IDmyBUG®

What's Biting Me?

Fri, 22 Feb 2013 12:38:00 -0500

Every person will undoubtedly suffer the bite of an arthropod (insect, spider, tick or similar creature) at some point. Some people are bitten far more often because of where they live, the season of the year or as a function of the activities in which they engage. Just because one ‘feels’ an itch or sees a small injury on the skin, however, does not necessarily mean that these sensations or marks resulted from the bite of an insect or other pest. How can you tell what is a bite and what is not? And if it is a bite, how can you stop it from happening again? The discussion that follows offers some insight on the myriad of possible causes along with some guidance on how to solve the mystery of “the bite”.

What is a bite, and how does a bite differ from a sting or other insult to your body?

Bites: A creature uses its mouthparts to bite. Many kinds of arthropods (insects, ticks, mites, centipedes and similar creatures) will bite to obtain nourishment or as a means of self-defense. The mouthparts of these creatures can be quite varied in form. Mosquitoes, lice, bed bugs and fleas have delicate thin stylets that they use to deftly probe for a skin capillary in search of blood. The wound quickly self-seals when the insect withdraws its proboscis. In contrast, black flies and deer flies have blade-like mouthparts that slice and dice the skin to cause blood and tissue fluid to pool at the wound. The physical damage that results is in stark contrast to that of the mosquito.

Other ‘biting’ pests such as ticks have harpoon-like mouthparts that serve to penetrate and anchor them in place for the minutes or days required for them to obtain a blood meal. These, and other kinds of creatures, feed upon animals to obtain nutriment to survive and/or to nourish their eggs.

Each of these blood-feeding creatures contaminates the wound with its own saliva while it probes for its meal. The saliva lubricates the mouthparts, diminishes clotting of the blood at the wound in mouthparts, and often deadens the sensation so you won’t feel the creature while it bites. That same saliva can also slow the healing of the wound and cause a person to develop an allergic sensitivity that may result in swelling or itchiness. It can also introduce microbes that may cause disease.

Other creatures bite to capture their prey, in self-defense or simply out of confusion. Spiders and centipedes and several kinds of insects are predators and bite other animals so they may capture, disable and feed upon them. The bite may be accompanied by a tiny - but potent - volume of venom injected into the wound. No spider or centipede would prey upon a person, but they might bite in self-defense if they’re intentionally or accidentally bothered. With few exceptions, the bite of a spider or centipede would be immediately apparent as a localized sharp and painful prick. Yet other creatures that normally feed upon plants might bite in defense or they may bite merely because they’re confused.

Should you observe a creature in the act of biting or fleeing from what felt like a bite, we encourage you to capture and submit the specimen for evaluation and identification via the IdentifyUS website. All you need to do is to capture the potential villain with your fingers, a piece of tape, or sweep it into a plastic bag or unbreakable jar or container and send it to us. If you can take pictures of it, you can upload those digital images right away via our Specimen Evaluation Form to receive a fast and confidential reply as the identity of your specimen. Even if you swat it and cause significant damage, we will still most likely be able to offer insight as to the creature’s identity based on recognizable features if you send the physical sample to us or can offer up high-resolution, close-up pictures in digital format. The information gained via a positive identification can be very useful to you, and can be used to better inform your health care professional and/or pest control personnel.

Stings: Whereas bites result from the mouthparts of insects and other creatures, stings are delivered via a specialized structure at the hind end of the creature’s body. Creatures may sting to capture and disable their prey or as a means of self-defense. Often, a small volume of venom is injected to the wound, and this may add much insult to injury. A person may develop an allergic sensitivity to the venoms of honeybees or certain kinds of wasps, and this allergy can, at times, be life threatening.

Irritating parts of arthropods: A person may experience irritation from direct contact with certain kinds of creatures or with parts they may shed. Some creatures are endowed with specialized setae or hairs that can be irritating upon contact. Some of these may cause discomfort because of mechanical insults (much like a tiny pin), particularly if they stick in the skin or worse, on the surface of the eye. Other kinds of specialized hairs are hollow and contain chemical agents that act much like a kind of venom. Often, these hairs have broken off the creature and are free in the environment. They may adhere to bedding or clothing and cause irritation whenever they contact skin. Similarly, air currents may carry such hairs and deposit them on surfaces where they may be felt, but not easily seen. A few kinds of creatures exude a caustic substance from their body when they are crushed on the skin. Such contact can result in chemical burns. Any and all of these irritations may be mistaken for bites.

