|Year : 2023 | Volume
| Issue : 1 | Page : 71-73
Pediculosis pubis presenting as pediculosis capitis, pediculosis corporis, and pediculosis ciliaris in a case of Alport syndrome
Manal D Dave, Hita H Mehta, Amitkumar Rameshbhai Gorasiya, Devanshi Nitin Nimbark
Department of Dermatology, Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
|Date of Submission||07-Sep-2022|
|Date of Decision||28-Oct-2022|
|Date of Acceptance||29-Oct-2022|
|Date of Web Publication||06-Jun-2023|
Dr. Manal D Dave
Department of Dermatology, Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Pediculosis is an infestation of lice on the human body. Pediculosis pubis is primarily found in the pubic region and is usually transmitted by sexual contact. Diagnosis is done by visualization of mites which can be aided by the use of dermoscope. Hereby, we report a case of an Alport syndrome patient having extensive pubic lice infestation with no sexual history and probable transmission from cattle.
Keywords: Dermoscopy, lice, pediculosis pubis
|How to cite this article:|
Dave MD, Mehta HH, Gorasiya AR, Nimbark DN. Pediculosis pubis presenting as pediculosis capitis, pediculosis corporis, and pediculosis ciliaris in a case of Alport syndrome. Indian J Sex Transm Dis 2023;44:71-3
|How to cite this URL:|
Dave MD, Mehta HH, Gorasiya AR, Nimbark DN. Pediculosis pubis presenting as pediculosis capitis, pediculosis corporis, and pediculosis ciliaris in a case of Alport syndrome. Indian J Sex Transm Dis [serial online] 2023 [cited 2023 Sep 30];44:71-3. Available from: https://ijstd.org/text.asp?2023/44/1/71/363121
| Introduction|| |
Humans infestation is by three species of lice: Pediculus humanus capitis (scalp louse), Pediculus humanus humanus (body louse), and Pthirus pubis (pubic louse or crab louse), each maintaining their territorial preferences. P. pubis infesting the pubic region is called pediculosis pubis. Mostly sexually transmitted and is frequently associated with other sexually transmitted diseases (STDs) although fomite spread has been reported. Relatively sedentary they remain localized to the pubic region and very rarely infest other body parts. It is the smallest of the human lice, difficult to see with the naked eye and thus dermoscopy can aid in diagnosis and monitoring treatment.
| Case Report|| |
A 21-year-old unmarried male, renal transplant recipient suffering from Alport syndrome presented with complaints of occasional itching and crawling sensation over the whole body and scalp for 2–3 months. His sanitation was good, and no sharing of clothes or bedding was done before the development of symptoms. None of the family members had similar complaints, and the patient denied any sexual exposure or history suggestive of STD. No history of new drug intake, irritant application, or atopy was present. Further elicitation of the history revealed that his symptoms developed after close contact with his livestock (cows and buffaloes) and claimed that they also had similar insects on their bodies.
Examination revealed multiple ill-defined small erythematous papules with few excoriations on the face, chest, abdomen, back, upper and lower extremities, and pubic region, and some pustules present on the chest and face [Figure 1]a. There were brownish-gray macules chiefly on the upper thighs– maculae cerulae [Figure 1]b. The lice and nits were attached to the skin surface and hair of the scalp, body as well as on eyelashes. There was no involvement of webspace or night itch.
|Figure 1: (a) Multiple ill-defined small erythematous papules and a few pustules with excoriation on the chest. (b) Brownish grey macules on the upper thighs – maculae cerulae|
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Dermoscopy of the lice on the scalp, face, body, and pubic region [Figure 2] with showed semitransparent whitish crab-like lice with three pairs of legs where the distal two pairs had pincer-like claws clutching on the hair as well as stuck on the skin surface [Figure 3]a. Numerous viable nits which were dark brown in color and convex in shape [Figure 3]b were presently attached to the hairs along with a few transparent empty crystalline nits [Figure 3]c. Nymphs smaller in size [Figure 3]d than the adult lice along with hemorrhagic red dots suggestive of the lice bite were present. Thus, the dermoscopic evaluation of the scalp, face, body, and pubic region showed similar species of lice in all these regions i.e., pediculosis pubis. This was confirmed by observing the lice isolated from these three regions under the USB dermoscope and microscope [Figure 4].
