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Posted by WEBMASTER on November 20, 2012 at 8:50 AM

Pediculosis


Es la parasitación del hombre y de los animales por insectos del género Pediculus del cual existen tres principales:

• P.capitis que produce la pediculosis de la piel cabelluda

• P. vestimenti produce la pediculosis del vestido y del cuerpo

• P. pubis esta se localiza fundamentalmente en el vello púbico.

La pediculosis es un problema de salud pública cosmopolita. Su alta prevalencia ha sido relacionada con la limitada disposición de agua y deficientes prácticas de aseo personal. Estas parasitosis se presentan en especial en personas desaseadas y que viven en hacinamiento, la del pubis se transmite por relación sexual. En la actualidad se ha visto un notable aumento de esta parasitosis en muchos países del mundo subdesarrollado.


 

Pediculosis de la piel cabelluda.

Esta es la temida plaga de todas las madres de familia que tengan a sus hijos pequeños en kinder garden. El llamado piojo negro o gris es el causante y parasita sobre todo la piel cabelluda aunque puede observarse en la barba y el bigote. El piojo es en realidad gris, pero toma a menudo el color del cabello que parasita y pone sus huevecillos que originan larvas ([Liendres] las cuales se adhieren fuertemente al pelo y son dificiles de desprender.

El piojo mide unos 3 mm, su cuerpo es alargado, se situa en la region occipital y sus movimientos originan el prurito. Los piojos, presentan el cuerpo dividido en tres regiones; la anterior o cabeza lleva un par de ojos, un par de antenas y un aparato bucal, especializado para succionar sangre del huésped, se situa sobre todo en la region occipital y sus movimientos originan intenso prurito lo cual provoca no en pocas ocasiones un impetigo secundario en esta region que es a menudo el motivo de consulta, por ello ante un impetigo secundario en esta region que es a menudo el motivo de consulta, por ello ante un impetigo sobre todo en un niño, en la region occipital, debe pensarse en la posibilidad de pediculosis previa.

El diagnóstico se establece mediante los síntomas y la inspección del pelo del paciente. Los insectos adultos son difíciles de ver, particularmente en el cabello oscuro.

Pero los pequeños huevos blancos o de un brillo plateado se pegan a la base del cabello aproximadamente a medio centímetro del cuero cabelludo y es allí donde se pueden identificar

Deben diferenciarse las liendres de simples escamas que en general se dejan atravesar por el pelo, mientras que la liendre esta adherida a su costado y avanza con el pelo al crecer este. La hembra dura poco o menos de 30 dias, pero en ese tiempo es capz de depositar entre 50 a 150 huevecillos.

El cuero cabelludo humano provee un ambiente controlado con una temperatura de aproximadamente 30ºC y una humedad relativa del 70%, fuera del cual ni los huevos ni las formas vegetativas del parásito pueden sobrevivir.

 

Forma de Contagio

La irritación por la saliva del parásito provoca eritema de cuero cabelludo, área retroauricular y nuca.

El prurito es el síntoma más común de esta infestación y la forma de contagio más frecuente es la directa, de cabeza a cabeza. La forma indirecta puede hacerse a través de los objetos personales usados por los niños como: peines, cepillos, hebillas, gomas, gorras, bufandas, audífonos, etc., o a través del medio ambiente, desde sillones, cabeceras, alfombras, colchones, muñecos de peluche, cojines, almohadas, areneros, albercas, etc.

Esta última forma es posible gracias a la gran adaptabilidad que tiene el piojo para sobrevivir fuera de su hábitat natural: el cuero cabelludo.

Síntomas y signos

• Prurito [picazón] y lesiones pruriginosas en el cuero cabelludo, especialmente detrás de las orejas.

• Puede haber infección secundaria de las lesiones producidas por estos parásitos.

• Llagas y costras en la zona de rascado.

• Liendres blancas pegadas a la base del cabello.


Complicaciones

Entre las complicaciones de la pediculosis capitis podemos mencionar:

Irritación: La piel presenta signos de inflamación, sensación de ardor, calor y prurito. La coloración de la piel es rojiza. El rascado puede llegar a eccematizarla, especialmente en niños alérgicos.

Pediculide: es una reacción papular secundaria a la infestación por Pediculus capitis, localizada en cuello y parte superior y posterior del tronco. Estas pápulas miden de 2 a 3 Mm y desaparecen espontáneamente después del tratamiento de la pediculosis capitis y reaparecen en las recidivas.

Excoriaciones: el síntoma principal de la pediculosis es el prurito, el cual lleva inevitablemente al rascado. Cuando éste es intenso provoca pérdida de sustancia epidérmica conocida como excoriaciones por rascado cicatrizando con secuelas hipopigmentadas e hiperpigmentadas. En el paciente alérgico el prurito es más intenso y comúnmente se extiende más allá de la piel cabelluda, afectando cuello, orejas, tronco superior y en casos muy particulares puede generalizarse.

Sobreinfección bacteriana: las excoriaciones favorecen el ingreso de bacterias [estreptococos y estafilococos] provocando la sobreinfección de las lesiones. Se han detectado Escherichia coli y Enterobacter sp., en la materia fecal de los piojos extraídos del cuero cabelludo de niños infestados.

