Tratamiento eficaz con tintura de añil 5 por ciento de una paciente infestada por Pediculus capitis / Effective treatment of a patient infested with pediculus capitis by using 5 percent Indigofera suffruticosa Mill tincture

Introducción: en Cuba se reportaron altas frecuencias de pediculosis capitis desde finales de los años noventa, particularmente en algunos grupos de escolares y sus convivientes. Estos últimos se involucran en la cadena de transmisión de esos insectos y pueden desempeñar, en la actualidad, una función importante como reservorios del parásito. Objetivo: reportar la eficacia del tratamiento con añil cimarrón en una paciente infestada de Pediculus capitis. Métodos: se describe un caso de infestación persistente con pediculosis capitis en una paciente de 55 años de edad, tratada con solución de permetrina 1 por ciento y posteriormente con tintura de añil cimarrón 5 por ciento. Resultados: la identificación microscópica de adultos y estadios pre-adultos del parásito confirmaron la presencia de Pediculus capitis. El tratamiento del cabello con permetrina 1 por ciento no fue eficaz en 2 aplicaciones realizadas. Como alternativa de tratamiento, se aplicó tintura de añil 5 por ciento, lo que permitió disminuir la población de ectoparásitos adultos y logró eliminar la infestación después de una segunda aplicación, con la constante extracción de las liendres realizada por el personal paramédico encargado del caso. Conclusión: la aplicación de este procedimiento inocuo podría servir como alternativa terapéutica para esta afección.

Introduction: pediculosis capitis was very frequently reported in Cuba since the end of the 90's, particularly in some groups of school children and their relatives. The latter are involved in a chain of transmission of these insects and may play an important role at present as parasite reservoirs. Objective: to report on the efficacy of the treatment of one female patient suffering from Pediculus capitis by using 5 percent Indigofera suffruticosa Mill (añil cimarrón) tincture. Methods: a case of persistent infestation with pediculosis capitis was described in which a 55 years-old patient was firstly treated with 1 percent permethrin solution and later with 5 percent Indigofera suffruticosa Mill tincture. Results: the microscopic identification of adult parasites and pre-adult stages of the parasite confirmed the presence of pediculus capitis. The hair treatment with 1 percent permethrin was not effective after two applications. As an alternative, 5 percent Indigofera suffruticosa Mill tincture was used and then the population of adult ectoparasites was reduced and the infestation was eliminated after the second application, with the paramedical staff continuously taking the nits out from the patient's hair. Conclusion: the use of this innocuous method may become a therapeutic alternative to treat this illness.

Ectoparasitosis de importancia en Chile: Epidemiología y terapia / Ectoparasitosis of clinical importance in Chile

Several parasitic diseases affect the skin and appendages in humans, the most common are head lice and scabies. Both diseases have worldwide distribution with geographical variations. In Chile, the reported prevalence of head lice is 20-25 percent and of scabies 1-5 percent. Other ectoparasites include fleas and mite, causing transient parasitosis related to human and animal contact. These parasites are associated with various factors such as poor personal hygiene, promiscuity, long hair, crowding, and sharing of combs, among others. Various effective pharmacological therapies are available, which base on several active compounds. Important therapeutic options include topical treatments with pyrethroids, lindane, crotamiton, and malathion as well as oral medications such as ivermectin, which is used in case of drug intolerance, poor treatment response, infections with multiple parasites or concomitant bacterial infections. For some drugs, resistance has been reported in patients received multiple dosis.