|Figure 2: Dermoscopy from the scalp (a), Eyelash (b), Chest (c) and pubic region (d). Brownish crab-like louse clutching on the hair and the skin surface- Phtirus pubis (white arrow), maculae cerulae (orange arrow), transparent whitish crystalline structure devoid of operculum – empty nits (green arrow), ovoid brown structure – active viable nits (blue arrow), nymph (yellow arrow)|
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|Figure 3: Dermoscopic images: (a) Adult lice, (b) Viable nit, (c) Empty nit, (d) Nymph|
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|Figure 4: Lice removed from scalp, chest, and pubis when observed under the USB dermoscope. (a) and microscope. (b) All were crab-like short-bodied organisms suggestive of Pthirus pubis|
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His complete blood count was within the normal limit. Viral serology was negative.
The differential diagnoses for this case are delusional parasitosis, scabies, irritant contact dermatitis, and atopic dermatitis which were ruled out with a detail history and visualization of mites.
He was advised to avoid animal contact and was given tablet ivermectin 12 mg stat, 5% Permethrin cream application overnight, and repeat application after 7 days with ivermectin 0.3% shampoo twice weekly. He was followed up after 2 weeks and was completely relieved of his symptoms. No lice were found on examination.
| Discussion|| |
The ectoparasite P. pubis, commonly known as the crab or pubic louse, has plagued prehistoric apes to Homo sapiens. The adult mite has six legs, the rear two pairs of legs terminate with pincer-like claws, whose grasp helps to attach to the pubic hair and skin hence the name crab louse. Pthirus pubis is primarily found in the pubic hair but on rare occasions can spread to the axilla, beard, eyebrows, eyelashes, or body hair. Pthirus pubis infesting eyelashes is known as phthiriasis palpebrarum. Pubic lice infestation is an STD transmitted mainly by sexual contact, though can occasionally be contracted through infected beds and toilets. Itching is the presenting complaint, secondary to allergic sensitization from louse saliva, and can be delayed for 2–6 weeks after exposure, while subsequent exposure causes pruritus after 1–2 days. Macula caerulea characteristics for chronic pubic lice infestation are asymptomatic, slate-gray to bluish, irregularly shaped macules that measure 0.5–1 cm in diameter mainly on the trunk and thighs. They are thought to result from the breakdown of bilirubin to biliverdin by enzymes in louse saliva.
Dermoscopy is a noninvasive technique that has been recently extrapolated in the diagnosis of skin infections and infestations, termed “Entodermoscopy” introduced by Zalaudek et al. Visualization of live lice or nits (eggs) confirms the diagnosis, but the adult pubic louse is 0.8–3 mm in length and stocky, yellow-to-light brown in appearance which makes it difficult to spot with naked eyes, and here, dermoscopy further aids in diagnosis. Dermoscopy also allows to differentiate vital nits from the empty cases and distinguishes it from “pseudonits”, which can arise from dandruff flakes, hair casts, hair spray or gel residues, etc, trichomycosis pubis, white piedra, or trichorrhexis nodosa. In the case of phthiriasis palpebrarum, lice are clinically difficult to identify leading to misdiagnosis as scales of atopic or seborrheic dermatitis. In these cases, dermoscopy can be of great diagnostic help by revealing the presence of lice and/or nits. Apart from diagnosis, dermoscopy assists the clinician to assess the treatment efficacy and screening household contacts.
Alport syndrome is an inherited progressive kidney disease accompanied by sensorineural hearing loss and ocular problems. Our patient was on immunosuppressants postrenal transplant. Thus, this immunocompromised state could have contributed to this widespread P. pubis infestation.
Such transmission of organisms from animals can be avoided by keeping the animals well groomed and keeping the infested animals separate from the others.
P. pubis is a specific parasite of humans, and although its transfer to a dog has been recorded. In our case, the patient developed symptoms after coming in contact with cows and buffaloes and had no symptoms before that. This is suggestive of probable transmission of P. pubis from cattle to humans making it the first of its kind case as per our knowledge.
| Conclusion|| |
Here, the use of dermoscope enabled us for prompt diagnosis, showing the need of more widespread use of it in the field of dermatological infestations. The extensive pubic lice infestation with no sexual history and probable infestation acquired from cattle makes our case a unique one.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]