazil. Head lice are considered to be a public health problem of both developed as well as developing countries. and they do not possess powerful legs for jumping.1 In this case a number of lice more than 200 adults and nits of 11 . Its diagnosis is based on the detection of adults.DISCUSSION Pediculosis infestation by Pediculus Capitis De Geer (head lice). In England. Interestingly. They move from one infested hair to another with the help of claw on their legs. Caucasians are more frequently infested as compared with black individuals. the prevalence of pediculosis has been on average 14%. Close personal contact and sharing of headgear is the chief mode of transmission among susceptible contacts. 80 years old. Head louse cannot fly as they lack wings. between the ages of 3–11 yr. 13% of the children were infested by head lice. For example.10 This is a case of pediculosis capitis in a adult . In general.9. in developed countries such as Canada and the United States. Similarly. and the incidence rate has been estimated to be 800 and 2400 new cases per 10. From 1% to 3%. the prevalence of head louse infestations was as high as 43% in urban areas and 28% in rural areas. Similar reports have shown that pediculosis is more prevalent in low-income groups. and is observed in all age groups. It is considered one of several ectoparasites neglected by the scientific community and healthcare authorities.000 children per year . in Australia. with anemia and sepsis. it is 2%. in China. nymphs and/or viable eggs in the human head. which represents an active infestation and requires an appropriate treatment for its control. Head to head contact is by far the most common route of lice transmission. though particularly among children. girls are infested more frequently than boys.

or indirectly. head louse takes a blood meal (hematophagia) usually 4 to 5 times per day. eyebrows. The sexual transmission hypothesis was rejected due to the absence of this louse in the pubis region. and scaling. The origin of this extraordinary infestation in this geriatric patient can only be hypothetical. but usually an examiner only excoriations.0000657 mL in female and male lice. erythema. the sexual transmission hypothesis was rejected due to the absence of louse in her pubis hair. respectively. lice favour the nape of the 12 . An indirect contamination. Although any part of the scalp may be colonized. chest. e. Bites of the mites may produce 2 mm erythematous macules or papules.1 While taking a blood meal. eyelashes or nails from any person surrounding her that carrying the Phthirus.0000387 mL to 0. appearing approximately 7-10 days after sensitivity to the parasite’s saliva or excrement antigens. towel. We therefore suppose that the infestation could stem directly from hair to hair contact. A single study conducted by Speare and associates attempted to quantitate the amount of blood a single head louse ingests during a single feed. considering to her age and her normal mental state. The value ranged from 0. which may have been already used by infected people. lice injects its saliva through the scalp skin to prevent clotting of blood. The most common symptom seen in the patients is itching on the scalp. For this woman.11 Infestation is characterized by intense itching. could also not be neglected. Suggested a primary infection more than a month. e. thereby maintaining the fluidity for an easy sucking. could be a suspect. towels.Phthirus present on her head. A direct contamination with beard.g. The source of contagious of this case could be from her grandson also has the same complain (lice on scalp). secondary infection and anemia in cases of severe infestation and inadequate diet.g. After successful landing on scalp skin.

Considering the animal reports of iron deficiency anemia consequent to heavy louse infestation. RR > 20. leukosit >12.7. where the eggs are usually laid. Severe pyoderma of the scalp can rarely lead irregular patches of cicatricial alopecia and cervical and occipital lymphadenopathy. Chronic and heavy lice infestation can rarely lead to secondary bacterial infection and sepsis (criteria t>38. The human head louse (Pediculus humanus capitis) is a parasite with 6 legs that cannot fly or jump. macule erythematosus.000. During its lifespan of 4 weeks. anemia.8 In this case patien with clinical presentation pruritus. humanus capitis and corporis could have a similar effect in humans. excoriations and crustation. it is not unexpected that bloodsucking P. thus lice are transmitted by head to head contact.1.6 The diagnosis of pediculosis requires the presence of live lice on the scalp.neck and the area behind the ears. parasite resistance to insecticides. It was surprising that the extensive literature review did not identify a single article or textbook notation that anemia was associated with louse infestation in humans.13 Severe infestations are associated with low socioeconomic status.12. not only the presence of nits (hatched empty eggshells). lice do not 13 . hair characteristics. Anemia (hb <12 in women) and Cervical lymphadenopathy cause complication from chronic and heavy lice.000 . genetic factors.HR>90 and suspected infection). In internal dapertemant patient diagnose with sepsis (2 criteria from 5 criteria) are leukosit > 12. As obligate human blood feeders. RR > 20 and there are suspected infection from pediculosis capitis. a female louse can lay 50–150 Eggs. and cultural habits. especially in rural females who are already suffering from iron deficiency anemia.