Alteración del tallo piloso: la pediculosis puede producir alteraciones en las características del pelo. Este puede presentarse ralo, opaco y seco producto de la infestación, del rascado intenso o como consecuencia del uso excesivo de productos químicos. El uso del peine fino y el rascado intenso pueden dejar una alopecia leve. Las alopecias circunscriptas pueden ser secundarias a infecciones del cuero cabelludo y, dependiendo si hubo o no destrucción del bulbo piloso, serán definitivas o transitorias, respectivamente

 

Pediculosis del cuerpo y vestido

En realidad los piojos llamados blancos, se encuentran en la ropa de personas sucias, vagabundos, alcoholicos que nunca se bañan ni cambian de ropa y ahí mismo el piojo deposita sus huevos que pueden observarse junto con los adultos en las costuras de la ropa.

Las lesiones que producen son papulas, costras hematicas, manchas hipercromicas en abdomen, nalgas, muslos con intenso prurito. El impetigo y la eczematizacion son complicaciones habituales. El piojo blanco transmite el tifo exantematico y otras ricketsiasis.

Pediculosis del pubis

El P. pubis llamado vulgarmente ladilla es mas corto y ancho que los anteriores y en sus extremidades se presenta unos ganchos que le dan aspecto de cangrejo y que lo adhieren fuertemente al pelo del pubis, perine, pliegue intergluteo y en ocasiones puede subir hasta cejas, pestañas y vello axilar.

El parasito es sedentario, se mueve poco, se alimenta continuamente y deposita sus deyecciones en el sitio y en la ropa interior por lo que el paciente cuando llega habitualmente al consultorio ya tiene el diagnostico porque ha sentido prurito en la region del pubis y hasta ha logrado visualizar y extraer el piojo el cual muestra al medico,. Al examinar la region se observaran los parasitos y las liendres y en la trusa o pantaleta se puede observar un fino puntillo producido por el deposito de las deyecciones del piojo [signo de la trusa] dato muy seguro para el diagnostico. En la piel se pueden ver costras hematicas y manchas hemorragicas, de color azulado de medio a un centimetro llamadas manchas cerúleas.

La hembrar vive unos 30 dias y llega a depositar en ese tiempo unos 30 huevecillos que se transformaran en adultos. La transmision es en la mayoria de veces por contacto sexual.

Tratamiento

Será necesario destruir a los parásitos adultos sin olvidar las liendres que no son fácilmente desprendibles del pelo, de otro modo en pocos días, estás darán origen a nuevos adultos y el tratamiento será inútil

Los adultos pueden destruirse con DDT, benzoato de bencilo al 25% por 7 días, gamexano o lo más útil y menos irritante: vaselina con xilol que los ahoga rápidamente. Se aplica tal mezcla en la cabeza o en el pubis y se deja toda la noche, con baño al día siguiente, puede hacerse dos noches seguidas.

Para destruir las liendres en necesario desprenderlas mediante la aplicación de fomentos con acido acético que disuelve la sustancia que las adhiere al pelo. Se usa solución de acido acético al 25 ó 30% ó simplemente vinagre blanco en agua y se empapan las regiones con esta mezcla dejando toda la noche. Al día siguiente baño y peinado con un peine de dientes apretados especial para piojos. Se aconseja hacer esta maniobra dos noches.

Por vía oral es útil la administración por 3 días de trimetropin-sulfametoxazol o una dosis de ivermectina de 250mcg/Kg.

En caso de pediculosis púbica se recomienda el régimen de tratamiento tópico con loción, crema de Lindano al 1%, dejar por 4 minutos, luego lavar con champú Kwell al 1%, durante 4 minutos. Dosis Única; esta medida esta contraindicada en el embarazo, lactancia y niños menores de 2 años, por su alta toxicidad; por lo cual también recomendamos otras alternativas

Champú a base de Piretrinas, lavar después de 10 minutos de aplicado, Dosis Única. En Embarazadas, lactantes o niños se trata con Crotamiton o Piretrinas.

Debe citarse una semana después si los síntomas persisten, posiblemente existan huevos y deberá darse un nuevo tratamiento. Se debe tratar todos los contactos de los últimos 30 días.

Hay que evitar medicamentos que pueden producir dermatitis por contacto como el calomel, el mismo DDT es también irritante y sensibilizante. Si hay dermatitis por contacto o impétigo, tratar primero estas complicaciones y deben atenderse todas las personas que tengan la parasitosis en la casa, sobre todo la pareja sexual en caso de parasitosis del pubis.

Las liendres permanecer viables diez días después del tratamiento con permetrina. Los parásitos del cuerpo, no requiere más tratamiento que lavar, hervir y planchar cuidadosamente la ropa que es la que contiene los parásitos y pasar la aspiradora por muebles ([sillones, colchones, alfombras].

Es importante no descuidar el tratamiento de los objetos que constituyen nuestro entorno y que puedan actuar como sitio ideales para presentar recidivas. Los piojos pueden sobrevivir fuera de la cabeza humana por varias horas [hasta 48 horas]. No es conveniente utilizar insecticidas en aerosol porque pueden generar intoxicaciones en el grupo familiar. Otra medida a tener en cuenta es el uso obligatorio de gorras de baño en las albercas.

Dr. Ricardo Ruano

 

Categories: Enfermedades de la piel, Conflictos sociales, Infectologia

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