UNIT-IV

LOUSE AS DISEASE VECTORS

ZOOLOGY

CONTENTS
 Human Louse as insect Vector
 Louse Borne Diseases
o Louse Borne Typhus Fever
o Relapsing Fever
o Trench Fever
o Vagabond’s Disease
o Phthiriasis

DR. WKB’S ZOOLOGY STUDY MATERIAL

B.SC. SEMESTER-VI (ZOOLOGY)

Authored By: Dr. Wahied Khawar Balwan

M.Sc.,Ph.D., D.Litt., D.Sc., PDF-H, FSLSc., FZSI, FAELS, FBPS, FABRF, FSASS, FGESA, FC-ISCA, SEFM, FIIOR, FGT, FIOASD
Senior Assistant Professor in Zoology, Higher Education Department Jammu & Kashmir, India
E-mail: [email protected]
Mob. No.: +91-94193-69557
 UNIT-IV LOUSE AS DISEASE VECTORS

HUMAN LOUSE AS humanus corporis (2.3 – 3.6 mm in

length).
IMPORTANT INSECT VECTOR 3. The Crab louse or Pubic louse,
Classification Phthirus pubis (1.1 – 1.8 mm in
Phylum : Arthropoda length).
Class : Insects They are 1.5 – 4mm long, flattened,
Order : Phthiraptera wingless and greyish white insect with
Family : Pediculidae piercing and sucking type of mouth parts.
Genus : Pediculus They live as blood sucking ectoparasite of
The louse has killed more human humans in almost all parts of the world.
beings than has any other insect, with, Pediculus humanus corporis is called
perhaps, the malaria mosquito excepted. body louse and is found in hairs of arm
Historically, lice are the major insect pots, clothes and garments. Pediculus
vector of disease in temperate and cold humanus capitis is found in head hair,
lands, as mosquitoes are in the hot ones. hence called head louse. Phthirus pubis,
Description known as crab louse, is found in the
Lice (Louse is singular) are tiny, hairs of pubic region of human beings.
flattened and flightless insects with Head lice and body lice are
parasitic mode of nutrition. They live on morphologically indistinguishable,
the body surface of human beings and although head lice are smaller than body
other mammals infesting skin and hair. lice. The head louse attaches itself to the
The eggs or nits are cemented to the hair hair or scalp by means of claws on its
or plumage of the host. legs. Young lice are sometimes called red
Human louse, a common type of backs because of their blood red color
sucking louse that is found wherever after feeding. They are called black backs,
human beings live, feeds on blood and or gray backs, after digestion has taken
can be an important carrier of epidemic place. The human head louse attaches
typhus and other louse borne human its eggs to the base of a hair, close to the
diseases such as trench fever and scalp. The body louse is larger than the
relapsing fever. Generally, lice spread head louse and ranges in color from
rapidly under conditions (frequently white to brown. It lives in the seams of
unsanitary) of crowding or close personal clothes but is not dependent upon
contact. These conditions occur in many clothing. The female lays her eggs, which
schools when children are in contact hatch in about a week, in underclothes.
through play (head lice particularly). Body lice are hardier since they live on
Three types of lice infest humans clothing and can survive if separated
namely: from human contact for up to a week
1. The Head louse, Pediculus without feeding. The head lice and pubic
humanus capitis (2.1 – 3.3 mm in lice are highly dependent upon human
length). body warmth and will die if separated
2. The Body louse or cootie or the from their host for 24 hours. The three
clothing lice, Pediculus humanus types favour different regions of the body
humanus, also known as Pediculus and live distinct and separate lifestyles.
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 1
 UNIT-IV LOUSE AS DISEASE VECTORS

