Clinical Communications: PediatricsPhthiriasis Palpebrarum Infection: A Concern for Child Abuse
Introduction
Pediculosis capitis (head lice) is a common parasitic infestation, especially in school-age children, caused by the obligate human parasite Pediculosis humanus capitis (1). Phthiriasis palpebrarum is an uncommon infection due to Phthiriasis pubis (pubic lice) inoculating the eyelashes and surrounding tissues of the eye (2). Coinfections of phthiriasis palpebrarum and pediculosis capitis are even more rare and, to our knowledge, no reports of a coinfection of both species have been published. We describe a case involving a phthiriasis palpebrarum infection, which was confounded by a concurrent case of pediculosis capitis. In this case, the child's social history ultimately triggered involvement of child protective services due to the suspicion of child abuse. Clinical diagnosis, the patient's family dynamics, and differential diagnoses, which may lead to the wrong diagnosis and thus, failure to recognize the implications of child abuse, are discussed herein.
Section snippets
Case Report
A 4-year-old girl was brought to the Emergency Department (ED) by her mother because of swelling and redness around her eyes. The girl had several recent incidents of head-lice infestation, which were treated successfully by the child's pediatrician. The mother noted that the head lice infections reoccurred whenever the child returned from visits with her father; the child's parents were divorced and had shared custody. However, on the day of presentation, the mother now noted that the lice
Discussion
Phthiriasis palpebrarum is an uncommon infection and can be mistaken for blepharitis or conjunctivitis 6, 7, 8. The presence of two species of lice was a confounder in the diagnosis of phthiriasis palpebrarum because head lice commonly do not infect the eyes 7, 8. Pubic lice are considered sedentary and rarely leave close contact with the body, making transmission through clothing or fomites less likely. Transmission is dependent upon close, often intimate, contact, which is why infection with
Conclusion
Not all cases of pediatric phthiriasis palpebrarum represent abuse, and may result from close contact such as shared sleeping arrangements with another carrier; nevertheless, the origins of phthiriasis palpebrarum need to be carefully discerned to assess for possible abuse (8). A thorough history can provide information to assess whether further action is needed and, if in doubt, social services should be contacted to ensure child safety.
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2020, Journal of the American Academy of DermatologyCitation Excerpt :Maculae ceruleae (blue-gray macules), red papules, and rust-colored feces can be seen at bite sites (Fig 4, B).60,114,115 In children, eyelashes are commonly involved112,116-118 and coinfestation with head lice has been reported.118 Diagnosis is achieved by visualizing lice or nits on hair shafts (Fig 4, B).
Crusts on the Eyelashes
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2016, Saudi Journal of OphthalmologyCitation Excerpt :Although it is not common, direct contact during a sexual abuse can also be the origin of phthiriasis palpebrarum in a child.7,8,10 Although most of the authors indicate that sexual abuse should be excluded in every child with phthiriasis palpebrarum, according to our publication search, we could find only a case report, which confirms sexual abuse in a 4 years old child with phthiriasis palpebrarum.10 Since pediatric phthiriasis palpebrarum may represent sexual abuse, the origin of the infection should be determined and in case of any suspicion, child protective services should be notified to ensure child safety.10
Misleading Presentation of Unilateral Phthiriasis Palpebrarum in a 2-Year-Old Boy
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