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More than a third of the children in the UK get head lice (pediculosis) in a year,1 and the prevalence of pediculosis increases in crowded conditions and with poorer hygiene.2 Increasing overcrowding of cities will result in an even greater prevalence.
A primary school child needs about 1.5 mg of iron per day3 and iron loss is about 0.6 mg/day.3 A louse can cause blood loss of 1 mg/day, and this could therefore tip this balance in favour of iron deficiency anaemia, especially in a child who is already depleted in iron due to a poor diet.
The effect of this infection has been poorly documented: most relevant articles are focused on the treatment and complications such as bacterial infection. Lice causing anaemia has been documented in cattle4 and, only recently, a case series in California showed a possible link between heavy infestation and anaemia in humans.5
We feel that this phenomenon deserves more research and broader case reporting. Rochdale Infirmary caters to a densely populated urban community, with one-third of its inhabitants living below the poverty line. We predicted that pediculosis would be rife in the area. We searched notes dating back 5 years and noted discharges with ‘iron deficiency’ or ‘anaemia’, along with ‘head lice’ or ‘pediculosis’. We consider two case studies. The children who presented with iron deficiency anaemia were fully investigated and the only cause was found to be severe pediculosis.
W was referred by her school nurse for severe pediculosis. A home visit by the home nurse ensued, and concern was noted with regard to W’s well-being, following which she was brought in to Rochdale Infirmary.
On admission, W’s height and weight were within normal limits. She had widespread pediculosis and extensive excoriation of the scalp. Extreme pallor was observed.
W's hair was cut and she was treated with malathion. Blood results showed anaemia with low iron levels. Extensive investigation as to the cause was unsuccessful. W received a blood transfusion. Oral iron was given over the next 5 weeks.
On subsequent follow-up, no head lice were seen and W’s haemoglobin levels were normalised.
V presented to the accident and emergency department with a viral infection. On examination, V was shown to be pale, with pediculosis and scabbed lesions on the scalp. Blood results showed anaemia with a low ferritin level. Blood and endoscopic testing revealed no other cause for the anaemia and V was diagnosed with iron deficiency anaemia secondary to pediculosis.
In hospital, treatment was started with lyclear and flucloxacillin for infected scalp lesions. Dietetic advice was given and V was discharged on oral iron, and a full social review ensued.
We can conclude that pediculosis may be a cause of iron deficiency anaemia, and a full medical and social history should be taken when assessing a child, especially where the cause of anaemia is in doubt. It is evident that pediculosis can cause anaemia, but owing to the lack of conclusive evidence of causality, we feel that further research is warranted.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
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