several fold. First of all, the social taboo

or unaceptance of the condition is
particularly apparent. Louse infestations
also may lead to personal discomfort,
anemia, lethargy and skin maladies if
allowed to continue without treatment.
The toxic reaction of louse feeding causes
itchiness, swelling, red spots (blue spots
with crab lice) and rash. Additionally,
continued scratching may lead to
Fig.: Human Louse
infection. This insect causes itching due
to biting and sucking of blood. While
Life History
sucking, they also transmit germs of
Eggs are laid by the fertilized
some diseases such as relapsing fever,
female. After about 7 days, the eggs
trench fever, typhus fever etc.
hatch into miniature larvae. These now
Control
feed and grow. An adult lives only for a
1. Cleanliness regarding clothes and
month. Lice have three distinct stages
body must be maintained. Change
namely the egg (nit), the nymph and the
and launder clothing often,
adult. The fertilized female louse lays
particularly underwear.
eggs (upto 200 in head and body lice),
2. The body louse is transferred by
which hatch in about a week. The young
direct contact. It is sensitive to
nymphs go through two moults. Nymph
heat and cannot survive hot
development takes about 2-3 weeks. The
temperatures. Therefore, ordinary
third moult produces adult lice. The
laundry procedures will kill it.
adult lives for 3-4 weeks.
3. Bathe frequently with hot water
Human Louse as Vector or Medical
and soap and rub dry with a rough
Importance of Human Louse
towel. This habit is not conducive
The best evidence of louse infection
to continued louse infestation.
is the discovery of the tiny egg cases
4. Avoid unsanitary, crowded
called nits attached to body hair or
conditions when possible.
clothing. In moving from host to host,
5. Contact with infected person,
lice may spread many diseases, including
particularly at night, must be
tapeworm infestation in dogs and murine
avoided.
typhus in rats. The only significant
6. Head lice pass from host to host by
disease spread by the lice in human is
direct contact. The easiest way to
typhus which is spread by body lice and
get rid of them is to keep the hair
is restricted to the very poorest areas.
and scalp clean and to use affine
Otherwise lice are merely a nuisance
tooth comb frequently. In earlier
because of allergic reactions and minor
times, when hygiene was not
skin infections caused by their bites.
commonly practiced, heads were
The implications of lice infestations
shaved and wigs worn in an effort
called pediculosis and pthiriasis are
to get rid of head lice. In some
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 2
 UNIT-IV LOUSE AS DISEASE VECTORS

societies, head lice are controlled disease will remain viable for many
by applying oil to the hair. The oil weeks in the dead louse.
suffocates the growing louse by Symptoms
sealing the air vents in the Symptoms of epidemic typhus begin
operculum of egg casing. within two weeks after contact with
7. Use of shampoo to clean the hair. infected body lice. Symptoms may
8. Use of insecticides for delousing. include:
 Severe Headache
LOUSE BORNE TYPHUS
 Sustained High Fever
FEVER  Cough
Louse Borne Typhus fever is also  Rash (A rash begins on the chest
called as Epidemic typhus because the about five days after the fever
disease often causes epidemics following appears, and spreads to the trunk
wars and natural disasters. It is an and extremities).
uncommon disease caused by bacteria  Severe Muscle pain
called Rickettsia prowazekii. It is  Chills (Feeling of coldness
transmitted by infected human body lice occurring during a high fever)
(Pediculus humanus corporis). It was Chills occur during fever due to the release of
responsible for millions of deaths in cytokines and prostaglandins as part of the
previous centuries but is now considered inflammatory response, which increases the set
as a rare disease. Occasionally, cases point for body temperature in the hypothalamus.
continue to occur, in areas where The increased set point causes the body
extreme overcrowding is common and temperature to rise (pyrexia), but also makes the
body lice can travel from one person to patient feel cold or chills until the new set point is
another. In the United States, rare cases reached. Shivering also occurs along with chills
of epidemic typhus, called sylvatic because the patient's body produces heat during
typhus, can occur. These cases occur muscle contraction in a physiological attempt to
when people are exposed to flying increase body temperature to the new set point.
squirrels and their nests.  Falling Blood pressure
Transmission  Stupor (Lack of critical mental
Feeding on a human who carries the function and a level of
bacterium infects the louse. Rickettsia consciousness wherein an affected
prowazekii grows in the louse's gut and person is almost entirely
is excreted in its feces. The disease is unresponsive and only responds to
then transmitted to an uninfected intense stimuli such as pain).
human who scratches the louse bite  Sensitivity to light
(which itches) and rubs the feces into the  Derilium (Also known as acute
wound. The incubation period is one to confusional state, is an organically
two weeks. Rickettsia prowazekii can caused decline from a previous
remain viable and virulent in the dried baseline mental functioning that
louse feces for many days. Typhus will develops over a short period of
eventually kill the louse, though the time, typically hours to days.

