Alleged bed bug infestation prompts lawsuit by Wilkes-Barre tenants

By Joe Dolinsky – jdolinsky@timesleader.com

 

WILKES-BARRE — More than a dozen current and former tenants at the Lincoln Plaza apartments have sued the property manager and city housing authority for allegedly concealing a severe bed bug infestation that has rendered the complex “essentially uninhabitable.”

Seventeen tenants allege housing authority officials and Donna Kozak, manager of the 200-unit public housing project, failed to address an infestation tenants reported in 2013, causing the apartments to become overrun with the tiny parasitic insects.

Lincoln Plaza is at the intersection of East Northampton Street and Wilkes-Barre Boulevard.

The lawsuit, filed in federal court Thursday, says Kozak concealed the infestation from residents and prospective tenants by repeatedly denying any bed bugs were present. She allegedly warned residents not to discuss the infestation and threatened to evict people who voiced their concerns, according to the lawsuit.

“Today, bed bugs can be found on every floor of all three buildings at Lincoln Plaza, in multiple apartments on each floor, as well as in common areas, including hallways, elevators, and the resident community room,” says the lawsuit, filed by Kingston-based attorney Peter C. Wood Jr.

According to the Environmental Protection Agency, bed bugs are small, oval-shaped brown insects — about the size of an apple seed — that feed on blood and cause itchy bites. Mainly active at night, they are not known to transmit or spread disease, but can “create other public health issues” if ignored, the agency says.

The infestation has made the apartments “dangerous and essentially uninhabitable,” and caused residents “loss of sleep, anxiety, aggravation, inconvenience, emotional distress, health-related problems and loss of personal property,” the lawsuit alleges.

According to the filing, 15 of the plaintiffs still live at the apartments. The other two moved out in May. All are at least 62 years old.

The tenants are forced to pay rent for apartments that no longer have fair rental value, the lawsuit argues.

The Wilkes-Barre Housing Authority owns and operates the housing project, which consists of a 10-floor, 150-unit high rise and two smaller buildings with 25 units each. Most of the residents are elderly, low-income families or have mental or physical disabilities, the suit says.

Messages left at the housing authority were not immediately returned.

In addition to damages, the lawsuit seeks orders requiring the extermination of the insects and certifying it as a class action.

Reach Joe Dolinsky at 570-991-6110 or on Twitter @JoeDolinskyTL

Brazilian study sheds new light on Zika neuro complications in adults

By: Lisa Schnirring 

neurons

In adults, Zika virus infection can cause a diverse array of serious neurologic complications, according to a case series of patients during Brazil’s outbreak who were treated at a neurology referral hospital in Rio de Janeiro.

In other developments, another research group from Brazil reported a reduction in the birth rate in one of the country’s biggest cities and the US Food and Drug Administration (FDA) recently issued an emergency use authorization (EUA) for the first test that can simultaneously assess for Zika, all dengue serotypes, chikungunya, and West Nile virus.

Patient series finds diverse problems, unusual features

In the neurologic complication study, researchers reported on 40 adults who were hospitalized with acute-onset neurologic symptoms who were evaluated for Zika infection Dec 5, 2015, and May 10, 2016. The team published its findings today in JAMA Neurology.

Of the 40 patients, 35 had evidence of recent Zika infection in blood or cerebrospinal fluid (CSF). Of those who were positive for Zika virus, 27 had Guillain-Barre syndrome (GBS), 5 had encephalitis, 2 had transverse myelitis, and 1 had chronic inflammatory demyelinating polyneuropathy.

Among the 27 with GBS, 13 had cranial nerve involvement and three had facial numbness or trouble swallowing. Of the patients with encephalitis, two had accompanying neuromuscular findings, seen with other flavivirus neurologic complications.

Serum and CSF were tested for Zika virus using real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) and IgM antibody assays. Researchers also recorded clinical data, radiographic and electrophysiological test findings, and 3-month function outcomes.

Nine of the patients required intensive care unit treatment and five required mechanical ventilation.

The authors found Zika IgM in the CSF of many of the patients, often at significantly higher levels than in blood, which they said is a sign of direct Zika virus penetration. Two patients tested positive for dengue on serum but not CSF samples.

When they compared the number of complications with baseline[MS1]  levels in Brazil, they found that the incidences of GBS and encephalitis rose 6-fold and 3.5-fold compared with the period before the outbreak.

