Effectiveness of heat treatment in rapid control of bed bugs in environmental conditions resembling their natural habitats.

We evaluated lethal temperatures and times for killing bed bugs in diverse covered and uncovered conditions simulating their natural habitats. A total of 5400 adult bed bugs were collected alive from 17 infested locations in Paris. They were morphologically identified in laboratory as Cimex lectularius. They were then distributed in multiple sets of 30 specimens to examine in covered (tissue, furniture, mattress or blanket) and uncovered (direct exposure) conditions and in diverse step-function temperatures (50, 55 and 60°C) and times (15, 30, 60 and 120 minutes), replicated three times. Effective mortality was observed in 1080 specimens exposed directly to 50°C for 60 minutes. In specimens covered by tissue (1080 specimens), furniture (1080) or mattress (1080), all were dead at 60°C within 60 minutes. The specimens covered by blanket (1080) at the same temperature were dead after 120 minutes. A 60-minutes delay in reaching to lethal temperature within blanket compared to uncovered thermometer was observed.

Extensive Dermatophytosis Caused by Terbinafine-Resistant Trichophyton indotineae, France.

Extensive dermatophytosis caused by terbinafine-resistant Trichophyton indotineae harboring Phe397Leu and Leu393Ser substitutions in the squalene epoxidase enzyme was diagnosed in France. Analysis of internal transcribed spacer sequences revealed the wide spread of this species in Asia and Europe. Detection of T. indotineae in animals suggests their possible role as reservoirs.

Molecular characterization and genetic diversity of Loa loa parasites responsible of a long-delayed filarial infection in an immigrant patient inhabited in Paris.

A 21-year-old young boy who lived alone since one year and a half ago in Paris was referred due to severe vertigo. He is originally from Ivory Coast but lived from 2011 to 2017 in Douala city in west of Cameroon. Beside vertigo, he complained from headache, sudden abdominal pain and edema in both left and right forearms for about two years. General examination demonstrated a healthy condition with no subcutaneous nodules and swelling on any other part of the body, not splenomegaly or lymphadenopathy. Moreover, the eyes were normal with clear lens. Blood count analysis revealed a hypereosinophilia (2670*106/L, N: <500*106/L). A couple of direct and May-Grunwald-Giemsa stained smears, analyzed by microscopy revealed the semitransparent cylindrical worms with almost 300 µm length and 45 µm width identified as Loa loa. The identity of the worm was then confirmed by bidirectional sequencing of 450 bp fragment of internal transcribed spacer 1 (ITS1-rDNA). Based on Neighbor-Joining phylogenetic tree, our isolate was clustered tightly with other few Loa species from Gabon in the same clade. No hybrid was observed among processed sequences since all species groups were discriminated separately. In the current case, he was originally from Ivory Coast but absence of medical and epidemiological evidences as well as the residency of our patient for 6 years in Cameroon made us suspicious that the patient has been most likely infected by L. loa worms in this country. The patient was treated by a couple of ivermectin (200 µg/kg for 3 days) and diethylcarbamazine (3 mg/kg, 2 times per day for 4 weeks) and a favorable evolution was observed within few weeks. Regarding at least one year and a half interval between the probable Loa loa infection in Cameroon and diagnosis, Loa loa worms are competent to persist in the human host for several years. Consequently, the clinicians should be aware of this parasitosis among the travelers or immigrants coming from endemic regions in Africa.

Severe long-delayed malaria caused by Plasmodium malariae in an elderly French patient.

BACKGROUND: Plasmodium malariae is the cause of the rare but severe form of malaria that sometimes affects individuals travelling to malaria-endemic regions. This report presents the unique case of a patient exhibiting severe malaria symptoms caused by P. malariae with no record of recent travel to any malaria-endemic areas. CASE PRESENTATION: An 81-year-old French woman was admitted to the emergency department with sustained fever and severe weakness for the past 5 days. She suffered from anaemia, thrombocytopenia, confusion, somnolence, pulmonary complications, and hypoxaemia. In the absence of any concrete aetiology that could explain the fever together with thrombocytopenia, physicians suspected malaria as a probable diagnosis. The LAMP-PCR and lateral flow test confirmed the presence of malaria parasite, Plasmodium sp. Microscopic examination (May-Grünwald Giemsa-stained thin blood smear) revealed the presence of trophozoites, schizonts, and gametocytes with 0.93 % parasitaemia. Conventional PCR amplification targeting 510 bp DNA fragment of small subunit ribosomal RNA (ssrRNA) and bidirectional sequencing identified the parasite as Plasmodium malariae. The travel history of this patient revealed her visits to several countries in Europe (Greece), North Africa (Tunisia and Morocco), and the West Indies (Dominican Republic). Of these, the latter was the only country known to be endemic for malaria at the time (three malaria parasite species were prevalent: Plasmodium falciparum, Plasmodium vivax, and P. malariae). The patient had most likely got infected when she visited the Dominican Republic in the summer of 2002. This time interval between the initial parasite infection (2002) till the onset of symptoms and its subsequent diagnosis (2020) is a reminder of the ability of P. malariae to persist in the human host for many years. CONCLUSIONS: This report highlights the persistent nature and ability of P. malariae to cause severe infection in the host even after a prolonged time interval.

