What are the symptoms of pubic lice infestation. How is pubic lice diagnosed and treated. What preventive measures can be taken against pubic lice. How do pubic lice spread between individuals. What are the key differences between pubic lice and other types of lice.

Understanding Pubic Lice: Causes and Transmission

Pubic lice, scientifically known as Pthirus pubis and colloquially referred to as “crabs,” are tiny parasitic insects that infest human pubic hair. These minuscule creatures, measuring about 2mm in length, have a distinctive crab-like appearance, which gives rise to their common nickname. Their grayish-brown color allows them to blend in with hair, making them challenging to spot with the naked eye.

How do pubic lice spread? These parasites are primarily transmitted through close body contact, with sexual intercourse being the most common mode of transmission. However, it’s important to note that pubic lice can also spread through non-sexual means, such as sharing contaminated bedding, clothing, or towels with an infested individual. Unlike some misconceptions, pubic lice cannot jump or fly; they can only crawl from one host to another during close physical contact.

Differentiating Pubic Lice from Other Lice Species

While pubic lice primarily infest the pubic region, they can also be found in other coarse body hair areas such as:

• Chest hair
• Armpit hair
• Facial hair (including beards and mustaches)
• Eyelashes (in rare cases)

It’s crucial to distinguish pubic lice from head lice (Pediculus humanus capitis) and body lice (Pediculus humanus corporis). Unlike their counterparts, pubic lice do not infest scalp hair. This distinction is vital for proper diagnosis and treatment.

Recognizing the Symptoms of Pubic Lice Infestation

Identifying a pubic lice infestation early is key to prompt treatment and preventing spread. While these parasites can be difficult to spot, there are several telltale signs and symptoms to watch for:

• Intense itching in the pubic region, which often worsens at night
• Visible lice or eggs (nits) in pubic hair
• Small, red or blue spots on the skin (lice bites)
• Presence of dark red or brown spots in underwear (lice feces)
• Crusted or sticky eyelashes if they’re affected

Are pubic lice visible to the naked eye? While adult lice can sometimes be seen, they are often difficult to spot due to their small size and ability to blend with hair. Using a magnifying glass can help in identifying these parasites or their eggs attached to hair shafts.

The Importance of Prompt Medical Attention

If you suspect a pubic lice infestation, it’s crucial to seek medical attention promptly. Untreated infestations can lead to complications such as secondary skin infections from excessive scratching. Additionally, the presence of pubic lice may indicate potential exposure to other sexually transmitted infections (STIs), making it important to undergo comprehensive STI testing.

Diagnosing Pubic Lice: Medical Examination and Procedures

Diagnosing pubic lice typically involves a thorough physical examination by a healthcare professional. During this examination, the doctor or nurse will carefully inspect the pubic area and other potentially affected regions for signs of lice or their eggs.

What tools are used to diagnose pubic lice? Medical professionals often use a combination of visual inspection and specialized tools, including:

• Magnifying lens for closer examination
• Fine-toothed comb to part hair and expose lice or nits
• Dermatoscope for detailed skin and hair inspection

In some cases, a sample of the suspected lice or eggs may be collected for microscopic examination to confirm the diagnosis. This step is particularly useful in differentiating pubic lice from other skin conditions or parasites.

The Role of Sexual History in Diagnosis

Given the primary mode of transmission, healthcare providers may inquire about recent sexual contacts. This information is crucial not only for diagnosing the current infestation but also for identifying potential sources and preventing further spread. It’s important to be honest and comprehensive when discussing sexual history to ensure accurate diagnosis and appropriate treatment for all affected parties.

Effective Treatment Strategies for Pubic Lice

Once diagnosed, treating pubic lice promptly is essential to alleviate symptoms and prevent transmission. The primary treatment options for pubic lice include:

1. Topical insecticides: Over-the-counter or prescription lotions, creams, or shampoos containing permethrin, pyrethrin, or malathion
2. Oral medications: In some cases, oral ivermectin may be prescribed
3. Manual removal: Using a fine-toothed comb to remove lice and nits

How long does treatment for pubic lice typically last? Most treatments require an initial application followed by a second treatment 7-9 days later to ensure all newly hatched lice are eliminated. It’s crucial to follow the treatment instructions carefully and complete the full course as prescribed.