They concluded that Zika infection is linked to a diverse array of serious neurologic disorders and that serologic and molecular tests on blood and CSF can be useful as a less expensive and more accessible alternative to plaque reduction neutralization testing in developing countries.

A good start, more in-depth epi studies needed

In an accompanying editorial, two US neurologists wrote that it’s critical to understand the spectrum and frequency of Zika-related neurologic disease. The new report, they said, serves as an initial approach, though more in-depth epidemiologic investigations will be needed to establish the frequency and the related risk factors. The authors are Kenneth Tyler, MD, with the University of Colorado School of Medicine, and Karen Roos, MD, with Indiana University School of Medicine.

Regarding the clinical findings, the Brazilian group found a slightly longer interval between GBS and Zika onset—a median of 10 days, with a range of 4 to 22 days—compared with earlier reports. Tyler and Roos also highlighted that the study authors found a mixed frequency of GBS subtypes, including some with unusual features.

They noted that the high number of patients with Zika virus IgM in both serum and CSF is intriguing if confirmed in other studies, because it points to intrathecal synthesis and likely reflects a Zika target within the central nervous system. “Understanding the complexities of flavivirus antibody responses will likely be critical for both diagnosing Zika virus infections and understanding their pathogenesis,” they wrote.

Birth rate drop, EUA for Zika test

Births in the Brazilian city of Sao Paulo dropped 6.37% in the last half of 2016, likely because of Zika-related panic, a study team reported in the Aug 8 early online edition of Annals of Epidemiology. The researchers examined birth data from January 2007 to June 2016 to estimate the expected number of births in Sao Paulo. They noted that the drop came about 9 months after Zika media coverage began, hinting that people may have panicked due to reports of Zika-related microcephaly. They said other factors could also explain the pattern, such as the country’s ongoing economic crisis, which has been under way since 2014.

The FDA on Aug 11 issued an EUA for a multiplex test to assess for Zika and other flaviviruses that was developed by the Center for Infection and Immunity (CII) at Columbia University’s Mailman School. The multiplex test, called the CII-ArboViroPlex rRT-PCR Test, also contains a host gene to ensure the accuracy of results. According to a Columbia University press release, the National Institute of Allergy and Infectious Diseases (NIAID) asked the FDA to consider issuing an EUA for the test for use in its multicountry study on Zika in infants and pregnancy. The test is the second this month to receive FDA EUA authorization: On Aug 2 the agency issued an EUA for Thermo Fisher Scientific’s TaqPath Zika Virus Kit, an RT-PCR test to detect Zika RNA in human blood and urine.

This beast kills at least 500,000 people a year; a Penn scientist is trying to stop it

 By: Tom Avril,

For as long as humans have shared the planet with mosquitoes, the goal has been to get rid of the winged pests, or at least keep them at bay. Drain the swamp. Spray the landscape. Put up screens and netting. And if all else fails — thwack!

Biologist Michael Povelones has a far more sophisticated, if subtle, approach in mind:

Boosting the insects’ immune systems.

Povelones’ goal is not to eradicate mosquitoes, but to stop them from spreading disease. Each week, he breeds thousands of the insects in his custom-designed, escape-proof lab at the University of Pennsylvania’s School of Veterinary Medicine, studying the intricate biology of how they become infected with malaria, Zika virus, and other threats to human health. If he can ramp up the insects’ ability to fight off these disease-causing agents, they are less likely to be passed on.

Already, Povelones has identified a type of protein in the mosquito immune system that seems to act like a brake, impairing its ability to fight off the parasite that causes malaria. Working with colleagues at Imperial College London and the American University of Beirut, Povelones used a type of genetic manipulation that caused the insect to make less of the protein, resulting in the production of fewer parasite-laden cysts in infected mosquitoes.

“We’re kind of removing the brakes,” he said. “If we can push the infection levels lower, then we’d have really resistant mosquitoes.”

Deadlier than sharks

Cocooned in an environment of screens, air conditioning, and robust government pest-eradication efforts, Americans of recent memory view the insects primarily as a backyard annoyance.

But for much of the world, the insects are killers, transmitting such maladies as malaria, yellow fever, and dengue — “breakbone” fever. Povelones likes to show people an illustration that the Gates Foundation produces each year, listing the deadliest animals in order. Sharks, those much-maligned creatures of horror movies and beachgoer phobias, are always near the bottom of the list, killing fewer than a dozen people a year.  Tigers are a bit higher, blamed for 50 deaths in 2015.