Lesions resulting from bites: An arthropod in the act of biting may be detected and observed immediately if the bite is painful. Other bites might not be noticed at all, or the effects may not be evident until some minutes, hours or days later. The resulting lesion may be so tiny and insignificant as to escape notice, or it may develop into something far more obvious. The incident may result in direct physical damage to the skin and/or cause a reaction from the saliva introduced to the wound. In some cases, the bite site may become itchy, swollen, reddened and otherwise quite noticeable and irritated. The site may also become infected if scratched with dirty fingernails or if the insect or tick transmitted a microbe that could cause disease.

But, what caused the bite? That question is usually easy to answer if you’ve captured the creature or good digital images of the villain. In that case, we can offer you a rapid, independent, confidential and expert answer. In the absence of the creature, it becomes far more difficult to incriminate the right culprit. You – or your physician – might be tempted to assume that the lesion resulted from the bite of a spider, mosquito, bed bug or other creature, but you’d most likely be wrong.

Lesions that result from bites are incredibly varied in their appearance, and differ dramatically from person to person. Hence, you may notice the bite on yourself, but a bite from the same creature might cause a more (or less) profound reaction on another person. To add to the complexity, a person’s reaction to the bite of an insect or tick depends upon his or her prior encounters with the same (or similar) kinds of creatures. This is most evident as a person ages. For instance, a child in the first year or so of life generally doesn’t react much to the bites of most mosquitoes. But, with repeated exposures during the next few seasons, the child may manifest with a vigorous allergic response. The bite lesions may become markedly inflamed, hard, red, painful and profoundly itchy. As one further ages and suffers additional bites, the reaction generally becomes far less intense and may even become nearly unnoticeable.

The take home message here is that it is rarely possible to identify the cause of an insect or tick bite merely by examining the appearance of the lesion.

For any location around the globe, there are many possible arthropod villains that may bite. The activities of many such pests are restricted to certain seasons. For others, however, the tempered environment within our homes and workplaces creates suitable habitat for several kinds of pests throughout the year.

Even if the creature is not directly observed, there are ways to narrow the field of likely candidates. For instance, it can be helpful to consider whether the presumed bites are restricted to specific areas or are more widespread on a person’s body. Some creatures, such as fleas and certain kinds of mosquitoes, tend to bite most often on exposed areas of the lower legs. Yet others, such as lice, are fairly restricted to the sites they bite. It is also useful to know the geography (where a person lives or has recently traveled), and the season of contact as well as whether that contact occurred during the day or night. Because many biting pests are associated with non-human animals, it is of value to know what kinds of animals or pets the bitten person owns or has encountered. As contact with biting pests and irritating insect parts may occur in the course of a person’s activities at home and away, it is useful to know the person’s occupation and hobbies, and the characteristics of the home environment.

Because there are many possible causes for bite-like sensations and skin lesions, it is always best to objectively confirm the identity of a genuine pest or parasite before treating oneself or the home. IdentifyUS is able to help by evaluating the creatures (and digital images) you capture. As with any medical concern, always consult with your health care professional. A dermatologist is the most appropriate expert to evaluate conditions that affect the skin.

How to find a villain if it is not immediately obvious: Often, one may be bitten or otherwise contact an irritant but not experience a reaction until sometime thereafter – long after the villain has left or gone into hiding. Sometimes, the attackers are just too small for most folks to notice. If bites or bite-like encounters continue, we suggest obtaining and deploying an array of non-baited insect glue traps. These can be placed under beds and sofas, behind furniture and in other rooms where the problem seems to occur. Allow these traps to sample passively for one week or more and then prepare them to be shipped to IdentifyUS in order for us to evaluate anything captured in them. To protect any captured creature and prevent the glue from contacting other items, cover each glue surface with a single sheet of clear plastic food wrap, and fold the excess around the back. Then, stack up the traps, insert them into a padded envelope or box and send them to IdentifyUS. We’ll examine these and – with few exceptions – report our findings back to you the same day the samples arrive at our lab. We encourage you to share our findings with your health care professional and to have them contact us if they have further questions.

