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Dermatosis Caused by Blood-Sucking Corythucha Ciliata FREE

Arezki Izri, MD, PhD1,2,3; Valérie Andriantsoanirina, PhD1,2; Olivier Chosidow, MD, PhD4,5; Rémy Durand, PharmD, PhD1,2,6,7
[+] Author Affiliations
1Université Paris 13, Bobigny, France
2Laboratoire de Parasitologie-Mycologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
3UMR 190, Unité des virus émergents, Université Aix-Marseille, Marseille, France
4Université Paris-Est Créteil Val de Marne, Créteil, France
5Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, et Centre d’Investigation Clinique (CIC) 006, Créteil, France
6Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
7PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
JAMA Dermatol. 2015;151(8):909-910. doi:10.1001/jamadermatol.2015.0577.
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Published online

Native to temperate regions of North America, Corythucha ciliata, orlace bug, is an invasive insect that is spreading from relatively cold regions to relatively hot regions and is now distributed throughout the temperate and subtropical zones.1 Until recently, lace bugs were not reported in the scientific literature as biting or stinging humans.

REPORT OF A CASE

A healthy man in his 20s presented with pruriginous skin lesions of several weeks’ duration suggestive of insect bites (Figure 1). Results of a search for Sarcoptes by skin scrapings and microscopy were negative, and the lesions were considered related to bedbug bites. Surprisingly, during the examination, the patient felt a sting on the chest, where a small insect (2- to 3-mm long) was discovered (Figure 2), identified as an adult C ciliata.

Place holder to copy figure label and caption
Figure 1.
Skin Lesions on the Left Arm and Shoulder Due to Lace Bug Bites
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
External Ventral View of Adult Corythucha ciliata
Graphic Jump Location

Subsequently, more adult lace bugs were provided by other patients presenting with similar symptoms, and these were evaluated under a binocular magnifier for entomological identification. The probable presence of blood in the insects’ digestive apparatus was noticed for each insect. For insect identification, a fragment of the mitochondrial cytochrome oxidase 1 gene was amplified, as previously described.2 To assess the presence of a blood meal and evaluate its origin, a fragment of vertebrate cytochrome b gene was amplified for sequence analysis, and a fragment of human β-globin was amplified and directly sequenced with primers for the human β-globin Control Primer set of the Takara kit (Takara Bio).

All insects were identified unambiguously as C ciliata by sequence alignment. The presence of human blood in each insect was confirmed by alignment of sequences of both studied genes.

DISCUSSION

Blood-sucking lace bugs appear to be an emerging problem. In 2013, 3 cases of slight dermatosis in Italy were attributed to bites of the lace bug, but the causality was not demonstrated.3 Our case report and the molecular study of blood ingested indicate that C ciliata may bite humans. As with the bites of bedbugs, the bites of lace bugs generally go unnoticed; most people do not report a reaction to the bite, and cutaneous lesions and systemic reactions develop in only a small proportion of those bitten.4,5 We did not observe bacterial or fungal infections among the reported cases, although this may occur with scratching.

Corythucha ciliata was reported for the first time in Europe in Padua, Italy, in 1964,6 and for the first time in France, in Antibes in 1975.7 Its host (Platanus species), a native forest tree, is used as a common shade and ornamental tree in many urban and suburban areas. Corythucha ciliata can usually be found on trees growing in natural stands, but as a pest, it is abundant in urban and suburban forests. In summer, adult lace bugs can become abundant and often drop from leaves and land on people. Adult lace bugs can also invade houses.

How this usually oligophagous and vegetarian insect became a human bloodsucker, and what proportion its numbers made the change, warrants dedicated studies. The possibility of C ciliata biting multiple people in sequence should be considered, with implications for transmission of infectious agents. Whether the insect can bite other animals is unknown.

Lace bug infestations may have health consequences, including nuisance biting and cutaneous and systemic reactions. Clinicians should be aware of the existence of this insect with its newly recognized bloodsucking ability as potentially responsible for skin lesions and pruritus that can cause real discomfort and anxiety. Bites from the lace bug may also be considered in the differential diagnosis of bedbug bites5 and scabies.8

ARTICLE INFORMATION

Corresponding Author: Rémy Durand, PharmD, PhD, Laboratoire de Parasitologie-Mycologie, Hôpital Avicenne, AP-HP, 125 rue de Stalingrad, 93009 Bobigny CEDEX, France (remy.durand@avc.aphp.fr).

