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Thomas C, Castillo Valladares H, Berger TG, Chang AY. Scabies, Bedbug, and Body Lice Infestations: A Review. JAMA 2024:2823413. [PMID: 39250129 DOI: 10.1001/jama.2024.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Importance Scabies, bedbug, and body lice infestations are caused by organisms that live on or in the skin, on clothing, or in the environment and commonly cause pruritus and rash. In 2021, approximately 622 million incident cases of scabies occurred globally. Data on bedbug infestations are limited. Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness worldwide. Observations Scabies is caused by mites (Sarcoptes scabiei) that burrow into the epidermis. Transmission primarily occurs from prolonged skin-to-skin contact with an individual who has an infestation. Common scabies is characterized by excoriated pruritic papules, plaques, and pathognomonic burrows on finger/toe web spaces, volar wrists, ankles, axillae, buttocks, male genitalia, and areolae. Permethrin cream and oral ivermectin are first-line treatments for adults, with similar clearance rates by week 2 (74% with permethrin vs 68% with ivermectin; relative risk, 0.91; 95% CI, 0.76-1.08). Treatment failure can occur with oral ivermectin (11.8%; 95% CI, 8.4%-15.4%) and topical permethrin (10.8%; 95% CI, 7.5%-14.5%). Bedbugs (Cimex lectularius, Cimex hemipterus) are insects that live on mattresses and furniture and feed on blood nocturnally, causing linear pruritic erythematous papules. New skin lesions on waking, cohabitants with similar symptoms, and recently residing in a high-occupancy setting should raise suspicion. Treatment requires eradication with pest management. Body lice (Pediculus humanus humanus) are insects found on clothing that travel to the skin for blood meals. Body lice bites cause pruritic excoriated macules/papules and hyperpigmentation in areas where clothing seams contact skin. Treatment and prevention require at least once-weekly bathing and laundering of clothing and bedding. Conclusions and Relevance Scabies, bedbug, and body lice infestations are common. Accurate diagnosis requires taking a history, including social drivers of health (eg, housing status, living environment), and physical examination. First-line treatments include scabicides for patients with common scabies and their close contacts. Scabies, bedbug, and body lice infestations should be treated with decontamination measures.
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Affiliation(s)
- Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Herbert Castillo Valladares
- Department of Dermatology, University of California, San Francisco, School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, School of Medicine, San Francisco
| | - Aileen Y Chang
- Department of Dermatology, University of California, San Francisco, School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024; 139:532-548. [PMID: 38379269 PMCID: PMC11344984 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
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Affiliation(s)
- Caroline J. Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S. Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M. Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A. Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K. Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C. Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rich SN, Carpenter A, Dell B, Henderson R, Adams S, Bestul N, Grano C, Sprague B, Leopold J, Schiffman EK, Lomeli A, Zadeh H, Alarcón J, Halai UA, Nam YS, Seifu L, Slavinski S, Crum D, Mosites E, Salzer JS, Hinckley AF, McCormick DW, Marx GE. Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States. Zoonoses Public Health 2024; 71:642-652. [PMID: 38514461 DOI: 10.1111/zph.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. METHODS AND RESULTS Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. CONCLUSIONS Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.