What if it is not a bite? Some people earnestly believe that they are actively infested, even though no louse, bed bug, mite or other parasite can be detected or captured. These cases can be particularly difficult to investigate and to manage. The affected individual should not be dismissed as being mentally unstable. Every reasonable effort should be explored to identify the true cause of the sensations / irritation, bite-like reactions / lesions, and to capture and identify any offending creature on the scalp or body. The irritant may, indeed, be some type of biting insect or mite, but it may not necessarily be infesting the person at the time of examination. Diverse insects (e.g. mosquitoes, fleas, bed bugs) may visit a person transiently, and may not be noticed in the act of biting. Certain blood-feeding mites associated with birds and rodents may be present in a home and cause annoyance when they feed upon a person. Itching and irritation in some cases may also be ascribed to hair care and laundry products, industrial fibers, underlying disease, or even to pesticide treatments and yet other kinds of products and drugs. The clinician will often find it valuable to consult with an entomologist on these matters. To learn more about our identification services, visit the section of our website on Specimen Evaluation.

A few people remain convinced that their infestation is real, even though they have been examined by one or more competent specialists who can find no physical cause for their discomfort. The condition is variously referred to as delusional-, delusory- or illusory-parasitosis, ‘Morgellons syndrome’ and Ekbom Syndrome. Based upon a recent thorough clinical review of 115 sufferers of “Morgellons syndrome”, none of these patients had a demonstrable parasite. Instead offending materials collected from the skin were composed mainly of cotton fibers, most likely from clothing or linens that had become adherent to existing lesions. Interesting, more than half of the patients manifested with a cognitive impairment, and a psychoactive drug was detected in hair samples of half of the patients.

A few patients may pose a danger to themselves and others by resorting to the misuse of toxic or flammable substances in attempts to rid themselves or their homes of their real or perceived infestation. Such a person may, indeed, be delusional, but should be treated with care and respect when referred for counseling. Certain people develop an extreme phobia or irrational fear that they will acquire lice or other parasites from virtually any animate or inanimate object. Patients who are unduly burdened by this condition are likely to benefit from counseling with a clinician specializing in phobias and obsessive-compulsive disorders. Readers are advised to exercise great care and healthy skepticism when reading blogs and other Internet resources about such matters.

Lousy deceptions and fraudulent pursuits?

Sat, 29 Dec 2012 10:12:00 -0500

A prominent and controversial head louse advocacy group, the National Pediculosis Association (NPA), has been accused of potentially engaging in scientific fraud. Matan Shelomi, the author of a newly published paper has concluded that an image that was included in an NPA-sponsored and co-authored published report was apparently ‘Photoshopped’; that is, digitally doctored in a manner that may have been intended to deceive. Such a finding should have far reaching implications, particularly as the image was central to the authors’ conclusions.   

Authors of the controversial article (Altschuler, D. Z., M. et al. 2004. Collembolla (Springtails) (Arthropoda: Hexapoda: Entognatha) found in scrapings from individuals diagnosed with Delusory Parasitosis. J New York Entomological Society 112: 87-95) reported that they discovered springtails (tiny primitive insects) infesting the skin of patients who otherwise might be categorized as suffering from delusional parasitosis. As evidence for that claim, they presented photomicrographs, certain of which they admitted were ‘enhanced’ to better depict the presumed insect. That report has subsequently served as a basis to substantiate a claimed biological cause for the suffering of many patients, and it continues to widely influence patients and clinicians. That same report, however, has also been frequently cited as being fatally flawed and deserving of retraction.   

In his exposé, Shelomi analyzed the controversial images and concluded that the outlines of a presumed springtail in the seminal article did not result from acceptable photo enhancement tools that would merely serve to enhance contrast. Instead, he suggested that the authors had intentionally manipulated images in a manner that might be considered a form of scientific misconduct. Shelomi’s findings bolster the long-held suspicions of other experts within the scientific and medical community.   

