Case history
Case history #1
A 7-year-old girl presents to the school nurse. She was referred by her teacher, who noted she was scratching her head a lot. The school nurse knows there have been no active cases of head lice identified in this student's class recently, but the girl says she had been to a "sleepover" about 1 month ago. The girl has shoulder-length hair, and claims she has never had head lice before. When the school nurse examines the nape of the girl's neck, she finds small whitish spots within 1 cm of the scalp that are firmly adhered to the hair shaft. As the nurse continues to examine the girl's scalp under bright light, she sees a sesame seed-sized insect-like object crawl quickly away from the area.
Case history #2
An 5-year-old girl presents to be checked for lice because her mother is concerned she may have an infestation. She has treated her daughter with over-the-counter pediculicide 3 times in the past 2 months, but admits she is not sure what to look for - she treats when she hears about a case in her daughter's class. When examining her scalp under a bright light, dozens of small white objects firmly adherent to the hair shaft can be seen, but all are more than 1 cm from the scalp. Microscopic examination of one shows it to be an empty louse egg case, indicating the girl most likely had an infestation 2 months ago that has resolved.
Other presentations
An atypical presentation would involve a bacterial infection (i.e., scalp impetigo caused by streptococci and/or staphylococci) with posterior cervical lymphadenopathy, secondary to a longstanding infestation with excoriated skin from frequent scratching. This would be seen most commonly in situations where there is overcrowding (e.g., homeless shelters) or where access to proper treatment may be limited.[2][3][4]
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