The patient was an 11 year old female. She presented herself with complaints of unusual fatigue and red welts on her calves and ankle areas on both legs. The welts were small and red and there was a darkening of the skin around the irritated areas. The skin was appeared to be thicker around the same areas. The patient had been scratching the welts and some of them were producing a puss-like substance.

The patient was with her mother. I asked the mother if anyone else in her family was experiencing the same symptoms and she said no. The only other person in the house was the mother’s elderly father. I asked the mother if she had traveled out of the country recently and she said no. I also asked if any long term visitors had been staying at her house and again the answer was no. At first I concluded that the patient was suffering from bed bug bites. However, it was curious that the irritated area was not presenting anywhere else on her body and that no one else in the house was presenting the same symptoms. I then asked the patient if she had any pets in the house, thinking it may be a flea infestation. She replied no. I examined her head for head lice and found no indication.

At my request, the patient had removed all of her clothing excerpt for her underwear. I asked to see her clothing and found indications of eggs and lice on the inside seams of her pants. I re-examined her lower legs and did not find any eggs or lice present. This is when I realized it might be body lice. Although it is possible, body lice is rare in children (Body Lice, 2013). I asked the patient directly if she had had a recently sleepover at a friend or family’s house and she responded yes — she had spent the night at a friend’s house the previous weekend. I asked the mother if she had spoken to the friend’s parents since the sleepover and she responded no. However, at this point, the patient said that her friend, the one whose house she slept over, was scratching her ankles in class and they both had joked that they were itchy in the same place.

Body lice and their eggs tend to gather in the seams of clothes worn close to the body and are especially apparent in colder months when people wear more layers of clothes (Body lice, 2014). It was February when I saw the patient. Research has shown that there are 14 genes showing significant differential expression between body and head lice. However, overall, the two organisms are from the same species (Olds et al. 2012).

Body and head lice resemble each other. However, rather than infest a head, body lice spend most of their life on a person’s clothing, crawling onto the skin to feed on the host’s blood. Female lice glue their eggs to the inside seams of clothing because that area is warm enough to hatch the eggs. A female louse can produce 10 eggs per day and up to 300 in its lifetime (Body Lice, 2013).

Spinosad may be prescribed if the recommended regimen of washing clothing and bedding in hot water, at least three times, and drying in a dryer set on high (more than 122 degrees) is not effective in killing louse and eggs. Spinosad has been shown to be effective in 82.5% and 86.1% of patients who become free of lice within 14 days after the first treatment. (Villegas & Breitzka, 2012). In addition, pediculicides may also be effective in killing louse and eggs if they have attached to an area of the skin with heavy body hair (Olds et al. 2012). It was also suggested to the patient’s mother that she contact the parent(s) of the friend.

This experience connects to my classroom studies in that it is important to look at a family, their lifestyle and surroundings, to sometimes determine a diagnosis that is not obvious at first. Asking questions about where a patient has been and with whom she has interacted, can also be helpful when the symptoms are less obvious, as in this case. In the case of lice, one has to be careful not to imply to the patient or parent that they live in an unsanitary environment, and that lice can be found in schools and homes regardless of location and demographics.