These findings are yet one more example of the odd antics of the NPA. The NPA is probably best known for their fanatical promotion of scientifically unjustified ‘no-nit policies’ that require children to be rendered free of any sign of a extant - or relic of an extinct - head louse infestation. Such ‘standards’, however, seem firmly based upon what is widely held as pseudoscience. Despite being presented as if they are sound public health pursuits, these no-nit policies are unjustified and counterproductive. Head lice infestations in children are regularly misdiagnosed, and, furthermore, excluding children with genuine or presumed head louse infestations has never been demonstrated to measurably reduce incidence. Such exclusions merely result in denying children educational opportunities. Parents of young children who are sent home can suffer from reduced earnings because of lost work time, and oddly enough, seem more likely to over-apply the very pesticides that the NPA proclaims are unnecessary, dangerous and unjustified.

To highlight the dangers of pesticides, the NPA hosts ‘Jesse’s Story’. Anyone with a shred of compassion will certainly shed a tear over this tragedy. Those who read the story with a more critical eye, however, will recognize the flawed logic presented. It was said that Jesse had been exposed to certain insecticides and then later suffered from leukemia. The outcome was tragic, but the association with the pesticide is likely mere coincidence. Despite the absence of a causal relationship that would incriminate the pesticide, the NPA’s presentation suggests otherwise. It would not be surprising if this story convinced misinformed donors to contribute to the NPA’s fund raising campaigns.  

The NPA claims non-profit status, yet some have suggested that their advocacy efforts cross the line into fiscal impropriety. We will let readers draw their own conclusions on the matter, but this blog article might help others see the forest for the trees.   

Some years ago, the NPA roiled the waters by inappropriately and prematurely disclosing research findings. In this case the NPA had provided a minor fraction of research funds for a Harvard-based study of insecticide resistance amongst head lice. Although the research was far from complete, and before data from a critical comparison group had even been collected and analyzed, the NPA released to the public the preliminary findings – along with their own flawed conclusion. The NPA’s premature release of information delayed the ultimate publication of the peer-reviewed study and also served as an impediment to its acceptability by certain peer-reviewed journals. See: (Disclosure of Lice Data Causes a Stir. Wall Street Journal 1 Apr 1998).   

Despite all these errors and transgressions, the NPA continues to unduly influence health policies in schools across the U.S. and abroad. With the publication of this latest critique, perhaps medical regulators and school health administrators will now better admire the emperor’s new clothes.

Ready for Halloween?

Tue, 23 Oct 2012 21:40:00 -0400

Autumn’s finery of colors is upon us, and many areas have already experienced the season’s first frost upon the pumpkins. Cicadas have ceased their summer serenades, shark fins have retreated from the seashore and headlines, and the nascent sound of rustling leaves underfoot (and never ending political rhetoric) dampen the chorus of the remaining mosquitoes on the wing. The annual shedding of leaves seems to proclaim that we can all relax and put aside our concerns about diverse seasonal risks. Not necessarily so.

Cooler temperatures and localized frosts have dramatically reduced the abundance of many kinds of mosquitoes and lessened risk from EEE and West Nile virus. Consequently, municipalities are loosening their restrictions on outdoor events on town and school properties. But, it is premature to assume that all the mosquitoes have succumbed. Many that found refuge in protected sites survived the first frost and continue to spread their joy (and perhaps infection). Whereas it does make good sense to recommence use of ball fields, participants and spectators should remain mindful of mosquitoes. They’d be wise to cover up exposed skin and continue to apply mosquito repellents just in case it is a warm night. Such products won’t repel ghosts, witches or spirits, but they may indeed be the best potions to ward off real health burdens.

Halloween promises a cornucopia of ghosts, goblins, monsters and treats. For an hour or so many kids will be out exercising their feet (instead of their thumbs on smart phones) in pursuit of carbs and camaraderie. Tis also the season when real little vampires, in the form of adult deer ticks, stretch their 8 legs as they quest protein and lipids from red blood. Though they’d far prefer to feast upon Bambi, they’ll settle for nutriment from Rover or his/her two-legged owners. While extracting a miniscule volume of blood, a few of these ticks deliver their own trick – or treat – in the form of microbes that may cause Lyme disease, human babesiosis and anaplasmosis.

Superman’s and Batman’s capes and witches’ robes, so emblematic of the evening, serve also as excellent tick magnets to sweep questing ticks from vegetation. Those ticks then wander upon the costume and may find flesh – and a convenient meal. So, when the kids (and adults and pets) return inside, check them carefully for ticks while they’re checking their haul of candy. Should you find a tick, remove it promptly and save it for evaluation. Finding and promptly removing ticks (from a person or pet) can dramatically reduce risk of infection.