Viable eggs are usually located within 6 mm of the scalp as morphogenesis is enhanced at human body temperature.survive away from a human host for more than 3 days. Nymphs mature after 3 molts (instar) and become adults about 7 .13 Eggs are laid by an adult fertile female and are cemented at the base of the hair shaft nearest the scalp. a cap through which the embryo respires. dull yellow and remains attached to the hair shaft. They are of size 0. The first and second instar forms are relatively immobile.2 An adult louse deposits eggs close to the scalp and the eggs hatch within 6 to 9 days. most spreadis related to the third instar forms and adults form.3 mm. Nits take about 1 week to hatch (range 6 to 9 days). They are hard to see and are often confused for dandruff or hair spray droplets. A single fertile female can lay about 150 . the adult female secretes glue-like substance from her reproductive organ. but is about the size of a pinhead. The nit shell then becomes a more visible.1 The egg hatches to release a single nymph. The nymph looks like an adult head louse. hair accessories.1 14 . This glue quickly hardens into a “nit sheath” that covers the hair shaft and the entire egg except for the operculum. The term nit refers to either a louse egg or a louse nymph.250 eggs during its 30-day life cycle. hence not easily transmitted between individuals. hats. To attach each egg. These nits cannot be moved along the hair shaft in contrast to pseudonits. oval and usually yellow to white. The life span of a louse is generally 3 to 4 weeks and it can lay 50 to 150 eggs in this time frame. The role and extent of fomite transmission (eg.8 mm by 0. bedding) remains controversial.10 days after hatching. Within 9 to 15 days these nymphs mature to adults and begin laying eggs.

adult louse need to feed on blood several times daily. Adult louse can live up to 30 days on a person’s head and. An adult male usually dies after copulation a phenomenon common in arthropod world. Head lice move at a speed of up to 23 cm/min. Head louse rarely survives beyond 36 hours away from the host without a blood meal. Lice are repelled by light and will usually favor darker areas. can lay up to 10 eggs per day. The female is distinguished from the male by her larger size and by the posterior protrusions that create an invaginated “V” structure. Adult head louse reproduce sexually. The male has dark brown bands across his back.1 Figure 6 Life cycle of pediculus capitis1 15 . once mature. and copulation is must for female to lay eggs. which she uses to cling onto the hair shaft for laying eggs. To live. hence girls are more heavily infested than boys.

however. When released. and if any sign of active infestation is noticed. then only treatment should be advised. pyrethrin and pyrethroid treatments were 88% to 99% successful in eradicating infestations. As per partition law. 1% permethrin) are the most common pediculicides. The principle of treating ectoparasite infestation is that the parasite should acquire the maximum amount of drug with minimal systemic penetration into human. 16 . Choice of treatment is determined by age. Head lice can be treated with pyrethroids. nits) and lice. studies in the past 10 years demonstrated efficacy of only 10% to 75%. after their widespread use. pediculicide shampoos containing pyrethrin or permethrin. The physical removal of eggs has become an important part of treatment of louse infestations. wet combing and oral therapy. louse resistance patterns particular to the local area. The cuticle of louse is lipoidal and allows penetration of insecticides according to law of partition. Pyrethrins and pyrethroids (eg. This can be achieved with 3 most effective treatment options: Topical pediculicidal agents available in different formulations. Various drug formulations that can be employed for treating pediculosis are1 a) Phase separation lotions b) Evaporating lotions c) Insecticidal conditioning shampoo Every suspected household member should be screened thoroughly. The main aim of the treatment is to kill the ova (eggs. and potential toxicity. insecticides move from higher concentration (drug formulation) to lower concentration (cuticle waxes). The marked reduction in effectiveness reflects the development of resistance in Pediculus humanus capitis. These agents quickly immobilize and kill lice.

