Mohammad Reza Youssefi, Mohammad Taghi Rahimi

1Department of Parasitology, Islamic Azad University, Babol Branch, Babol, Iran

2Young Researchers Club, Islamic Azad University, Babol Branch, Iran

Extreme human annoyance caused by Ctenocephalides felis felis (cat flea)

Mohammad Reza Youssefi1, Mohammad Taghi Rahimi2*

1Department of Parasitology, Islamic Azad University, Babol Branch, Babol, Iran

2Young Researchers Club, Islamic Azad University, Babol Branch, Iran

PEER REVIEW

Peer reviewer

Behzad Esfandiari, Assistant Professor, Epidemology Department of Pasteur Institute, Tehran, Iran.

Tel: +989111836073

Fax: +985442451

E-mail: esfandiari88@hotmail.com

Comments

This is a good report in which the authors try to describe a case of dermatitis, hypersensitivity and severe discomfort caused by flea bites. The report is interesting and informs our colleagues about the presence of flea and their probable public health concern.

Details on Page 336

The authors report a case of human dermal complications by Ctenocephalides felis felis (cat flea) in a 28 years old woman who dwell in rural area in Mazandaran province, Iran. Furthermore, in the current report clinical manifestations, etiology and different aspects of infestation were discussed elaborately. And the importance of controlling fleas was highlighted as well.

Flea, Skin, Dermatitis, Human, Iran

1. Introduction

Fleas are hematophagous ectoparasites on warmblooded hosts and they are a matter of high importance both in medical and veterinary field. Fleas are known as a vector of some important disease including plague, murine typhus, tularemia and dipylidiasis. This pest annually imposes a considerable economical losses and damages to humans and livestock industries. Furthermore, fleas bite is one of the causative agents of hypersensitivity responses, dermatitis, allergies and severe discomfort. Dermal complications annually have been reported in human and animal particularly in spring and summer owing to proper conditions of these seasons for these aggressive insects. In addition, in general, though fleas do not have exclusive hosts but they have preferred hosts[1,2].

Ctenocephalides felis felis(C. felis) (cat flea) has a worldwide distribution; despite of its name it can invade cats, dogs, humans and a wide variety of mammals. Moreover,C. felisandCtenocephalides canis(dog flea) can be very harassing pest of humans due to their painful bites when they have a close association. Cat fleas and their feces are considered as allergens and they increase the allergenicity of house dust. At least 15 proteins fromC. felisare proved as allergen[3].

Despite of all above mentioned facts including transmission of diseases, economical damages and public health concerns, there is not enough information about flea and its complication in our country. Therefore, the current paper provides a commentary on human infestation by fleacausing a severe dermatitis and allergic reactions.

2. Case report

A 28 years old woman who lives with her parents in Azizac, a rural residential area, Babol city, Mazandaran Province, Iran, referred to a dermatology department in Babol with complaining of multiple bites in different parts of body especially back and hips by very tiny insects which were collected by her in a small container. She complained about discomfort, itching and being anxious especially at night and having uncontrolled tendency for scratching of lesions. She noted that she had been suffering for 7 d.

Typical urticarial papules with erythema concentrated on her back and hips, with the size of 3-20 mm were observed in her primary examination. And also a red hemorrhagic punctum was seen in the center of some lesions. The bites were normally multiple, often with a tendency to clustering and sometimes dispersed in a linear form (Figure 1). The number of bites was approximately 150. After inquiring she mentioned that she lives in rural area and she just enjoys having hens and roosters as a pet but stray animals particularly cat can be seen in her vicinity.

Figure 1. Multiple popular urticaria lesions covering the back of a 28 year old woman.

