Study: Bites Can Induce Potentially Deadly Systemic Reactions

Editor’s note: This article is based on an Oct. 26, 2016, paper in Austral Entomology (Australian Entomological Society) titled “Systemic and erythrodermic reactions following repeated exposure to bites from the Common bed bug Cimex lectularius (Hemiptera: Cimicidae).” The paper can be found here. The following information is reprinted in PCT with permission of Stephen Doggett, Department of Medical Entomology, Pathology West — Westmead Hospital, Westmead, Australia.

As always, pest management professionals should never offer medical advice to their clients. This article is provided for informational purposes only.

Bed bugs (Cimex spp.) readily bite humans, producing a range of cutaneous reactions. This article documents systemic reactions in two patients following repeated bites from the common bed bug, Cimex lectularius. Both patients had previously fed bed bugs on themselves without any serious complication, however, upon feeding a new batch of the insects, they subsequently developed systemic urticarial reactions. Both were admitted to an emergency department for treatment and subsequently made a full recovery.

Patient 1 fed 40 to 50 bed bugs on himself and after eight minutes, he developed itch, swelling of the face, lethargy, profuse sweating and widespread wheals on the torso and limbs. The reaction disappeared in five hours after treatment with systemic prednisone and antihistamines. Patient 2 developed a similar reaction after feeding five to six bed bugs on himself. In this case, the patient also developed chest tightness and breathing difficulties. Following a similar treatment, symptoms disappeared in four hours.

In light of the increasing exposure of this insect to the general public, systemic reactions in patients may present more commonly to the medical practitioner. This report demonstrates how bed bugs can be a serious threat to the health of the community. If people are constantly exposed to bed bug bites (especially in low-income housing), then the effects can be extremely harmful to the individual.

Click Image to View Gallery

DISCUSSION. There are a limited number of published cases of systemic reactions to bed bugs and symptomology has been ill defined. Consequently, these reactions can create a diagnostic dilemma for health-care professionals. A diverse number of dermatological differential diagnoses exist. Multiple bed bug bites are typically characterized by a cluster or linear distribution of erythematous macular lesions and can progress to wheals and widespread urticarial (Doggett & Russell 2009).

Although rare, systemic reactions can involve widespread pruritis, asthma, anaphylaxis and fever (Doggett et al. 2012). There is increasing evidence to support sensitization after initial exposure to bed bugs with the latency period between bed bug bite and cutaneous reaction decreasing substantially between subsequent bites (Reinhardt et al. 2009).

In the case of the 28-year-old male, he had been exposed to bed bug bites since November 2012 and has developed progressively more severe cutaneous reactions from each subsequent bite.

CONCLUSION. Physical impacts of bed bug bites are of growing concern, and there has been a surge of legal disputes throughout the western world recently. State and local governments have been overwhelmed with complaints by residents in regards to bed bug infestations, which are at times resistant to pest control measures (Aultman 2013). Bed bug infestations have become a particular problem among the socially disadvantaged, where infestations often go untreated, leading to massive bed bug populations and ongoing bites. Therefore, patients with systemic reactions may increasingly present to medical practitioners.

REFERENCES
Aultman JM. 2013. Don’t let the bedbugs bite: the Cimicidae debacle and the denial of healthcare and social justice. Medicine, Health Care and Philosophy 16, 417–427.

Bernardeschi C, Le Cleach L, Delaunay P & Chosidow O. 2013. Bed bug infestation. British Medical Journal 346, f1044.

Dang K, Lilly DG, Bu W & Doggett SL. 2015. Simple, rapid and cost-effective technique for the detection of pyrethroid resistance in bed bugs, Cimex spp. (Hemiptera: Cimicidae). Austral Entomology 54, 191–196.

Deshazo RD, Feldlaufer MF, Mihm MC & Goddard J. 2012. Bullous reactions to bedbug bites reflect cutaneous vasculitis. American Journal of Medicine 125, 688–694.

Doggett SL & Russell RC. 2008. The resurgence of bed bugs, Cimex spp. (Hemiptera: Cimicidae) in Australia. In: Proceedings of the Sixth International Conference on Urban Pests, Budapest, Hungary, 13–16 July 2008 (eds WH Robinson & D Bajomi), pp. 407–425. OOK-Press, Budapest, Hungary.

Doggett SL & Russell RC. 2009. Bed bugs. What the GP needs to know. Australian Family Physician 38, 880–884.

Doggett SL, Orton CJ, Lilly DG & Russell RC. 2011. Bed bugs: the Australian response. Insects 2, 96–111.

Doggett SL,Dwyer DE, Penas PF&Russell RC. 2012.Bed bugs: clinical relevance and control options. ClinicalMicrobiology Reviews 25, 164–192.

Goddard J & De Shazo R. 2009a. Bed bugs (Cimex lectularius) and clinical consequences of their bites. Journal of the American Medical Association 301, 1358–1366.

Goddard J & De Shazo R. 2009b. Multiple feeding by the common bed bug, Cimex lectularis, without sensitization.Midsouth Entomologist 2, 90–92.

Goddard J, Hasenkampf N, Edwards KT, De Shazo R & Embers ME. 2013. Bed bug saliva causes release of monocytic inflammatory mediators: plausible cause of cutaneous bite reactions. International Archives of Allergy and Immunology 161, 127–130.

LeverkusM, Jochim RC, Schäd S et al. 2006. Bullous allergic hypersensitivity to bed bug bitesmediated by IgE against salivary nitrophorin. Journal of Investigative Dermatology 126, 91–96.

Lilly DG, ZaluckiMP, Orton CJ, Russell RC,Webb CE&Doggett SL. 2015. Confirmation of insecticide resistance in Cimex lectularius (Hemiptera: Cimicidae) in Australia. Austral Entomology 54, 96–99.

Phan C, Brunet-Possenti F, Marinho E & Petit A. 2016. Systemic reactions caused by bed bug bites. Clinical Infectious Diseases 63, 284–285.

Potter MF, Haynes KF & Fredericks J. 2015. Bed bugs across America. Pestworld November/December, 4–14.

Price JB, Divjan A, MontfortWR, Stansfield KH, Freyer GA & Perzanowski MS. 2012. IgE against bedbug (Cimex lectularius) allergens are common among adults bitten by bed bugs. The Journal of Allergy and Clinical Immunology 129, 863–865.

Reinhardt K, Kempke D, Naylor RA & Siva-Jothy MT. 2009. Sensitivity to bites by the bedbug, Cimex lectularius. Medical and Veterinary Entomology 23, 163–166.

Stucki A & Ludwig R. 2008. Images in clinical medicine. Bedbug bites. New England Journal of Medicine 359, 1047.