The two biggest killers of people around the globe, each accounting for hundreds of thousands of deaths each year, are other people – generally in second place – and then at the top: the object of study in the Povelones lab.

The toll from mosquitoes has been at least 500,000 for years, hitting 830,000 in 2015, the foundation estimates.

“I respect mosquitoes,” he said. “But I hate mosquitoes.”

That kind of thinking gained a lot more public attention here in 2016 with the spread of Zika virus, blamed for causing brain damage and abnormally small heads in thousands of babies.

Transmission of the virus by mosquito is not yet widespread in the United States, and is not thought to pose a threat in Philadelphia, because the primary type of Zika-carrying mosquito does not live here. But it can be transmitted between people who have sexual contact, prompting a billboard campaign this summer by the Philadelphia Department of Public Health.

“Mosquitoes aren’t the only ones that spread Zika” reads one such sign. “Love your partner. Use condoms.”

‘Mosquito accountants’

Povelones, who came to Penn’s vet school in 2014, is tackling the problem through science.

A key tool in his lab is a gene-silencing technique called RNA interference, allowing him to temporarily “turn off” individual genes in mosquitoes to test how that might affect their ability to ward off the malaria parasite or viruses.

First, he knocks out a cupful of mosquitoes by administering a stream of carbon dioxide.

“They’re going to sleep now,” he said, demonstrating the process recently. “They’re out cold.”

Then, while looking through a microscope, he administers a dose of gene-silencing fluid to one mosquito at a time, using a slender pipette. The precision instrument, made by  Drummond Scientific in Broomall, can be used to inject mere nanoliters of fluid — billionths of a liter — at a time.

A few days after the treatment, Povelones can then “challenge” mosquitoes by exposing them to a parasite or virus. In the case of malaria, he and his colleagues would later pull out the stomach of an infected mosquito and count how many cysts had formed.

There are many layers of protection to prevent any risk to the outside world. The lab, which Povelones calls the insectary, is laid out in a warren of climate-controlled little rooms with sealed vents and air “curtains” — jets of air rippling across the doorways. Each successive space has lower and lower air pressure, gently sucking errant insects away from the exit on the rare occasion that one gets loose within the insectary. None has gotten outside of the lab, and even if it did, Povelones works  with only two species, and  they do not thrive in Pennsylvania’s climate.

An extra level of caution is exercised with mosquitoes that are exposed to disease-causing agents. Glove-wearing lab members handle them only inside a plexiglass containment box fitted with multiple fail-safe measures, including a carbon dioxide port to gas the insects, if necessary. Povelones has never needed to use it.

Each infected mosquito is carefully logged to ensure that all are accounted for.

“The books are always balanced,” he said. “We’re like mosquito accountants.”

Many paths, same goal

If he and colleagues identify some sort of promising immune-system pathway that influences the insects’ ability to ward off viruses and parasites, the idea is that someday mosquitoes could be permanently modified to improve this ability and then be released into the wild.

Or scientists could go the other direction, said Sara Cherry, a professor of microbiology at Penn’s Perelman School of Medicine who has collaborated with Povelones.

“There are two different ways of thinking about it,” she said. “One is to boost the immune system of the mosquitoes so they don’t get infected. Another is to destroy the immune system of mosquitoes so they get so infected that they die.”

Other cutting-edge approaches already are being tested in the real world. In Brazil and other warmer climes, officials have released mosquitoes that have been genetically modified so their offspring will die.  In Florida and California, mosquito-control specialists have released insects that are infected with a bacterium  called Wolbachiathat renders them less able to become infected by Zika.

The term “genetic modification” provokes concern in some quarters. If humans were to use such techniques to disrupt or eradicate the mosquito population, would that somehow be bad for the ecosystem? The general thinking in the scientific community, for now, is no. For example, birds and bats eats mosquitoes, but the insects make up such a small part of their diets that they are unlikely to be missed.

Cherry and Povelones also are exploring another intriguing possibility: the insect’s microbiome. When a mosquito bites a human being, it ingests twice its body weight in blood. That is fuel for the insect, and also for the bacteria that live within it, causing them to multiply by the hundreds and even thousands — though some types of bacteria thrive on blood more than others.

Research has shown that these altered bacterial populations can directly impact the mosquito’s ability to fight off malaria. And Cherry’s lab discovered that certain components of the mosquito microbiome could boost the insect’s immunity to viruses.

‘The choke point’

All of these potential strategies hinge on a basic element of the insect’s behavior: the bite. In order for a mosquito to transmit a virus or the malaria parasite, it must first bite someone with the disease, become infected, and then bite someone else. Interfering with that middle step is what excites Povelones.