By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 3
 UNIT-IV LOUSE AS DISEASE VECTORS

Delirium is a syndrome o Treat bedding, uniforms, and

encompassing disturbances in other clothing with 1%
attention, consciousness, and permethrin or 10% DDT or
cognition). 1& Malathion. These kill lice
 Death and may provide long-lasting
Treatment protection for clothing for
 It is treated with the antibiotic many washings.
doxycycline, Tetracycline and o People should avoid contact
Chloramphenicol. with flying squirrels and
 Antibiotics are most effective when their nests.
given soon after symptoms begin. RELAPSING FEVER
 Intravenous fluids and oxygen may
It is also called as Tick Fever or
be needed to stabilise the patient.
Famine Fever or Recurrent Fever. It is a
recurring febrile disease caused by
Prevention
several species of the spirochete Borrelia
 There is no vaccine to prevent
and is transmitted by lice or ticks. It is
epidemic typhus.
usually characterized by repeated
 Reduce your risk of getting
episodes of fever. The Sudden fever
epidemic typhus by avoiding
occurs within two weeks of infection.
overcrowded areas.
Causes
 Body lice thrive in areas that are
Relapsing fever is an infection
overcrowded and where people
caused by several species of bacteria in
aren't able to bathe or change
the Borrelia family. There are two major
clothes regularly. To avoid body
forms of relapsing fever:
louse infestations:
1. Tick Borne Relapsing Fever
o Bathe regularly and change
(TBRF): It is transmitted by the
into clean clothes at least
Ornithodoros tick. It occurs in
once a week.
Africa, Spain, Saudi Arabia, Asia
o Wash louse-infested clothing
and certain areas in the western
at least once a week.
United States and Canada. The
Machine wash and dry
bacteria species associated with
infested clothing and
TBRF are Borrelia duttoni, Borrelia
bedding using hot water (at
hermsii, and Borrelia parkerii.
least 130°F), and dry on high
In TRBF, multiple episodes
heat when possible. Clothing
of fever occur, and each may last
and items that are not
up to 3 days. People may not have
washable can be dry-cleaned
a fever for up to 2 weeks, and then
or sealed in a plastic bag
it returns.
and stored for two weeks.
2. Louse Borne Relapsing Fever
o Do not share clothing, beds,
(LBRF): It is transmitted by body
bedding, or towels used by a
lice. It is most common in Asia,
person who has body lice or
Africa, and Central and South
is infected with typhus.
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 4
 UNIT-IV LOUSE AS DISEASE VECTORS