The collected tiny insects were examined precisely, the causative agent of disturbance were recognized asC. felisin Department of Parasitology, Islamic Azad University, Babol Branch, Iran (Figure 2). Shortly thereafter, the patient received an effective treatment by using calamine ointment two times per day, and within a week all clinical manifestations disappeared and she was free from symptoms. In addition, fleas were eliminated by spraying Simetrin and fumigating of the home, the yard, mattress and all suspected locations. In addition, in her small family, just her father had similar lesions but he did not have complaint and he did not receive any treatment.

Figure 2. C. felis (cat flea).

3. Discussion

Fleas are considered as a highly specialized blood sucking pest and they are equipped with advanced and specific mouth parts which can pierce their host skin in order to prepare their vital requirements. The consequences of this invasion in vulnerable people may lead to erythema, dermatitis, allergies, delayed reactions and hypersensitivity. In addition, flea saliva has a low molecular weight anticoagulant that will be responsible for subsequent reactions. After abating initial wheal, a mild urticaria will be remained shortly and it is a trace of flea activity. Concerning age, younger subjects have more sensitivity in comparison with older groups to the stings with regard to the delayed reaction and males revealed more proportion of delayed reactions to flea bites compared to females[4].

According to our literature review, a family of three members shown severe dermatitis and allergic reactions toC. felisbites in Golestan Province, Iran[5]. In Switzerland a couple was attacked by pigeon fleas (Ceratophyllus columbae) and patients had allergic urticarial reaction to the bites[6]. In another similar report a young woman was invaded repeatedly by cat flea from suburban raccoons[7]. An outbreak of human flea (Pulex irritans) occurred in hospital staff in UK and 13 staffs were bitten. In some cases, fleas had been found by staff on their uniform and in two subjects, all family members had been bitten at home[8]. Totally 244 cases of human infestation by flea were recorded from sixteen provinces of Iran. The most involvement were observed in animal care-men and their relatives, and their reactions to flea’s bites were variable from moderate to highly sensitized and the most of lesions were on legs and ankles[9]. Environmental circumstances can influence the survival and multiplication of ectoparasites. For example, the development of flea larvae requires moderate temperatures and high relative humidity in their protected habitations. In fact, allproper and suitable conditions are prepared in tropical and subtropical areas. Hence, dermatologists in tropical and subtropical areas should pay more attention to flea bite and human infestation, particularly differential identification between fleas bite from similar cases such as cutaneous leishmaniasis and cercarial dermatitis particularly in the beginning of their manifestations[10].

This is noteworthy to mention that nowadays there is a high tendency among people to maintain pet animals for a wide verity of reasons such as an entertainment, companion, breeding,etc. which can be considered as a main source of infestation. Considering aforementioned facts, in order to prevent from infestation, fleas should be removed from pets and habitation while our surrounding and environment are infested with fleas; we should bear in mind that only elimination of fleas from animal is insufficient. Because the house and the yard can also maintain all developmental stages of the fleas which are new source for re-infestation.

In conclusion, the authors deduced that being in close contact with animal either domesticated or stray without control of their ectoparasites, particularly flea, treats human life and imposes a considerable burden. And finally we highly suggest conducting further researches on transmitted disease and human infestation complications caused by flea.

Conflict of interest statement

We declare that we have no conflict of interest.

Acknowledgements

We wish to express our sincere thanks to Mr. Solimani for kind collaboration. And also Islamic Azad University, Babol Branch.

Comments

Background

The importance of many ectoparasite species, especially fleas, ticks, mites, and lice to human welfare cannot be neglected. The roles of fleas in the transmission of plague and murine typhus are well known. Moreover, human may be exposed to painful bites resulting in direct pathological effects, both from wild animal ectoparasites or from others more directly associated with man and domestic animals. Human infestation to ectoparasites particularly flea causes an intense allergic itching, skin infection and sever discomfort.

Research frontiers

Studies are being performed in order to survey the flea saliva showed that there is at least 15 proteins which are allergen. Besides, a low molecular weight anticoagulant in flea saliva can also lead to a severe reaction.