“The mosquito is sort of the choke point,” he said.

In a similar vein, he is investigating why certain types of mosquitoes transmit heartworm, a serious health threat for dogs, while other species of the insect do not. Pet owners can treat their animals for heartworm, but even if all of them did so, the parasite still can persist in feral dogs and wolves. What if Povelones could modify more mosquitoes so they could not transmit heartworm from animal to animal?

He and Cherry are well-aware that their object of study wins no popularity contests, yet they also feel moved to come to its defense, to a degree.

“It’s not like the mosquitoes particularly want to transmit these pathogens,” Cherry said. “It’s not like they have some insidious plan.”

It is just biology. Over millions of years, mosquitoes evolved an efficient mechanism for feeding on blood. The parasites and viruses simply take advantage of that phenomenon to spread human disease.

Unless, someday, science can help mosquitoes fight off these diseases at the choke point.

Bed bugs – a painful, sleepless nightmare

IT had been a sleepless, living nightmare.

For mStar editor Zainal Azhar Mohamed, it was a year-long battle with bed bugs that ended with him “surrendering” and moving his family out of the rented home.

He believes the ordeal began after his travels in Vietnam last year.

“I think there were bed bugs at the hotel. I got itchy bites while I was there,” he recalls.

He went to three doctors. They told him that it could be mosquito bites or an allergic reaction. They gave him medication that stopped the itchiness. Yet, he kept getting bitten.

“It was only around May last year when my part-time Indonesian maid noticed that there was a musty smell – a tell-tale sign of the presence of bed bugs,” he says.

Zainal Azhar checked his bed and noticed black marks on his mattress, a sign of bed bug fecal matter.

He recalls feeling helpless after having “tried everything” and failed.

“All the sprays and pesticides were ineffective. I mixed Clorox with hot water and sprayed it all over my house, I used natural remedies such as soursop leaves and soursop fruits, but it all did not work.”

“I would also mop, clean and vacuum every day. I tried everything,” he says.

His children suffered, too. “My babies kept crying at night from the bites.”

“Even I could not sleep. And when I did fall asleep, I would have nightmares about them,” he says.

Zainal Azhar says the infestation was so severe that he could see the bed bugs in the crevices of the wall sockets in the room. He called a pest control company, which quoted him RM1,200 for one room but could not guarantee that they will be exterminated.

“I was told that they can guarantee results for mosquito, ant and rat infestations but not for bed bugs,” he says.

After months of sleepless nights, Zainal Azhar made the decision to move out.

“I threw away all the beds and bought new ones. I sent all my clothes and carpets to the laundromat to get washed in hot water,” he says.

Zainal Azhar’s younger brother Zainal Abidin is another victim.

“When I moved into my rented room, I realised that I started getting really itchy bites,” Zainal Abidin says.

It dawned on Zainal Abidin that he might have the same infestation as his brother.

“Sure enough, when I had a closer look, I found bed bugs on the mattress and in the grout between the tiled floor.”

Zainal Abidin and his housemates swung to action. They filled the grout with concrete, got rid of all the mattresses, and washed all the carpets and curtains.

“Thankfully, it seems to have worked.”

Star Media Group digital content manager Lim Cheng Hoe says his agony began when he started sleeping on a futon on the floor to help ease his backache.

He started getting itchy welts and spotted bugs that looked like “watermelon seeds”.

“I would go to bed about midnight and two hours later, wake up itchy,” he says. “Then it was search and destroy. I had to pick them off one by one otherwise I wouldn’t get any sleep.”

It got to a point where he dreaded going to bed.

“Over-the-counter pest killers won’t get rid of bed bugs. I Googled home remedies; but they tell you that salt, baking soda and whatnot doesn’t work,” he says.

He even tried using a steam iron to kill the bugs, plotting a “scalding death” for them. “But the nozzle wasn’t really suitable for the job.” Using bed bug sprays was another exercise in futility.

“They still feasted on me, night after night,” he says.

He ended up “sterilising the bed” by emptying a few bottles of bed bug sprays on the bed frame and mattress.

Luckily, for the past three months, Lim says he has “been off the menu” for the bed bugs.

For copywriter Chan Ren Cheian, some of the bites became infected.

“Some of it became so swollen and full of pus. It was so bad that it was throbbing with pain. The doctor had to prick it to dig all the pus out,” said Chan.