America. The bacteria species midgut of the louse migrate to the

associated with LBRF is Borrelia haemocoel where they multiply.
recurrentis. It has a linear From the sixth day after an
chromosome of 1Mb and five or six infective blood meal, spirochaetes
plasmids that vary in size from 11 become increasingly abundant in
to 192kb. Borreliae are helical, 8 to the haemocoel of the vector.
30 µm long and 0.2 to 0.5 µm in  Transmission occurs when the
diameter, are motile and have 8 to louse is crushed and the infected
30 flagella. haemocoel is released onto the
LBRF is mainly a disease of the human skin. Borrelia recurrentis is
developing world. It is currently able to penetrate intact mucosa
seen in Ethiopia and Sudan. and skin. The transmission
Famine, war, and the movement of invokes the death of the louse,
refugee groups often results in hence an individual louse can only
LBRF epidemics. infect one person. Consequently,
In LBRF, the fever commonly louse borne relapsing fever
lasts 3 to 6 days. It is often outbreaks are dependent on high
followed by a single, milder episode louse densities in human
of fever. populations.
The disease can be severe  On average a mature body louse
and death occurs in 10% to 40% of will live for 20–30 days.
cases in the absence of appropriate Symptoms
treatment and in 2-5% of treated The incubation period is usually
patients. between four and eight days (range: 2–
In both forms, the fever 15). The symptoms are associated with
episode may end in "crisis." This circulation or presence of bacteria in the
consists of shaking chills, followed blood (Bacteremia). The onset of
by intense sweating, falling body symptoms is usually sudden.
temperature, and low blood Common symptoms include:
pressure. This stage may result in  High fever
death.  General malaise
Transmission  Chills and sweats
 Borrelia recurrentis is transmitted  Headache
from human to human by the body  Meningism
louse Pediculus humanus humanus.  Myalgia/arthralgia and
Head lice, Pediculus humanus  Non-specific gastrointestinal
capitis, have been found to be symptoms (nausea and
infected, but their role as vector vomiting).
has not been established. Mycocutaneous symptoms include
 When feeding on an infected
conjunctival injection, scattered
human, the body louse will ingest petechiae and erythematous rash.
Borrelia recurrentis. The
spirochaetes that survive in the
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 5
 UNIT-IV LOUSE AS DISEASE VECTORS

Cardio-respiratory symptoms such linked with periods of war and

as tachycardia, mild tachypnea and non- famine.
productive cough can occur.  The geographical distribution of
Patients may present with LBRF has declined due to
hepatomegaly and splenomegaly, with improvements in living standards.
risk of splenic rupture. Currently, the disease is primarily
Neurological and ocular found in limited endemic foci in
complications can occur like Ethiopia but also in Somalia and
meningoencephalitis, meningitis, Sudan. The disease has also been
neuropathies and cranial-nerve palsy, recorded in the rural Andean
iritis and acute opthalmitis. community in Peru and in
Haemorrhage is a common complication northern China.
with epistaxis, blood-tinged sputum and  Antibodies to Borrelia recurrentis
even central nervous system or were detected in homeless
gastrointestinal haemorrhage. populations in Marseille in 2002,
The symptoms increase in intensity suggesting that a small, unnoticed
over five days on average (range: 2–7), outbreak occurred in this
then subside as the pathogenic agent particular homeless population
disappears from the blood. Diagnosis
After a first remission, spirochaetes  The diagnosis of relapsing fever is
reappear in the blood and symptoms suggested by recurrent fever.
recur. The relapse occurs over several  The diagnostic test of choice is the
days to weeks, but fewer than 10 direct identification of spirochaetes
relapses are usually observed among in the blood.
untreated patients.  The leucocyte count is often low
Infection confers a partial immunity and thrombocythaemia is usually
due to antigenic variation of Borrelia observed.
strains. Treatment
The disease can be severe and death 1. Relapsing fever is easily treated
occurs in 10% to 40% symptomatic cases with a one to two week course of
in the absence of appropriate treatment, antibiotics and most people
and in 2% to 5% of treated patients. improve within 24 hours.
Epidemiology Complications and death due to
 Historically, the disease has been relapsing fever are rare.
most common among slum 2. In relapsing fever transmitted by
dwellers, prisoners and persons ticks, tetracycline or erythromycin
living in impoverished overcrowded 500 mg orally every 6 hours is
and unhygienic conditions. given for 5 to 10 days. For louse
 In the first half of the twentieth transmitted relapsing fever, a
century, major outbreaks of louse- single 500 mg oral dose of either
borne relapsing fever occurred in drug is effective.
Eastern Europe, the Balkans, the
former Soviet Union and Africa,
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 6
 UNIT-IV LOUSE AS DISEASE VECTORS

