Groundbreaking outpatient activity in medical entomology in France: An eight-year experience in a french university hospital

INTRODUCTION

Arthropods are known to impair human health in various manners, acting as infectious disease vectors, or as simple nuisances. Even though considerable research is being produced in medical entomology, no reports on patient management in clinical entomology units are available in the literature.

PATIENTS AND METHODS

We retrospectively surveyed all the records from patients having consulted in our outpatient clinical entomology unit in Nice University Hospital from 2012 to 2020. For each patient, physical examination findings and treatment data were analyzed.

RESULTS

A total of 518 patients were analyzed in this study. Most were diagnosed with arthropod infestation (55.8%), the most common being Sarcoptes scabiei (35%), bedbugs (23%), Pyemotes dermatitis (17.6%) and flea infestation (15.9%). Along with symptomatic treatments, targeted environmental measures could be proposed for infested patients. For many of our patients, on the other hand, active infestation was ruled out.

CONCLUSION

Given today's lack of expertise in medical entomology, we advocate for the creation of medical entomology units in university hospitals, not only allowing fair and proportionate multidisciplinary management of patients in whom arthropod infestation is suspected, but also generating cost savings.

Age-related mating rates among ecologically distinct lineages of bedbugs, Cimex lectularius

Understanding how many mates an animal has in its lifetime is a critical factor in sexual selection. At the same time, differences in an organism's ecology, such as the quantity and quality of food, could be reflected in different mating rates. Mating rate had a significant effect on female net fitness (i.e., lifetime offspring production), however, laboratory measurements cannot well mirror the situation in wild. The common bedbug (Cimex lectularius) is a well-established model for studying traumatic insemination and sexual conflict. The species comprises two host lineages that feed on bats (BL) or humans (HL). HL can constantly feed on human hosts throughout the year, while BLs feed only during summer months when their bat hosts occupy the roosts. Because mating in female bedbugs is closely linked to foraging, this system provides a valuable model to study mating variation in the field. We established a new method for estimating age-dependent mating rates of females in the wild by relating the fluorescent pigment accumulation in the eyes of females to the number of mating scars that manifest as melanized spots caused by the injection of sperm through the wall of the female abdomen by the male into the spermalege. In addition, using laboratory bedbugs we found that three and a half observed matings on average lead to one observed melanized mating scar. Although young BL and HL females (with low pteridine concentrations) did not differ in the number of matings, the mating rate increased with age only in HL but not in BL females. We sampled on average older BL than HL females. The lack of access to food (bat blood) during winter could explain the lack of increase in the number of scars with age in BL. In species where mating leaves visible marks, using fluorescent pigments to determine female age (applicable to most arthropods) could be an important tool to study sexual selection and mating rate in the wild. The method can help formulate sustainable and biologically lucid approaches for their control.

Staphylococcus aureus native mitral valve endocarditis associated with bed bug bites - A case report and review of the literature

Staphylococcus aureus is a leading cause of community acquired bacteremia and infective endocarditis. S. aureus is a part of the normal skin flora in approximately one third of the human population. Infective endocarditis due to S. aureus can cause several complications and is associated with increased mortality. A 48-year-old female with no significant medical history presented with S. aureus bacteremia and native mitral valve endocarditis. Multiple cutaneous skin lesions were identified, which she reported were due to recent bed bug bites. No source of infection was found except for the skin lesions. Her hospital course was complicated by pulmonary and cerebral septic emboli, left pleural empyema, and acute renal injury. We suspected the bed bug skin bites were the most likely source of bacteremia. Bed bugs carry many human pathogens but have not been shown to be a competent vector. We did not find any literature on endocarditis associated with bed bug bites; thus, our case will be a novel finding.

Insecticidal efficacy of afoxolaner against bedbugs, Cimex lectularius, when administered orally to dogs

The objective of this experimental study was to assess the insecticidal efficacy of afoxolaner (NexGard^®) against bedbugs (Cimex lectularius) on dogs. For each challenge, 20 bedbugs were placed in two chambers positioned in contact to the dog’s skin for 15 min, after which live fed parasites were counted and incubated for survival evaluations. On Day 0, 7 dogs assigned to the treated group were administered afoxolaner orally at the registered dose. All 14 dogs were challenged on Days 1, 7, 14, 21 and 28, and the collected live fed C. lectularius incubated for 72 h (Day 1), and 72 h and 96 h (Days 7, 14, 21 and 28) for survival evaluation. The percent feeding in the control group ranged from 95% to 98.6% and the percent of live fed bedbugs at 96 h ranged from 99.3% to 100% in the control group, demonstrating the viability of the strain and their capacity to feed on dogs. Significantly fewer live fed bedbugs were counted in the treated group, compared to the control group, at all time-points. The reduction of live fed C. lectularius in the afoxolaner group was 41.4% at 72 h after the Day 1 challenge, and 77.2%, 82.7%, 85.0% and 63.5% at 96 h after the Days 7, 14, 21 and 28 challenges, respectively. It is hypothesized that monthly treatment of dogs with afoxolaner could help in preventing a bed bug population from installing in a household if bedbugs bite dogs in the presence of humans.

