Case guesses:

Jon writes:

Hi TWIP hosts

This is my first time writing in after listening to many of the episodes since coming across the podcast in my 2nd year of undergraduate studies, of which now I’m currently in my first year of my MSc degree in Microbiology. To answer the case study: 

I believe this “risk of being helpful” has led to the volunteer becoming the nourishing blood meal for one of the five nymphal stages of Cimex hemipterus, commonly known as the tropical bed bug. The series of lesions that appeared to be the paired bite marks (breakfast, lunch and dinner) which are supposedly characteristic of Cimex species compared to single bites from other insects. Although this cannot be the sole reason for diagnosis and actual identification of the insect is needed for confirmatory diagnosis. Moving from the bed of origin, deep cleaning of their clothes, especially with a hot dryer, and treating the room with insecticides such as pyrethroid and neonicotinoid would hopefully eradicate the pests. .

P.s, coming from Cape Town, South Africa where TB and HIV are endemic leaves me wondering how devastating the effect of COVID-19 may be on these vulnerable groups of people? Our government has recently taken action (15/03/2020) to slow the spread, as this would be vital to make sure there are beds available for severe cases that may arise from those that may have HIV, TB or both. Have there been any reports of individuals with both TB and COVID-19 and what were their outcomes?  

Wishing you all the best

— 

Josh Aaron

Bsc (Hons) Medical Virology

Stellenbosch University

James writes:

Linear bites. The differential diagnosis is short.

One trip my wife and I made to Seattle to visit the Grandkids (oh and my daughter too) we stayed in a nice local hotel, and also in a really nice hotel in Vancouver.

We noted linear bites that itched. The red marks were a lot less than a cm, more like 3 mm, but it was the first time I’d ever been exposed to…bedbugs. Cimex lectularis. 

Ick.

We washed and dried everything and thank God did not bring them home to Denver with us. But then my brother called and said he was being evicted from his apartment due to bedbugs! I frankly was more worried about them getting a ride from him to my elderly parents’ condo in a big building, what a disaster that could have been. As I recall it was summer, so we packed up his stuff and put it all in an unventilated storage unit for a while and baked the little buggers.

We looked up and found a whole variety of home-brew bedbug traps often based on carbon dioxide emission, with dry ice, vinegar/soda, and even sugar and yeast (well, I’m a mycologist so I should say “Saccharomyces cerevisiae”, right? drawing the bugs into various sticky places.

These dudes ARE found in Uganda, google shows them in all kinds of hotels there.

In my active Pathologist days, the infection control folks knew that there was this weird guy in the lab who liked to identify weirdness and often they appeared with usually a urine cup, held carefully in gloved hands, usually coming straight from the ED. Usually it was either lice or bedbugs. I had to instruct the Pathology Assistants and fellow pathologists NOT to embed the bug for histology; a thin 2-D slide through an insect is like so unhelpful. A hand lens on the other hand…reminds me of the old Pathology saying, “High power lens, low power mind.”

I read that the eggs hatch in 6-10 days and both nymphs AND adults need blood meals. Now this is a huge bummer: nymphs and adults can live without a blood meal for months to maybe even a year. Talk about “intermittent fasting” and a Low Carb diet…

There are, on the UMN extension site, all kinds of delightful pictures of bedding with bloody bedbug poop-stains. I suppose it would be prudent when traveling to look at the bedding but does anybody really do that?

Thanks for the memories,

James M. Small, MD PhD

Associate Professor of Pathology

Rocky Vista University

Andrew writes:

Kia ora from Pongaroa

No book won yet but I see sending a picture had a magical effect last time – see below.

The weather is dry and windy 19°C – the drought continues.

Pongaroa has no cases of Covid-19 yet; with only 28 cases recorded so far in the country (all infected overseas or close family) and our international borders are now closed to all but citizens and permanent residents. It might be a while before Pongaroa will see any cases but we are routinely prepared to survive alone for at least two weeks due to the earthquake risk. It will be interesting to see how many cases there are when the next TWIP is produced.

My guess for this month’s case is Cimex hemipterust – the tropical bedbug.

I have had experience with their temperate cousins Cimex lectularius and recognised the line formation of the swollen lesions the young ladies had. The main difference between the two types is morphological as far as I can determine – the tropical variety have necks. Necks or not they are just as execrable.