3. Doxycycline 100 mg orally every Prevention

12 hours for 5 to 10 days is also 1. Primary prevention of louse borne
effective. relapsing fever relies on measures
4. Children < 8 years of age are given to avoid infestation with body lice.
erythromycin estolate 10 mg/kg 2. Body lice infestations are linked to
orally 3 times a day. low socioeconomic status, over-
5. When vomiting or severe disease crowding and poor personal
precludes oral administration or hygiene. In Europe, populations at
when the CNS is affected, risk for such infestations, and
parenteral ceftriaxone 2 g/day for hence louse borne diseases,
10 to 14 days or doxycycline 1 to 2 include the homeless and
mg/kg, every 12 to 24 hours may migrants.
be given to adults or children > 8 3. Body lice are transmitted primarily
years of age. Children < 8 years by direct contact with an infested
are given penicillin G 25,000 person, transmission of the body
units/kg, every 6 hours. lice also occurs through fomites,
6. Dehydration and electrolyte like clothes or bedding. Lice
imbalance should be corrected multiply rapidly and a population
with parenteral fluids. can increase by 11% per day.
7. Acetaminophen with oxycodone or 4. Body lice are highly susceptible to
hydrocodone may be used for cold and desiccation. They are
severe headache. found on clothing close to the
8. Nausea and vomiting should be human skin. Discarding infected
treated with prochlorperazine 5 to clothes is an effective way to
10 mg orally or intramuscular control the infestation. If this is
once a day to 4 times a day. not possible, clothes should be
A potential severe or fatal Jarisch– washed at a temperature of 60oC
Herxheimer reaction can be induced by or above.
antibiotic treatment of louse-borne 5. In outbreak situations, dusting
relapsing fever, requiring the close powder with an appropriate
monitoring of patients under antibiotic insecticide has been applied to
treatment. This reaction is often obtain a rapid decrease of infested
observed a few hours after the first persons with some lasting benefits.
antibiotic treatment and follows two Few cases of LBRF
successive phases: the chill phase transmission through blood
(rigours, high fever, anxiety or confusion, transfusion have been reported.
increasing metabolic rate) and the flush Data on survival and persistence of
phase (decrease in temperature, Borrelia recurrentis in donated
drenching sweat, and significant blood are lacking. Transmission
decrease in arterial pressure and through organs or cells and tissues
myocardial dysfunction requiring has not been reported. Due to
supportive care for monitoring fluid possible transmission through
balance and arterial/venous pressure). substances of human origin,
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 7
 UNIT-IV LOUSE AS DISEASE VECTORS

infected donors should be deferred When feeding on an infected


until signs and symptoms have human, the body louse ingests B.
subsided and a course of treatment quintana which multiplies in the
has been completed. Donation of intestinal tract of the body louse.
cells and tissues from deceased Body louse infection is lifelong. B.
donors with louse-borne relapsing quintana is excreted in body louse
fever is not recommended. faeces.
 Infected dried body louse faeces
TRENCH FEVER
can remain infectious for 12
It is also called as Bartonella
months and new cases can arise
quintana infection. It is a vector borne
for some time even after
disease primarily transmitted by the
elimination of the louse population.
human body louse Pediculus humanus
 Human infection probably results
humanus. The infection is associated
from inoculation of B. quintana
with a wide variety of clinical conditions,
from contaminated louse faeces
including chronic bacteraemia,
when scratching and itching. The
endocarditis, lymphadenopathy and
transmission does not invoke the
bacillary angiomatosis. Since the 1990s,
death of the louse, therefore an
it has been recognised as a re-emerging
individual louse can spread the
pathogen among impoverished and
disease to several persons.
homeless populations so called ‘urban
 On average a mature body louse
trench fever’ living in unsanitary
lives for 20–30 days.
conditions and crowded areas
Symptoms
predisposing them to infestation with
 The incubation period is usually
ectoparasites that may transmit the
between 15 and 25 days but has
infection.
been reported as shorter, up to six
B. quintana is slow-growing Gram-
days, under experimental
negative bacterium with short rods
conditions.
morphology (0.3 to 0.5 mm wide and 1.0
 Clinical manifestations of B.
to 1.7 mm long). B. quintana has a
quintana infection include the
circular chromosome (≈1.6 Mb)
classical recurrent fever ‘trench
recognised as a genomic derivative of
fever’, chronic bacteraemia,
Bartonella henselae, the causative agent
endocarditis and, among immune-
of cat scratch disease.
compromised individuals, bacillary
Transmission
angiomatosis. Lymphadenopathy
 B. quintana is transmitted from
and ocular complications are
human to human by the body
occasionally reported.
louse Pediculus humanus humanus.
 Trench fever or quintana
However head lice, Pediculus
fever (5-day fever) is a
humanus capitis, have been found
recurrent fever among non-
to be infected, but their role as a
immunocompromised
vector has not been established.
individuals. Fever episodes