At the peak of the infestation in 2015, Chan says he had around 30 bites all over his body.

“The itch really drives you crazy.”

Chan says that the thought of getting bitten by the bed bugs made him paranoid.

“I could not sleep for months. I would wake up in the middle of the night to inspect my body for new bites,” he says.

Chan sprayed his room with insect spray and threw his mattress away. The problem went away for a few months but it recently came back; luckily, it was not as bad as before.

Another victim, L. Sasha, says she came to know of the problem after sleeping on an old bed in a rented room.

“I had trouble sleeping. I felt things moving on my bed but I didn’t feel any bites,” she says.

When she inspected her bed, she says she saw about 20 bed bugs at one corner, “It was so gross!”

She disposed of the mattress but the problem did not end there despite her vacumming every day and buying bed bug pesticide.

Sasha says she could not stop thinking about it and became obsessed with checking her room for the pesky bugs.

“Whenever I felt something move on my bed, I would get up to check. I would wake up and check my bed every two hours, I would not sleep,” she says.

“I even vacuumed my room in the middle of the night. It was just horrible.”

Sasha said that she would also observe the floor. “Whenever I see a black speck, I would panic. Sometimes, it would just be a speck of dirt,” she says, adding that this took a toll on her mentally.

“I found that even though I did not get any bites, they were still feeding from me. Because when I kill them, there would be blood. It was creepy,” she said.

After months of suffering, Sasha finally decided to move out. She washed all her clothes in hot water and hung them in the sun.

“I do not want the bed bugs to follow me to my new place.”

 

With Zika season here, spread via sex is new danger

BY DR. ANTONIO CRESPO, OPINION CONTRIBUTOR

With Zika season here, spread via sex is new danger 
© Getty Images

This time last year, an outbreak of the Zika virus was spreading across Florida, creating a potential nightmare scenario for public health officials.

By mid August, cases had been confirmed in 35 counties, hitting Miami-Dade county especially hard. Nearly 250 cases had been registered there, and throughout the state, 70 cases had been confirmed in pregnant women. The outbreak prompted the Centers for Disease Control and Prevention (CDC) to issue a travel advisory for pregnant women who were planning to travel to Florida.

By the end of last summer, Zika had spread across the country with cases documented in every state except Alaska.

This year, Zika is posing another kind of threat in Florida. While the overall number of cases has dropped considerably, the virus has spread in a different and dangerous way.

Earlier this month, the Florida Department of Health confirmed its first case of Zika spread by sexual contact. While doctors and public health officials have long been aware of the risk of sexual transmission, and there have been a handful of documented cases sprinkled throughout the U.S., it’s imperative that we remind the public of this risk.

Here’s why: Zika is most commonly spread by mosquitoes, which affords us certain protections. First, public health officials can take measures to control mosquito populations at the city and country level. Timely and targeted spraying of pesticides can dramatically cut down on the adult population of mosquitoes in a given area.

We can also take personal measures of protection. Avoiding mosquito-prone areas, wearing pants and long sleeves outdoors and using insect repellant consistently can also reduce your risk of infection.

Beyond that, if you are bitten by a mosquito and you do become infected, you may be tipped off to the virus. Symptoms include fever, muscle aches, rash and red eyes and can last up to a week. Symptoms are rarely serious for adults, but can cause severe birth defects in babies.

What makes sexual transmission so concerning is that warning signs may be much more subtle, if there are any at all.

Often, those who are infected with Zika have no discernable symptoms and the incubation period can last up to two weeks. That means if a person contracts the virus and has unprotected sex with multiple partners, the disease could quickly spread even without the presence or personal encounters with mosquitoes.
The situation may be even worse for couples who are trying to have a child. Their risks are especially high for a number of reasons. Either the man or woman may be infected and not know it, their desire to become pregnant, obviously, necessitates unprotected sex and, should they conceive a child, the baby’s wellbeing could be in jeopardy.

For all those reasons, infection through sexual transmission poses a new set of problems for the public.

So, how do you protect yourself? The best way is to avoid areas where the Zika virus is active. If you are traveling within the United States or abroad, the CDC has maps identifying areas of concern.

If you are a woman who is pregnant or trying to become pregnant and have traveled to an area with active transmission of Zika virus or had sex with a partner who lived or traveled to these areas you should be tested if you develop symptoms of Zika or if there are abnormalities in an ultrasound that raises that concern. Routine testing of pregnant women is not recommended although the test is available and some doctors may recommend it on an individual basis.

