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Men, African-Americans at highest risk for body lice among homeless in San Francisco
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The existence of body lice appeared to be positively correlated with male gender, African-American ethnicity and sleeping outdoors among homeless persons in San Francisco, according to recent findings.
Moreover, testing of lice pools from this population found that 15.9% of those with body lice were infected with Bartonella quintana, the bacterium responsible for trench fever.
In the study, the California Department of Public Health’s Vector-Borne Disease Section administered lice-related medical services as part of San Francisco’s Project Homeless Connect on nine dates in 2008-2010 and 2012. Researchers used a 15-question survey pertaining to lice transmission for all willing homeless adults who sought these services. The questionnaires addressed sleeping quarters, frequency of sharing or trading clothing, and previous lice exposure.
The lice-related services included examination for ectoparasites of the individual’s hair, body and clothing. Those with lice on their clothing or on the body below the neck were suspected to be infested with body lice. They were given a shower and clean clothing to remove the source of lice. They also were provided with educational materials on the prevention and control of body lice. They were then escorted to a licensed medical provider for a medical evaluation. Lice discovered on the head or hair, accompanied by nits, were considered evidence of head lice infestation. Individuals with head lice or more than 20 nits within a quarter inch of the scalp were given a kit consisting of 1% permethrin lotion and a nit-removing comb, and were instructed on its use. Free haircuts also were offered to those with severe infestations or matted hair.
After collecting between one and 20 lice of each species from the body or head of each patient, the researchers placed the specimens into tubes with 70% ethanol and labeled by identifying number and species. One pool of each louse species per participant was sent for DNA extraction, sequencing and PCR testing to the CDC’s Bartonella Laboratory in Fort Collins, Colo. B. quintana, a louse-borne disease consisting of severe frontal headache, dizziness, conjunctival congestion, shin pain, lymphadenopathy and fever, lasts from 4 to 8 days.
Of the 203 individuals who received lice examinations and completed questionnaires, 30% were found to have body lice, 4.9% had head lice, and 3% were confirmed as having body and head lice. Testing of the lice pools revealed the presence of B. quintana in 15.9% of 63 body lice pools, and in 37.5% of the 16 head lice pools.
The presence of body lice was correlated (P≤.05) with the following variables: male gender, African-American race and sleeping outdoors.
According to the researchers, these findings suggest that the homeless population in San Francisco has a relatively high rate of lice, and also may be at risk for bartonellosis.
“Our findings suggest that focusing prevention information, such as promoting the use of clean sleeping bags or explaining how to use clean bedding, to those who sleep outside may be of additional benefit for decreasing lice infestations, and this possibility warrants further investigation,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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