Addressing Treatment Challenges

In some instances, pubic lice may show resistance to standard treatments. If symptoms persist after completing the prescribed treatment, it’s important to consult a healthcare provider. They may recommend alternative treatments or higher concentrations of medications to combat resistant lice.

Preventing the Spread of Pubic Lice

Preventing the spread of pubic lice involves a combination of personal hygiene practices and environmental measures. Key preventive strategies include:

• Washing all clothing, bedding, and towels used by the infested person in hot water (at least 50°C) and drying on high heat
• Dry cleaning items that can’t be washed, or sealing them in plastic bags for at least a week
• Vacuuming mattresses and upholstered furniture thoroughly
• Avoiding sharing personal items like combs, brushes, or clothing
• Informing recent sexual partners about the infestation so they can seek treatment if necessary

Can pubic lice be prevented through the use of condoms? While condoms are crucial for preventing many sexually transmitted infections, they do not provide complete protection against pubic lice. These parasites can infest any hairy areas of the body, not just the genitals, making condom use insufficient for prevention.

The Importance of Partner Notification and Treatment

To prevent re-infestation and further spread, it’s crucial to notify all sexual partners from the past month about the pubic lice infestation. These individuals should be examined and treated if necessary, even if they don’t show symptoms. This approach, known as partner notification, is a vital public health measure in controlling the spread of pubic lice and other sexually transmitted infections.

Pubic Lice in Special Populations: Considerations and Challenges

While pubic lice can affect anyone, certain populations may face unique challenges or require special considerations in treatment and prevention:

Pregnant Women

Pregnant women diagnosed with pubic lice require careful consideration in treatment selection. Some topical insecticides may not be suitable during pregnancy due to potential risks to the fetus. In such cases, healthcare providers may recommend alternative treatments or manual removal methods.

Children

The presence of pubic lice in children, particularly in eyelashes or eyebrows, may raise concerns about potential sexual abuse. Healthcare providers are trained to approach these situations sensitively and may involve child protection services if necessary.

Immunocompromised Individuals

People with weakened immune systems may be more susceptible to complications from pubic lice infestations, such as secondary skin infections. They may require more aggressive treatment and closer monitoring during the treatment process.

How does the treatment approach differ for these special populations? Treatment for these groups often involves a more personalized approach, taking into account individual health status, potential risks, and the need for ongoing monitoring. Healthcare providers may opt for treatments with lower toxicity profiles or more frequent follow-up appointments to ensure complete eradication of the infestation.

The Psychological Impact of Pubic Lice Infestations

While pubic lice are a common and treatable condition, the psychological impact of an infestation can be significant. Many individuals experience feelings of embarrassment, shame, or anxiety upon discovering they have pubic lice. These emotional responses can sometimes lead to delayed seeking of treatment or reluctance to inform partners, potentially exacerbating the spread of the infestation.

What are some common psychological reactions to pubic lice infestations? Individuals may experience:

• Feelings of uncleanliness or contamination
• Anxiety about sexual relationships or intimacy
• Embarrassment or fear of judgment from healthcare providers
• Stress related to the process of treatment and decontamination
• Worry about recurrence or re-infestation

Addressing the Emotional Aspects of Treatment

Healthcare providers play a crucial role in addressing these psychological aspects. By providing non-judgmental, factual information about pubic lice and emphasizing the commonality of such infestations, they can help alleviate patient anxiety and encourage prompt treatment-seeking behavior. Some healthcare facilities may offer counseling services or support groups for individuals dealing with the emotional impact of sexually transmitted infections, including pubic lice.

Pubic Lice in the Context of Public Health

From a public health perspective, pubic lice infestations present unique challenges and opportunities. While not typically considered as serious as some other sexually transmitted infections, pubic lice can serve as an indicator of risky sexual behavior and potential exposure to other STIs.

Surveillance and Epidemiology

Public health agencies often monitor trends in pubic lice infestations as part of broader STI surveillance efforts. This data can provide valuable insights into sexual health trends within communities and inform targeted prevention and education initiatives.

