陰蝨
趙宇坤，醫學碩士；羅迪慶，醫學碩士 / 2024 年 1 月 13 日 / n engl j med 390;3
59歲男性因陰部嚴重搔癢4週就診至皮膚科。就診前十六週，他與新伴侶發生了性接觸。體檢時，發現小的棕色蝨子（圖 A）和移動的蟹狀蝨子（圖 A [箭頭] 和圖 B）分別附著在陰毛的軸部和基部；身體的其他地方則沒有發現蝨子。皮膚鏡檢查顯示，虫卵的一端有帽子或蓋子（圖 C，箭頭），並且有六足蝨子攝入血液（圖 D 和影片）。診斷為陰蝨。陰蝨（Phthirus pubis）是最常見經由性接觸傳播的寄生蟲。生物體的生命週期包括卵、幼蟲和成蟲階段。成年蝨子如果不吸血，會在 48 小時內死亡。患者接受了局部的林丹 (Lindane，成分是gamma-benzene hexachloride ,γ-BHC )治療，這是當地唯一可用的殺蝨藥物。梅毒、人類免疫缺乏病毒感染和淋病檢測結果均為陰性。也建議患者用熱水清洗衣服和床單，並避免性接觸，直到治療成功。治療完成一週後，他的搔癢減輕了。
DOI: 10.1056/NEJMicm2303713 版權所有 © 2024 麻薩諸塞州醫學會
趙宇坤，醫學碩士羅迪慶，醫學碩士。中山大學附設第一醫院東院廣州，中國
luodq@mail.sysu.edu.cn
本文於 2024 年 1 月 13 日發表於新英格蘭醫學期刊
Pubic Lice
Yu‑Kun Zhao, M.Med.Sci. Di‑Qing Luo, M.Med.Sci. / January 13, 2024 / n engl j med 390;3
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59-year-old man presented to the dermatology department with a 4-week history of severe itching in his pubic region. Sixteen weeks before presentation, he had had sexual contact with a new partner. On physical examination, small, brown nits (Panel A) and mobile, crab-shaped lice (Panel A [arrow] and Panel B) were seen attached to the shafts and bases, respectively, of pubic hairs. No lice were seen elsewhere on the body. Dermoscopic examination showed nits that had a cap, or operculum, at one end (Panel C, arrow) and six-legged lice ingesting blood (Panel D and video). A diagnosis of pubic lice was made. Pubic lice (Phthirus pubis) are parasites that are most commonly transmitted through sexual contact. The life cycle of the organism involves stages as a nit (or egg), nymph, and adult louse. An adult louse will die within 48 hours without a blood feeding. Treatment with topical lindane — the only lice-killing medication available locally — was given. Testing for syphilis, human immunodeficiency virus infection, and gonorrhea was negative. The patient was also advised to wash his clothing and bedsheets in hot water and to avoid sexual contact until treatment was successful. One week after treatment was completed, his itching had abated.
DOI: 10.1056/NEJMicm2303713 Copyright © 2024 Massachusetts Medical Society
Yu‑Kun Zhao, M.Med.Sci. Di‑Qing Luo, M.Med.Sci. East Division of the First Affiliated Hospital of Sun Yat‑sen University Guangzhou, China
This article was published on January 13, 2024, at NEJM.org