Existen varias enfermedades parasitarias capaces de comprometer piel y fanéreos en el humano, siendo los más frecuentes la pediculosis y la escabiosis. Ambas enfermedades tienen distribución mundial variable según la localidad. En Chile, se describe una prevalencia de pediculosis capitis cercana a 20-25 por ciento y de escabiosis, entre 1 y 5 por ciento. Otras ectoparasitosis son la pulicosis y la acarosis, parasitosis transitorias relacionadas al contacto humano y animal. Estos agentes se asocian a diversos factores entre los que se encuentran escasa higiene personal, promiscuidad, uso de cabello largo, hacinamiento, intercambio de peines, entre otros. Las terapias farmacológicas disponibles son variadas y eficaces. Hay diversos compuestos activos entre los que destacan tratamientos tópicos como derivados piretroides, lindano, crotamitón y malatión; y medicamentos orales como ivermectina, utilizada en casos de mala tolerancia, escasa respuesta a tratamiento tópico, infestación múltiple o infección bacteriana concomitante. Se ha descrito resistencia a algunos compuestos en pacientes que han recibido múltiples dosis.

Uso deliberado de diversos productos para el control de Pediculus capitis (De Geer, 1778 ) por padres o tutores de niños de escuelas primarias / Deliberate use of several products for Pediculus capitis (De Geer, 1778 ) control by parents or tutors of elementary school children

INTRODUCCIÓN: la automedicación y el uso de diversos productos como pediculicidas parece ser frecuente entre los convivientes para tratar de eliminar los piojos de la cabeza en los escolares. OBJETIVO: analizar el uso deliberado, por los convivientes con educandos de primaria, de diversos productos para controlar la pediculosis capitis en los niños. MÉTODOS: se realizó una encuesta por cuestionario e intercambio de opiniones con 896 convivientes con niños entre 5 y 10 años, que estudiaban en 19 escuelas urbanas y semiurbanas de primera enseñanza, de las provincias de las zonas occidental, central y oriental de Cuba, sobre los productos utilizados para controlar o eliminar los piojos de la cabeza. RESULTADOS: la población encuestada cita más de 40 productos. Entre las sustancias más reportadas se encuentra el alcohol, el DDT y el lindano, que fueron anteriormente rechazados por su toxicidad e ineficacia. Se reportan en uso productos empleados en la agricultura, la salud pública y la medicina veterinaria para el control de plagas; entre ellos, temephos, esteladón, malathion, parathión, baytex; también derivados del petróleo como el líquido de freno, keroseno y la gasolina. CONCLUSIÓN: en el trabajo se refieren numerosas sustancias tóxicas utilizadas en la terapéutica para el control de Pediculus capitis en niños, cuyo riesgo supera los beneficios esperados. Resulta bajo el porcentaje de personas que utilizan la extracción manual como único tratamiento, no obstante ser el método menos dañino y más eficaz.

INTRODUCTION: self-medication and use of several products as peliculicides seem to be common procedures for those persons living with schoolchildren, in order to eliminate head lice. OBJECTIVE: to analyze the deliberate use of several products by the people living with elementary school children, so as to control their pediculosis capitis. METHODS: a questionnaire- and exchange of opinion-based survey on the products used to control or eliminate head lice was administered to 896 people who lived with children aged 5 to 10 years. These children studied in 19 elementary schools in urban and suburban areas located in the western, central and eastern provinces of Cuba. RESULTS: the surveyed population mentioned more than 40 products. Among the most reported substances were alcohol, DDT and lindano which were previously rejected owing to their toxicity and ineffectiveness. There were also reports on products from agricultural, public health and veterinary medicine, including those devoted to plague control such as temephos, steladon, malathion, parathion, baytex; also oil derivatives like brake fluid, kerosene and gasoline. CONCLUSIONS: the paper mentioned a number of toxic substances used in treating Pediculus capitis in children, the risks of which outweighted the expected benefits. The percentage of persons who manually remove lice from the head as the only treatment is low; however, this is the less harmful and more effective method.

