Body lice is currently uncommon in the United States. Infestation is more likely to occur in persons with poor hygiene or overcrowded living conditions. The lice reside on hair-bearing areas of the body but attach their nits to clothing. The lice and nits can survive as long as 30 days without contact with a human host. Clinically, the bite is often not perceived by an individual but leaves a pruritic red urticarial papule. This lesion is not distinguishable from other bite reactions. A clue to diagnosis is that areas not covered by clothing, such as the face and hands, are usually spared. A high index of suspicion is needed, especially in patients with poor hygiene. Close inspection of clothing reveals nits, especially along clothing seams.
The body louse is the vector for epidemic typhus fever (Rickettsia prowazekii), trench fever (Rickettsia quintana), and relapsing fever (Borrelia recurrentis).
Treatment is similar to that for head or pubic lice. Since the nits can survive long periods without human contact, infested clothing and linens should preferably be destroyed. If not, recommendations include washing and drying on hot cycles and ironing the seams of the textiles. Oral antihistamines and topical corticosteriods may be necessary when itching is severe. Secondary infection, if present, should be treated.
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