A case of co-infection with head lice and varicella in a child: considerations for rational management

Abstract

Pediculosis and varicella, common in children, typically pose no significant diagnostic or treatment challenges. However, the ongoing full-scale war in Ukraine has led to severe humanitarian consequences, including mass migration and health care infrastructure damage. Under such conditions, standard treatment modalities, including isolation and hygiene measures, may be impracticable. These challenges underscore the need for adapting patient management strategies to crisis conditions. We report a case of a previously well 10-year-old female, presenting with pediculosis capitis and varicella co-infection, complicated by folliculitis. Pediculosis had been detected by the parents one week before the onset of varicella, and they self-administered a topical anti-pediculosis agent based on clearol and dimethicone once. On the 12th day of varicella infection, we found purulent rash elements on the scalp, severe pruritus, and presence of lice eggs and nits. Considering the evidence of folliculitis on the scalp, which complicated the use of external pediculicides and hygienic procedures, the case necessitated a tailored treatment approach. This included oral cefuroxime for bacterial superinfection, and two doses of oral ivermectin for pediculosis 200 mcg/kg one week apart, along with chloropyramine hydrochloride for pruritus management. The strategy resulted in elimination of head lice infestation with no adverse events. This case illustrates the critical need for updated clinical protocols and health care provider education on optimal treatment practices, especially in crisis contexts. The coexistence of varicella with a pediculosis infection precipitated a secondary bacterial infection requiring systemic antibacterial treatment. Clinical research provides evidence of oral ivermectin effectiveness in pediculosis treatment when topical pediculicides cannot be utilized. To mitigate varicella complications and control epidemic processes, integrating varicella vaccination into the national immunization schedule is recommended. Moreover, for cases with varicella and ectoparasitic infections, systemic treatment with antiviral and antiparasitic agents like acyclovir and ivermectin should be considered to minimize the risk of superinfection. The registration of oral ivermectin for pediculosis treatment by state health authorities is advocated to formalize its use in clinical practice.