Elsevier

Microbial Pathogenesis

Volume 149, December 2020, 104564
Microbial Pathogenesis

Severe anemia due to bed bugs hyperinfestation

https://doi.org/10.1016/j.micpath.2020.104564Get rights and content

Highlights

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    Bed bugs bite is considered as a possible cause of anemia in individuals inhabiting in hyperinfested locations.

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    Psychiatric disorders (depression and dementia) and socially isolation of the individuals can make these conditions worse.

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    It is reported mainly in the elders with poor hygienic condition and lost autonomy in doing personal affairs.

Abstract

Bed bugs bite can be considered as a possible cause of chronic blood loss and anemia in individuals inhabiting in hyperinfested locations. We report the rare case of a patient with massive bed bugs infestation suffered from severe dementia, malnutrition and social isolation which provided susceptible background for severe anemia.

Introduction

Bed bugs (Cimex lectularius and C. hemipterus) are obligate hematophagous insects that feed on human [1]. They are one of the most common ectoparasites engaged in human life worldwide. Since 1990s, the formal reports of bed bugs resurgence in 135 countries from five continents pinpoint a serious problem for human wellness and health [2,3]. They are responsible for multiple economic problems affecting apartment complex, public transport and health centers. Furthermore, they affect in particular the tourism industry (e.g., the economic impact of the resurgence was 100 million AUS dollars in Australia in 2008) [4].

Bed bugs feed on human in both sexes and at all life stages. The infestation occurs in all ethnic groups and at all socioeconomic levels. Despite the reports of more than 40 microorganisms detected in the bed bugs and in spite of transmission of some pathogens (e.g., Trypanosoma cruzi, Bartonella quintana) demonstrated in laboratory settings [[5], [6], [7]], there is no evidence certifying their vectorial role in epidemiology and transmission of human pathogenic agents. The blood feeding of bed bugs can cause a wide range of clinical manifestations depending mainly on the sensitivity of individuals to salivary components and corresponding immunological reactions [5]. Clinical manifestations to bed bug bites can include a wide spectrum of dermatological manifestations, varying from erythematous macules or papules to bullous eruptions which can be occurred as several bites in a row or cluster [5]. Beside clinical issues, they are responsible of significant psychological disorders [8]. They may scarcely cause systemic reactions including asthma, generalized urticaria, angioedema, anaphylaxis and iron deficiency anemia documented in a limited number of case reports [9]. Although, the latter can be occurred rarely but bed bug bites can be considered as a possible cause of chronic blood loss and anemia in individuals inhabiting in infested locations. This anemia can be caused by repeated chronic bed bug bites. This suspicion of anemia can be most likely after evaluating all other possible causative factors.

In this report, we present the case of a patient who had a severe anemia strongly suspected to be due to massive infestation by bed bugs.

Section snippets

Case description

A 70-year-old man was brought to Avicenne hospital emergency, an university-hospital in Northern suburbs of Paris, due to sudden fainting on the street. After primitive recovery, he was hospitalized in the internal medicine department for further investigations. He lived alone in the second-floor of a private apartment with no help at home. He had no history of smoking but a chronic ethylism with an evaluated alcohol rate of 40 g/day in the day of incident. Skin examination revealed the

Discussion

In spite of long history of human dwelling infestation by bed bugs, the excessive bed bugs infestation and blood feeding leading to the iron deficiency anemia in the human has been documented scarcely. It is reported mainly in the elders with poor hygienic condition and lost autonomy in doing personal affairs. So far, four cases of anemia caused by bed bug bites have been reported in the literature. Most of them had an age over 60 years old [[10], [11], [12]]. Two of mentioned cases were the

Conclusions

Bed bugs can be considered as a potential cause of iron deficiency of anemia in the elderly. This issue becomes more important by considering the increasing number of bed bug infestations worldwide as well as the aging in European countries. Psychiatric disorders (depression and dementia) and socially isolation of the individuals can make these conditions worse. This condition is commonly observed among elders with lost autonomy living in poor conditions. Lack of attention to these cases can

Conflicts of interest

All authors do not declare any conflict of interest.

Informed consent

Informed consent was obtained from the patient described in the case report section.

CRediT authorship contribution statement

Arezki Izri: Conceptualization, Investigation, Methodology, Validation, Writing - review & editing. Anthony Marteau: Formal analysis, Investigation, Methodology. Theo Ferreira: Formal analysis, Investigation, Methodology. Christiane Bruel: Formal analysis, Investigation, Methodology. Ruben Benainous: Formal analysis, Investigation, Methodology. Robin Dhote: Investigation, Methodology, Validation, Writing - review & editing. Mohammad Akhoundi: Conceptualization, Investigation, Methodology,

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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