Men who were infected with Zika or who traveled to an endemic area should use barrier precautions during sexual intercourse with his partner for 6 months or during the entire pregnancy if that is the situation. In the case of a woman that becomes infected or traveled to a Zika-infected area, it is recommended to postpone pregnancy for at least 8 weeks.

As with so many threats of widespread infection, including past outbreaks of diseases like swine and bird flu and the MERS virus, Zika got a lot of attention last year. It was still relatively new to the United States and because we were beginning to see first hand its devastating consequences in babies born with severe birth defects, the threat was taken seriously.

This year, as is often the case, the hype has died down and perhaps we have come a bit complacent when it comes to Zika.

But the diagnosis of cases spread through sexual contact should remind us that we can not let our guard down and assume the risk is gone.

The is message especially important to couples trying to conceive, who may be putting their baby at considerable risk without ever knowing it.

Antonio Crespo, MD is the Chief Quality Officer at Orlando Health Dr. P. Phillips Hospital and a clinical instructor at Florida State University’s College of Medicine. He is a board certified infectious disease specialist focused on helping patients afflicted with a range of illnesses including Zika, MERS, staph, malaria and HIV. 

 

Bed Bugs Can Transmit Parasite that Causes Chagas Disease

by 

Bed bugs suck. Literally.

However, while they are indeed annoying and can keep people awake at night, they have not been regarded as a public-health concern because they have not been documented as transmitters of diseases like malaria, yellow fever, dengue, or others.

However, that status has just changed. A new study from Penn Medicine researchers in the Center for Clinical Epidemiology and Biostatistics demonstrated that bed bugs can transmit Trypanosoma cruzi, the parasite that causes Chagas disease, one of the most prevalent and deadly diseases in the Americas.

In a study published online this week in the American Journal of Tropical Medicine and Hygiene, senior author Michael Z. Levy, PhD, assistant professor in the Department of Biostatistics and Epidemiology at the University of Pennsylvania’s Perelman School of Medicine, and researchers at the Universidad Peruana Cayetano Heredia in Peru conducted a series of laboratory experiments that demonstrated bi-directional transmission of T. cruzi between mice and bed bugs.

In the first experiment run at the Zoonotic Disease Research Center in Arequipa, Peru, the researchers exposed 10 mice that were infected with the parasite to 20 uninfected bed bugs every three days for a month. Of about 2,000 bed bugs used in the experiment, the majority acquired T. cruzi after feeding on the infected mice. In a separate experiment to test transmission from bug to mouse, they found that 9 out of 12 (75 percent) uninfected mice acquired the parasite after living for 30 days with 20 infected bed bugs.

In a third experiment, investigators succeeded in infecting mice by placing the feces of infected bed bugs on the animal’s skin that had either been inflamed by bed bug bites, or scraped with a needle. Four out of 10 mice (40 percent) acquired the parasite by this manner; one out of five (20 percent) were infected when the skin was broken by the insect’s bites only.

“We’ve shown that the bed bug can acquire and transmit the parasite. Our next step is to determine whether they are, or will become, an important player in the epidemiology of Chagas disease,” Levy said.

T. cruzi is also especially at home in the guts of bed bugs.

“I’ve never seen so many parasites in an insect,” said Renzo Salazar, a biologist at the Universidad Peruana Cayetano Heredia and co-author on the study. “I expected a scenario with very low infection, but we found many parasites — they really replicate well in the gut of the bed bugs.”

These days, more people in the U.S. are being infected with T. cruzi than ever before. The Centers for Disease Control and Prevention estimates that the number of Chagas disease cases in the U.S. today could be as high as 300,000.

“If the parasite starts to spread through bed bugs, decades of progress on Chagas disease control in the Americas could be erased, and we would have no means at our disposal to repeat what had been accomplished,” Levy said.

Often referred to as a silent killer, Chagas disease is hard to diagnose in its early stages because the symptoms are mild or absent. The parasites are hidden mainly in the heart and digestive muscle, and over time can cause cardiac disorders and sometimes digestive or neurological problems. In later years, the infection can lead to sudden death or heart failure caused by progressive destruction of the heart muscle. Although there are some drugs to treat Chagas disease, they become less effective the longer a person is infected.

The long asymptomatic period of Chagas disease complicates surveillance for new outbreaks of transmission. In Arequipa, Peru, thousands became infected with the parasite before a case appeared in the hospital. The same could happen in cities in the United States if the parasite were to emerge in the bed bug populations, according to the authors.