Amputation of a type II diabetic patient with cutaneous leishmaniasis due to Leishmania major.

BACKGROUND: Leishmaniases are neglected tropical diseases of public health concern in Algeria. The immunocompromised patients with HIV, autoimmune diseases, or chronic alcohol abuse are at a higher risk of leishmaniasis. Herein, we present the case of an immunocompetent diabetic patient infected by Leishmania major, leading to life-threatening consequences. CASE PRESENTATION: An Algerian diabetic patient developed a cutaneous lesion with large polymorphous inflamed granuloma and pyoderma gangrenosum in the left foot, following L. major infection. A delayed follow-up led to a treatment failure, resulting in the amputation. CONCLUSIONS: This report highlights the absence of timely treatment of Leishmania infection as a life-threatening point among high-risk diabetic patients. Clinicians should be aware of this parasitosis leading to severe complications in diabetic patients.

Autochthonous Gnathostomiasis in Madagascar.

We used molecular tools to identify an autochthonous case of gnathostomiasis in Madagascar. This severe ocular infection, caused by Gnathostoma spinigerum nematodes, led to vision loss in the patient's left eye. Clinicians should be aware of this parasitosis in Madagascar and other countries in Africa.

Severe anemia due to bed bugs hyperinfestation.

Bed bugs bite can be considered as a possible cause of chronic blood loss and anemia in individuals inhabiting in hyperinfested locations. We report the rare case of a patient with massive bed bugs infestation suffered from severe dementia, malnutrition and social isolation which provided susceptible background for severe anemia.

Molecular identification of Actinomadura madurae isolated from a patient originally from Algeria; observations from a case report.

BACKGROUND: Mycetoma is a chronic granulomatous subcutaneous infection caused by anaerobic pseudofilamentous bacteria or fungi. It is commonly prevalent in tropical and subtropical countries. Men are more susceptible to the disease due to greater participation in agricultural works. Mycetoma commonly involves lower extremities, wherein untreated cases lead to aggressive therapeutic choices, such as amputation of the affected body organs and consequently lifelong disability. CASE PRESENTATION: In this report, we present the rare case of a 58-year-old man, originally from Algeria with a left foot chronic tumefaction of 5 years. In the initial clinical examination, mycetoma was diagnosed based on tumefaction and the presence of multiple sinuses with the emission of white grains. The latter was observed via direct examination. The histopathological analysis demonstrated an actinomycetoma caused by bacteria, as the etiological agent. Imaging showed a bone involvement with osteolysis at the levels of 2nd to 4th metatarsal diaphysis. The mycological and bacterial cultures were both negative. For an accurate diagnosis, the obtained grains were subjected to molecular analysis, targeting the 16S-rDNA gene. Molecular identification yielded Actinomadura madurae as the causal agent, and 800/160 mg of trimethoprim/sulfamethoxazole was prescribed twice a day for 1 year, as a treatment. CONCLUSION: Considering low information about this disease, especially in non-endemic areas, it is of high importance to enhance the knowledge and awareness of clinicians and healthcare providers, in particular in the countries with immigration issues.

Essential Oils as a Potential Treatment Option for Pediculosis.

Pediculosis is a prevalent ectoparasite infestation caused by lice. The head louse (Pediculus humanus capitis) and body louse (Pediculus humanus humanus) are obligatory parasites whose only known hosts are humans. Pediculosis is probably the most common ectoparasitic infestation, affecting up to 80% of the population in several countries, and particularly prevalent in the infant population worldwide. Several treatment options, including shampoos and creams containing insecticides, have been introduced for the treatment of pediculosis. Recently, the use of synthetic chemicals to control human lice has raised concerns pertaining to human health and the environment. Therefore, increasing efforts have been undertaken to develop effective pediculicides with low environmental toxicity and minimal environmental residual activity. In this study, we focus on the essential oils derived from 22 plant genera, their constituents, and the major factors that play important roles in the effectiveness of these oils in the treatment of pediculosis. Furthermore, we discuss the advantages and limitations of the mentioned essential oils, and ultimately suggest those demonstrating the most effective in vitro pediculicidal activities. The genera such as Aloysia, Cinnamomum, Eucalyptus, Eugenia, Lavandula, Melaleuca, Mentha, Myrcianthes, Origanum, Pimpinella, and Thymus appear to be more efficient against lice. These genera are rich in anethole, 1,8-cineole, cinnamaldehyde, p-cymene, eugenol, linalool, limonene, pulegone, terpinen-4-ol, and thymol compounds.