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Affiliation(s)
- Shannan N Rich
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Ann Carpenter
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bree Dell
- Communicable Disease Epidemiology & Immunization Section, Public Health - Seattle & King County, Seattle, Washington State, USA
| | - Rachel Henderson
- University of Colorado Anschutz Medical Campus at Colorado State University, Fort Collins, Colorado, USA
| | - Sydney Adams
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - Nicolette Bestul
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher Grano
- Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Briana Sprague
- Communicable Disease Branch, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Josh Leopold
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Elizabeth K Schiffman
- Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Andrea Lomeli
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA
| | - Hassan Zadeh
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, USA
| | - Jemma Alarcón
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Umme-Aiman Halai
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Yoon-Sung Nam
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Leah Seifu
- Epidemic Intelligence Service, Epidemiology and Laboratory Workforce Branch, Division of Workforce Development, National Center for State, Tribal, Local, and Territorial (STLT) Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Sally Slavinski
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - David Crum
- Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Emily Mosites
- Office of the Director, Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Johanna S Salzer
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison F Hinckley
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - David W McCormick
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace E Marx
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Lutz L, Klinger MF, Holz F, Verhoff MA, Amendt J. How to prove neglect in the context of the post-mortem examination. Forensic Sci Med Pathol 2024; 20:603-613. [PMID: 37578627 PMCID: PMC11296964 DOI: 10.1007/s12024-023-00695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
Understanding the causes, extent, and period of neglect is not only a medical but also a forensic task when it comes to legal investigations. In this study, we evaluated 46 autopsied cases where there was clear evidence of physical neglect during the last period of the deceased's life. The age of the deceased ranged from 21 to 96 years; most of them were female (71.7%). The majority of cases (89.9%) took place in a domestic environment, with partners or relatives providing care. The most frequent post-mortem findings were pressure sores, followed by inflammatory skin changes, and signs of malnutrition and dehydration. Neglect was the cause or co-cause of death in 23% of the cases. More than half of the deceased showed severe contamination of the skin surface by excrement, and in almost 40% of the cases, fly infestation was found. The majority of insects belonged to the group of house flies (Diptera: Muscidae), mainly the common house fly, Musca domestica. By analyzing the entomological evidence, it was possible to prove an insect infestation period of at least several days ante-mortem. Since the period of neglect may be relevant in terms of legal proceedings, the present work demonstrates the particular importance of insect traces in providing this evidence. While prosecution and conviction of caregivers remain challenging, it is all the more essential that entomology and legal medicine collaborate on the analysis of findings of neglect.
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Affiliation(s)
- L Lutz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, D-60596, Frankfurt Am Main, Germany.
| | - M F Klinger
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, D-60596, Frankfurt Am Main, Germany
| | - F Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, D-60596, Frankfurt Am Main, Germany
| | - M A Verhoff
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, D-60596, Frankfurt Am Main, Germany
| | - J Amendt
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, D-60596, Frankfurt Am Main, Germany
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Avelar Portillo LJ, Kayser GL, Ko C, Vasquez A, Gonzalez J, Avelar DJ, Alvarenga N, Franklin M, Chiang YY. Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California. Int J Equity Health 2023; 22:108. [PMID: 37264411 PMCID: PMC10233557 DOI: 10.1186/s12939-023-01920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. METHODS We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services. RESULTS Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07). CONCLUSION Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.
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Affiliation(s)
- Lourdes Johanna Avelar Portillo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California San Francisco, 2789 25th Street, San Francisco, CA, 94110, USA.