By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 8
 UNIT-IV LOUSE AS DISEASE VECTORS

lasting for one to five days angiomatosis due to B. quintana was

are associated with non- mainly reported among immunodeficiency
specific and varying virus-infected persons in the 1990s, but
symptoms such as severe can affect other immunocompromised
headache, Tenderness or individuals.
pain in the shin, Weakness, Epidemiology
Anorexia or abdominal pain.  Historically, trench fever was
Splenomegaly is common. described in relation to outbreaks
The number of periodic fever among soldiers during the first and
episodes varies (from one to second world wars. Since then, few
five in general) and are cases have been documented,
separated with mainly in Europe and Russia. The
asymptomatic periods of disease is considered to have a
four to six days. Episodes worldwide distribution based on
usually decrease in severity serological evidence and molecular
over time. Although it identification (Africa and South-
causes prolonged disability, east Asia notably).
the mortality of trench fever  During the 1990s, B. quintana
is low. infections and outbreaks were
 Chronic bacteraemia is reported among the homeless in
possible due the ability of B. USA and Europe (France) leading
quintana to cause to the infection being recognised as
intraerythrocytic paratism a re-emerging disease among
that can be asymptomatic. deprived populations. The main
This has been demonstrated risk factors for infection are
in both impoverished, overcrowded and
immunocompromised and unhygienic conditions, chronic
immunocompetent patients. alcoholism, cat-contact, and body
 B. quintana infection is a louse infestation. The disease is
significant cause of blood therefore primarily observed
culture-negative among homeless people.
endocarditis. Fever is  Small case series of B. quintana
frequently reported. infections were reported among
Valvular vegetations are immune-competent patients
often visible on without body louse infestation: a
echocardiography. family cluster with pigeon mites
Bacillary angiomatosis is a proliferative (Dermanyssus sp.) as the
vascular disease due to both B. quintana presumed vector in Czech Republic
and B. henselae. The disease is (2007) and three paediatric cases
characterised by angioproliferative lesions of lymphadenopathy in Italy (2014).
of skin (sarcoma-like skin lesions) or  Humans are considered the main
various organs (spleen, liver, bone host for this organism but several
marrow and lymph nodes). Bacillary publications have reported
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 9
 UNIT-IV LOUSE AS DISEASE VECTORS