Plasmodium vivax severe imported malaria in two migrants in France.

BACKGROUND: With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. CASE PRESENTATIONS: Patient 1: A 27-year old male, born in Afghanistan and living in France since 2012, was admitted on August 2015 to the Avicenne hospital because of abdominal pain, intense headache, fever and hypotension. The patient was haemodynamically unstable despite 5 L of filling solution. A thin blood film showed P. vivax trophozoites within the red blood cells. To take care of the septic shock, the patient was given rapid fluid resuscitation, norepinephrine (0.5 mg/h), and intravenous artesunate. Nested polymerase chain reactions of the SSUrRNA gene were negative for Plasmodium falciparum but positive for P. vivax. The patient became apyretic in less than 24H and the parasitaemia was negative at the same time. Patient 2: A 24-year old male, born in Pakistan and living in France, was admitted on August 2016 because of fever, abdominal pain, headache, myalgia, and nausea. The last travel of the patient in a malaria endemic area occurred in 2013. A thin blood film showed P. vivax trophozoites within the red blood cells. The patient was treated orally by dihydroartemisinin-piperaquine and recovered rapidly. Nine months later, the patient returned to the hospital with a relapse of P. vivax malaria. The malaria episode was uncomplicated and the patient recovered rapidly. Three months later, the patient came back again with a third episode of P. vivax malaria. Following a rapid haemodynamic deterioration, the patient was transferred to the intensive care unit of the hospital. In all the patient received 10 L of filling solution to manage the septic shock. After 5 days of hospitalization and a specific treatment, the patient was discharged in good clinical conditions. CONCLUSION: Clinicians should be aware of the potential severe complications associated with P. vivax in imported malaria, even though the primary infection is uncomplicated.

In vitro efficacy of five essential oils against Pediculus humanus capitis.

Treatment of head lice has relied mainly on the use of topical insecticides. Today, conventional topical pediculicides have suffered considerable loss of activity worldwide. There is increasing interest in the use of natural products such as essential oils for head louse control, and many of them are now incorporated into various over-the-counter products presented as pediculicides, often without proper evaluation. The aim of the present study was to assess the in vitro efficacy of five essential oils against adults of Pediculus humanus capitis using a contact filter paper toxicity bioassay. The chemical composition of the essential oils from wild bergamot, clove, lavender, tea tree, and Yunnan verbena was analyzed by gas chromatography-mass spectrometry. All treatments and controls were replicated three times on separate occasions over a period of 11 months. In all, 1239 living lice were collected from the scalp of 51 subjects, aged from 1 to 69 years. Clove oil, diluted either in coco oil or sunflower oil, demonstrated the best adulticidal activity, reaching > 90% mortality within 2 h in lice submitted to a 30-min contact. Yunnan verbena oil diluted in coco oil showed also a significant efficacy. Other essential oils showed a lower efficacy. The oil's major component(s) differed according to the tested oils and appeared chemically diverse. In the case of clove oil, the eugenol appeared as the main component. This study confirmed the potential interest of some of the essential oils tested, but not all, as products to include possibly in a pediculicidal formulation.

Morphological discrimination of human lice (Anoplura: Pediculidae) by eggs' cap-like operculum.

Human lice have long been parasites of humans and are responsible for several epidemics in human medical history. However, their morphology, particularly head and body lice, remains very similar. In this study, we discriminate human louse species based on the number, shape and size of aeropyles (respiratory pores) of the egg operculum as well as the size of the respiratory orifice in the aeropyles. For this purpose, lice and eggs were collected from infested patients referring to Parasitology Department of Avicenne Hospital (Bobigny, France) and analyzed morphologically. The microscopic examination of the aeropyles revealed a large variation in the number ranging from 5 to 12 for head lice, 10 to 16 for body lice and 13 to 18 for pubic lice with a statistically distinct average of 8.3, 12.9 and 15.7, respectively. Although the length of the head and body louse eggs were almost similar, the width of body louse eggs were bigger than those of head louse (412.9 µm and 363.5 µm, respectively), while pubic louse eggs had the smallest length (692.9 µm) and width (286.1 µm). In addition, pubic louse eggs had a greater operculum length and width (253.7 µm length and 220.7 µm width) than head (230.6 µm length and 210.2 µm width) and body lice (227.9 µm length and 199.9 µm width). Moreover, pubic lice had the smallest average aeropyle size (41.2 µm) compared to head (51.1 µm) and body lice (49.1 µm). The respiratory orifice on the aeropyles of head and body lice (9.9 µm) were almost twice as big as those of pubic lice (4.9 µm). There was an inverse correlation between the number of aeropyles and their size in head, body and pubic lice. These findings are helpful in accurate identification of human louse species using their eggs, which could be useful for control management strategies against these ectoparasites.

