Clinical Communications: Pediatrics
Phthiriasis Palpebrarum Infection: A Concern for Child Abuse

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Abstract

Background

Pediculosis capitis is a common parasitic infestation, whereas phthiriasis palpebrarum is an uncommon infection due to Phthirus pubis (pubic lice) inoculating the eyelashes and surrounding tissues of the eye. Emergency physicians should recognize the causes of this uncommon disease. Cases of phthiriasis palpebrarum should trigger the clinician to consider the potential for child abuse when suspected or when social history dictates the risk for abuse.

Objective

A case of a pediculosis capitis and phthiriasis palpebrarum coinfection in a 4-year-old girl is presented, which was suspicious for child abuse given the patient's social history. Diagnosis, treatment, and need for vigilance when encountering cases of phthiriasis palpebrarum, especially in young children, are discussed herein.

Case Report

A 4-year-old girl presented with swelling and redness around her eyes. The girl had recurrent head lice infestations, however, on the day of presentation the mother noted lice appeared on the girl's eyelashes and eyelids. Head lice typically do not infect the eyes, and given the different morphology of the lice on the patient's head and eyes, a diagnosis of phthiriasis palpebrarum was made. Because phthiriasis pubis infection of the eyelids may represent sexual abuse, especially in children, child protective services was notified to ensure patient safety.

Conclusions

Pediatric phthiriasis palpebrarum can represent child abuse, and the origins of this infection need to be carefully discerned. 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.

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.

References (10)

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