escmid online lecture library © by author · eggs and faecal traces . nymph stages 2 ou 3 . 1 mm ....

Pascal DELAUNAY

Global Emergence of Bed bugs

Cimex lectularius

An Increasing cause of Dermatitis

Pascal DELAUNAY Parasitologie - Entomologie Médicale

Centre Hospitalier Universitaire de Nice FRANCE

ESCMID Online Lecture Library

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Bed bugs Cimex lectularius Ectoparasite Hematophagous for both sexs

Feed on humans and/or domestic animals

cosmopolite insects living preferently in house

Adults and Nymphs walking insect wingless Reddishbrown, flat, ovals, resembling confetti

Terzi in R.L.USINGER 1966, The Thomas Say Foundation VII, Baltimore, USA.

Global Emergence of Bed Bugs Cimex lectularius - An Increasing Cause of Dermatitis Pascal DELAUNAY Entomologie-Parasitologie-Mycologie CHU de Nice - FRANCE


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Eggs and faecal traces Nymph stages 2 ou 3

1 mm

1 to 4 mm

nymph stage 1

Bed bugs Cimex lectularius



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Time of a blood meal 10 - 20mn Adult life span 6 - 24 months Duration of life cycle (egg to egg) 40 - 70 days from 30 to 200 days Time to egg laying after mating 3 - 10 days Female egg-laying rate 5 - 15 eggs per day Hatching time 7 - 15 days Time between 2 nymph stages 3 - 7 days Lifetime total number of eggs 150 - 500 eggs

♂ ♀

N1

N2

N3

N4

N5

Egg

Adult

female

Adult

male

Traumatic insemination

Egg Nymphs

N1-N2-N3-N4-N5

Adult male or femelle

Bed bugs Cimex lectularius

Bedbugs number = secret increase then exponential increase



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Bed bugs - DISPERSAL

Active Passive



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Pascal DELAUNAY

Pascal DELAUNAY

Véronique BLANC

bedbugs, feces, eggs…..hiden in mattress, cracks, furnitures, curtains….

Pascal DELAUNAY

Bed bugs do not have wing… …Bed bugs walk !

From hiding place to a new hiding place

Local spreading

‘‘Active Dispersal.’’



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World spreading

Bedbugs do not have wing ! But….Bed bugs travel !

clothing, luggage, furniture…

‘‘Passive Dispersal.’’



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« Commentaires sur la matière médicale de Dioscoride » par MATTHIOLI Bois gravé de l’édition de John

GOODYER 1655

Human vs Bed Bugs BALANCE

MILLENNIUM

Adaptation, 40.000 years ago

KNOWLEDGE correlated to the age > 70 years

Who knows the bed bug? Knowledge of adult bed bug appearance increases with people's age in three counties of Great Britain.

Reinhardt K et al. J Med Entomol. 2008 Sep;45(5):956-8.



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Increasing number of PubMed citations for the search words "Bedbugs - Bed bugs - Cimex "

2012

Increase in the 1990s…WHY ?



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Volume

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TRANSPORT Enhanced resistance to pyrethroid insecticides

The re-emergence of the bed bug as a nuisance pest

implications of resistance to the pyrethroid insecticides.

Davies TG, Field LM, Williamson MS.

Med Vet Entomol. 2012 Sep

26(3):241-54. doi: 10.1111/j.1365-2915.2011.01006.x. Epub 2012 Jan 11.

Increase in the 1990s…WHY ?



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Bed bug infestation. Bernardeschi C, Le Cleach L, Delaunay P, Chosidow O. BMJ. 2013 Jan 22;346.

Olivier CHOSIDOW

Delaunay

Delaunay

MEDICAL IMPACT



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A B

C D

Del-guidice Del-guidice

Delaunay Delaunay

Bites are painless… …. but in the morning Typical skin lesions: - curve or line - located in unclothed zones - Pruritic erythematous maculopapules, - 5 mm to 2 cm in diameter - Central hemorrhagic crust or vesicle

MEDICAL IMPACT



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Are bed bugs considering as vector of infectious diseases ?

… NO … …but research is on going



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Competence Capacity VECTOR =

Bedbugs and infectious diseases

Delaunay P, Blanc V, Del Giudice P,

Levy-Bencheton A, Chosidow O, Marty P, Brouqui P.

Clinical Infectious Disease 2011 Jan 15;52(2):200-10.