Education and Awareness Campaigns

Public health organizations play a crucial role in educating the public about pubic lice, including:

• Dispelling myths and misconceptions about transmission and treatment
• Promoting safe sex practices and regular STI screenings
• Encouraging open communication between sexual partners about sexual health
• Providing resources for proper diagnosis and treatment

How do public health initiatives address the stigma associated with pubic lice? Many campaigns focus on normalizing discussions about sexual health and emphasizing that pubic lice infestations are common, treatable, and not indicative of poor hygiene. By framing pubic lice as a public health issue rather than a personal failing, these initiatives aim to reduce stigma and encourage proactive health-seeking behaviors.

Research and Development

Ongoing research in the field of pubic lice focuses on several key areas:

1. Developing more effective and less toxic treatment options
2. Investigating potential resistance to current treatments
3. Exploring novel prevention strategies
4. Studying the co-occurrence of pubic lice with other STIs

These research efforts contribute to improving diagnostic techniques, treatment protocols, and public health strategies for managing pubic lice infestations on a population level.

Pubic lice – NHS

Pubic lice are tiny insects that can live on body hair, especially the pubic hair around the penis or vagina. They’re spread through close body contact, most commonly through sexual contact.

Pubic lice are sometimes also called crabs.

Check if you have pubic lice

Pubic lice are very small (2mm long) and grey-brown in colour.

They can be hard to spot, but sometimes you may be able to see them in your hair.

They most often live on pubic hair around the penis or vagina, but can also be found in hair on the chest, armpits, face and eyelashes. They do not affect hair on the head.

Other symptoms of pubic lice include:

• itching, which is usually worse at night
• small red or blue spots on your skin (lice bites)
• white/yellow dots attached to your hair (lice eggs)
• dark red or brown spots in your underwear (lice poo)
• crusted or sticky eyelashes, if they’re affected

Non-urgent advice: Go to a sexual health clinic or see a GP if:

• you think you might have pubic lice

Pubic lice will not go away without treatment.

If you’re sure you have pubic lice, you may be able to get treatment from a pharmacist.

What happens at your appointment

If you go to a sexual health clinic or GP surgery because you think you have pubic lice, a doctor or nurse will check your hair for lice.

They may check your pubic hair around your penis or vagina and any other areas that could be affected, such as your armpits, chest or eyelashes.

To help spot any lice, they might use a comb and a magnifying lens.

If they think you might have caught the lice during sex, they may ask about your sexual partners. They may also suggest getting tested for any sexually transmitted infections (STIs).

Treatment for pubic lice

The main treatments for pubic lice are medicated creams or shampoos that kill the lice.

You usually need to use the treatment on your whole body and leave it on for a few hours before washing it off. You’ll need to repeat this again a week later to make sure all the lice have been killed.

You may be asked to come back a week after you finish treatment, to check if the treatment has worked.

Any current or recent sexual partners should also be treated, even if they do not have symptoms.

How to stop pubic lice spreading

While you’re being treated for pubic lice, there are some things you can do to help stop the lice spreading to others and stop the lice coming back.

Do

• wash your clothes and bedding on a hot wash (50C or higher), get them dry cleaned, or put them in a plastic bag for at least a week – this will help kill any lice

• vacuum your mattress to remove any lice

How you get pubic lice

Pubic lice are mainly spread by close body contact, most commonly sexual contact.

The lice cannot jump or fly, but can climb from one person to another.

You can also catch the lice from clothes, bedding or towels used by someone with pubic lice, but this is rare.

How to avoid getting pubic lice

It can be hard to prevent pubic lice.

The only way to avoid getting them is to avoid having sexual contact (or sharing bedding or clothing) with anyone you know who has pubic lice, until they’ve been treated.

Condoms and other forms of contraception will not protect you from pubic lice. But it’s still a good idea to use condoms during sex because they reduce the risk of sexually transmitted infections (STIs).

Page last reviewed: 24 May 2022
Next review due: 24 May 2025

Pediculosis (lice, head lice, body lice, pubic lice, cooties, crabs)

Last Reviewed: October 2011

What is pediculosis?

Pediculosis is an infestation of the hairy parts of the body or clothing with the eggs, larvae or adults of lice. The crawling stages of this insect feed on human blood, which can result in severe itching. Head lice are usually located on the scalp, crab lice in the pubic area and body lice along seams of clothing. Body lice travel to the skin to feed and return back to the clothing.

Who gets pediculosis?