2. The physical removal of eggs has become an important part of treatment of louse infestations. pediculicide shampoos containing pyrethrin or permethrin.5 All pediculicidal agents should be rinsed after prescribed time limit with cool water over a sink. Head lice can be treated with pyrethroids. Those allergic to ragweed. pyrethrin and pyrethroid treatments were 88% to 99% successful in eradicating infestations. which is documented worldwide and which has grown rapidly with susceptibility patterns varying substantially even between schools.1.100 mg/kg/ day) and further antibiotic therapy should be tailored as per microbiological studies.25 . These agents quickly immobilize and kill lice. When released.1 For choice of treatment is determined by age. Rinsing with warm water can increase systemic absorption due to vasodilation of scalp vasculature. The common side effect of topical treatments is local irritation with scalp burning and itching. louse resistance patterns particular to the local area. after their widespread use. Pyrethrins and pyrethroids (eg. studies in the past 10 years demonstrated efficacy of only 10% to 75%. preferably firstgeneration cephalosporin (cephalexin: Adult dose. The marked reduction in effectiveness reflects the development of resistance in Pediculus humanus capitis. chrysanthemums. Any suspected bacterial infection should be treated with anti-staphylococcal antibiotic.which is documented worldwide and which has grown rapidly with susceptibility patterns varying substantially even between schools.0·25 -1 gm 6 . however. and potential toxicity. 1% permethrin) are the most common pediculicides. or related plants should avoid pyrethrins. The common side effect of topical treatments is local irritation with scalp burning and 17 .3.8 hourly/ children dose. as they might develop dyspnea and wheeze.

clean. (Gamma for seizure benzene no more than disorders age hexachloride) 4 <2 minutes to years. Those allergic to ragweed.3.5%)b.12 hours paralysis Lindane Organochlorine CNS toxicity Topical Neurological (1%) application problems. pregnancy. for 8 sensation on respiratory .c cholinesterase application stinging inhibitor.5%) cholinesterase application inhibitor inhibitor.2.1.12 hours eroded skin paralysis Carbaryl Carbamate Acetyl Topical Cholinesterase (0. then lactation add water to lather and rinse 18 . or related plants should avoid pyrethrins. as they might develop dyspnea and wheeze. chrysanthemums.itching. dry hair.5 Table 2. (0. for 8 respiratory . Topical drugs for head lice1 Agent Group Mechanism Method of Risk Factors of action use on day 1 and 8 Permetrin Synthetic Disrupts the Topical None 1% pyrethroid sodium application channel on clean and current dry hair for leading to 10 delayed minutes depolarization Permethrin Synthetic Disrupts the Topical None cream pyrethroid sodium overnight (5%)a channel application to current clean dry hair leading to delayed depolarization Malathion Organophosphate Acetyl Topical Burning.

or those with seizures or HIV. should be instructed to allow the hair to dry naturally. Lindane is not recommended for children younger than 10 years old. Instruct them to contact their healthcare provider if they develop febrile episodes related to secondary staphylococcal infection or if product fails to eliminate the infestation. repeat the treatment in 7 to 10 days as directed because resistance patterns have led to reduced ovicidal activity of pyrethoids. prescription treatment may be needed. Because resistance to insecticides can vary according to geographic location. and not to smoke near a child receiving treatment. Topical Avermectin Inhibition of Topical None Ivermectin glutamate application (1%) gated for 10 chloride minutes channel Benzyl kills head lice Topically for Pyoderma and Alcohol 5% by 10 ocular asphyxiation minutes irritation aApproved for individual more than 2 months of age. Other options if these treatments don’t work include malathion. Many pediculicides are neurotoxic. spinosad. those weighing less than 50 kg. not to use a hair dryer or flat iron while the hair is wet. cHigh alcohol content of the product (78% isopropylalcohol). To ensure success. and topical ivermectin. The side effects of neurotoxicity and anemia due to absorption through human skin are rare but serious. Women who are pregnant or breastfeeding should consult their healthcare provider before applying any treatment. Lindane is an insecticide that is recommended by the Canadian Paediatric Society as a second-line treatment in the management of head lice. Patients and their parents. Tell patients that using conditioners on the hair before treatment with a pediculicide may reduce its effectiveness by preventing it from adhering to the hair shaft and scalp. Fifty-seven countries have banned lindane for all uses and many other 19 . therefore. so teach patients (or their parents) to check age limitations on product labels and follow directions carefully. benzyl alcohol. makes it highly flammable. bApproved for individual more than 6 years of age.