Case Report: First Report of Mucocutaneous Leishmaniasis in Algeria: Observations from a Case Report.

We present the first case of mucocutaneous leishmaniasis in Algeria, diagnosed in an immunocompetent 42-year-old man exhibiting an infiltrated and ulcerated plaque leading to macrocheilitis of the entire lower lip. He was a police officer who lived in a village in Ain El Hammam (Kabylie region, known as an active focus of zoonotic visceral leishmaniasis) without any history of travel for the previous 3 years. He suffered from cutaneous lesions for 22 months due to the misdiagnosis of a skin lesion resembling other diseases such as Crohn disease or sarcoidosis. A compilation of clinical, histopathological, parasitological, and molecular examinations revealed Leishmania infantum as the etiologic agent. The patient was treated with meglumine antimoniate, which resulted in the complete disappearance of the lesion 4 months after treatment.

First official report of bed bug (Hemiptera, Cimicidae) infestations in Algeria.

Background: Bed bugs are hematophagous insects with a long history of presence in human communities. Over the last three decades, infestations by bed bugs in human dwellings have drastically increased, leading to a rise in bed bug concerns. Nevertheless, very little is known about the bed bug species and their population diversity in Algeria. Method: A pilot entomological inventory was performed in May 2019 in Tizi Ouzou, in northern Algeria. The gathered bed bug specimens were identified by morphological and molecular approaches, followed by neighbor-joining and network phylogenetic analyses. Results: A total of seven out of 12 requested locations were allowed to inspect for bed bug infestation. Of these, three locations were found with active bed bug infestations. A total of 145 specimens belonging to different life stages [egg (21), nymph (74), adult male (17), and female (33)] were collected and analyzed using morphological and molecular approaches. The adult specimens were identified as Cimex lectularius according to specific morphological criteria, most importantly the pronotum laterally expanded with more flattened extreme margins. Morphological identification of the adults was confirmed further by conventional PCR targeting 450 bp fragment of the COI gene. All the nymphs and eggs were also molecularly identified as C. lectularius. Neighbor-Joining phylogenetic tree reconstructed with the collected specimens provides clues on the presence of two closely phylogenetic groups. The first one gathers our samples of Algeria with previously reported COI haplotype sequences from Asian, European, and North American countries. The second group encompasses a lesser-documented haplotype reported in Europe and Central America. These findings were further confirmed by network analysis. Conclusions: These results provide evidence of established C. lectularius infestation in Algeria and its potential dispersal capacity by travelers or immigrants and will help future management of these ectoparasites.

Oral ivermectin versus malathion lotion for difficult-to-treat head lice.

BACKGROUND: Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old. Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure. The efficacy of alternative agents is controversial. METHODS: We conducted a multicenter, cluster-randomized, double-blind, double-dummy, controlled trial comparing oral ivermectin (at a dose of 400 microg per kilogram of body weight) with 0.5% malathion lotion, each given on days 1 and 8, for patients with live lice not eradicated by topical insecticide used 2 to 6 weeks before enrollment. The cluster was defined as the household. Infestation was confirmed and monitored by means of fine-toothed combing. Patients were at least 2 years of age and weighed at least 15 kg; all were treated at the study sites. The primary end point was the absence of head lice on day 15. RESULTS: A total of 812 patients from 376 households were randomly assigned to receive either ivermectin or malathion. In the intention-to-treat population, 95.2% of patients receiving ivermectin were lice-free on day 15, as compared with 85.0% of those receiving malathion (absolute difference, 10.2 percentage points; 95% confidence interval [CI], 4.6 to 15.7; P<0.001). In the per-protocol population, 97.1% of patients in the ivermectin group were lice-free on day 15, as compared with 89.8% of those in the malathion group (absolute difference, 7.3 percentage points; 95% CI, 2.8 to 11.8; P=0.002). There were no significant differences in the frequencies of adverse events between the two treatment groups. CONCLUSIONS: For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment. (ClinicalTrials.gov number, NCT00819520.)