Anyone may become louse infested under suitable conditions of exposure. Pediculosis is easily transmitted from person to person during direct contact. Head lice infestations are frequently found in school settings or institutions. Crab lice infestations can be found among sexually active individuals. Body lice infestation can be found in people living in crowded, unsanitary conditions where clothing is infrequently changed or laundered.

How is pediculosis spread?

For both head lice and body lice, transmission can occur during direct contact with an infested individual. Sharing of clothing and combs or brushes may also result in transmission of these insects. While other means are possible, crab lice are most often transmitted through sexual contact.

What are the symptoms of pediculosis?

Usually, the first indication of an infestation is the itching or scratching in the area of the body where the lice feed. Scratching at the back of the head or around the ears should lead to an examination for head louse eggs (nits) on the hair. Itching around the genital area should lead to an examination for crab lice or their eggs. Scratching can be sufficiently intense to result in secondary bacterial infection in these areas.

How soon do symptoms appear?

It may take as long as two to three weeks or longer for a person to notice the intense itching associated with this infestation.

For how long is a person able to spread pediculosis?

Pediculosis can be spread as long as lice or eggs remain alive on the infested person or clothing.

What is the treatment for pediculosis?

Medicated shampoos or cream rinses containing pyrethrins or permethrin are preferred for treating people with head lice. Products containing pyrethrins, permethrin or malathion are available over-the-counter, but those containing lindane or malathion are available only through a physician’s prescription. Lindane-based shampoos are not recommended for infants, young children, pregnant women, lactating women, the elderly, persons with HIV or seizure disorders, persons who have very irritated skin or sores where the lidane will be applied and persons who weigh less than 110 pounds. Retreatment after 7 to 10 days is often recommended to ensure that no eggs have survived. Nit combs are available to help remove nits from hair. Dose and duration of shampoo treatment should be followed carefully according to label instructions.

What can be done to prevent the spread of pediculosis?

Physical contact with infested individuals and their belongings, especially clothing, headgear and bedding, should be avoided. Health education on the life history of lice, proper treatment and the importance of laundering clothing and bedding in hot water or dry cleaning to destroy lice and eggs is extremely valuable. In addition, regular direct inspection of children for head lice, and when indicated, of body and clothing, particularly of children in schools, institutions, nursing homes and summer camps, is important.

Coronavirus: why do pharmacists need the blue blood of horseshoe crabs and how will it help the Covid-19 vaccine?

July 8, 2020

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Image copyright, Getty Images

They have ten eyes, are 60 centimeters long, have lived on Earth for more than 300 million years, and they actually have pale blue blood, which is highly valued in pharmacology and saves our health .

No, this is not science fiction, but ordinary, good old science. Meet horseshoe crabs, or, as they are also called, horseshoe crabs – although, strictly speaking, they are not actually crabs, but their closest relatives are arachnids.

People are very dependent on horseshoe crabs, or rather, on their blood, which, among other things, is used to determine the purity of medicines, and now also to create a potential coronavirus vaccine.

However, every medal has a downside, in this case it is the life of the horseshoe crabs themselves, who also have their blood (in fact, hemolymph, which is actually a cross between blood and lymph).

Therefore, wildlife conservationists want to end the practice of “milking” these crabs (let’s call them that for convenience).

What are the benefits of horseshoe crabs?

Image copyright, Getty Images

Image caption,

Some of us quite possibly owe our lives to these creatures and don’t even know it

The blood of these “living fossils” has a unique property: it coagulates when it enters even the smallest amount of pathogenic bacteria or other foreign microorganisms, turning into jelly. Thus, the immune system of horseshoe crabs protects other organs from damage.

Using an extract made from the cells of this hemolymph, testing new medical preparations, scientists can be absolutely sure that bacteria or their metabolic products have not got into them, which can then harm a person.

Only horseshoe crab blood possesses this amazing property.

Therefore, every year, thousands of these crabs are caught at sea and sent to American laboratories, where some of their blood is taken and then released into the wild.

The reagent extracted from the hemolymph of horseshoe crabs is highly valued – the cost of one liter of Limulus amebocyte lysate is about 15 thousand dollars, which makes it one of the most expensive medicines in the world.

Image copyright, Getty Images

Image caption,

About 30% of horseshoe crab’s hemolymph is extracted in the “milking shop”

What happens to “donors” afterwards

but these animals.

At first, experts thought that almost all horseshoe crabs survived this forced donation. Another ability of these sea creatures is that they give exactly as much blood as they can give without harming their health.