Penn Study Shows Bed Bugs Can Transmit Parasite that Causes Chagas Disease

Like the “Kissing” Bug, Bed Bugs Can Transmit Deadly Parasite Via Feces

PHILADELPHIA — The bed bug may be just as dangerous as its sinister cousin, the triatomine, or “kissing” bug. A new study from Penn Medicine researchers in the Center for Clinical Epidemiology and Biostatistics demonstrated that bed bugs, like the triatomines, can transmit Trypanosoma cruzi, the parasite that causes Chagas disease, one of the most prevalent and deadly diseases in the Americas.

The role of the bloodsucking triatomine bugs as vectors of Chagas disease—which affects 6 to 8 million worldwide, mostly in Latin America, and kills about 50,000 a year—has long been recognized. The insects infect people not through their bite but feces, which they deposit on their sleeping host, often around the face, after feeding. Bed bugs, on the other hand, are usually considered disease-free nuisances whose victims are left with only itchy welts from bites and sleepless nights.

In a study published online this week in the American Journal of Tropical Medicine and Hygiene, senior author Michael Z. Levy, PhD, assistant professor in the department of Biostatistics and Epidemiology at the University of Pennsylvania’s Perelman School of Medicine, and researchers at the Universidad Peruana Cayetano Heredia in Peru conducted a series of laboratory experiments that demonstrated bi-directional transmission of T. cruzi between mice and bed bugs.

In the first experiment run at the Zoonotic Disease Research Center in Arequipa, Peru, the researchers exposed 10 mice infected with the parasite to 20 uninfected bed bugs every three days for a month. Of about 2,000 bed bugs used in the experiment, the majority acquired T. cruzi after feeding on the mice.  In a separate experiment to test transmission from bug to mouse, they found that 9 out of 12 (75 percent) uninfected mice acquired the parasite after each one lived for 30 days with 20 infected bed bugs.

In a third experiment, investigators succeeded in infecting mice by placing feces of infected bed bugs on the animal’s skin that had either been inflamed by bed bug bites, or scraped with a needle. Four out of 10 mice (40 percent) acquired the parasite by this manner; 1 out of 5 (20 percent) were infected when the skin was broken by the insect’s bites only. A final experiment performed at the Penn bed bug lab in Philadelphia demonstrated that bed bugs, like triatomines, defecate when they feed.

“We’ve shown that the bed bug can acquire and transmit the parasite. Our next step is to determine whether they are, or will become, an important player in the epidemiology of Chagas disease,” Levy said. “There are some reasons to worry—bed bugs have more frequent contact with people than kissing bugs, and there are more of them in infested houses, giving them ample opportunity to transmit the parasite. But perhaps there is something important we don’t yet understand about them that mitigates the threat.”

T. cruzi is also especially at home in the guts of bed bugs.  “I’ve never seen so many parasites in an insect,” said Renzo Salazar, a biologist at the Universidad Peruana Cayetano Heredia and co-author on the study. “I expected a scenario with very low infection, but we found many parasites—they really replicate well in the gut of the bed bugs.”

Wicked Cousins

Bed bugs and kissing bugs are distant cousins but share many striking similarities. Both insects hide in household cracks and crevices waiting for nightfall and the opportunity to feed on sleeping hosts. They are from the same order of insects (Hemiptera) and both only feed on blood.  (One main difference is their size: kissing bugs are five times as big as a bed bug). With so much in common, it seemed logical to the authors that the kissing bug’s most infamous trait, the transmission of T. cruzi, is also shared by the bed bug.

Other investigators have shared this suspicion. In 1912, just three years after Carlos Chagas described the transmission of the disease by kissing bugs, French parasitologist Émile Brumpt recounted that he had infected almost 100 bed bugs exposed to an infectious mouse, and then used them to infect two healthy mice. Decades later an Argentine group replicated his work.  These experiments, largely ignored during the recent bed bug resurgence, missed one key point.

“Mice can hunt and eat bed bugs,” said Ricardo Castillo-Neyra, DVM, PhD, coauthor and postdoctoral fellow at the Universidad Peruana Cayetano Heredia and Penn. “The older studies were almost certainly only documenting oral transmission of the parasite. Our work shows for the first time that bed bugs can transmit the parasite when their feces are in contact with broken skin, the route by which humans are usually infected.”

Emerging Problem

More people in the U.S. are infected with T. cruzi now than ever before. The Centers for Disease Control and Prevention estimates that the number of Chagas disease cases in the U.S. today could be as high as 300,000.