Drugs like cotrimoxazole and ivermectin have demonstrated good efficacy against head lice while others like albendazole. Due to an immaturity of blood-brain barrier in pediatric population. Death results from vitamin B deficiency. Head lice depend on the vitamins B and folic acid. which occur in invertebrate nerve and muscle cells. structurally similar to the macrolide antibiotics without antibacterial activity. and thereby depriving the lice of essential vitamins.5 Systemic therapy of pediculosis acts as an adjuvant therapy in conjunction with topical treatment. 1. levamisole have shown moderate killing effect.3. containing antibiotic.10 days apart give satisfactory eradication. as a result. synthesized by bacterial flora present in its alimentary tract. causing an increase in the permeability of the cell membrane to chloride ions of the nerve or muscle cell.3. 2 oral doses of 12 mg once a day at 7 . gut flora of Pediculus is killed. leading to flaccid paralysis culminating in the death of the parasite. drug reaches the circulation of lice during blood meal.5 Ivermectin is an anthelminthic drug.countries have severely restricted uses for lindane. which is derived from Streptomyces avermitili s. which has sequential blockade of action in the folate metabolism. Fortunately. Cotrimoxazole is not approved by US-FDA for treatment of head lice. In a recent study of 2010 20 . This results in hyperpolarization. Ivermectin binds to glutamate-gated chloride channels with high affinity and specificity. Ivermectin have minimal affinity for mammalian glutamate gated chloride channel and does not readily cross the blood brain barrier in humans. The recommended dose of Ivermectin is 200 µg/kg of body weight. Ivermectin is not recommended below 5 years of age. When cotrimoxazole is administered to infested individual. pregnancy and lactation.

however.3. and minimal or no symptoms of pruritus were reported in 93% (N = 41). ultimately leading to ATP depletion and cell death.10 has been recommended. This thick petrolatum jelly covers the operculum of eggs and respiratory apparatus of lice leading to asphyxiation and death.1. uncoupling of oxidative phosphorylation and inhibition of glucose transport pathway. It also binds to β -tubulin protein of the microtubules of the parasite with high affinity and inhibits its polymerization. the study was poorly randomized and had pitfalls 21 . this method is messy and difficult to remove during bath.5 Albendazole is a broad-spectrum antiparasitic pregnancy category X drug. Cetaphil® cleansing lotion has been shown to be effective in removal of lice by causing suffocation. chiefly: Inhibition of mitochondrial function.5% (single dose + repeated at day 7) and 66. 1. workers have noticed complete resolution of excoriations in all children. used worldwide for treatment of various helminthic and protozoal infections. It is commonly employed in the dose of 400 mg as either single oral dose or repeated over 3 days. Thorough shampooing of scalp skin and hairs for 10 days is needed to remove the residual occlusive agent. Akisu et al have demonstrated the efficacy of 61. However. Ivermectin is also available as a 1% topical preparation that is applied for 10 minutes and has shown promising results.where 44 children with an active infestation were treated with a single dose of 200 µg/kg. A repeat dose of 400 mg at day 7 .6% (3 daily doses + repeated at day 7). It has manifold action against the parasite.3.5 Another messy treatment option is to apply petrolatum jelly to entire scalp surface and hairs and left on overnight with shower cap.