To learn more about ticks and other pests, visit the IdentifyUS website at identify.us.com

To receive a rapid, independent, confidential and expert evaluation of any tick (or other pest of concern), submit the physical sample (or upload a digital image) directly to our expert entomologist who will confirm the identity of your specimen and also provide further guidance on the potential for disease transmission from what you have found.

You can also directly engage in a private, two-way conversation with an IdentifyUS expert on ticks at help.identify.us.com

Head Lice | EOL: Learning and Education Group

Wed, 15 Aug 2012 09:07:46 -0400

Head Lice | EOL: Learning and Education Group:

Dr. Richard Pollack of IdentifyUS is highlighted in this podcast on the Encyclopedia of Life. EOL Podcasts are hosted by Ari Daniel Shapiro.

Proper tick removal technique - courtesy of Glen Needham and the...

Wed, 18 Jul 2012 13:38:00 -0400

Proper tick removal technique - courtesy of Glen Needham and the Wildlife Matters group at the Ohio Department of Natural Resources - Wildlife Division.

Dr. Richard Pollack of IdentifyUS speaking about mosquitoes and...

Wed, 04 Jul 2012 11:18:12 -0400

Dr. Richard Pollack of IdentifyUS speaking about mosquitoes and mosquito protection on New England Cable News morning show - July 3, 2012

When you hear hoofbeats, think horses, not zebras: Monkeypox or bed bug bites quarantine a plane.

Tue, 01 May 2012 14:27:00 -0400

In a previous post, we discussed the power of tiny creatures (alleged to be head lice) so mighty that they briefly shuttered Newark’s Penn Station. For this installment, we’ll discuss a small crisis presumably involving other pests and their impressive ability to ground an airliner.

In this case it was a Delta commuter jet (with passengers) that was quarantined on the tarmac at Chicago’s Midway airport for a few hours because of fears that a one passenger had a dreaded infectious disease. The passenger, a 50 year old Minnesota woman, was returning from Uganda. Apparently, a child she was visiting and trying to adopt there manifested with pus-filled red bumps on the skin. This prospective adoptive parent also complained of some skin lesions of her own.

During a layover in Detroit, she innocently triggered what turned into a reality TV version of the ‘telephone game’ we may recall from our own childhood. In a telephone call to her mother, the traveler described the skin lesions. Her mother then phoned a local hospital for advice. Hospital workers, in turn, contacted the CDC. When Delta commuter flight 3163 landed in Chicago, it was surrounded by phalanx of police cars, fire trucks and ambulances. Local health officials wearing protective garb and masks boarded to inspect and interview the traveler, and to capture digital images of her lesions. Initial suspicions focused on monkeypox (caused by a virus related to smallpox). Monkeypox is a real public health threat and can cause considerable morbidity and mortality.

Close-up of monkeypox lesions on the arm and leg of a female child.
(image courtesy of CDC Public Health Image Library, 1971)

The monkeypox presumption represents the ‘zebra’ conclusion in response to the sound of hoofbeats. Whereas exotic pathogens should, indeed, be considered (being the travel history involved), the more mundane ‘horse’ conclusion is a safer bet. The federal and local health experts quickly ruled out monkeypox as the cause, and the passengers were released, having been inconvenienced for just a few hours. That’s a fairly remarkable turnaround considering the circumstances involved. Many readers likely have experienced their own delays, some considerably longer, because of poor weather, maintenance issues or other events at the airport. So, kudos to CDC and the local health officials for their remarkable efforts to protect the public health. Perhaps, they applied this well-devised and useful algorithm in their assessment.

Ah, but if it wasn’t monkeypox, then what caused this traveler’s irritation? An outbreak of news reports mentioned that health authorities or others postulated that the lesions most likely resulted from bed bug bites. Yet other reports suggested scabies mites as the cause of the lesions. What were the bases for these alternative conclusions, and with what assurance could they be delivered?

