To determine the diagnostic accuracy of visual inspection and wet combing in pediculosis capitis (head lice infestation). Visual inspection of 5 predilection sites (temples, behind the ears, and neck) was performed first, followed by wet combing of hair moistened with conditioner. Presence of mobile stages was defined as active infestation, presence of nits alone as historic infestation. Design: Observer-blinded comparison of 2 diagnostic methods. Setting: Five primary schools in which head lice infestation was epidemic. Participants: A total of 304 students aged 6 to 12 years. Main Outcome Measures: Presence of nymph, adults, and nits; sensitivity, predictive value, and accuracy of both methods. Results: Visual inspection underestimated the true prevalence of active infestation by a factor of 3.5. The sensitivity of wet combing in diagnosing active infestation was significantly higher than of visual inspection (90.5% vs 28.6%; PϽ.001). The accuracy of the former method was 99.3% and that of the latter method, 95%. In contrast, visual inspection had a higher sensitivity for the diagnosis of historic infestation (86.1% vs 68.4%; P Ͻ.001). Conclusions: Wet combing is a very accurate method to diagnose active head lice infestation. Visual inspection is the method of choice, if one aims to determine the frequency of carriers of eggs or nits.
Pediculosis capitis is one of the most frequent infectious diseases in childhood. If not diagnosed and treated rapidly, considerable clinical pathology may develop. The ubiquitous parasitic skin disease is characterized by a lack of sound epidemiological data, and factors which influence disease occurrence are still enigmatic. To investigate whether, in Germany, head lice infestation follows a seasonal pattern, we analyzed the weekly head lice consultations at the Health Department of Braunschweig City, Lower Saxony, for a period of 5 years, and compared the data with the units of pediculocides sold by two wholesalers to German pharmacies during a period of 2 and 3 years, respectively. The number of consultations did not show a clear seasonality, although there was a tendency of fewer consultations during school holidays, and an increase when schools opened again after Christmas, Easter, summer, and autumn holidays. In contrast, the number of packages of pediculocides sold followed a distinct seasonal rhythm with a maximum between calendar week 34 and 40, i.e., from mid September to end of October. In Germany, occurrence of pediculosis capitis varies according to the season of the year with a maximum in late summer and early autumn.
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