Who Bites Me? A Tentative Discriminative Key to Diagnose Hematophagous Ectoparasites Biting Using Clinical Manifestations

Presentation and management of insect bites in out-of-hours primary care: a descriptive study

OBJECTIVES

To describe the population presenting to out-of-hours primary care with insect bites, establish their clinical management and the factors associated with antibiotic prescribing.

DESIGN

An observational study using routinely collected data from a large out-of-hours database (BORD, Birmingham Out-of-hours general practice Research Database).

SETTING

A large out-of-hour primary care provider in the Midlands region of England.

PARTICIPANTS

All patients presenting with insect bites between July 2013 and February 2020 were included comprising 5774 encounters.

OUTCOME MEASURES

This cohort was described, and a random subcohort was created for more detailed analysis which established the clinical features of the presenting insect bites. Logistic regression was used to model variables associated with antibiotic prescribing.

RESULTS

Of the 5641 encounters solely due to insect bites, 67.1% (95% CI 65.8% to 68.3%) were prescribed antibiotics. General practitioners were less likely to prescribe antibiotics than advanced nurse practitioners (60.5% vs 71.1%, p<0.001) and there was a decreasing trend in antibiotic prescribing as patient deprivation increased. Pain (OR 2.13, 95% CI 1.18 to 3.86), swelling (OR 2.88, 95% CI 1.52 to 5.46) and signs of spreading (OR 3.45, 95% CI 1.54 to 7.70) were associated with an increased frequency of antibiotic prescribing. Extrapolation of the findings give an estimated incidence of insect bite consultations in England of 1.5 million annually.

CONCLUSION

Two-thirds of the patients presenting to out-of-hours primary care with insect bites receive antibiotics. While some predictors of prescribing have been found, more research is required to understand the optimal use of antibiotics for this common presentation.

Molecular Research on Vector-Borne Diseases of Medical Interest: From Bench to Application 2.0

Infectious diseases caused by parasites (malaria, leishmaniasis, trypanosomiasis, filariasis…), viruses (chikungunya, dengue, phlebovirus, etc [...].

The Palearctic blackfly Simulium equinum (Diptera: Simuliidae) as a biting pest of captive nyala antelopes (Tragelaphus angasii)

Blackflies (Diptera: Simuliidae) are cosmopolitan nuisance pests of great economic importance as well as vectors of many pathogens. After reports of massive blackfly biting of captive nyala antelopes in the Vienna Zoo, Austria, this study aimed to identify the species causing multiple skin lesions on the antelope hosts. The Palearctic species Simulium equinum, belonging to the medically and veterinary important Wilhelmia subgenus, was identified as the most likely causative agent. Barcoding and maximum likelihood analysis supported morphological species identification and highlighted the complex phylogeny of the subgenus Wilhelmia. Our study gives first evidence of the multi-host feeding blackfly S. equinum in the Vienna Zoo, thereby raising the question whether other hosts could also be bitten on a regular basis. The preliminary results urge for further analysis of blackfly breeding sites as well as the clarification of the host spectrum to assess the medical and veterinary importance of blackflies in the Zoo.

Epidemiology of Vector-Borne Diseases 2.0

Arthropods’ vectors—those of a large variety of families, including Culicidae, Simuliidae, Psychodidae, Ixodidae, Agarsidae, Pulicidae, Glossinidae, Reduviidae, and Tabanidae [...]

Bed Bugs (Hemiptera: Cimicidae) Population Diversity and First Record of Cimex hemipterus in Paris

Cimex lectularius and C. hemipterus are blood-sucking insects with a long history of presence in human communities. We investigated the molecular diversity of the bed bug population of Paris and its suburb cities using cytochrome oxidase 1 (CO1) sequencing. A total of 1211 specimens belonging to different life stages were collected from 62 infested human dwellings in Paris (13 out of 20 arrondissements) and the surrounding cities (18 cities). Morphological determination and COI sequencing of 132 specimens demonstrated C. lectularius as the predominant species and, surprisingly, the presence of C. hemipterus in four infested areas of Paris and its suburb cities. Neighbor-joining tree and network analyses depicted the presence of two C. lectularius populations. Most samples from Paris and its suburb cities clustered in a major clade. The second population encompasses specimens from Paris (arrondissements 11 and 19) and its suburb cities (e.g., Bobigny, Pantin, and Montreuil) that clustered with Hungary, Czechia, and Finland. This is the second evidence for C. hemipterus infestation in France and the third in Europe, which challenges the classic pattern of C. hemipterus dispersion and implies sympatric occurrence of C. lectularius and C. hemipterus. Since Paris is one of the most popular tourist destinations in the world, our observations shed light on bed bugs' dispersal dynamic and may help future vector control strategies.