Bed bugs (or the fear of encountering them) are the modern day plague of travelers. Populations of the more cosmopolitan bed bug (Cimex lectularius) have, indeed, resurged recently throughout North America and Europe, but they’ve always been somewhat frequent bed companions elsewhere around the globe. To add insult to injury, their closely related old world cousins, Cimex hemipterus, also list human beings as menu entree choices. Could this traveler have had strange encounters of the bed bug kind during her visit to Uganda? Absolutely, and she could have also encountered these at virtually every other stopover along her journey.

Had the lesions resulted from bed bug bites? Without a confirmed sighting of a bona fide bed bug, one is limited to speculating the cause based on the appearance of the lesions and activities of the injured party. Any conclusions as to the identity of the villain rest upon very shaky terrain. Some persons bitten by bed bugs may suffer no obvious signs of such encounters. Less fortunate folks may exhibit profound dermal lesions and systemic symptoms (unusual, but possible). More often, the bites might resemble those caused by mosquitoes, fleas, or a myriad of other creatures. With few exceptions, there’s really no good way to proclaim the cause of a bite without observing the culprit in the act or at least nearby.

If this traveler suspected she had been bitten by bed bugs or other pests while overseas (or elsewhere), she could have submitted digital images of them to IdentifyUS LLC for a rapid and expert evaluation. She’d have received a reply with our insight and guidance within the day, and likely in just hours. This information could have resolved the mystery, unburdened her from these concerns and averted the inconvenience to her and her fellow passengers. Even if bed bugs were the culprits, they’d not be traveling on her person. She would not pose risk (of bed bugs) to anyone else - but her checked and carry on baggage might if bugs were hiding within. Let’s hope that there were no stowaway bugs within her possessions. She likely would have benefited by reading our guidance on safe traveling.

With all this said, the bed bug conclusion is merely a presumption. Assuming that her injuries were caused by contact with an arthropod, the list of potential villains could also include: lice, fleas, mosquitoes and a myriad of other biting flies, a panoply of biting and/or infesting mites, stings from ants and their relatives, or contact with irritating hairs and exudates from a even larger array of insects. Then again, red pus-filled lesions might result from diverse infections or exposure to plant-derived irritants.

At the end of the day, this event caused a small amount of anxiety for the traveler and a few others. A little inconvenience and due diligence can make life far safer for everyone concerned. What we described here is not an isolated incident by any means. We’ve been consulted multiple times by officials of major airlines and transportation agencies because of a real or presumed insect stowaway within the cabin, the cargo hold, or even on or in a passenger. The distress caused to passengers, flight crews, maintenance workers and fiscal bean counters for the airlines (and other transportation providers) have been profound. For the passengers and flight crews, any such incidents could be markedly reduced by seeking insight from good travel medicine clinicians long before departing on travel to exotic locations, and by exploiting eHealth / mHealth resources such as those provided by IdentifyUS. We’re just a mouse click away from your computer or just ask Siri to ‘Search the web for IdentifyUS’.

Furthermore, we are prepared to offer helpful insight and valuable guidance to those in the transportation arena, whether they pertain to travel by airplanes, ships, trains or other vehicles. Our proactive and reactive strategies will help reduce risk and protect the physical as well as fiscal health of your companies, employees, passengers and clients.

We’ll describe yet other such incidents and missteps in forthcoming installments of this blog. Stay tuned.

Lice at the station: A train (of thought) on the wrong track.

Mon, 30 Apr 2012 12:25:00 -0400

What’s so mighty that it can hold up a massive jetliner, stop a speeding train or shutter buildings? No, not Superman in this case. Instead, we speak of things that should cause that superhero to scratch his head (and elsewhere) figuratively if not in reality. Our citizens are seemingly plagued by an insidious array of real and imagined beasties that cause officials to shoot first, and ask questions later. What tiny creatures have the power to encumber rational thought processes, and how do they exercise their control? Let us ponder a few recent events. In this installment, we’ll discuss a small crisis at a NJ train station.

A fifty-something gentleman caused a stir recently in the waiting room of Newark’s Penn Station. Apparently, this fellow (described as a transient) had decided that a bench there satisfied his preferred ‘sleep number’. According to news reports, this fellow was thought to host a thriving population of head lice. Transit officials concluded that he posed a threat to others. Was it because others might ‘catch’ his head lice, or were they upset because those little beasts were potential fare-evaders? In any case, he was removed from his perch for inspection at a local ER. The next day (why the delay?), the station was closed while maintenance workers in protective suits and carrying fumigation gear attended to the ‘crisis’. What was the actual threat, and was this response justified? The gentleman in question may, indeed, have served as host for a menagerie of beasts. He may have had head lice on his scalp hair, body lice and/or bed bugs on his vestments, and/or scabies mites in his skin. If any of these were the case, he could then refer to himself in the plural, as in the Royal ‘we’, that would include his own little traveling companions.