Ceftriaxone 2x1 gr. Use of synthetic pyrethroids (eg. Those allergic to ragweed. the presence of live lice after 2 pediculicide applications. towels. permethrin) does not result in this adverse reaction profile. or related plants should avoid pyrethrins. chrysanthemums. is now considered more likely a result of resistance than a lack of compliance with treatment.in methodology.2 Treatment also includes decontamination of clothing. More important.1 The common side effect of topical treatments is local irritation with scalp burning and itching. and all personal items by washing them in hot. Treatment failure. Patient also get systemic therapy antibiotic Inj. Patient education is key in preventing pediculosis capitis and remind patients that they can take measures to help prevent the spread of these pesky parasites. bedding.3 The misdiagnosis and overtreatment of head lice has promoted resistance to available treatments and exposed children to insecticides unnecessarily. soapy water that’s at least 130° F (54 ° C) or drying on high heat for a minimum of 20 minutes. stuffed animals. metronidazole drip 3x500 mg. as they might develop dyspnea and wheeze. 22 . the ongoing presence of nits or itch is not a sign of treatment failure. transfusi PRC 2 kolf/day until HB>10.5 This patient treated with permetrin 1 % ( Peditox) and repeat in 7 day give good results on the kill lice and in this case there were no side effects.

Guss DA. Inst. Influence of the formulations in removing eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae). Sao paulo 2015. Insaurralde IO. 5. Marty P. Singer M. Parasitol Res (2013) 112:1363–1366 3. Comparative efficacy of commercial combs in removing head lice (Pediculus humanus capitis) (Phthiraptera: Pediculidae). adults and the elderly in manaus. 2015. Türker T. Vassena C. Journal of Medical Entomology. 852–909 12. Mendes J. Gulgun M. Braoudaki M. Canadian Family Physician 2012. 1–4 10. Arab MK.4: 362-365. 7. turkey. An incurable itch. Picollo MI. 315: 801-10 8.41. Socioeconomical Factors Associated With Pediculosis (Phthiraptera: Pediculidae) in Athens. Castillo EM. Tagka A. Justiniano CSB. Laggas D. Seymour CW. Panagiotopoulos. Parasitol Res (2014) 113:3439–3444 23 . Pediculosis capitis: prevalence and its associated factors in primary school children living in rural and urban areas in kayseri. Med. Babacan O. and Leprology 2012. Smith MB BS Ran D. Turkiye Parazitol Derg 2012. Greece. An old lady with Pediculosispubis on the head hair. Barbosa CS. Moroni BR. Vassena C. Tekin Z. JEADV 2016.369:840-51 9. Balcı E. Venereology. Trop.21(2):104– 108. Rev. Severe Sepsis and Septic Shock. Goldman MD FRCPC. Severe iron deficiency anemia and lice infestation. Papanikolaou E.Head lice in hair samples from youths.58:839-41 4. Shankar-Hari M et al.78.Cannet A. 57(3):239-244. Madke M. Khopkar U. Pediculosis capitis: An update. REFERENCES 1. Toloza AC. Poll TVD. Delaunay P. Indian Journal of Dermatology. The Journal of Emergency Medicine 2011. Cueto GM. amazonas state. 30. Angus DC. 4:429-39 2. Karadağ AS. Moroni FT. Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA 2016. Karaoğlu A. A Pediculid Case: Autosensitization Dermatitis Caused by Pediculosis Capitis. Koenig M. 36: 185-7 11. Gallardo A. brazil. Toloza A. An incurable itch. Picollo MI. Christine H. Cent Eur J Public Health 2013. N Engl J Med 2013. Lambrou GI. Takc Z. Akhoundi M. 6. Deutschman CS.

13. ISRN Dermatology 2012. Dermatologic Therapy. Assessment of the Efficacy and Safety of a New Treatment for Head Lice. Messikh R. Vol. Mary SM. Guidelines for treatment of pediculosis capitis 2008. Ahmad HM. Aziz RTA. 27. Azim ESA. Assessment of topical versus oral ivermectin as a treatment for head lice. 2014. Jeudy A. 15. 1-6. 307–310 24 . 14.

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