They are tenacious creatures and unless the bedding is washed in very hot water and the room and furniture is carefully inspected – with a magnifying glass and every adult, nymph and egg removed, they would need to wait at least four months but probably longer due to the higher temperatures and humidity one would expect in Uganda. Perhaps 18 months before the last egg has perished.

Now to my picture. I was made aware that two young PhD candidates, who are researching in microbiology, would like to share their love of science with the people of Pongaroa. As it is the birth place of Nobel Prize winner Maurice Wilkins there was a definite hook to microbiology. We organised two events. A talk for the adults and an experiment at the local primary school. While the adult event was a success the school kids had a blast extracting DNA from kiwi fruit. The young PhD students hammed it up by wearing lab coats and safety glasses and the teachers had prepared the children with age appropriate explanations of what scientists do and what DNA is. 

The little kids mashed up the kiwifruit and the older ones mixed the buffer solution and poured the methanol into the beakers. The all watched the DNA precipitate out with wonder and delight. We are sure that some of those children will be inspired to pursue science as a career and who knows – Pongaroa might get its second Nobel prize winner in due course. 

We could not obtain ethanol for the experiment, as most online descriptions recommend, but the purple colour of the methanol used made for a rather fetching combination, with the green of the kiwifruit and the white of the strands of DNA – see picture.

If any listeners are interested – maybe they have bored kids in quarantine or a lock-down – the experiment is detailed at the Naked Scientist’s web site:

https://www.thenakedscientists.com/get-naked/experiments/how-extract-dna-kiwi-fruit

ma te wa, (mah tey wah) [see you later]

Andrew

David writes:

Dear TWiP Hosts,

I believe the parasite-plagued patient from Uganda is suffering from the bites of bed bugs; hematophagous insects in the genus Cimex which have a penchant for human blood. The three-four raised lesions in a line on the torso were a dead giveaway, and seeing the lesions disappear after the bedding was left behind is another insightful clue. I remember Dickson once saying three lesions in a line of this sort represent “breakfast, lunch, and dinner”, and maybe the fourth could be dessert. Unfortunately, bed bugs can be rather difficult to remove, and require pesticide usage and mechanical controls (removing the bugs with a vacuum, heating up mattresses). Depending on where the eggs of this insect were laid in the room, it can take quite a long time to fully eradicate the bed bugs. New Stork State Integrated Pest Management claims it may take at least three weeks to get rid of bed bugs (https://nysipm.cornell.edu/whats-bugging-you/bed-bugs/bed-bug-faqs/#17), but this information is coming from NY, not a resource-limited region such as Uganda where some of these pesticides or amenities may be lacking. 

 Thank you once again for the informative and entertaining podcasts, and I hope you are all keeping healthy and safe.

Sincerely,

David P.

P.S. I wanted to share with you and the listeners my first research article published in Biology Open since I joined Tufts Vet School as a PhD student. I cannot believe after starting to listen to TWiP ~4-5 years ago that I would be a published author in the field of parasitology. Your podcasts have served me well in my time in and out of the lab. Thank you for being an inspiration to eager scientists and listeners alike.

Link: https://bio.biologists.org/content/9/3/bio050385.long

Schuyler writes:

Dear Twipsters,

I hope you are all staying well and washing your hands like someone scrubbing-in for surgery. I used to listen to TWiP when traveling home during freshman year of college (2013!) and recently started listening to podcasts again, including the wonderful TWiP. I like to listen to your podcast especially when going for walks. It is a pleasant 50F here in Cambridge, MA, though it’s a bit overcast. I must say, I have three motives for writing in this week. First, I just listened to TWiP 177, where you discussed that scabies is specific to humans and could therefore theoretically be eradicated. As someone who considered veterinary medicine before deciding to pursue human medicine instead, I wanted to let you know that sarcoptic mange (aka scabies) affects dogs as well as humans and is not specific to humans alone. The second form of mange, demodex, is specific to dogs. Poor dogs. Second, I would absolutely love a book as I do not have one yet and I would love to bring it with me when I start medical school at Georgetown this summer! Third, I finally listened to a recent episode instead of an old one and guessing seemed like fun.