Of those denizens that might rely upon him for their very shelter and sustenance, head lice are by far the least concerning. Head lice are tiny insects that mainly cause a few children to scratch their scalps while parents and school officials panic and begin seek and destroy missions. Adults, too, sometimes are endowed with head lice. These diminutive insects pose a risk, though just a tiny one, to those those who might have direct scalp hair-to-scalp hair contact. That’s not a likely scenario in the case of this sessile fellow. Head lice may be eliminated by use of diverse pediculicides (anti-louse pharmaceuticals), by mechanical removal of the lice and their eggs from the scalp hair, or by removal of the scalp hair itself (an instant cure, but usually an overreaction). Any head louse shed to the environment will almost certainly perish within a few hours as a result of water loss and starvation. Hence, there’s no need to pursue costly environmental intervention. Closing the station and decontaminating the bench would, then, have been an unnecessary and unjustified reaction. But, was this fellow with head lice, or did he host other kinds of living baggage?

In contrast to head lice, body lice (denizens that inhabit the clothes but return to the skin to partake in a bloodmeal) and scabies mites (which inhabit the skin) do pose a bit more concern - but mainly to those who would have direct contact with the infested gentleman and his clothing. Body lice are most readily shared amongst those unfortunate souls who might call a refrigerator box ‘home’ and who have contact with other folks in similar situations. Body lice, themselves, can cause the host to feel ‘lousy’ (hence the name). Most troublesome, body lice (but not head lice) in North America occasionally transmit (via their feces) the bacterial agent of trench fever. Infection by the trench fever pathogen often goes undetected, but it can lead to significant medical illness. Elsewhere in the world, body lice (but not head lice) may also transmit far more serious infections. So, if this fellow was ‘with body lice’, what might have been the appropriate response? Generally, a person can be rendered free of body lice merely by changing his/her clothing. The contaminated clothing, then, should be discarded or disinfected and laundered. If the lice or their eggs are clinging to body hair, then the person will benefit from treatment with an appropriate pediculicide (louse-killing product), prescribed by a clinician. Was there a need to close the station? Certainly not. Although body lice may survive for several days off a person, they’ll soon succumb. The chances would be slim that others who later might sit on that same bench would acquire body lice or the agent of trench fever. The bench on which he slept need only deserve a thorough cleaning with an appropriate disinfectant solution. Nothing else is justified.

What if his skin contained the microscopic mites of scabies? As with body lice, scabies mites are a risk mainly to those who have direct (and usually prolonged) contact with an infested person or his/her clothing or bedding. They, too, would not survive long away from their host. Scabies treatment requires a prescription medication, and this should be expected to render a person free of that infestation within a day. The gentleman’s clothing should certainly be laundered, and his sleeping bench could use a quick cleaning with an appropriate solution, but that is all that would be necessary.

This fellow’s clothing and possessions might also hide one or more bed bugs. Whereas these reviled insects visit a person (and other animals) for their occasional blood meals, they don’t remain on a person for more than a few minutes at a time. Instead, they’ll usually sequester nearby (such as on the bed or other furniture) or within clothing and possessions. In contrast to lice and scabies mites, bed bugs can survive weeks or months without a host present. They can hide on a bench in a train station (or elsewhere), and may subsequently attack other persons or hitch a ride to a new home if the bugs invade the baggage and possessions of other travelers. Reducing risk to others should be based on a well-conceived integrated pest management program that includes a monitoring effort, frequent cleaning of seats or benches, and an appropriate intervention, as appropriate.

Far more educational information about the biology and management of lice, bed bugs and other pests can be found at IdentifyUS LLC. The NJ Transit officials are most welcome to contact us for further insight as to how they might better handle this and other such situations in the future. We are available to review and update your current strategies and evaluate diverse risk-benefit scenarios. We’re independent of pest management companies. Our advice and guidance will be based upon a thorough review of your situation, consideration of the science and practices available, and an appreciation of budget limitations as well as public relations concerns. We’ll describe other such incidents and missteps in forthcoming installments of this blog… Stay tuned.

