Bedbugs: Unwelcome Travel Companions

A 50-year-old man presented in August 2018 with a three-week history of recurrent clusters of small, highly pruritic, cutaneous lesions. He was a resident of the city of Rio de Janeiro and reported a history of travel to Sergipe, Northeast Brazil, three months before presentation. Oral dexamethasone was prescribed at another facility, with incomplete and temporary relief. Clinical examination revealed several pruritic, erythematous maculopapules mainly over the lateral aspect of his arms (Figure 1A and 1B) as well as on his back (Figure 1C). A topical corticosteroid cream was prescribed, and he was instructed to search for evidence of a bedbug infestation at home. Two days later, he returned with samples of Cymex spp. arthropods (Figure 2) gathered from his mattress. He also found blood spots and excrement on his bedsheets.

FIGURE 1:
Clinical images of a 50-year-old man with several pruritic, erythematous maculopapules mainly over the lateral aspect of his arms (A and B) and back (C). Bites arranged in a row of three (referred to as breakfast, lunch and dinner) are indicated by arrows (A).

FIGURE 2:
Samples of Cymex spp. recovered by the patient from his mattress.

Bedbugs such as Cimex lectularius and C. hemipterus are resurgent hematophagous ectoparasites with worldwide distribution^1-3. They belong to the Hemiptera order of insects, family Cimicidae, and are suspected of transmitting pathogens; however, no report has yet proved their role as vectors³. Bedbugs prefer feeding on humans during minimal host activity, usually at night. They may survive more than a year without feeding. Diagnosis relies on clinical manifestations and direct observation of the arthropod. Bedbugs are usually transported passively, mainly in clothing and luggage^1-3. Presumably, our patient’s luggage or clothing was infested during his hotel stay in Sergipe. He recovered completely after topical corticosteroid treatment, in addition to inspection of and application of insecticide to the infested sites.

REFERENCES

• ¹
  Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol. 2004;50(6):819-424.
• ²
  Heukelbach J, Hengge UR. Bed bugs, leeches and hookworm larvae in the skin. Clin Dermatol. 2009;27(3):285-90.
• ³
  Delaunay P, Blanc V, Del Giudice P, Levy-Bencheton A, Chosidow O, Marty P, et al. Bedbugs and infectious diseases. Clin Infect Dis. 2011;52(2):200-10.

• Informed Consent: Informed consent was obtained from the patient for the publication of this case and the accompanying images.

Publication Dates

• Publication in this collection
  18 July 2019
• Date of issue
  2019

History

• Received
  02 Feb 2019
• Accepted
  15 Apr 2019