INTRODUCTION
Pthirus pubis Linnaeus, 1758 (Anoplura: Pthiridae), is a 
hematophagous and ectoparasite insect, known as a crabs or 
lobster crab. The insect does not transmit any infectious 
agent, prefers temperatures from 28 to 32 °C and cannot live 
outside the body for more than one day (Alarcón, Hinostroza & 
Santamaría 2001). The typical infestation of Pthirus pubis in 
the world is approximately 2% of the adult population. 
According to Ibarra 1993, P. pubis has a cosmopolitan 
distribution. Records are often related to clinical records of 
sexually transmitted diseases or travel data (Díaz, 2006). 
Pubic lice have been present in the human population for 
thousands of years, but they have never been of great 
importance as a serious plague (Anderson & Chaney, 2009). In 
South America in pre-Columbian cultures and the Chiribaya 
culture in southern Peru, evidence of the presence of pubic lice 
in human remains is reported (Rick et al., 2002). The 
infestation of these parasites is attributed to the lack of 
hygiene and promiscuity, it is a parasite that is transmitted 
sexually, but it has been observed that transmission can occur 
by contact with clothing, sheets and personal items of infected 
people (Pérez-Cano, 2013). It is found with high prevalence in 
prisons, brothels and similar places (Ragne et al., 1995). In 
addition, the socieconomic status and disaster situations are 
factors in the transmission (Díaz 2006). Information on reports 
of pubic lice is less frequent than head or body lice, yet their 
epidemiology is important due to the correlation with the 
appearance of other sexually transmitted diseases (STDs) 
and these adapt to a sedentary lifestyle in pubic hair, body 
hair, groin, perianal region and sometimes in eyelashes 
(Newsome et al., 1979; Rundle, 1993; Klaus, Shvil & 
Mumcougly, 1994; Hernández-Contreras et al., 2001; Mimouni 
et al., 2001, Pierzchalski et. al., 2002; Bingel 2005; Flinders & 
DeSchweinitz 2005; Pakeer et al., 2008; Yagoob 2015; Tang & 
Ran 2017; Lin Li 2018). According to Mumcuoglu (2015), P. 
pubis infection is more frequent in adults than in children. 
Veraldi, Pontini & Nazzaro (2018), reports it on children's 
eyelashes and eyebrows and Nazzal et al., (2019), indicates 
Phthiriasis Palpebrarum (eye infestation) as rare disease.

CASE REPORT 
We describe a case of infestation by Pthirus pubis in a 46-year-
old adult man. The patient presented in our department due to 
pruritus in the left eye for 3 weeks. The skin test found small 
yellowish-brown ecks attached to the eyelashes. Brown or 
white eggs or nits containing nymphs were observed, these 
were rmly attached to the base of the eyelash hair. Adults 
were seen grabbing the hairs of the eyelashes with claws or 

inserted in the eyelid and sucking blood. The adult females of 
P. pubis found are semi-transparent. The patient reports that 
approximately 1 month after his return from a trip to Austria in 
a tourist area, he felt severe itching in his left eye. The patient 
did not have a history of any STD, or known infestation in any 
other part of his body. Slit lamp biomicroscopy revealed 
multiple eggs attached to the eyelashes along with eight 
insects moving in the margin of the top line of the eyelash and 
much secretion accumulated in the tear. Examination of 
insects under light microscopy revealed translucent crawsh, 
wingless, with three pairs of legs and claws. Insect sizes were 
between 2 and 5.5 mm, the species was conrmed as 
Phthiriasis Palpebrarum caused by Pthirus pubis [Figure 1]. 
For identication we rely on Anane et al., 2013 & Salavastru et 
al., 2017. The patient was successfully treated with 
mechanical removal of insects and nits together with the 
application of topical permethrin at 1%.

Figure 1. Pthirus pubis. A. Biomicroscopy of an adult's left eye. 
(Scale bar= 10 mm). B. The arrow indicates, eggs attached to 
the patient's eyelashes. (Scale bar= 10 mm). C. Scanning 
electron microscopy of adults (500 µm). D. Scanning electron 
microscopy of egg. (200 µm) E. Drawing of an adult female. 
(Scale bar= 0.5 mm). F. Drawing of egg attached to an 
eyelash. (Scale bar= 0.12 mm).

PHTHIRIASIS PALPEBRARUM (PTHIRUS PUBIS): A CASE REPORT IN THE 
DOMINICAN REPUBLIC

Original Research Paper

O. P. Perdomo*
Instituto Tecnológico de Santo Domingo (INTEC) Área de Ciencias Básicas 
y Ambientales Av. de Los Próceres 49, 10602. Santo Domingo. Dominican 
Republic *Corresponding Author

Clinical Research

Pthirus pubis, is a hematophagous and ectoparasite insect. We present the case of a 46-year-old male 
patient diagnosed with an eye infection. Phthiriasis palpebrarum is reported for the rst time for the 

Dominican Republic.

ABSTRACT

KEYWORDS : Human Louse, Pthirus pubis, Dominican Republic.

VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

A. Pineda
Facultad de Ciencias. Escuela de Microbiología y Parasitología 
Universidad Autónoma de Santo Domingo Santo Domingo. Dominican 
Republic 

A. Binet Álvarez 
Facultad de Ciencias. Escuela de Biología Universidad Autónoma de Santo 
Domingo Santo Domingo. Dominican Republic

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CONCLUSION 
It is necessary to alert the health centers of the country and the 
medical schools of the universities to promote informative and 
educational efforts of this insect and the importance of 
monitoring these ectoparasites to assess emerging and 
modiable trends and behaviors in order to establish 
treatment and prevention measures. Phthiriasis Palpebrarum 
(ocular infestation) had never been reported in eyelashes in 
the Dominican Republic and is frequently misdiagnosed as 
blepharoconjunctivitis of bacterial or viral etiology.

Acknowledgements
The authors thank Queiroz Portorreal of the Instituto 
Tecnológico de Santo Domingo (INTEC) for the assistance in 
scanning electron microscopy photography, the Espaillat 
Cabral Institute for providing us with the photo of 
biomicroscopy, Daniel Ortega for the illustration of P. pubis 
and Linda M. Rodríguez Guglielmoni of the English 
Department of the University of Puerto Rico-Mayagüez for the 
revision of the text.

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