Molecular analysis of pyrethroid resistance in Cimex hemipterus (Hemiptera: Cimicidae) collected from different parts of Iran

The present study was aimed to assess the bedbugs susceptibility to pyrethroid insecticides using molecular analysis. With the aid of pest control companies, adult bedbugs were collected from various places such as hotels, residential houses, and industrial buildings in seven cities highly crowded with domestic and foreign tourists in Iran from May 2016 to August 2017. Bedbugs were colonized in the laboratory to evaluate their resistance to pyrethroid using insecticide resistance bioassay. Genomic DNA was extracted from susceptible and resistant bedbugs. At first, specie specific primers targeting cytochrome oxidase subunit I (COI) gene was performed to confirm Cimexhemipterus species. Then, kdr-like gene was examined for point mutation using PCR and nucleotide sequencing. Bioassay showed that 11 out of 35 examined bedbugs were resistant to pyrethroids (31.43%; 95.00% confidence interval: 29.48-33.08%). The DNA sequencing showed that all examined bedbugs collected from Tehran province had homozygous V419L kdr-like gene mutations. The level of pyrethroid resistance found in the collected bugs from Tehran province indicated that this phenomenon has already been prevailed in the site and prompts the need to reevaluate the large use of pyrethroids to control the bedbugs.

MALDI-TOF MS identification of Cimex lectularius and Cimex hemipterus bedbugs

Bedbugs (Cimex lectularius and C. hemipterus) have reemerged as a major public health problem around the world. Their bites cause various skin lesions as well as discomfort and anxiety. Their role as potential vectors of various infectious agents is discussed. Accordingly, all suspected cases of bedbug infestations need to be documented thoroughly, with an unequivocal identification of the arthropods involved, if any are present. Although morphological identification is easily and quickly performed by entomologists or professionals, it can be challenging otherwise. Also, distinguishing Cimex lectularius and C. hemipterus requires entomological expertise. MALDI-TOF mass spectrometry has been recently presented as an additional tool for arthropod identification. In this study, we assess the use of MALDI-TOF MS for the identification of laboratory and wild strains of C. lectularius and C. hemipterus. Several body parts of laboratory reared C. lectularius specimens were used to develop a MALDI-TOF MS protocol for bedbug identification, which was later validated using five other laboratory and wild populations of C. hemipterus and C. lectularius. A total of 167C. lectularius and C. hemipterus bedbug specimens (98 laboratory specimens and 69 wild specimens) were submitted to MALDI-TOF MS analysis. 143/167 (85.63%) provided high quality MS spectra. The in-lab database was then upgraded with a total of 20 reference spectra from all bedbug populations and the rest of the MS spectra (123 bedbugs) were blind tested. All specimens were properly identified to the species level using MALDI-TOF MS and 86,25% (69/80) were aptly identified according to their origin with LSVs ranging from 1.867 to 2.861. MALDI-TOF MS appears as a reliable additional tool for the identification of these two anthropophilic species.

Insecticides Susceptibility Status of the Bedbugs (Cimex lectularius) in a Rural Area of Magugu, Northern Tanzania

The recent spread of bedbugs, Cimex lectularius L. (Heteroptera: Cimicidae), has received attention of the public health sector for designing of effective plan of action for control. Several studies have focused on determining the distribution and abundance of bedbug populations in tropical areas. This study establishes baseline information on deltamethrin, permethrin, alphacypermethrin, lambdacypermethrin and K-O tab susceptibility status in a bedbug population collected from Magugu area in northern Tanzania. The evolution of insecticide resistance could be a primary factor in explaining this resurgence of bedbugs in many areas, both rural and urban. Evaluation of the bedbug population from houses in Magugu indicates that the population of bedbugs is susceptible to pyrethroid insecticides, which are commonly used. Without the development of new tactics for bedbug resistance management, further escalation of this public health problem should be expected when resistant gene spreads within the population. These results suggest that although all concentrations kill bedbugs, more evaluations should be done using WHO kits and mechanisms involved in pyrethroid resistance should be evaluated, such as metabolic and knockdown resistance gene, to have a broad picture for better design of control methodologies.