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Med Trop (Mars). 2005;65(1):13-23.
[Lice and lice-borne diseases in humans]
[Article in French]
Houhamdi L, Parola P, Raoult D.
L 'Unite des Rickettsies, CNRS UMR 6020, Marseille, France.
Among the three lice which parasite the human being, the human body louse, Pediculus humanus humanus, is a vector of infectious diseases. It lives and multiplies in clothes and human infestation is associated with cold weather and a lack of hygiene. Three pathogenic bacteria are transmitted by the body louse: 1) Rickettsia prowazekii, the agent of epidemic typhus of which the most recent outbreak (and the largest since World War II) was observed during the civil war in Burundi; 2) Borrelia recurrentis, the agent of relapsing fever, historically responsible of massive outbreaks in Eurasia and Africa, which prevails currently in Ethiopia and neighboring countries; 3) Bartonella quintana, the agent of trench fever, bacillary angiomatosis, chronic bacteremia, endocarditis, and lymphadenopathy. Body louse infestation, associated with a decline in social and hygienic conditions provoked by civil unrest and economic instability, is reemergent worldwide. Recently, a forth human pathogen, Acinetobacter baumannii, has been associated to the body louse.
Am J Manag Care. 2004 Sep;10(9 Suppl):S264-8.
Clinical update on resistance and treatment of Pediculosis capitis.
Global Health Associates of Miami, Inc, Florida, USA.
The anatomy and physiology of head lice make them extremely adaptable to their human hosts but also difficult to eradicate. Their coloring and small size make them difficult to see, and the larvae, or nymphs, have multiple exoskeletons for protection. When exposed to pediculicides, a nymph can shed its outer exoskeleton and receive only a sublethal dose. Through natural selection, head lice have developed resistance to commonly used pediculicides, making it increasingly difficult to eliminate infestations. Other contributors to resistance include changes in formulations of pediculicides and improper use. Over the last 20 years, the efficacy of pyrethrins has declined because of necessary safety changes in formulations and unintentional effects of new packaging on chemical components of these products. Pediculicides designed to be applied to wet hair may become too diluted to produce the desired effect. Patients also may use too little product to conserve costs. The combination of decreased product efficacy and exposure of head lice to diluted or insufficient amounts of pediculicides has reduced their effectiveness substantially. Studies comparing the current efficacy of several over-the-counter and prescription pediculicides with effectiveness in the 1980s has shown that OVIDE (malathion) Lotion, 0.5% is the only product that has retained its efficacy over time. The efficacy of over-the-counter pyrethrin products had declined significantly, and lindane, another prescription product, was least effective of all products tested both in the 1980s and in more recent studies. In addition to retaining its efficacy, malathion 0.5% also is effective when applied for only 20 minutes. The shorter application time is safer for children and also decreases the likelihood that residual product remains in the hair, further contributing to resistance.