Ivermectina: sus múltiple usos, seguridad y toxicidad / Ivermectin: its multiple uses, safety and toxicity

La Ivermectina, con más de 30 años de uso en humanos, es una droga que aún sigue siendo estudiada en otras indicaciones. Su seguridad es alta; se han dado casi 2.000 millones de dosis en humanos con efectos colaterales mínimos. Se excreta por las heces, no es nefrotóxica ni hepatotóxica. Es el tratamiento de elección en pacientes con SIDA, recibiendo terapia HAART para estrongiloidiasis sistémica y sarna noruega. Es empleada en niños mayores de dos años de edad o con más de 15 kilos de peso. La dosis es de 200 microgramos/kg en forma oral, al 0,6 por ciento en gotas (1 gota/kg de peso) y de 400 microgramos/kg en forma tópica al 0,1 por ciento (0,4 cc/kg de peso). Logró erradicar la oncocercosis que produce la “ceguera del río” y fue considerada como el triunfo de la humanidad sobre la adversidad por la OMS en 2009.

Ivermectin has been used during more than 30 years and yet it is an old drug in search for additional indications. Ivermectin has high safety profile, and more than 2 billion doses have been administered with mild side effects. Ivermectin is metabolized in the liver, and the drug or its metabolites are excreted almost exclusively in the feces over an estimated 12 days, with less than 1percent of the oral dose excreted in the urine. The plasma half-life of ivermectin in humans is approximately 18 hours following oral administration. Ivermectin is primarily metabolized by CYP3A4, and does not provoke hepato /nephrotoxicicty. This molecule is the gold standard treatment for strongyloidiasis and crusted scabies in patients with AIDS during treatment with HAART therapy. Ivermectin is used in children older than 2 years or more than 15 kg weight. Oral ivermectin 0.6 percent dose is 200 micrograms/kg (1 drop per kg) and topical ivermectin 0.1 percent dose is 400 micrograms/kg (0.4 cc per kg). Ivermectin was able to eliminate human river blindness (onchocerciasis) and “represent one of the most triumphant public health campaigns ever waged in the developing world” by WHO in 2009.

Forma de aplicación y efectividad de la Permetrina 1 por ciento, utilizada por convivientes con escolares, para el control de la pediculosis capitis en los niños / Ways of application and effectiveness of 1 permethrin used by schoolchildren relatives for the control of pediculosis capitis

Introducción: entre los problemas que inciden en los fallos, de los tratamientos pediculicidas, están la forma de aplicación y la baja efectividad de los productos utilizados. Objetivos: conocer, por medio de encuestas de opiniones, la forma de aplicación y la efectividad de la Permetrina 1 por ciento fabricada en Cuba para el control de los piojos. Métodos: los cuestionarios se distribuyeron entre los convivientes con escolares de primaria, que con anterioridad habían utilizado el producto en los niños. El trabajo se realizó de mayo a julio de 2007 en escuelas urbanas y rural-urbanas de las provincias Ciudad de La Habana, Sancti Spíritus y Las Tunas, en Cuba. Resultados: de 786 convivientes encuestados, 637 (81,17 por ciento) no aplicaron el pediculicida según las indicaciones formuladas en el prospecto, que se adjunta al frasco, 579 (73,66 por ciento) la consideran ineficaz y solo 143 (16,32 por ciento) la han utilizado como único tratamiento. Conclusiones: no existe sincronización en los pasos seguidos durante el tratamiento. Se evidencia una alta heterogeneidad en las respuestas, porque más de 70 por ciento de los encuestados la consideran ineficaz para el tratamiento de la pediculosis capitis.

Background: Among the problems that influence on failure of pediculosis treatment is the way of application and low effectiveness of used products. Objectives: to find out, through surveys, the ways of application and the effectiveness of 1 percent permethrin manufactured in Cuba for the control of pediculosis capitis. Methods: the questionnaires were distributed among people living with elementary schoolchildren, who had previously applied the products to children. The study was performed from May to July 2007 in urban and rural-urban schools located in City of Havana, Sancti Spiritus and Las Tunas provinces in Cuba. Results: Seven hundred and eighty six people were surveyed, 637 of them (81,17 percent) did not follow the instructions given in the flask in applying the anti-pediculosis products, 579 (73,66 percent) considered it as ineffective and only 143 (16,32 percent) had used it as unique treatment. Conclusions: there is not any agreement in steps followed by these people during treatment. Responses were very heterogeneous because over 70 of surveyed persons stated that permethrin was ineffective for treatment of pediculosis capitis.