My initial suspects for case 181 are bedbugs and kissing bugs. If it were some sort of internal parasite, the lesions wouldn’t stop after changing rooms, unless the patient happened to move at the time the disease resolved itself. Well, the CDC website says kissing bugs that transmit Chagas Disease only live in the Americas, so that’s out (1) – or so I thought. The International Association for Medical Assistance to Travelers (IAMAT) still warns against kissing bugs on their Uganda page (2), so maybe another variant that doesn’t carry Chagas lives in Uganda? Regardless, I think bed bugs are more likely, though I find it odd she got so few bites per night. Perhaps the infestation was not that bad yet. The line of bumps (bites) is apparently a sign of bedbugs (3, 4). Wikipedia refers to these as “breakfast, lunch, and dinner” (3) and IAMAT warns of bed bugs in Uganda as well (2). I’m not sure I would return to the room or even the same building. My understanding is that eradication of a bed bug infestation is a nasty thing, requiring extensive cleaning, heat treatment, and multiple washes of all affected cloth. Of course if you starve the bugs, they’ll eventually die. According to University of California Agriculture & Natural Resources, bed bugs can live 20 to 400 days without feeding, depending on the age of the bug (5). Adults can go 400 days without feeding, so I will say no-one should use that room until at least 400 days have passed. But the woman should dispose of or treat any of her belongings that could be carrying bed bug eggs or nymphs from the old room to the new one.

Wishing you all the best,

Schuyler (pronounced Skyler)

Master of Biomedical Science, ’20

Tufts University School of Medicine

(1) https://www.cdc.gov/parasites/chagas/gen_info/detailed.html

(2) https://www.iamat.org/country/uganda/insect-bite-prevention#

(3) https://en.wikipedia.org/wiki/Bed_bug

(4) https://www.cdc.gov/parasites/bedbugs/faqs.html

(5) http://ipm.ucanr.edu/PMG/PESTNOTES/pn7454.html

WesternU Global Health Track Students: Dana, Steven, and Chris write:

We believe the most likely diagnosis to be bed bugs. Beds bugs normally bite 3-4 times in succession over a few minutes to engorge themselves. This would appear symptomatically as lesions in a line like the patient is experiencing. Also, the fact that the lesions stopped after they left the room and bedding behind suggests an infestation in the bedding. However, identification of the insect is required to confirm the diagnosis. 

As for moving back into the room, it’d be best to have the bedding washed and put through a hot dryer to kill the bed bugs. Vacuuming can have a significant impact on reducing bed bugs, but considering the floors are concrete, that probably wouldn’t help. Maybe they could sweep the floor every day? The beds bugs could be infested in the mattresses as well so possibly those would need to be replaced. Alternatively, the room could be treated with products containing pyrethroid and/or neonicotinoid. 

According to your book, hosts can become desensitized to bed bug bites over regular exposure so possibly the volunteers could be told to wait it out, but that would probably be very annoying to hear as a patient. Maybe the desensitization bit is why the manager was so casual about the whole situation since he has possibly been there long enough to reach that point. 

Thanks for all you do. We really appreciate the COVID-19 daily updates on your website. 

Sincerely, 

WesternU Global Health Track Students: Dana, Steven, and Chris

Evan writes:

Hello Drs. Racaniello, Despommier, and Griffin,

I hope you are all doing well amidst the coronavirus pandemic. Here in Virginia we are trying our best to stay at home and all medical school classes have moved online. With my new-found ‘free time’ I’ve been able to catch up on my podcasts.

I hope I am not too late in entering a guess for the case from episode 181. Here we have a medical volunteer in Uganda presenting with red lesions clustered on the torso upon waking in the morning. Lesions are absent upon moving to a new room to sleep.

I believe this is a case of bed bugs as the rashes match the classic description and there are multiple which rules out other common bug bites/stings. Ideally the bedding should be washed and room cleaned to get rid of the offending buggers.

Hopefully this is correct, if not I’ll be sure to check out Parasitic Diseases 7th edition soon. 

I wish you all the best and look forward to more TWIP,

Evan

Peter writes:

The description of lesions appearing overnight that appear to be associated with a particular room in lodgings suggest to me that the culprit here is the same as the one discussed in TWIPs 100/101: the bed bug (Cimex lectularius or C. hemipterus). The description of 3 or 4 raised red lesions in a line corresponds to the apocryphal “rule of 3 bites” (Parasitic Diseases, 7th Ed, p. 470). 

