Severe Iron Deficiency Anemia and Lice Infestation

David A. Guss, MD; Mark Koenig, MD; Edward M. Castillo, PHD

Disclosures

J Emerg Med. 2011;41(4):362-365. 

In This Article

Abstract and Introduction

Abstract

Background: Lice infestation is a commonly encountered disorder in emergency medicine. The louse survives from a blood meal from its host; hence, iron deficiency anemia is a theoretic possibility. A limited number of reports of severe iron deficiency anemia have appeared in the veterinary literature, but a thorough review of the medical literature did not reveal a single instance in human beings.
Objective: We report a small case series of patients with heavy louse infestation and profound iron deficiency anemia.
Case report: The index case along with two other cases discovered from an exhaustive search of 4 years of the institution's Emergency Department records all had heavy infestation with head and body lice. Laboratory evaluation revealed serum hemoglobin levels under 6 gm/dL, low serum ferritin levels, and microcytic red blood cell indices. All patients were admitted to the hospital, received transfusions, and had evaluation of their anemia. No patient had evidence of gastrointestinal blood loss or alternative explanation for their anemia.
Conclusions: Although cause and effect cannot be established from this case series, to the best of our knowledge, this is the first published evidence of a provocative association of louse infestation and severe iron deficiency anemia in humans.

Introduction

Pediculus humanus corporis and capitus are common infestations. These lice survive from a blood meal from their hosts. The veterinary literature has a series of reports of profound anemia in cattle and one report of anemia in spider monkeys attributed to species-specific infestation with lice.[1–6] A recent case of a patient with profound iron deficiency anemia associated with heavy louse infestation without other apparent cause for anemia raised the question of a possible causative relationship between louse infestation and anemia. A search of the medical literature employing PubMed, EMBASE, and Google Scholar with keywords "pediculosis," "lice," and "louse," each coupled with the term "anemia" dating back to 1953 did not reveal a single case of anemia associated with louse infestation. Furthermore, a review of several recent major texts in the field of infectious disease and parasitology did not reveal any mention of louse infestation and anemia in humans.[7–10] To the best of our knowledge, presented herein is the index case of severe iron deficiency anemia associated with heavy louse infestation. This case led to a 4-year review of an emergency department (ED) database for additional cases. The findings of that review are presented as well.

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