isolation or molecular 3 mg/kg/day IV for 14 days

identification of the bacteria in can be added. Ceftriaxone
mammals (macaques, cats and and fluoroquinolones may
dogs). also be considered as an
Diagnosis alternative therapy.
 The laboratory diagnostic of choice Prevention
is isolation in culture from blood or  Primary prevention of B. quintana
tissues on specific media under relies on measures to avoid
specific conditions. infestation with body lice.
 Due the low-growing characteristic  Body louse infestations are linked
of B. quintana, diagnosis is often to low socioeconomic status, over-
based on supportive diagnostic crowding and poor personal
tests such as serology or hygiene.
polymerase chain reaction (PCR)  Body lice are transmitted primarily
based genomic assays. by direct contact with an infested
Treatment person; transmission of the body
 Information on efficacy of lice also occurs through fomites,
treatment is limited due to the clothes or bedding. Lice multiply
small number of studies available rapidly and a population can
and so choice of treatment relies increase by 11% per day.
on expert recommendations.  Body lice are highly susceptible to
 Antibiotic treatment protocols are cold and desiccation. They are
different according to the disease found on clothing close to the
presentation: human skin. Discarding infested
 Trench fever and chronic clothes is an effective way to
bacteraemia: Doxycycline control the infestation. If this is
200 mg orally daily for 28 not possible, clothes should be
days combined with washed at a temperature above
gentamicin 3 mg/kg/day 60ºC. Oral ivermectin for body
intravenous for 14 days. delousing has been proposed for
 Endocarditis: Doxycycline populations with low compliancy
100 mg orally twice daily for but does not protect from lice
six weeks combined with reinfestation.
gentamicin 3 mg/kg/day  In outbreak situations, dusting
intravenous for 14 days. powder with an appropriate
 Bacillary angiomatosis: insecticide has been applied to
Erythromycin 500 mg orally obtain a rapid decrease of infested
four times daily for three persons with some lasting benefits.
months (first line therapy) or Although there are no reports of
doxycycline 100 mg orally transmission, a risk of B. quintana
twice daily for three months infection by substances of human origin
(alternative therapy); in (SoHO) cannot be excluded because of
refractory cases, gentamicin possible donations by asymptomatic
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 10
 UNIT-IV LOUSE AS DISEASE VECTORS

donors with bacteraemia. In addition, a quintana, relapsing fever caused by

case of possible transfusion transmission Borrelia recurrentis, and epidemic
of the closely related B. henselae has (louse borne) typhus caused by
been reported. Due to possible Rickettsia prowazekii. Trench fever
transmissibility through SoHO, infected and epidemic typhus are not
donors should be deferred for at least two transmitted by louse bites but rather
weeks after signs and symptoms have through infected feces. When feeding,
resolved and a course of effective the body louse often excretes its feces
treatment has been completed. Donation onto the skin, which can be
of organs, cells and tissues from inadvertently rubbed into the bite site,
deceased donors with a trench fever is eyes, or mucous membranes.
not recommended. Transmission of Rickettsia prowazekii
VAGABOND’S DISEASE can also occur through inhalation of
aerosolized fecal dust, which has
It is also called as Pediculosis
been documented as a potential
corporis or pediculosis vestimenti. It is a
source of infection for clinicians.
cutaneous condition caused by Body lice
Unlike trench fever and epidemic
(specifically Pediculus corporis). It is
typhus, transmission of relapsing
called vagabond disease because it is
fever, caused by Borrelia recurrentis,
common in vagabonds i.e. peoples
does not occur through contaminated
wandering from place to place without
feces. Infection occurs when a person
any settled home also called nomadic or
crushes an infected louse, and the
a vagabond tribe.
bacteria then invade the bite site or
Pathophysiology
the skin of the fingers or hand that
1. Body lice infestations can involve
crushed the louse. In addition, a
thousands of mites, each biting an
person can acquire the infection if
average of 5 times per day. During
they rub their eye or put their fingers
feeding, body lice pierce the skin,
in their mouth after crushing the
inject a salivary anticoagulant, and
louse.
then suck the blood meal into their
3. Some pathogenic bacteria found in
digestive tract. Bites of the body
body lice include Salmonella typhi,
louse can produce a variety of skin
Serratia marcescens, and
lesions, and severe pruritus thought
Acinetobacter baumannii. The DNA of
to be due to an allergic and/or
Yersinia pestis, which causes
inflammatory reaction to the louse
bubonic plague, has been identified
saliva. Intense scratching of pruritic
in body lice, and it is believed they
bites can result in skin excoriation,
may serve as supplementary vectors
potentially leading to significant
for the organism.
secondary bacterial infections.
Epidemiology
2. The greatest medical impact of body
As body lice cannot jump or fly, they
lice is their ability to transmit
spread primarily by direct contact,
bacterial diseases, most notably
though transmission can also occur
trench fever caused by Bartonella
through clothing, bed linens, and towels.
By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 11
 UNIT-IV LOUSE AS DISEASE VECTORS