Treatment of the room is with insecticides (pyrethroid and/or a neonicotinoid based product), vacuuming, washing of all bedding, covers etc and heat-drying and ensuring that cracks and other hiding places are covered up when possible. “Encasing” of matresses in plastic covers is also recommended. (ref: US EPA) Sounds like this last advice could leave you with a crinkly night’s sleep though. The room can be re-occupied after treatment, that is in about a day’s time. (ref: Michigan State University)

I do not know how much the above advice needs to be adapted for the conditions of warmer climes.

References:

US EPA: https://www.epa.gov/bedbugs/top-ten-tips-prevent-or-control-bed-bugs

Michigan State University: https://www.canr.msu.edu/news/what_to_expect_after_bed_bug_treatment

Peter

locked down in a Cape Town that is turning to autumn and colder evenings.

P.S. Prof Despommier often mentions the story of Mao’s army, the planned invasion of Formosa and schistosomiasis. I do not know if he is aware that Mao Zedong wrote a poem about scistosomiases:

Farewell to the God of Plague

Mao writes: “When I read in the Renmin Ribao of June 30, 1958 that schistosomiasis had been wiped out in Yukiang County, thoughts thronged my mind and I could not sleep. In the warm morning breeze next day, as sunlight falls on my window, I look towards the distant southern sky and in my happiness pen the following lines.”

I

So many blue streams and green Hills, but to what avail? 

This tiny worm defied even the greatest physicians!

Hundreds of villages choked with weeds. Men wasted away; 

Thousands of homes deserted, spirits chanted mournfully.

Merely sitting here, daily I travel eighty thousand li a day, 

Surveying the sky I see a myriad of Milky Ways from afar. 

Should the Herdboy star ask tidings of the God of Plague, 

I’d reply, “His joy is gone as our sorrows.” 

II

The spring wind blows amid profuse willow wands, 

Six hundred million in this land all like saintly sires. 

Crimson rain swirls in waves  

Green mountains turn to bridges at our wish. 

Gleaming pick axes fall on all of China from the Five Ridges to the Yellow and Lo rivers; 

Mighty arms pound the rock to earth. 

We ask the God of Plague: “Where are you bound?” 

Paper boats lit by candles illuminate the sky taking the Demon God away

(The “Herdboy star” otherwise translated as the Cowherd is a reference both to Altair and to the story of The Cowherd and the Weaver Girl. The poem feels quite fitting in these times.)

(sources for the poem: http://jrtph.jcu.edu.au/vol/v06caban.pdf and https://www.marxists.org/reference/archive/mao/selected-works/poems/poems25.htm)

Cecelia writes:

Dear Doctors,

   Your volunteer in Uganda was probably sleeping in a room that was infested with bed bugs. 

  Cimex lectularius and C. hemipterus hide in the seams of bedding, crevices of flooring and furniture, and behind peeling wallpaper. The bed bugs come out at night to feed by biting the victim for a blood meal. Their nocturnal feeding results in more than one bite, usually 3 to 4. This can differentiate the bites caused by bed bugs and mosquitoes or fleas.

  The infested room needs to be treated by washing the bedding and any clothes that may be stored in the room. In addition the mattress, and surrounding area should be inspected for evidence of bed bug infestation by looking for the bugs and feces in the seams of the mattress, and any cracks and crevices.

  Thanks again for the podcast and the interesting case studies.

Sincerely, 

Cecelia 

St. Petersburg, Fl 

Ben writes:

To the TWiPtastic Trio,

The case study sounds like a classic case of bed bugs! Getting rid of bed bugs can be difficult, but can be achieved through use of insecticides (although resistance is increasing), or more mechanical approaches like steaming of beds etc. 

Thought I would add a paper suggestion https://www.biorxiv.org/content/10.1101/2020.02.25.962589v1.full. The authors investigate two proteins and how they’re involved in microtubule assembly and anchoring to the conoid of Toxoplasma gondii. In particular the paper has some absolutely beautiful microscopy, with the first published example of expansion microscopy in Apicomplexan parasites! Since the last TWiP episode, my first, first-author paper was published where we look at a protein involved in malaria parasite invasion. We did quite a lot of super-resolution microscopy in that paper and I’m hoping to use expansion microscopy on malaria parasites in the near future, so I was very excited to see this. 

