(Cimex lectularius)

Unusual clinical case

Dott. Luciano Schiazza, Dott. Luca Anselmi

The bed bugs are temporary ectoparasites. Living on the surface of the host (vertebrates homeotherm animals- animals able to maintain their body temperature) long enough to feed on blood (hematophagy), except for the time spent on the host's skin to nourish themselves, they take refuge in sparsely accessible from view (unless large infestations).

Small (5-7 mm. as an Appleseed), have bodies that are flattened dorso-ventral direction with an oval-shaped profile (if starving) or developed more in length and width (oblong) (if they have eaten recently).

The bed bugs begin to feed from late in the evening and at night. Their meal is short: approximately 3-12 minutes, then return to their hiding place. Are skilled in reaching the guest walking on surfaces: they can also get to the ceiling and then let fall on the victim, attracted by the warmth of the body and the nitrogen dioxide that is emitted during respiration.

Their mouthparts are done in such a way that they can both suck blood both inject their saliva which contains substances that prevent blood clotting (anticoagulants) and promote the dilation of blood vessels (vasodilation).

It is believed that a bug you foods every 5-10 days, while having the ability to not eat for more than a year.

The sting of CL causes itching which is not warned until after minutes, hours or even days.

Lesions caused by bed bug bites are not different from those caused by other insects, such as mosquitoes and fleas. Reddish bumps (papules) is usually arranged as to follow a line or grouped.

Where are located? Usually the exposed areas, with few or numerous injuries due to the degree of infestation, with an itch variable from person to person. Sometimes the intensity of symptoms is so intense as to generate even painful sensation.

We described the case of a young man who slept, torso naked, on the belly on a bed infested by bedbugs.

The intensity of the clinical picture and the symptoms above and beyond a simple itching, (approaching pain), has led us to perform promptly a biopsy of an item, to find confirmation to our supected diagnosis, also because the patient said that he didn’t see any parasite in the room.

Histological examination showed a superficial perivascular infiltrate of lynphocytes and eosinophils, variable in density, consistent with our diagnosis.

Ematossilina-Eosina 2 x Superficial perivascular and interstitial infiltrate of eosinophils and lynphocytes (variable density)

Ematossilina Eosina 4x Superficial perivascular and interstitial infiltrate of lynphocytes and eosinophils  (variable density)

Ematossilina-Eosina 10xSuperficial perivascular infiltrate of lynphocytes and eosinophils

Ematossilina-Eosina 10x Superficial perivascular infiltrate of lynphocytes and eosinophils

Ematossilin-Eosina 20x Superficial perivascular infiltrate of lynphocytes and eosinophils

Ematossilina-Eosina 20x Superficial perivascular infiltrate of lynphocytes and eosinophils

Colorazione di Lennert 2x.   Lennert stain confirms the superficial perivascular and interstitial infiltrate of lynphocytes and eosinophils (variable in density)

Colorazione di Lennert 20x   Superficial perivascular infiltrate of lynphocytes and eosinophils

Colorazione di Lennert 40x Numerous eosinophils

Accurate look for in the room used by the patient permit to find reddish stains and black specks on bed sheets and live bed bugs.

Professional management to control infestation was approached in the room.

Systemic and topical steroid therapy was prescribed. In a few days the lesions disappeared at all.

Thanks to Dr. Anselmi, chairman Institute of Pathology Villa Scassi Hospital Genoa, for the histologic pictures.