Published Online: May 13, 2015. doi:10.1001/jamadermatol.2015.0577.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was partially funded by a research grant from the French Society of Dermatology.

Role of the Funder/Sponsor: The French Society of Dermatology had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Additional Contributions: We thank the staff at the dermatology department at Avicenne Hospital, Bobigny, France.

REFERENCES

Ju  RT, Li  YZ, Wang  F, Du  Y.  Spread of and damage by an exotic lacebug, Corythucha ciliata (Say, 1832) (Hemiptera: Tingidae), in China. Entomol News. 2009;120(4):409-414.
Link to Article
Navajas  M, Gutierrez  J, Lagnel  J.  Mitochondrial cytochrome oxidase I in tetranychid mites: a comparison between molecular phylogeny and changes of morphological and life history traits. Bull Entomol Res. 1996;86:407-417.
Link to Article
Dutto  M, Bertero  M.  Dermatosis caused by Corythuca ciliata (Say, 1932) (Heteroptera, Tingidae). diagnostic and clinical aspects of an unrecognized pseudoparasitosis. J Prev Med Hyg. 2013;54(1):57-59.
PubMed
Durand  R, Cannet  A, Berdjane  Z,  et al.  Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France. Parasite. 2012;19(4):381-387.
PubMed   |  Link to Article
Bernardeschi  C, Le Cleach  L, Delaunay  P, Chosidow  O.  Bed bug infestation. BMJ. 2013;346(7892):f138.
PubMed   |  Link to Article
Servadei  A.  Un tingide neartico comparso in Italia (Corythuca ciliata Say). Bull Soc Ent It. 1966;96:94-96.
d’Aguilar  RP, Rabasse  JM, Mouton  R.  Introduction en France du tigre du platane: Corythucha ciliata (Say) (Hemiptera: Tingidae). Bull Soc Entomol Fr. 1977;82:1-6.
Chosidow  O.  Clinical practices: scabies. N Engl J Med. 2006;354(16):1718-1727.
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.
Skin Lesions on the Left Arm and Shoulder Due to Lace Bug Bites
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
External Ventral View of Adult Corythucha ciliata
Graphic Jump Location

Tables

References

Ju  RT, Li  YZ, Wang  F, Du  Y.  Spread of and damage by an exotic lacebug, Corythucha ciliata (Say, 1832) (Hemiptera: Tingidae), in China. Entomol News. 2009;120(4):409-414.
Link to Article
Navajas  M, Gutierrez  J, Lagnel  J.  Mitochondrial cytochrome oxidase I in tetranychid mites: a comparison between molecular phylogeny and changes of morphological and life history traits. Bull Entomol Res. 1996;86:407-417.
Link to Article
Dutto  M, Bertero  M.  Dermatosis caused by Corythuca ciliata (Say, 1932) (Heteroptera, Tingidae). diagnostic and clinical aspects of an unrecognized pseudoparasitosis. J Prev Med Hyg. 2013;54(1):57-59.
PubMed
Durand  R, Cannet  A, Berdjane  Z,  et al.  Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France. Parasite. 2012;19(4):381-387.
PubMed   |  Link to Article
Bernardeschi  C, Le Cleach  L, Delaunay  P, Chosidow  O.  Bed bug infestation. BMJ. 2013;346(7892):f138.
PubMed   |  Link to Article
Servadei  A.  Un tingide neartico comparso in Italia (Corythuca ciliata Say). Bull Soc Ent It. 1966;96:94-96.
d’Aguilar  RP, Rabasse  JM, Mouton  R.  Introduction en France du tigre du platane: Corythucha ciliata (Say) (Hemiptera: Tingidae). Bull Soc Entomol Fr. 1977;82:1-6.
Chosidow  O.  Clinical practices: scabies. N Engl J Med. 2006;354(16):1718-1727.
PubMed   |  Link to Article

Correspondence

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