Self-diagnosis of active head lice infestation by individuals from an impoverished community: high sensitivity and specificity

To compare sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-diagnosis for head lice infestation with visual inspection, we conducted a study in an urban slum in Brazil. Individuals were asked about active head lice infestation (self-diagnosis); we performed visual inspection and thereafter wet combing (gold standard). Of the 175 individuals included, 77 (44 percent) had an active head lice infestation. For self-diagnosis, sensitivity (80.5 percent), specificity (91.8 percent), PPV (88.6 percent) and NPV (85.7 percent) were high. Sensitivity of visual inspection was 35.1 percent. Public health professionals can use self-diagnosis as a diagnostic tool, to estimate accurately prevalence of pediculosis in a community, and to monitor ongoing intervention strategies.

Foi conduzido um estudo em uma favela urbana no Brasil com o objetivo de comparar a sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) do auto-diagnóstico de pediculose com a inspeção visual. Dos 175 indivíduos incluídos, 77 (44 por cento) apresentavam pediculose. Para o auto-diagnóstico, a sensibilidade (80.5 por cento), a especificidade (91.8 por cento), o VPP (88.6 por cento) e o VPN (85.7 por cento) foram altos. A sensibilidade da inspeção visual foi 35.1 por cento. Profissionais de saúde podem utilizar o auto-diagnóstico como uma ferramenta diagnóstica para estimar de forma acurada a prevalência de pediculose em uma comunidade, como também para monitorar estratégias de controle da doença.

Pesquisa, tratamiento y resistencia en pediculosis capitis en comuna de la región metropolitana, Santiago, Chile / Investigation, treatment and resistance in pediculosis capitis in comune of metropolitan region, Santiago, Chile

Por la importancia médica que reviste, la ectoparasitosis más importante es la pediculosis humana variedad capitis, que podría definirse como la infestación de la cabeza por piojos. Dada la alta prevalencia de pediculosis, sobre todo en la población pediátrica, es vital el conocer las características epidemiológicas de esta patología. Por otra parte, son cada vez más los reportes tanto a nivel nacional coma internacional. de resistencia al tratamiento por parte de los parásitos, por lo que saber cuáles son los tratamientos más usados por la población, si estos tienen o no indicación médica y cuáles fueron sus resultados, es relevante. Se realizó un estudio descriptivo de corte transversal en el Consultorio Esmeralda, comuna de Colina, aplicando una encuesta prediseñada que consignaba los siguientes datos: numero de habitantes del hogar (especificando niños y adultos), grado de hacinamiento, probable fuente de contagio, tratamiento utilizado, quién indicó el tratamiento y efectividad de este. Los datos se tabularon y analizaron expresando los resultados en porcentajes. Un total de 320 encuestas consignó 951 casos de pediculosis. El grado de hacinamiento fue en promedia de 2,4 personas por dormitorio. El promedio de edad de los infestados fue de 13,03 alias (rango entre 0 y 53 años), observándose que un 78,65 por ciento correspondía a menores de 16 años. En cuanto a la probable fuente de contagio, un 93,7 por ciento consideraba que el origen de la infestación familiar era el establecimiento educacional de uno de las niños de la casa. Del total de los casos un 96,6 por ciento recibió tratamiento farmacológico, de los cuales solo un 35,9 por ciento tenía indicación por algún profesional de la salud. Destacó dentro del tratamiento farmacológico, el uso de Lindano (30,1 por ciento) y de champú pediculicida (69,90 por ciento).