Keep up all the fantastic work,

Ben

Ben Liffner

PhD Candidate – Malaria Biology Lab (Wilson Lab)

Research Centre for Infectious Diseases

School of Biological Sciences

The University of Adelaide

Kevin writes:

“There are other health impacts of bed bugs: the challenge and costs of pest control often lead people to desperate and dangerous acts” (Doggett et al)

“…that nauseous, venomous insect…” J Southall 1730, A Treatise of Buggs

The volunteer nurses from TWiP 180, recovering from severe Cyclospora diarrhea have now experienced another degrading visitation: nocturnal assassins. 

I won’t beat about the bush, BUT…habit forces me to make a brief differential diagnosis. Patient’s often present with a lesion that they insist is a spider bite. Why is this? Anyway, our volunteers do not seem to have scabies, bites of the tumbu floor maggot, mosquito bites, lice, or cutaneous larval migrans. Here be Cimex. Bed-bugs. Either Cimex lectularis or the tropical bed bug Cimex hemipterus. Old references mention slang terms like ‘mahogany flats’ and ‘red coats’ but one wonders how often these terms were used. Despite the now decades long global resurgence of bed bugs I am aware of no common slang expressions. Massive amounts of treasure have been expended in eradication efforts, but the bugs endure. Regarding our African location, the Nigerian reference below states that only 16% of inspected dwellings were without bug infestations.  I will list some essential facts that may assuage a few of the more irrational fears that bug victims nourish.

* Bed bugs carry no known human disease despite laundry lists of suspects that have appeared through the years.

*Bed bugs cannot fly, hop, jump or perform other acrobatics.

*They can live for over one year without feeding. (but normally live 4-5 months under ‘normal household conditions.’)

* Bed bugs do not live upon the host. They are hit and run raiders. (I have seen the molted exoskeletons on people however).

* Some people are seemingly unaffected by bed bug bites while others can have exuberant or even bullous lesions.

*The old saw that bed bug bites occur in clusters of three; the so-called breakfast, lunch, dinner pattern, has been largely debunked as oversimplified. Doggett however (the Australian Cimex guru) presents good evidence of linear and clustered biting patterns however and his 2012 review shows clear photographic evidence for this. 

I would like to further calumnize the bed bug by first mentioning its legendary disagreeable odor, described in detail by most authors. I regret to say that I have personally been in rooms that were heavily infested and never noticed this buggy odor. Must get my olfactories checked. Another despicable characteristic of these creatures is their practice of traumatic (also known as hypodermic) insemination. Despite the females possession of perfectly formed genitalia, the male bug mates by directly piercing his partner’s abdomen with his foul aedeagus. I will finalize this jeremiad by repeating a finding from 1976 where the orthobunyavirus Kaeng Khoi virus was recovered from bat bugs in Thailand. Vigilance is required regarding the bat /bat bug matrix and the theoretical potential for some kind of spillover of bat viruses to bat bugs and thence to other mammals. 

What do our volunteers do now?

Professional extermination services are probably hard to find in Bududa. If insecticide spray is not available, cracks, crevices etc should be inspected and manually cleaned. The bedding should be completely inspected and if possible encapsulated in bug-proof mattress covers. Placing the mattress in direct sunlight for several hours may have some effect, but sustained temperatures of 150 degrees F are required to kill the bugs. Bed furniture, springs etc must be inspected and cleaned. Once the bed and mattress is determined to be bug free, bed isolation can be performed. pitfall or sticky traps on each of the 4 legs of the bed, taking special care that no sheets or blankets are in contact with the floor. Pitfall traps can be filled with a borax solution or diatomaceous earth. This is not a permanent solution to the problem but may help at night. The WHO states that pyrethrin impregnated mosquito nets may kill bedbugs. They also note that DEET can mitigate biting but the deterrent effects will not last through the night without reapplication.

As early as 1730, simple, unadorned and easily cleaned bed furniture has been recommended to deny harborage to the pests. An elderly patient I once knew had an extensive infestation in her bedroom, especially involving her ornate headboard. When advised to dispose of this furniture, she offered the stricken reply: “not my French provincial!….”

Thanking TWiX-humans, superspreaders of science.

