A 53–year–old female presented with complaints of watery bowel movements every 30 minutes for several days. Although previously plagued with chronic diarrhea, it had resolved 1 month prior with cessation of alcohol abuse. At presentation she was afebrile, tachycardic, and found to have severe volume and electrolyte deficiencies for which she was admitted. The patient had a history of hypertension, and multifactorial fatty liver disease due to Hepatitis C, alcohol abuse and protein malnutrition. Her social history was positive for alcoholism, tobaccoism and occasional marijuana. She denied injection drug use and lives alone in an urban apartment building. Despite volume resuscitation, electrolyte repletion and improvement in her symptoms of what was determined to be C. Difficile colitis, the patient remained tachycardic and became febrile on hospital day three. Her dominant clinical sign was a diffuse pruritic rash which she related to a bed bug infestation of her apartment. Examination revealed widespread excoriated and ulcerated papules. Some lesions were in the “breakfast, lunch and dinner” distribution. A dermatologist confirmed the lesions were consistent with bed bug bites. Erythema underlying these lesions indicated an extensive skin and soft tissue infection (SSTI). There was no evidence of track marks or inflammation at her previous peripheral IV sites. Chest x–ray demonstrated no infiltrate. Three blood cultures, drawn over 24 hours, were positive for methicillin sensitive Staphylococcus aureus (MSSA). IV Vancomycin, initially empiric, was continued due to documented anaphylaxis with cephalexin. The patient was desensitized to nafcillin when the TTE suggested a posterior tricuspid leaflet density. A subsequent TEE clarified this as the tip of the central venous catheter which had been placed at the time of her first positive blood culture. Her hospital course was further complicated by nafcillin induced interstitial nephritis after which vancomycin was resumed. The patient was discharged to a skilled nursing facility to complete a 4 week course of IV vancomycin.
To date, reported clinical sequelae of Cimex lectularis (a.k.a. “bed bug”) infestations are limited to dermatologic manifestations, local and systemic allergic reactions, and late onset allergic reactions including serum sickness. While hematophagous and having demonstrated the ability to acquire and maintain infectious agents after a blood meal, there is still not enough evidence to suggest that bed bugs act as vectors of disease. We report the first known case of C. lectularis providing a portal of entry for prolonged MSSA blood stream infection via an SSTI. This patient’s prolonged hospital stay involved invasive procedures, was complicated by AKI, and culminated in an extended nursing facility admission.
Hospitalists should be aware that C. lectularis can impart significant morbidity by offering a portal of entry for systemic infection.