By the medical importance that has, the most important ectoparasites is the human pediculosis variety capitis, that could be defined as the infestation of the head by lice. Given the high prevalence of pediculosis, coverall in the paediatric population, is vital knowing the characteristic epidemiologists of this pathology on the other hand, they are more and more the reports as much at national level as International, of resistance to the treatment on the part of the parasites, reason why to know which are the treatments more used by the population, if these has or medical indication and which were not their results, is excellent. A descriptive study was realised of cross section in the Emerald Health Consulting Institution, commune of Colina, applying a predesigned survey that bnefed the following data: number of inhabitants of the home (specifying young and adult), overcrowding degree, probable source of contagion, used treatment, who indicated the treatment and effectiveness of this one. The data were tabularon and analyzed expressing the results in percentage. A total of 320 surveys briefed 957 cases of pediculosis. The overcrowding degree was in average of 2.4 people by dormitory The average of age of the infested ones was of 13.03 years (rank between 0 and 53 years), being observed that a 78.65 percent corresponded to minors of 16 years. As far as the probable source of contagion, a 93.7 percent considered that the origin of the familiar infestation was the educational establishment of one of the children of the house. From the total of the cases a 96.6 percent received pharmacological treatment, of which a 35.9 percent only had indication by some professional of the health. It emphasized within the pharmacological treatment, the use of Lindane (30.7 percent) and pediculicide shampoo (69.90 percent).

A survey on head lice infestation in Korea (2001) and the therapeutic efficacy of oral trimethoprim/sulfamethoxazole adding to lindane shampoo

Total of 7, 495 children including 3, 908 boys and 3, 587 girls from a kindergarten and 15 primary schools were examined for head lice infestation (HLI). The overall prevalence of HLI in this study was found to be 5.8%. Head lice were much more commonly detected in girls than in boys with prevalence of 11.2% and 0.9%, respectively. Sixty-nine children with HLI were treated with 1% lindane shampoo alone (group 1), and 45 children with HLI were treated with 1% lindane shampoo and oral trimethoprim/sulfamethoxazole (group 2), and follow-up visits were conducted 2 and 4 weeks later. The children who still had HLI 2 weeks after the primary treatment were treated again. At the 2-week follow-up visit, the treatment success rates of groups 1 and 2 were 76.8% and 86.7%, respectively, and at the 4-week follow-up visit, the rates were 91.3% and 97.8%, respectively. No statistically significant synergistic effect was observed for the combination of a 1% lindane shampoo and oral trimethoprim/sulfamethoxazole.

Estudo comparativo da eficiência de três diferentes pentes finos na retirada de piolhos e lêndeas / Comparative study on the efficienty of three different fine-tooth combs to remove lice and nits

No presente estudo foram avaliados três pentes finos para retirada de piolhos e lêndeas, em indivíduos comdiagnóstico de pediculose capitus (Pediculus humanus capitis). Foram selecionadas 30 crianças com idade entre 2 e 12 anos. O objetivo foi avaliar a eficácia dos três pentes finos na retirada de piolhos e lêndeas,sendo: pente 1, incluíndo na embalagem do produto Toppyc, pente 2 incluíndo na embalagem do produto à base de permetrina a 1 porcento, fabricado pelo Laboratório Sintofarma S/A. Os resultados obtidos mostram que näo há diferença estatística significante entre os números médios de piolhos retirados pelos três pentes. Em relaçäo às lêndeas, é notável a média do pente 1 que se apresenta cinco vezes superior à do pente 2 e 15 vezes superior à do pente 3 (au)

Efectos colaterales del lindano en niños con pediculosis / Side effects of lindane in children with pediculosis

The side effects of lindane in children with pediculosis were reported. 2.54 of the 551 primary school children who underwent treatment had adverse reactions to this drug. It was recommended to increase knowledge about this parasitization and to avoid the indiscriminate use of chemicals and other products to eliminate lices.