Review

45 pathogens have been evocated



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“Bed Bugs and Infectious Diseases” Pascal Delaunay, Véronique Blanc, Pascal Del-Giudice, Anna Levy-Bencheton, Olivier Chosidow, Pierre Marty, and Philippe Brouqui

Clinical Infectious Diseases, 2011:52 (15 January) 201-210

Bacteria: Bacillus anthracis, Bartonella quintana, Borrelia recurrentis, Borrelia duttoni, Brucella melitensis, Candidatus Midichloria mitochondrii, Coxiella burnetii , Francisella tularensis, Leptospira, Mycobacterium leprae, Mycobacterium tuberculosis, Rickettsia africae, Rickettsia conorii, Rickettsia prowazekii, Rickettsia rickettsii, Rickettsia typhi, Salmonella typhi, Staphylococcus aureus, Streptococcus pneumonia, Wolbachia, Yersinia pestis….

Viruses Hepatitis B, Hepatitis C, Hepatitis E, Human immunodeficiency, Influenza, O’nyong-nyong, Polio, Rabies, Reovirus, Smallpox, Yellow Fever

Parasites Brugia malayi, Wuchereria bancrofti, Mansonella ozzardi, Onchocerca volvulus, Leishmania braziliensis, Leishmania donovani, Leishmania tropica, Plasmodium spp., Trypanosoma cruzi, Trypanosoma gambiense

45 pathogens have been evocated



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Rickettsia parkeri is a Rickettsi in the Spotted Fever group transmitted by tick

Goddard J, Varela-Stokes A, Smith W, Edwards KT.

Journal Med Entomol. 2012 Jul;49(4):922-6. Artificial infection of the bed bug with Rickettsia parkeri.

Rickettsia parkeri inoculated by an infectious blood meal of Rickettsia parkeri After few weeks…Bed bugs are not able to amplificate R. parkeri

Artificial infection of the bed bug with Rickettsia parkeri.



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Not vector but … Bed bugs may transportation pathogens as any biting insect or walking insect

Fungi Aspergillus, Penicillium, Scopulariopsis … Bacteria: Streptococci, Stapylococci

Canadian staff report recovery of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) from bedbugs

Bed bugs as Vectors for Drug-Resistant Bacteria Christopher F. Lowe and Marc G. Romney

Emerging Infectious Diseases Vol. 17, No. 6, June 2011

PHORESY = Pathogens transport



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Anxiety, nervousness, insomnia, crying, depression …!!!

PSYCHOLOGICAL IMPACT



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PHRC - France Clinical Research

Hospital Programm

Collected Bed Bugs found homestays Establish laboratory colonies of Bed Bugs

Start test on resistance to pyrethroid

Analyse bacteria and virus in body with collected Bed Bugs

1 2

3 4



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Collected bed bugs to infested places 1


PHRC FRENCH STAFF Visited places 285 Positive places 81 Collected BED BUGS 2891

PHRC - France Clinical Research

Hospital Programm


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Laboratory colony of bed bugs 26

6 29

2 30

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374 411 50

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adults F0 Nymph F0 Bed bugs F1

2



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Durand R, Cannet A, Berdjane Z, Bruel C, Haouchine D, Delaunay P, Izri A. Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France. Parasite. 2012 Nov;19(4):381-7

- 2 building at Saint Ouen (93) Suburb of Paris (France) 198 flats - 196 flats investigated 76 infested flats - 97 people - 53 people were disturbed by these bedbugs - 564 bed bugs collected

Resistance to pyrethroid insecticides 3



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499 bed bugs collected

339 bed bugs investigated 8 BACTERIA genus investigated : Rickettsies sp., Coxiella like, Coxellia burnetti, Bartonella sp Bartonella quintana, Erlhichia sp., Wolbachia sp., Acinetobacter sp. BACTERIA detected: for 32 bed bugs 9.4% 29 bed bugs for Acinetobacter 8.5% 3 for Wolbachia 3 for Erlichia 2 for Coxellia

Bacteria 4



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Bed bugs Eradication

Efficient search-and-destroy operation

6 STEPS

IDENTIFICATION

ASSESSMENT OF THE SPREADING

NON CHIMICAL ERADICATION CHIMICAL ERADICATION

ASSESSMENT OF YOUR FIGHT

PREVENTION



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Bed bugs Eradication

Efficient

search-and-destroy operation

- Dismantling or Removing all furniture to access all bed bugs hiding places - Destroy eggs, nymphs,

and adults Insecticide, vacuum, brush….

- Clothes, Linens… : Warming at 60°C Freezing at minus - 20°C



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Short inspection … for bed bugs or black spots (faeces)

Separate … used linen and clean linen …with small bags

Luggage deposit preferentially in the bathroom

DURING THE TRAVEL

AFTER THE TRAVEL

Luggage deposit in the bathroom

Take a shower

Wash your clothes over 60°C Freeze at minus - 20°C or

Rub or Wash your suitcase with a brush…do not forget the zip area



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Thank you… … have a good trip … without any bed bugs

Pascal DELAUNAY

Pascal DELAUNAY Parasitologie - Entomologie Médicale

Centre Hospitalier Universitaire de Nice FRANCE



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