FIGURE 4.13 Eggs of the human body louse (Pediculus humanus humanus) attached to clothing. (Courtesy of Elton J. Hansens.)

FIGURE 4.13 Eggs of the human body louse (Pediculus humanus humanus) attached to clothing. (Courtesy of Elton J. Hansens.)

and creases. Each nymphal instar lasts for 3—5 days, and adults can live for up to 30 days.

Biting by body lice often causes intense irritation, with each bite site typically developing into a small red papule with a tiny central clot. The bites usually itch for several days but occasionally for a week or more. Persons exposed to numerous bites over long periods often become desensitized and show little or no reaction to subsequent bites. Persons with chronic body louse infestations may develop a generalized skin thickening and discoloration called Vagabond disease or Hobo disease, names depicting a lifestyle that can promote infestation by body lice. Several additional symptoms may accompany chronic infestations. These include lymphadenopathy (swollen lymph nodes), edema, increased body temperature often accompanied by fever, a diffuse rash, headache, joint pain, and muscle stiffness.

Some people develop allergies to body lice. Occasionally, patients experience a generalized dermatitis in response to one bite or small numbers of bites. A form of asthmatic bronchitis has similarly been recorded in response to allergy to louse infestations. Secondary infections such as impetigo or blood poisoning can also result from body louse infestations.

Body lice tend to leave persons with elevated body temperatures and may crawl across the substrate to infest a nearby person. This has epidemiological significance because high body temperatures of lousy persons often result from fever caused by infection with louse-borne pathogens.

Human head louse (Pedieulus bumanus capitis)

The human head louse is virtually indistinguishable from the human body louse on the basis of morphological characters and its life cycle. Unless a series of specimens is available for analysis it is often impossible to separate the two subspecies. Generally, adult head lice are slighdy smaller (2.1—3.3 mm in length) than body lice.

As indicated by their name, human head lice typically infest the scalp and head region, rather than other areas of the body infested by body lice. Females attach their eggs to the base of individual hairs. As the hair grows, the eggs become further displaced from the scalp. An indication of how long a patient has been infested can be gleaned by measuring the farthest distance of eggs from the scalp and comparing this to the growth rate of hair.

Today, head lice are far more frequently encountered than body lice, especially in developed countries. Transmission occurs by person-to-person contact and via shared objects such as combs, brushes, headphones, and caps. School-age children are at high risk because they are often more likely to share such items. Some school districts in the United States and Britain have infestation prevalences approaching 50% in students. It has been estimated that 6—12 million people, principally children, are infested with head lice annually in the United States. Some ethnic groups, such as persons of African origin, have coarser head hairs and are less prone to head louse infestations. The reason for this is simply that the tibio-tarsal claws of these lice cannot efficiently grip the thicker hairs.

Although head lice are not known to transmit pathogens, heavy infestations can cause severe irritation. As is the case with human body lice, the resultant scratching often leads to secondary infections such as impetigo, pyoderma, or blood poisoning. Severe head louse infestations occasionally result in the formation of scabby crusts beneath which the lice tend to aggregate. Enlarged lymph nodes in the neck region may accompany such infestations.

Human crab louse (Pthirus pubis)

The crab louse, or pubic louse, is a medium-sized (1.1 — 1.8 mm long), squat louse (Fig. 4.7B), with robust tibio-tarsal claws used for grasping thick hairs, especially those in the pubic region. It also may infest coarse hairs on other parts of the body, such as the eyebrows, eyelashes, chest hairs, beards, moustaches, and armpits. This louse typically transfers between human partners during sexual intercourse and other intimate contact; in France, crab lice are described as "papillons d'amour" (butterflies of love). Transfer via infested bed linen or toilet seats can also occur. This is uncommon, however, because crab lice can survive for only a few hours off the host.

Female crab lice lay an average of three eggs per day. Eggs hatch after 7—8 days; the three nymphal instars together last for 13—17 days. Under optimal conditions the generation time is 20—25 days. The intense itching caused by these lice is often accompanied by purplish lesions at bite sites and by small blood spots from squashed lice or louse feces on underwear. Crab lice are widely distributed and relatively common throughout the world. They are not known to transmit any pathogens. One epidemiological study, however, revealed a positive relationship between infection with hepatitis B virus and crab louse infestation.

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