Anti-headlice activity of a preparation of Annona squamosa seed extract.

Various parts of Annona squamosa Linn. (custard apple) have long been used in Thai folk medicine. The effectiveness of organic solvent extracts of custard apple seeds and leaves against headlice has been reported. The present study is focused on the efficacy and stability of seed extract prepared as a cream. A petroleum ether extract of seeds was prepared as a 20% w/w oil in water cream and tested for anti-headlice activity in school girls. After a 3 hour-hair exposure to 20 g of freshly prepared custard apple cream, 95.34+/-1.96% of headlice were killed. This killing rate was higher than that obtaned from the control (cream base) or the standard drug (25% benzyl benzoate emulsion). The anti-headlice efficacy of the 6 and 12 month-storage preparations kept in a refrigerator and 12 month-storage at room temperature were 99.19+/-0.60%, 97.55+/-2.06% and 89.47+/-3.64%, respectively, which were not significantly different from that of the freshly prepared cream. This cream did not cause any irritant effect on the scalp or neck skin while benzyl benzoate emulsion produced burning sensation or redness. The results demonstrate that the petroleum ether extract of Annona squamosa seeds prepared as a cream is stable for at least 12 months. The custard apple cream may be, therefore, suitable for use as an alternative therapy against headlice.

Pediculosis capitis, un permanente y renovado problema / Pediculosis capitis, a permanent and renewed problem

Pediculosis capitis is still a world-wide public health problem. Pediculus humanos capitis, the agent, is a permanent and specific human blood-sucking ectoparasite extended throughout the world. By the end of sixties and begin of seventies an important increase of prevalence of this parasitose was observed in many countries and lice infestation throughout the world was estimated to run into hundreds of millions. Decline of personal hygiene, increased promiscuity and long hairstyle, particularly in adolescents and young people seemed to mark the beginning of this new situation. At present pediculosis capitis not only affects low socio-economic groups, but middle and high level groups. Several observations have shown a alear relationship between long hair and pediculosis capitis. Prevention of pediculosis capitis is supported by community health education, stressing the personal hygiene, the use of reasonable short hair and frequent washing of head

comparative study on the efficacy of 0.4% sumethrine and 1% lindane in the treatment of pediculus humanus capitis in Turkey

Two different chemicals were used in the treatment of Pediculus h. capitis in cases which were found to be infested during the screening of 1 secondary and 3 elementary schools in Bostanli- Karsiyaka, Izmir. Sumithrin was found to be more effective than Lindane according to the follow up control performed a month after the treatment. While, the efficacy of Sumithrin in Emlakbank elementary school, Metin Asikoglu elementary school and Emlakbank secondary school was noted as 93%, 96% and 86.8%, respectively. The efficacy of lindane was found to be 67.5% in Murside Akyuz elementary school

Tratamiento de la pediculosis capitis en niños con permetrina al 1 por ciento en champú o loción / Treatment of pediculosis capitis in children with 1 percent permethrin shampoo or lotion

A clinical and entomological trial was carried out in 88 head louse (pediculus humanus capitis) infested children treated with a single dose of 1 percent permethrin shampoo or lotion. The sex distribution was 47 males and 41 females with ages ranging between 5 and 14 years old. In order to assess the efficiency of treatments, search for adult forms, nymphs and eggs (nits) of the parasite was performed in each of the children, before and after treatment (30 minutes, 7 days and 21 days). The entomological evaluations consisted in stereoscopic and microscopic examination of a mean of 12 hair samples taken from the retroauricular and occipital regions of each of the children, the biological condition of eggs, viable (inmature, mature), dead ans empty, was recorded. The cure rates, both clinical and entomological, obtained were 91,5 percent for shampoo and 95.2 percent for lotion. No adverse reactions with the 2 formulations used were reported. In conclusion, 1 percent permethrin shampoo or lotion is an effective and safe treatment for pediculosis capitis