Cimicose T00.9

Skin symptoms caused by the bites of blood-sucking bugs(Cimex lectularis/bedbugs, Cimex columbarius/pigeon bugs, very rarely - Oeciacus hirundinis/swallow bugs), which cause severe itching. Increasingly common again in Central Europe today. Favoring factors include increasing travel, flourishing international trade, reduced public awareness, inadequate pest control measures and the increasing resistance of bedbugs to insecticides (Egg M et al. 2024).

The common bed bug, Cimex lectularius, had virtually disappeared from Central Europe by the 1950s, probably due to an improvement in general hygiene in homes and the effective use of DDT and other organochlorine compounds.

Since the early 1990s, bedbugs have become increasingly common again in Central Europe (Egg M et al. 2024). The worldwide reappearance concerned two species, C. lectularius and C. hemipterus. The latter is possibly regularly introduced by travelers from tropical to temperate regions, but the winter months in Central Europe are probably too cold for the species to become established there. The prevalence of C. hemipterus is much lower than that of C. lectularius. The reasons for the resurgence are controversial, but resistance to insecticides appears to be the main factor, along with the increase in international traffic due to tourism and trade.

Bedbugs nest mainly in dark cracks in furniture, walls, behind pictures in neglected rooms and seek out people at night, e.g. by falling from the ceiling. The saliva secretion injected with the bite causes an initially urticarial, later papular skin reaction.

Typically on uncovered parts of the body.

Grouped (footprint-like linear stinging lines - consisting of 3-5 bites - they are also known as breakfast-lunch and dinner - the pests do not always hit a blood vessel during the first bites so that they move on), up to 0.5 cm in size, intensely itchy, bright red wheals, papules or plaques with a central, punctiform, hemorrhagic sting site. Over the course of days, transformation into more indurated papules or plaques that continue to itch to varying degrees, possibly blistering. Occasionally pustules also develop. The nitrophorin found in bug saliva appears to be an important allergen.

Phenomenon of repetition: co-reaction of old lesions when new bites occur. Decrease in the intensity of the skin symptoms with repeated infestation.

The skin changes can persist for up to 10 days.

Differential diagnosis for bullous bug bites (varies according to Maximilian Egg et al. 2024)

Flea bites: covered skin areas, mostly limited to the lower extremity

Bullous pemphigoid (in blistering bug bites): older people, gradual onset, no linear lesions, flexor sides of limbs, axillae, evidence of pemphigoid antibodies

Epidermolysis bullosa acquisita: bulging blisters, erosions, scars and milia formation. Localized on mechanically irritated areas.

Linear IgA dermatosis: Childhood or age >60 years, isolated bulging blisters on non-inflamed skin, grouped or ring-shaped, gradual onset of disease, no sudden acuity, mucosal involvement in >50%.

Bullous drug eruption: exanthematic pattern, possibly also fixed drug eruption (relapsing remitting), multiforme plaques, history with reference to drugs

Bullous allergic (toxic) contact dermatitis: localization with allergen contact site detectable. In the case of e.g. grass dermatitis, contact marks are detectable.

The transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence that such transmission has ever taken place. In older scientific literature, it has been postulated that bed bugs can be vectors of plague, yellow fever, tuberculosis, relapsing fever, leprosy, filariasis, kala azar (leishmaniasis), cancer, smallpox, yellow fever and Chagas disease (Trypanasoma cruzi). Recently, the possibility of transmission of human immunodeficiency virus and hepatitis B virus (HBV) by bed bugs has been investigated and found to be unlikely .

The best candidate for transmission of diseases to humans by bed bugs is HBV. Bed bugs collected from huts in an HBV endemic area in northern Transvaal, South Africa, were hepatitis B surface antigen positive, as were samples from Senegal, Egypt, Côte d'Ivoire and China. Hepatitis B surface antigen has also been shown to persist in bed bugs for more than 7 weeks after experimental feeding, but no replication of HBV has been detected in the insects.

To date, no study has demonstrated the "vector competence" of bed bugs (the ability to acquire, maintain and transmit an infectious agent) (Jourdain F et al. 2016).

Remediation of infested rooms using insecticides(permethrin, malathion, pyriproxyfen, pyrethrin), removal of niches if necessary (loose wallpaper, wooden ceilings), remediation by an exterminator.

All stages of the bedbug life cycle are temperature-sensitive and can be killed by dry heat or steam. The treatment of entire rooms requires heating to ^55-600Cfor several hours.

A patient with bullous bite reactions after sequential contact with C. lectularius over a period of one year was described. Immediate reactions to the salivary gland solution of C. lectularius were observed in skin tests, followed by a pronounced, partially blistering late phase. Immunoblot analysis of patient serum with salivary gland extracts and recombinant C. lectularius salivary proteins revealed specific IgE antibodies against the 32 kDa C. lectularius nitrophorin, but not against the 37 kDa C. lectularius apyrase. These data indicate that bullous cimicosis is the late phase of allergic IgE-mediated hypersensitivity to C. lectularius nitrophorin (Leverkus M et al. 2006,Price JB et al. (2012).

1. Arayesh A et al (2013) Pruritus and urticarial inflammatory reaction of the skin of unclear etiology. Dermatologist 64: 187-189
2. Beck W (2017) Infestation with bed bugs by Cimex lectularis and Cimex columbarius. Derm 23: 362-366
3. Doggett SL et al. (2012) Bed bugs: clinical relevance and control options. Clin Microbiol Rev 25:164-192.
4. Egg M et al (2024) Disseminated bullous eruptions: bed bugs. JDDG 20: 999-1002
5. Jourdain F et al. (2016) The Common bed bug (Cimex lectularius) in metropolitan France. Survey on the attitudes and practices of private- and public-sector professionals. Parasite. 23:38.
6. Leverkus M et al. (2006) Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin. J Invest Dermatol 126:91-96.
7. Price JB et al. (2012) IgE against bed bug (Cimex lectularius) allergens is common among adults bitten by bed bugs. J Allergy Clin Immunol 129:863-865.e2
8. Studdiford JS et al.(2012) Bedbug infestation. Am Fam Physician 86:653-658.