REFERENCES:

Etymology of Cimex lectularis:

Latin: cīmex , ĭcis, m. BUG      lectŭlus , i, m. COUCH, BED

Crenshaw, WS et al. Bat bugs, bed bugs and relatives. Fact Sheet 5.574, Insect Series/Home and Garden. Colorado State University Extension Service.  https://extension.colostate.edu/topic-areas/insects/bat-bugs-bed-bugs-and-relatives-5-574/excellent fact sheet about human and various bird and bat species. The most approachable reference I reviewed was this info sheet from the Colorado State University Extension Service. The illustrations are excellent and the summaries of the biology of the 5 species of Cimicidae in Colorado are reviewed. 

https://www.who.int/docstore/water_sanitation_health/vectcontrol/ch23.htm

They possibly play a role in transmission of hepatitis B virus….can live several years without food.  Repellents: Deet and other insect repellents are effective against bedbugs. They can be used by travellers who have to sleep in houses infested with the insects. However, repellents applied to the skin are unlikely to last the whole night. It is likely that burning mosquito coils offer some protection.

Doggett SL, et al. Bed bugs: clinical relevance and control options. Clin Microbiol Rev. 2012;25(1):164–192. doi:10.1128/CMR.05015-11 OPEN ACCESS.   A massive and comprehensive review. 

Usinger RL. 1966. Monograph of Cimicidae. Thomas Say Foundation, College Park, MD.Called by Doggett ‘the seminal work on bed bugs.’

Lai O, Ho D, Glick S, Jagdeo J. Bed bugs and possible transmission of human pathogens: a systematic review. Arch Dermatol Res. 2016;308(8):531–538. doi:10.1007/s00403-016-1661-8 OPEN ACCESS  Increase in infestations due to global travel and growth of pesticide resistance. “Upwards of 45 disease pathogens have been reported in bed bugs. Recent studies report that bed bugs may be competent vectors for pathogens, such as Bartonella quintana and Trypanosoma cruzi. However, public health reports have thus far failed to produce evidence that major infectious disease outbreaks have been associated with bed bugs.”****”To date, no published study has demonstrated a causal relationship between bed bugs and infectious disease transmission in humans.” …. Additionally, other members of the family Cimicidae are competent vectors for arboviruses for birds and, also, likely for wild bats . Authors reviewed ~1000 articles…table showing research that suggested some potential for transmission but no unequivocal evidence: Based upon published evidence that we reviewed, there are no reports of bed bugs acting as infectious disease vectors in humans for B. quintana, Burkholderia multivorans, T. cruzi, Rickettsia parkeri, hepatitis B virus, hepatitis C virus, methicillin-resistantStaphylococcus aureus, vancomycin-resistant Enterococcus, Penicillium chrysogenum, Stenotrophomonas maltophilia, Enterobacter hormaechei, Bacillus licheniformis, and Staphylococcus saprophyticus. Although bed bugs may act as phoretic vectors (solely for transport) for these pathogens, there were no confirmed cases of human disease transmission.

Delaunay P, et al. Bedbugs and infectious diseases. Clin Infect Dis. 2011 Jan 15; 52(2):200-10.

Omudu EA, Kuse CN. Bedbug infestation and its control practices in Gbajimba: a rural settlement in Benue state, Nigeria., J Vector Borne Dis. 2010;47(4):222–227  Survey of 119 apartments and dwellings. Only 16% of apartments investigated showed no signs of bedbugs.

Jean-Michel Berenger, Philippe Parola,Arthropod Vectors of Medical Importance in Infectious Diseases (Fourth Edition), 2017

For now, bed bugs are not considered as vectors for infectious agents relevant for humans, but care may be taken because recent studies tend to indicate a role in the transmission of bacteria (Bartonella, Rickettsia) to humans and wild Cimicidae (Stricticimex parvus and Cimex insuetus), associated with bats in Asian caves, may be vectors of Kaeng Koi virus to humans.–>33 ref: 

Williams JE, et al. Kaeng Khoi virus from naturally infected bedbugs (cimicidae) and immature free-tailed bats. Bull World Health Organ. 1976;53(4):365-9. Kaeng Khoi virus was recovered from bedbugs (Stricticimex parvus and Cimex insuetus) and from suckling wrinkle-lipped bats (Tadarida plicata) collected in central Thailand. The data implicate bedbugs as possible vectors of this virus. Research from the pre-molecular biology era involving extraction process from insect, injection into suckling mouse brain, extraction and addition to cell culture and identification by rabbit serum neutralization.