| | - Georgia L Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charlene Ko
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Angelica Vasquez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Jimena Gonzalez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Diego Jose Avelar
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Nayib Alvarenga
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Meredith Franklin
- Department of Statistical Sciences, University of Toronto, 700 University Ave., Toronto, ON, Canada
| | - Yao-Yi Chiang
- Department of Computer Science and Engineering, University of Minnesota, 200 Union St. SE, Minneapolis, MN, 55455, USA
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6
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Gerbig GR, Piontkivska H, Smith TC, White R, Mukherjee J, Benson H, Rosenbaum M, Leibler JH. Genetic characterization of Staphylococcus aureus isolated from Norway rats in Boston, Massachusetts. Vet Med Sci 2023; 9:272-281. [PMID: 36524786 PMCID: PMC9856981 DOI: 10.1002/vms3.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite the importance of domesticated animals in the generation and transmission of antibiotic-resistant Staphylococcus aureus, the role of wild animals, specifically rodents, in the ecology of S. aureus remains unclear. We recovered and genotyped S. aureus isolates from wild Norway rats (Rattus norvegicus) in Boston, Massachusetts to examine genetic relationships between common human and animal S. aureus isolates in a large US metropolitan area. METHODS We collected and necropsied 63 rats from June 2016 to June 2017. Nasal, foot pad, fur, and fecal swabs were collected. Staphylococcus aureus was isolated using culture-based methods and polymerase chain reaction confirmation. S. aureus isolates were spa typed, tested for antibiotic susceptibility, and whole genome sequenced. Assembled sequences were uploaded to the Comprehensive Antibiotic Resistance Database to identify antibiotic resistance elements. A phylogenetic tree was constructed using the neighbor-joining method with the maximum composite likelihood distance in MEGA7. RESULTS We recovered 164 Gram-positive bacterial isolates from Norway rats. Nineteen isolates from eight individual rats were confirmed as S. aureus (prevalence: 12.9% (8/63)). All S. aureus isolates were methicillin-susceptible S. aureus (MSSA), pvl-negative, and resistant to penicillin. Two isolates displayed resistance to erythromycin. Four different S. aureus spa types were detected (t933, t10751, t18202, and t189). Thirteen unique antibiotic resistance elements were identified, and all isolates shared genes mepR, mgrA, arlR, and S. aureus norA. Phylogenetic analysis if the 19 S. aureus isolates revealed they were genetically similar to four clades of S. aureus with similar resistance gene profiles isolated from both human- and animal-derived S. aureus, as well as formed a distinct phylogenetic cluster composed only of rat isolates. CONCLUSIONS Wild rodents may serve as a reservoir or vector of antibiotic resistance genes in the urban environment with relevance for human and animal health.
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Affiliation(s)
| | | | - Tara C. Smith
- College of Public HealthKent State UniversityKentOhioUSA
| | - Ruairi White
- Department of Infectious Disease and Global Health, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachussetsUSA
| | - Jean Mukherjee
- Department of Infectious Disease and Global Health, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachussetsUSA
| | - Hayley Benson
- Department of Infectious Disease and Global Health, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachussetsUSA
| | - Marieke Rosenbaum
- Department of Infectious Disease and Global Health, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachussetsUSA
| | - Jessica H. Leibler
- Department of Environmental HealthBoston University School of Public HealthBostonMassachusettsUSA
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7
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Combs MA, Kache PA, VanAcker MC, Gregory N, Plimpton LD, Tufts DM, Fernandez MP, Diuk-Wasser MA. Socio-ecological drivers of multiple zoonotic hazards in highly urbanized cities. GLOBAL CHANGE BIOLOGY 2022; 28:1705-1724. [PMID: 34889003 DOI: 10.1111/gcb.16033] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 12/04/2021] [Indexed: 06/13/2023]
Abstract
The ongoing COVID-19 pandemic is a stark reminder of the devastating consequences of pathogen spillover from wildlife to human hosts, particularly in densely populated urban centers. Prevention of future zoonotic disease is contingent on informed surveillance for known and novel threats across diverse human-wildlife interfaces. Cities are a key venue for potential spillover events because of the presence of zoonotic pathogens transmitted by hosts and vectors living in close proximity to dense human settlements. Effectively identifying and managing zoonotic hazards requires understanding the socio-ecological processes driving hazard distribution and pathogen prevalence in dynamic and heterogeneous urban landscapes. Despite increasing awareness of the human health impacts of zoonotic hazards, the integration of an eco-epidemiological perspective into public health management plans remains limited. Here we discuss how landscape patterns, abiotic conditions, and biotic interactions influence zoonotic hazards across highly urbanized cities (HUCs) in temperate climates to promote their efficient and effective management by a multi-sectoral coalition of public health stakeholders. We describe how to interpret both direct and indirect ecological processes, incorporate spatial scale, and evaluate networks of connectivity specific to different zoonotic hazards to promote biologically-informed and targeted decision-making. Using New York City, USA as a case study, we identify major zoonotic threats, apply knowledge of relevant ecological factors, and highlight opportunities and challenges for research and intervention. We aim to broaden the toolbox of urban public health stakeholders by providing ecologically-informed, practical guidance for the evaluation and management of zoonotic hazards.