法國巴黎科學與生物多樣性小學，其所處位置也在一個狹小的地塊中，不僅包括教學空間，還有一個面向居民開放的體育館。學校針對自己的教學特性，將體育館置于一端對外開放，剩余部分圍繞內(nèi)院布置半環(huán)形的教學空間及綠帶，打造了一個可循環(huán)的生態(tài)系統(tǒng)。這種內(nèi)院與綠帶既提供了學生的校園活動空間，又使學生與自然能零距離的接觸，達到了需要的教學目的（圖2）。

Related reports

The report indicated four similar studies which reported human severe dermatitis caused by flea bites. In Switzerland pigeon fleas (Ceratophyllus columbae) was the causative agent of disturbance, in UKPulex irritansinvaded to hospital staff, in Iran and NetherlandC. feliscaused erythema and hypersensitivity in human.

Innovations and breakthroughs

Despite of large quantity of insects and ectoparasites in tropical and subtropical areas, reports and studies regarding human dermatitis and discomfort are rare. And this report has showed the importance of ectoparasites and pest to human life.

Applications

It may be significant to know about flea bite complications and also other ectoparasite particularly for pet owners, veterinarians and dermatologists. Thus, it is important to prevent and control this pest owing to their remarkable socioeconomic burden.

Peer review

[1] Service M. Medical entomology for students. 8th ed. Cambridge, UK: Cambridge University Press; 2008, p. 173.

[2] Ichikawa Y, Beugent F. Epidemiological survey of anti-flea IgE in dogs in Japan by using an antigen-specific IgE quantitative measurement method. Parasite 2012; 19: 173-176.

[3] Larry SR, Janovy J. Foundations of parasitology. 7th ed. New York: MCGraw Hill Publishing Company; 2006, p. 590.

[4] Marro A, Pirles M, Schiaffino L, Bin L, Dávila H, Bottasso OA, et al. Successful immunotherapy of canine flea allergy with injected Actinomycetales preparations. Immunotherapy 2011; 3: 971-978.

[5] Youssefi MR, Rezaei M, Rakhshanpour A, Ahmadpour E, Rahimi MT. Dermatitis caused by Ctenocephalides felis felis (cat flea) in human. Caspian J Intern Med. Forthcoming 2014.

[6] Haag-Wackernagel D, Spiewak R. Human infestation by pigeon fleas (Ceratophyllus columbae) from feral pigeons. Ann Agric Environ Med 2004; 11: 343-346.

[7] Hunter KW Jr, Campbell AR, Sayles PC. Human infestation by cat fleas, Ctenocephalides felis (Siphonaptera: Pulicidae), from suburban raccon. J Med Entomol 1979; 16: 547.

[8] Thomas PD, Cutter J, Joynson DH. An outbreak of human flea infestation in a hospital. J Hosp Infect 2000; 45: 330.

[9] Rahbari S, Nabian S, Nourolahi F, Arabkhazaeli F, Ebrahimzadeh E. Flea infestation in farm animals and its health implication. Iran J Parasitol 2008; 3: 43-47.

[10] Laffort-Dassot C, Carlotti DN, Pin D, Jasmin P. Diagnosis of flea allergy dermatitis: comparison of intradermal testing with flea allergens and a FcepsilonRI alpha-based IgE assay in response to flea control. Vet Dermatol 2004; 15: 321-330.

10.12980/APJTB.4.2014C795

*Corresponding author: Mohammad Taghi Rahimi, Young Researchers Club, Islamic Azad University, Babol Branch, Iran.

Tel: +989122930625

E-mail: rahimimt@gmail.com

Foundation Project: Supported by the Young Researchers Club, Islamic Azad University, Babol Branch, Iran (Grant NO.: BPJ1392).

Article history:

Received 10 Feb 2014

Received in revised form 14 Feb, 2nd revised form 18 Feb, 3rd revised form 23 Feb 2014

Accepted 25 Mar 2014

Available online 28 Apr 2014