Maurice Crowther Hall, The Bedbug: Its Relation to Public Health, Its Habits and Life History, and Methods of Control, 1937, Public Health Reports (1896-1970), Vol. 35, No. 50 (Dec. 10, 1920), pp. 2964-2970   According Hall (1937) the common house centipede Scutigera forceps is known to attack bedbugs. Here’s a reason not to kill centipedes…Hall goes on to comment, “control effected by these means is unsatisfactory”. Hall’s recommended extermination method is hydrocyanic acid gas. He also cites the effectiveness of the 18th century method of burning sulfur (he mentions that metal will be tarnished and must be coated with vaseline….)

THE BED-BUG AND THE ‘AGE OF ELEGANCE’, L. O. J. Boynton, Furniture History, Vol. 1 (1965), pp. 15-31 The Furniture History Society There is much to be disgusted with in this history, with its detailed and unsparing descriptions of the appearance, composition and odors of 17th and 18th century bedding. Fascinating section on various methods of extermination, the most dramatic being his description of room fumigation employing 4 pounds of burning sulfur, “which gives off a prodigiously strong Funck, as such will kill all creatures in the universe.”

A TERMINAL CURIOSITY (and a few others)

Bruce Frederick Cummings (nom-de-plume Wilhelm Nero Pilate Barbellion) in 1919 wrote the very famous diary Journal of a Disappointed Man, which, among many other things, is one of the best known accounts of multiple sclerosis ever published. Of interest to us here is his 1917 publication (under the name B F Cummings) of The bed-bug: its habits and life-history and how to deal with it. (British Museum Natural History; Economic Series 5. Partially re-written and reprinted 1937 E E Austen. 

Any bed bug aficionado must consult A Treatise on Buggs by John Southall 1730. Free on google books and archive.org. Illustration from his Treatise:

from John Southall’s Treatise of Buggs 1730. Note the big size of the American ‘full grown’

Annals of the “Hair of the dog that bit ya”

….Doggett’s review discusses the use of bed-bugs in traditional medicine:

“An example is the treatment of ringworm in India with Cimex crushed in the herb holy basil. Other Indian bed-bug containing remedies were used for the treatment of epilepsy, ‘piles,’ alopecia, urinary disorders, and snake bites. Greek army surgeons around 50 AD claimed that bed bugs could neutralize snake venom.”

Illustration of a common pitfall type bedbug trap. Exterminators note that these contrivances are probably best used for detection of a bed bug problem rather than as a viable solution. 

Ryan writes:

I have read news articles that Hydroxychloroquine was originally used for Malaria and Lupus prior to COVID-19/ SARS-II-CoV testing. 

When antimalaria drugs become not effective what will be the alternative treatments going to be? When Lupus treatments are not effective or is no longer accessed with Hydroxychloroquine what will the be the alternatives going to be and where do I look. 

Also is there a phage that can attack only plasmodium as a way to bypass antimalarial resistance. 

Christine writes:

Good day professors, 

Strange days we are in right now. 

Over the last week Canada has been locking down to try and prevent the spread of the virus. I don’t disagree with it at all but as a small business owner and no government assistance yet, we are scared and worried. Our sales have dropped by 80% and we’re only 6 months old so this has the potential to be devastating and we don’t know what to expect for our future. Experiencing something like this is almost surreal.

I have a quick question and I hope I get this in before your next episode. My boyfriend read an article, I don’t have the link as he didn’t send it to me, but it was saying that the virus death rate is probably closer to 1% because a lot of people have caught the virus but because they’re healthy they just think it’s a flu and aren’t being counted in the virus totals but if they were it would drop that death rate percentage. 

We’re just curious about your thoughts on that. 

I also would like to thank you and everyone who has come on the show to provide us listeners with fact based information. I wish the whole world was listening to you and not the media. I believe it would be a much calmer and informed situation if they did. Instead we have people panic shopping, killing bats in national parks and avoiding the asian community because you know, being asian or a bat must mean they automatically have the virus? I feel like we are devolving as a species..🤦‍♀️

I also attached a little cartoon I came across and thought it was kind of cute. Hope you enjoy it. 

Wishing you and everyone listening the best! And don’t forget to WASH YOUR HANDS! 

Christine