Body Lice Tied to Low Hemoglobin, Anemia Risk

NEW YORK (Reuters Health) – Body lice infestation was associated with lower hemoglobin levels and greater likelihood of anemia in a retrospective study of hospitalized patients.

“We had observed anemia in our hospitalized patients who had body lice infestation and wanted to better understand this potential association,” Dr. Aileen Chang of the University of California, San Francisco told Reuters Health by email. “We were also motivated to conduct this study in order to shed light on a medical condition that predominantly affects marginalized populations, including persons experiencing homelessness and individuals living with mental health illness.”

Body lice infestation should be considered in someone “with an itchy rash who lacks access to washing facilities or is unable to wash themselves and does not have support to do so,” she noted. “The skin lesions… are usually marks from scratching and picking due to being itchy.”

Noting where the lesions occur on the body can be helpful in making the diagnosis, she said. “Skin lesions are typically in areas where the clothing seams touch the skin, namely the upper back, shoulders, flanks, waistline, sides of the legs.”

“Since body lice live on the clothing and not the body, examine clothing seams to confirm the diagnosis,” she suggests. “Treatment is bathing and replacement of clothing if hot water washing and high heat drying are not options. If the individual also has anemia, consider body lice as a potential cause, along with other causes of anemia.”

As reported in JAMA Dermatology, Dr. Chang and colleagues compared admission hemoglobin levels between hospitalized patients with (exposed) and without (unexposed) body lice, matched in a 1:3 ratio on age, sex, and housing status.

The secondary outcome was anemia, defined as a hemoglobin level less than 12 g/dL in women and less than 13 g/dL in men

Twenty-seven patients with body lice and 81 without were included in the analysis. Overall, the mean age was 53.8; 20 (18.5%) were women; and 92 (85.2%) were experiencing homelessness.

Patients with body lice infestation had significantly lower mean hemoglobin levels (10.4 g/dL vs.12.9 g/dL; after adjustment, body lice infestation was associated with a 2.5 g/dL lower hemoglobin level.

Further, the proportion of patients with anemia was higher among those with body lice than without (70.4% vs. 46.9%).

Dr. Chang said, “Our study showed an association between body lice infestation and low hemoglobin in hospitalized patients that were seen by the dermatology team, at the request of the patient’s main hospital team. Not all hospitalized patients with body lice infestation are seen by a dermatologist, so that raises the question of whether there was something about these patients’ condition that prompted a dermatology consult. We were not able to measure that ‘something’ in this study.”

SOURCE: JAMA Dermatology, online April 20, 2022.

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