“There have always been triatomine bugs and cases of Chagas disease in the U.S., but the kissing bugs we have here don’t come into homes frequently like the more dangerous species in South and Central America do,” Levy said. “I am much more concerned about the role of bed bugs. They are already here—in our homes, in our beds and in high numbers. What we found has thrown a wrench in the way I think about transmission, and where Chagas disease could emerge next.”

Equally worrying is the invasion of bed bugs into areas where Chagas disease is prevalent, especially in countries where traditional insect vectors of the parasite have been nearly eliminated, Levy said.  In these areas, bed bugs will be repeatedly exposed to T. cruzi, and could re-spark transmission where it had been extinguished.

“Bed bugs are harder to kill than triatomines due to their resistance to common insecticides.” Levy said. “No one is prepared for large scale bed bug control. If the parasite starts to spread through bed bugs, decades of progress on Chagas disease control in the Americas could be erased, and we would have no means at our disposal to repeat what had been accomplished.”

Often referred to as a silent killer, Chagas disease is hard to diagnose in its early stages because the symptoms are mild or absent. The parasites are hidden mainly in the heart and digestive muscle and over time can cause cardiac disorders and sometimes digestive or neurological problems. In later years, the infection can lead to sudden death or heart failure caused by progressive destruction of the heart muscle. Although there are some drugs to treat Chagas disease, they become less effective the longer a person is infected.

The long asymptomatic period of Chagas disease complicates surveillance for new outbreaks of transmission. In Arequipa, Peru, thousands became infected with the parasite before a case appeared in the hospital. The same could happen in cities in the United States if the parasite were to emerge in the bed bug populations, the authors say.

“Carlos Chagas discovered T. cruzi in triatomine insects before he saw a single case of the disease,” Levy said. “We need to learn from his intuition—check the bugs for the parasite.”

Other co-authors of the study include Aaron W. Tustin, Katty Borrini-Mayorí and César Náquira.

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

3 New Locally Acquired Cases of Zika Confirmed in Miami-Dade

State health officials do not anticipate any new Zika zones as a result of the new cases.

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MIAMI — Florida health officials confirmed three new locally acquired cases of the Zika virus in Miami-Dade County on Thursday but said they will not lead to any new Zika zones in the city or nearby South Beach.

“Two are cases that had samples collected in October as part of our ongoing investigation and the department just received confirmatory testing back from CDC.,” according to the Florida Department of Health, which added that both cases have been added to 2016 data.

“The third case reported no symptoms, but screening conducted after blood donation in January showed evidence of a past infection,” officials added on Thursday.

“This individual had multiple exposures in Miami-Dade County and likely contracted Zika in 2016,” health officials explained. “Because the individual was asymptomatic, it is difficult to determine when infection occurred. Since the first positive sample was collected in January, this is considered our first locally reported case of Zika in 2017.”

State health officials, however stressed that Florida still does not have any identified areas with ongoing, active Zika transmission.

With the two new cases, the total number of Zika cases reported in Florida for 2016 stands at 1,384. So far in 2017, the total of Zika cases reported in Florida is 18.

Gov. Rick Scott announced on Dec. 9 that the final remaining Zika zone in the state had been lifted — an area of about 1.5 square miles between Eighth and 28th streets in South Beach.

Secretary of Florida Department of Health Dr. Celeste Philip, who accompanied the governor, warned that the battle over Zika was not over.

“We will continue to see travelers bringing Zika infections into our state and so we must remain on alert and continue all the protective efforts that we’ve doing that have led to this success,” cautioned Philip, who also serves as Florida’s surgeon general. “That means continuing to use repellent, keeping your skin covered as much as possible …. And we cannot forget about the risk associated with sexual transmission.”

On Dec. 2, the governor announced that the Little River zone in Miami had been cleared. That area included a one-square-mile stretch between NW 79th Street to the north, NW 63rd Street to the south, NW 10th Avenue to the west and N. Miami Avenue to the east.

In November, Scott gave the all clear to the Miami Beach area north of 28th Street to 63rd Street. Before that, he announced that the Wynwood area of Miami had also seen no new transmissions of Zika. This included the area of Northwest 5th Avenue to the west, U.S. 1 to the East, 38th Street to the north, and 20th Street to the south.

Despite Zika concerns, Florida set a tourism record last year with 112.8 million visitors.

Additional information can be found on the Department of Health website.