Magnitude and Spread of Bed Bugs (Cimex lectularius) throughout Ohio (USA) Revealed by Surveys of Pest Management Industry

Simple Summary

Bed bugs are small blood-sucking insects that live indoors and feed on humans. They have become a problem in countries worldwide. In this study, the problem in Ohio (Midwest U.S.) was measured based on treatments by licensed pest control companies throughout the state. Results from 2005 showed that Ohio’s bed bug problem likely started in Hamilton County, which includes Cincinnati. Much larger numbers of bed bug treatments were performed in 2011 and again in 2016, especially in counties with large cities. Almost every Ohio county had numerous bed bug treatments in 2016. Most treatments were in apartments/condos and single-family homes. Residents misused many pesticides, especially over-the-counter “bug bombs” and household cleaners, trying to eliminate bed bugs. Many people also threw away unwrapped infested furniture, which may further spread these bugs. More public education is needed to stop such practices. This study shows that bed bug problems can grow and spread quickly. Federal, state, and local officials and the public should immediately deal with bed bugs rather than waiting until they become an even bigger problem.

Abstract

Bed bugs have recently re-emerged as human pests worldwide. In this study, two surveys queried licensed pest management companies in Ohio (Midwest USA) about their experiences managing bed bugs. A primary objective was to assess the magnitude and spread of bed bug infestations statewide based on companies’ treatment records from 2005 and 2011 (first survey) and 2016 (second survey). The survey response rates were 35.6% and 31.6%, respectively. Treatment data from 2005 indicated that Ohio’s bed bug problem likely started in the SW corner of the state in Hamilton County (includes city of Cincinnati), since it totaled five times more treatments (approximately 4500) than second-ranking, centrally located Franklin County (Columbus). In the first half of 2011, more than 15,000 treatments were performed in these two counties. In 2016, treatments reached nearly 38,000 in Franklin County and in NE Ohio in the three combined counties that include Cleveland-Akron-Canton. Bed bug problems expanded statewide during an 11 y period, with an estimated 100+ treatments in 7 counties in 2005, 45 counties in 2011, and nearly all 88 counties in 2016. Apartments/condos and single-family residences comprised the largest share of bed bug work. Residents misused many pesticides and household cleaners trying to eliminate bed bugs. Many also discarded unwrapped infested furniture, which may further spread these bugs. More public education is needed to stop such practices. This study shows that bed bug problems grow and spread quickly; federal, state, and local officials and the public should immediately deal with bed bugs.

Widespread Mutations in Voltage-Gated Sodium Channel Gene of Cimex lectularius (Hemiptera: Cimicidae) Populations in Paris

Bed bugs, Cimex lectularius and C. hemipterus, are common blood-sucking ectoparasites of humans with a large geographical distribution, worldwide. In France, little is known about the status of bed bugs’ infestation and their resistance to insecticides, particularly, pyrethroids. Here, we aimed to find mutations in the kdr gene, known to be involved in resistance to insecticides. We gathered bed bugs from various infested locations, including 17 private houses, 12 HLM building complex, 29 apartments, 2 EHPAD, and 2 immigrants’ residences. A total of 1211 bed bugs were collected and morphologically identified as C. lectularius. Two fragments of the kdr gene, encompassing codons V419L and L925I, were successfully amplified for 156 specimens. We recorded sense mutation in the first amplified fragment (kdr1) in 89 out of 156 (57%) samples, in which in 61 out of 89 (68.5%) sequences, a change of valine (V) into leucine (L) V419L was observed. Within the second fragment (kdr2), a homozygous mutation was recorded in 73 out of 156 (46.7%) specimens at the codon 925. At this position, 43 out of 73 (58.9%) specimens had a sense mutation leading to the replacement of leucine (L) by isoleucine (I). Among 162 mutant sequences analyzed (89 for the kdr1 fragment and 73 for the kdr2 one), we detected single point mutation in 26.6%, while 73.4% presented the mutation in both kdr1 and kdr2 fragments. All modifications recorded in bed bug populations of Paris are described to be involved in the knockdown resistance (kdr) against pyrethroids.

Yersinia pestis: the Natural History of Plague

The Gram-negative bacterium Yersinia pestis is responsible for deadly plague, a zoonotic disease established in stable foci in the Americas, Africa, and Eurasia. Its persistence in the environment relies on the subtle balance between Y. pestis-contaminated soils, burrowing and nonburrowing mammals exhibiting variable degrees of plague susceptibility, and their associated fleas. Transmission from one host to another relies mainly on infected flea bites, inducing typical painful, enlarged lymph nodes referred to as buboes, followed by septicemic dissemination of the pathogen. In contrast, droplet inhalation after close contact with infected mammals induces primary pneumonic plague. Finally, the rarely reported consumption of contaminated raw meat causes pharyngeal and gastrointestinal plague. Point-of-care diagnosis, early antibiotic treatment, and confinement measures contribute to outbreak control despite residual mortality. Mandatory primary prevention relies on the active surveillance of established plague foci and ectoparasite control. Plague is acknowledged to have infected human populations for at least 5,000 years in Eurasia. Y. pestis genomes recovered from affected archaeological sites have suggested clonal evolution from a common ancestor shared with the closely related enteric pathogen Yersinia pseudotuberculosis and have indicated that ymt gene acquisition during the Bronze Age conferred Y. pestis with ectoparasite transmissibility while maintaining its enteric transmissibility. Three historic pandemics, starting in 541 AD and continuing until today, have been described. At present, the third pandemic has become largely quiescent, with hundreds of human cases being reported mainly in a few impoverished African countries, where zoonotic plague is mostly transmitted to people by rodent-associated flea bites.