Infestations are strongly correlated with distributed worldwide. Current

poor body hygiene, lack of access to worldwide prevalence has been very
clean clothing, and crowded conditions, approximately estimated at two percent
which facilitate spread of the lice of the human population.
through direct physical contact. Life Cycle of Pubic Lice
Outbreaks most commonly occur in Pubic lice (Pthirus pubis) have three
situations where large groups of people stages namely egg, nymph and adult.
live in unsanitary conditions such as Eggs (nits) are laid on a hair shaft.
prisons or camps of large groups of Females will lay approximately 30 eggs
refugees from war, famine or natural during their 3-4 week life span. Eggs
disasters. hatch after about a week and become
Treatment / Management nymphs, which look like smaller versions
1. Treatment of body lice does not of the adults. The nymphs undergo three
usually require the use of a moults before becoming adults. Adults
pediculicide because are 1.5-2.0 mm long and flattened. They
improvements in hygiene, are much broader in comparison to head
including showering and and body lice. Adults are found only on
laundering clothing in hot water at the human host and require human
least 50oC, will most often blood to survive. If adults are forced off
eradicate the infestation. the host, they will die within 24-48 hours
2. All clothing, bed linens and towels without a blood feeding.
should be washed in hot water and Symptoms
machine dried on the hot cycle. The majority of infestations are
3. Itching can be treated with topical asymptomatic. When symptoms are
corticosteroids and systemic noted they may include:
antihistamines.  Tickling feeling of something
4. Secondary skin infections are moving in the hair.
managed with appropriate  Itching, caused by an allergic
systemic antibiotics. reaction to louse saliva and
5. Permethrin cream applied to the irritability.
entire body for 8 to 10 hours.  Pruritis caused by the bites of
6. Additional treatments include 5% pubic lice may be very intense.
benzyl alcohol lotion, 0.5%  Discoloration of the skin may
ivermectin lotion, 0.5% Malathion occur if the infestation is left
lotion, 0.9% spinosad topical untreated for an extended length of
suspension, and 1% lindane time.
shampoo. Infestation of eyelashes with pubic lice is
PHTHIRIASIS called phthiriasis palpebrarum or
It is also called as pubic louse pediculosis ciliarum. Infections of the
infestation or Phthiriasis pubis. It is eyelashes may be treated with either
caused by Pthirus pubis, the pubic or petroleum jelly applied twice daily for 10
crab louse. Phthiriasis is common and is

By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 12
 UNIT-IV LOUSE AS DISEASE VECTORS

days or Malathion, phenothrin, and

carbaryl.
Transmission
The main mode of transmission is
person to person by sexual contact with
someone who is already infested. Fomites
(bedding, clothing) may play a minor role,
although rare.
Diagnosis
A pubic louse infestation is usually
diagnosed by carefully examining pubic
hair for nits, nymphs, and adult lice. Lice
and nits can be removed either with
forceps or by cutting the infested hair
with scissors (with the exception of an
infestation of the eye area). A magnifying
glass or a stereo-microscope can be used
for identification.
Treatment / Management
1. Management includes initial
bathing with soap and water,
followed by two topical or systemic
treatments with pediculicides, 7 to
10 days apart.
2. Effective pediculicides include
0.33% Pyrethrins + 4% piperonyl
butoxide shampoo, 1% - 5%
Permethrin cream rinse, 0.5% Any Error in this manuscript is
Malathion lotion, 1% malathion silent testimony of the fact that
shampoo, 1% Lindane lotion and it was a human effort”
shampoo, 0.9% Spinosad “Dr. WKB”
suspension, 5% Benzyl alcohol
lotion and Ivermectin, 200-
400 µg/kg single PO {per os (orally)}
dose, repeated in 7-10 days.

By Dr. Wahied Khawar Balwan, Senior Assistant Professor in Zoology, Higher Education Department, Jammu & Kashmir, India WKB 13