However, according to recent estimates, up to 30% of individuals die as a result of this procedure.

Other studies have shown that after blood sampling, female crabs are less likely to mate.

Image copyright Getty Images

Image caption,

Scientists estimate the age of horseshoe crabs at 300-450 million years, which makes them one of the oldest species on Earth.

“Right now they are milking about half a million crabs,” lamented Dr. Barbara Brammer, who leads an environmental group in New Jersey, where most of the American horseshoe crabs are caught.

In an interview with the BBC she lamented that no one does not know exactly how blood sampling affects the future life of crabs after they are released.0005

As a result, American horseshoe crabs are approaching the threshold beyond which they can be officially considered endangered.

At the same time, large pharmaceutical companies point to statistics, according to which the number of horseshoe crabs has remained at the same level over the past summer.

Is it possible to find an artificial substitute?

Research to create an artificial analogue of horseshoe crab hemolymph extract has been going on for a long time, but the real breakthrough came only in 2016.

Scientists have succeeded in creating a substitute that has been approved for use in Europe. Some American pharmaceutical companies have also begun to use it.

Image copyright, Getty Images

Image caption,

The blood of these “living fossils” is indeed blue due to its high copper content.

What’s the problem then?

And the fact is that in June of this year, the organization responsible for the safety of medicines in the United States (Food and Drug Administration, or FDA), said that it could not guarantee that the substitute works as reliably as like a natural product.

Therefore, all companies that sell their drugs in the US are required to use horseshoe crab blood for purity testing.

The same goes for any potential coronavirus vaccine: whoever invents it will be required to test it in the old tried and true way if they want to sell their product to millions of Americans.

Dr. Brammer wants to force the American authorities to reconsider their approach, especially since in other countries the artificial substitute is already widely used.

Image copyright, Getty Images

Image caption,

Ridley Scott may have been inspired by horseshoe crabs to create the facehugging parasitoid in Alien

“We need to stop depending on this natural source,” she says .

Some pharmaceutical companies claim they can meet the demand for a coronavirus vaccine without multiplying their crab harvest.

However, according to Barbara, there are at least 30 companies working on the vaccine, and each of them will be required to conduct testing.

“That’s why I’m very worried about horseshoe crab populations,” says Dr. Brammer. “They’re a key part of the ecosystem.”

Why modern medicine needs horseshoe crab? Chemwatch

Virtually unchanged since they first crawled the Earth over 450 million years ago, these ancient creatures (sometimes referred to as living fossils) have outlasted almost every other species – largely due to their incredibly robust immune systems. Their unique way of clotting in the presence of endotoxins makes them incredibly useful in detecting harmful bacteria.

In this article we will take a closer look at horseshoe crabs and what they do for us.

What are horseshoe crabs?

The horseshoe crab is an arthropod species that, despite its name, is technically more closely related to spiders and scorpions than to crabs. There are four species of horseshoe crabs: Atlantic, mangrove, Indo-Pacific and Chinese horseshoe crab.

Limulus polyphemus aka Atlantic horseshoe crab

What makes them so special?

It’s very simple – their blood. Surprisingly, the mesmerizing blue color – due to the high copper content – is not the most attractive feature of horseshoe crab blood. What scientists are most interested in is the “amoebocytes” it contains. These specialized cells protect horseshoe crabs from bacteria and viruses by gelling and coagulating around these invaders, preventing them from spreading and multiplying in the crab’s system. This immune defense mechanism is not unusual in animals. The uniqueness of the amoebocytes in horseshoe crab blood lies in their extreme sensitivity to lethal endotoxins (cell wall molecules of certain bacteria) and the rapid and violent clotting that occurs once they enter their bloodstream.

When this high sensitivity and rapid blood clotting process was first discovered in 1968, scientists immediately noted the potential for human health applications. Thus began the development of the Limulus Amebocyte Lysate (LAL) test to detect endotoxins produced by harmful bacteria.

The bright blue blood of the horseshoe crab is even more mesmerizing than it looks

Limulus Amebocyte Lysate (LAL) test

The LAL test is named after the creature whose observed immune behavior led to the discovery of this test, the Atlantic horseshoe crab (scientific name Limulus polyphemus ).

