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      Bed bugs reproductive life cycle in the clothes of a patient suffering from Alzheimer’s disease results in iron deficiency anemia Translated title: Le cycle reproductif des punaises de lit dans les vêtements d’une patiente souffrant de la maladie d’Alzheimer entraîne une anémie ferriprive

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          Abstract

          We report the case of an 82-year-old patient, hospitalized for malaise. Her clothes were infested by numerous insects and the entomological analysis identified them as being Cimex lectularius (bed bugs). The history of the patient highlighted severe cognitive impairment. The biological assessment initially showed a profound microcytic, aregenerative, iron deficiency anemia. A vitamin B12 deficiency due to pernicious anemia (positive intrinsic factor antibodies) was also highlighted, but this was not enough to explain the anemia without macrocytosis. Laboratory tests, endoscopy and a CT scan eliminated a tumor etiology responsible for occult bleeding. The patient had a mild itchy rash which was linked to the massive colonization by the bed bugs. The C. lectularius bite is most often considered benign because it is not a vector of infectious agents. Far from trivial, a massive human colonization by bed bugs may cause such a hematic depletion that severe microcytic anemia may result.

          Translated abstract

          Nous rapportons le cas d’une patiente âgée de 82 ans, hospitalisée pour malaise. Ses vêtements sont infestés par de multiples insectes et l’analyse entomologique les identifie comme étant des Cimex lectularius (punaises des lits). L’anamnèse de la patiente met en exergue des troubles cognitifs sévères. Le bilan somatique retrouve une anémie profonde, microcytaire, arégénerative, fortement ferriprive. Parallèlement, une carence en vitamine B12 imputable à une maladie de Biermer (anticorps anti facteur intrinsèque positifs) est mise en évidence aussi, sans expliquer à elle seule cette anémie sans macrocytose. Un bilan biologique, endoscopique et scannographique élimine une étiologie tumorale responsable d’un saignement occulte. La patiente présente une discrète éruption cutanée prurigineuse, que l’on met en rapport avec la colonisation massive par les punaises des lits. La piqûre de C. lectularius est le plus souvent considérée comme bénigne du fait qu’elle n’est vectrice d’aucun agent infectieux. Loin d’être anodine, une colonisation humaine massive par des punaises des lits peut causer une spoliation hématique telle qu’une sévère anémie microcytaire peut en être la conséquence.

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          Most cited references 25

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          Bed bugs (Cimex lectularius) and clinical consequences of their bites.

          Bed bug (Cimex lectularius) infestations are rapidly increasing worldwide. Health consequences include nuisance biting and cutaneous and systemic reactions. The potential for bed bugs to serve as disease vectors and optimal methods for bed bug pest control and eradication are unclear. To present current knowledge of the health and medical effects of bed bugs and to explore key issues in pest control and eradication efforts. A search of MEDLINE and EMBASE databases (1960-October 2008) for articles using the keywords bed bugs, Cimex lectularius, humans, parasitology, pathogenicity, and drug effects. For pest control, PubMed and Toxline searches (1960-October 2008) were performed using the keywords bed bugs, Cimex, control, prevention, and eradication. Manual searches of older journals, textbooks, pest control trade journals, and newspapers (1892-October 2008) were also performed. Original accounts or investigations of bed bugs, clinical responses with sufficient detail of cause and effect between the bed bug bite and clinical response, and convincing evidence of substantiated presence of bed bug exposure. For pest control, documentation that an eradication measure quantitatively decreased bed bugs. A trained medical reference librarian assisted with the literature search. Two authors with expertise in the diagnosis, treatment, and eradication of bed bugs reviewed the clinical articles. One author evaluated the pest control articles. Fifty-three articles met inclusion criteria and were summarized. Only 2 clinical trials concerning bed bugs were identified and tested the ability of pest control interventions to eradicate bed bugs. Although transmission of more than 40 human diseases has been attributed to bed bugs, there is little evidence that they are vectors of communicable disease. A variety of clinical reactions to bed bugs have been reported, including cutaneous and rarely systemic reactions. A wide range of empirical treatments, including antibiotics, antihistamines, topical and oral corticosteroids, and epinephrine, have been used for bite reactions with varying results. No evidence-based interventions to eradicate bed bugs or prevent bites were identified. Treatment options for cutaneous and systemic reactions from bed bug bites have not been evaluated in clinical trials and there is no evidence that outcomes differ significantly from those receiving no treatment. Evidence for disease transmission by bed bugs is lacking. Pest control and eradication is challenging due to insecticide resistance, lack of effective products, and health concerns about spraying mattresses with pesticides.
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            Bed bugs: clinical relevance and control options.

            Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.
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              Illness after international travel.

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                Author and article information

                Journal
                Parasite
                Parasite
                parasite
                Parasite
                EDP Sciences
                1252-607X
                1776-1042
                2013
                15 May 2013
                : 20
                : ( publisher-idID: parasite/2013/01 )
                Affiliations
                [1 ] Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg 1–3 rue Koeberlé 67000 Strasbourg France
                [2 ] Pôle de Gériatrie, Pavillon Schutzenberger, Hôpital de la Robertsau, Hôpitaux Universitaires de Strasbourg 83 rue Himmerich 67000 Strasbourg France
                [3 ] Médecine Interne Médicale B, Hôpitaux Universitaires de Strasbourg 1 place de l’Hôpital 67000 Strasbourg France
                [4 ] Service d’Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg 3 rue Koeberlé 67000 Strasbourg France
                Author notes
                [* ]Corresponding author: amsabou@ 123456unistra.fr
                Article
                parasite130003 10.1051/parasite/2013018
                10.1051/parasite/2013018
                3718524
                23673315
                © M. Sabou et al., published by EDP Sciences, 2013

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 5
                Categories
                Research Article

                cimex lectularius, iron deficiency anemia

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