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Affiliation(s)
- Matthew A Combs
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
| | - Pallavi A Kache
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
| | - Meredith C VanAcker
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
| | - Nichar Gregory
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
| | - Laura D Plimpton
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
| | - Danielle M Tufts
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
- Infectious Diseases and Microbiology Department, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria P Fernandez
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
| | - Maria A Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, New York, USA
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8
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Streptobacillus moniliformis subdural empyema in a homeless patient. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Pietri JE. Case not Closed: Arguments for New Studies of the Interactions between Bed Bugs and Human Pathogens. Am J Trop Med Hyg 2020; 103:619-624. [PMID: 32342854 DOI: 10.4269/ajtmh.20-0121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bed bugs (Cimex spp.) are common ectoparasites of humans. Their ubiquity across diverse human environments combined with their blood-feeding behavior creates an ideal interface for the transmission of pathogenic microbes. Despite this potential, the current dogma is that bed bugs are not vectors of any known infectious agents. However, this conclusion is based largely on the results of studies conducted before the advent of modern molecular biology and the resurgence of bed bugs on a global scale. More importantly, a small but compelling body of modern research suggesting that bed bugs can potentially vector some human pathogens exists but is often overlooked. This article critically examines the current classification of the bed bug as an insect that does not transmit disease agents. In doing so, it highlights key knowledge gaps that still exist in understanding the potential of bed bugs as pathogen vectors and outlines several arguments for why new research on the topic is necessary.
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Affiliation(s)
- Jose E Pietri
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
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10
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Pietri JE, Yax JA, Agany DD, Gnimpieba EZ, Sheele JM. Body lice and bed bug co-infestation in an emergency department patient, Ohio, USA. IDCases 2020; 19:e00696. [PMID: 31988849 PMCID: PMC6970161 DOI: 10.1016/j.idcr.2020.e00696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/17/2022] Open
Abstract
Body lice and bed bugs are hematophagous insects that parasitize humans. Body lice are established vectors of several bacterial pathogens (e.g. Bartonella quintana, Borrelia recurrentis). Bed bugs are biologically competent vectors of some of the same agents, but their vectorial capacity for these in nature is unclear. In particular, a lack of exposure to louse-borne pathogens in bed bugs in the field could be a factor that limits their contribution to transmission. Here, we describe a case of a patient seen in an urban emergency department who was suffering from infestation with both body lice and bed bugs. Insects were collected from the patient and tested for the presence of louse-borne bacterial pathogens using 16S rRNA gene amplicon sequencing. Although no Bartonella, Borrelia, or Rickettsia were detected, this case provides evidence of ecological overlap between body lice and bed bugs and highlights several potential risk factors for co-infestation. The ecological relationships between bed bugs, body lice, and louse-borne bacteria should be further investigated in the field to determine the frequency of co-infestations and identify possible instances of pathogen infection in bed bugs.
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Affiliation(s)
- Jose E. Pietri
- University of South Dakota, Sanford School of Medicine, Division of Basic Biomedical Sciences, Vermillion, SD, United States
| | - Justin A. Yax
- University Hospitals Cleveland Medical Center, Division of Population Health, Department of Emergency Medicine, Cleveland, OH, United States
| | - Diing D.M. Agany
- University of South Dakota, Biomedical Engineering Program, Sioux Falls, SD, United States
| | - Etienne Z. Gnimpieba
- University of South Dakota, Biomedical Engineering Program, Sioux Falls, SD, United States
| | - Johnathan M. Sheele
- Mayo Clinic, Department of Emergency Medicine, Jacksonville, FL, United States
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