LAL’s manufacturing process involved collecting horseshoe crabs from the beach and shipping them to one of five manufacturing labs around the world. There, 30% of the blood is drained from them before returning them to the water. The collected blood is then processed, purified and lyophilized to obtain LAL.

Prior to the introduction of the LAL test, endotoxin testing involved injecting a group of rabbits with a specific sample and closely monitoring their condition for the next four hours. Because the response of rabbits to endotoxins is similar to our human response, a subsequent fever in rabbits would indicate that the test sample was contaminated with endotoxins.

At the time, this method of testing in rabbits was considered a highly effective, albeit very laborious and costly, method for detecting endotoxins. It soon became clear that the LAL test offered a much cheaper, simpler, faster and more effective solution, and the test was adopted as the global standard for screening for bacterial contamination.

LAL testing requires the technician to simply add LAL to the sample and observe the response. Even at concentrations of 1 part per trillion, endotoxins will be detected almost instantly through the formation of a jelly-like clot in the sample.

The LAL test is incredibly important for detecting the presence of endotoxins in pharmaceuticals and medical implants/prostheses. Every product certified (including medical prostheses and implants) by the US Food and Drug Administration (USFDA) must first pass the LAL test. If you have ever received any kind of injection, you should thank the horseshoe crab for its safety!

Future LAL

LAL producers report that the measured mortality rate of 500,000 crabs bled annually is only 15%. However, recent independent studies have shown the number to be closer to 30%-75,000%, corresponding to 150,000-15,000 dead horseshoe crabs annually. Because LAL is so rare and highly prized (one liter can cost up to $1,000!), it’s no wonder manufacturers downplay their mortality rate.

The Atlantic horseshoe crab, currently classified as Vulnerable, is only one level away from Critically Endangered, soon to be followed by Critically Endangered, Extinct in the Wild and Extinct if no action is taken soon. The fate of this species will be in jeopardy if we don’t reevaluate current LAL harvesting practices, and it’s not only humans that will suffer when this species goes extinct. Many coastal birds, fish and turtles that feed on horseshoe crab eggs will also be affected by their extinction.

Critically endangered birds are among the many animals that feast on the protein-rich horseshoe crab eggs.

However, this is not all bad news. In 1995, researchers at the National University of Singapore were able to identify and isolate the gene responsible for the sensitive blood clotting that characterizes LAL. This gene, known as “factor C”, was synthesized in yeast, leading to the creation of “recombinant factor C” (rFC). Synthetic CFL differs from organic CFL in that instead of clotting in response to the presence of endotoxins, synthetic CFL causes the endotoxins to emit fluorescent colors.

Although its discovery was a major breakthrough, regulatory and safety concerns regarding this alternative to LAL have slowed the mass adoption of synthetic LAL. Europe did not recognize rFC as an alternative to LAL until 2015, and the USFDA only approved the first drug tested with rFC in 2018. In 2020, the USP, which sets the scientific standard for drugs in the US, refused to recognize rFC as equivalent to LAL, insisting that its safety has not yet been proven. This is despite the fact that their European, Japanese and Chinese counterparts have recognized and accepted the use of synthetic LALs.

As industry ideals and opinions change slowly, it is likely that the biomedical field will continue to satiate their insatiable thirst for the blue blood of these ancient animals for the foreseeable future. This is hardly viable, and we can only hope that we do not reach the point where the choice is made for us through the disappearance of the horseshoe crab.

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Sources:

• https://en.wikipedia.org/wiki/Limulus_amebocyte_lysate
• https://en.wikipedia.org/wiki/Atlantic_horseshoe_crab
• https://myfwc.com/re search/saltwater /crustaceans/horseshoe-crabs/facts/
• https://www.frontiersin.org/articles/10.3389/fmars.2018.00185/full
• https://theconversation.com/living-fossils-we-mapped-half- a-billion-years-of-horseshoe-crabs-to-save-them-from-blood-harvests-141042
• https://bigthink.com/surprising-science/horseshoe-crab-blue-blood
• https://www.theatlantic.com/science/archive/2018/05/blood-in-the-water/559229/
• https://www.wnycstudios.org/podcasts/radiolab/articles/baby- blue-blood-drive
• https://www.theguardian.com/environment/2018/nov/03/horseshoe-crab-population-at-risk-blood-big-pharma
• https://myfwc.