Louse & nit removing salons

Sun, 19 Feb 2012 21:03:00 -0500

Regulating louse salons: Nit picking over regulations or just scratching the surface? - updated 27 March 2012

A contentious battle is brewing in the Golden State. This began as a NIMBY (not in my backyard) report of the planned opening of a delousing salon in Martinez, CA. Main Street business operators, residents and local politicians were said to have expressed incredulity and disapproval of this planned venture, and detractors have cited a zoning issue - the absence of a category ‘lice removal salon’ from the extensive list of permissible commercial ventures. Even the Mayor doesn’t believe such a business should operate in the downtown area. Some business managers in the area expressed fear that clients of the louse-attracting venture would somehow impart risk to them or their clientele. Now, eyebrows are being finally being raised to consider the legality of louse removal salons.

Before we discuss the salons and their activities, it is important to consider what is a head louse, and how likely is it that a person will be endowed with these villainous creatures? Head lice are tiny blood-feeding insects that infest the scalp hair solely of people. Despite the often repeated claim that ‘6-12 million’ kids are infested each year in the U.S., those numbers are without any merit and amount to gross exaggerations based upon flawed statistics. In reality, head lice are most prevalent amongst kids in the K-4^th grade levels, and should, on average, be expected on just about 1 in every 100 kids of that age group. Hence, MOST kids are not infested, and most never will be ‘with lice’.

What about the eggs of lice? Female head lice affix their eggs (‘nits’) to the scalp hair of their hosts. Unless the mother louse had mated, any eggs she deposits will never give rise to another louse. Similarly, the hatched (empty) eggs from a long-extinct infestation may remain cemented to the hair for months or even years. They will merely be miniscule shiny adornments, no more significant than would be a dusting of glitter on the hair. The presence of nits on the hair, by themselves, is not a sufficient basis to proclaim a child to be infested.

Let’s be clear. Head lice may cause some annoyance, but a person with head lice is not ‘diseased’. Furthermore, head lice should not be expected to transmit any disease-causing microbe. So, being ‘with head lice’ neither is a significant health issue nor a public health matter.

Next, let’s consider the clients of these louse-removal salons. These are folks who believe that they (or more usually, their children) are infested by head lice or have been exposed to others who are so infested. Upon observing a foreign object on the hair, many parents jump to the conclusion that it must be a louse or louse egg. But, the vast majority of such sightings are made in error. Many of the moving objects are other kinds of insects (such as flies or ants) that became entrapped in the hair while walking or flying by. They pose no harm, and can easily be let loose with the flick of a finger or a stroke from a brush. The bulk of the non-movable objects are merely bits of scalp debris (e.g. dandruff, detritus, etc.). Hence, the majority of folks who seek to patronize such services are there for the wrong reasons; they (or their children) don’t have lice or louse eggs in the first place. Nonetheless, these clients patronize such services, often with the mistaken expectation that every nit or nit-like object must be removed from the hair. The presence of nits, by themselves, is NOT indicative of an ongoing infestation, and should not be the basis for treatment.

Now, what about the louse salons? What are these establishments and what do they claim to offer? These businesses range from those composed of a lone operator who may work out of her home or make house calls, to glitzy modern franchised brick and mortar storefronts that bear an uncanny resemblance to upscale beauty salons. They advertise that they provide services to inspect hair for lice and nits, to manually comb or otherwise pick these objects from the hair, and they sell and apply products that are claimed either to treat or repel lice from a person or the home environment. A few salons rely upon a reasonably effective hot air treatment from an FDA-registered device to kill lice and their eggs. Louse and nit removal salons are popping up across the country (and abroad), and may soon become as prevalent as are head louse infestations, themselves. Apart from the question as to whether or not such establishments are actually needed, state regulators should carefully examine whether these salons are even legal.

What services or products from the salons might deserve some level of regulation? Personnel that work at these establishments may touch, comb and cut hairs of their clients. Barbers and beauticians who perform similar manipulations of the hair are almost invariably licensed to do so by the state or municipality, and must demonstrate that they operate within the applicable cosmetology and sanitary codes. So, why are the owners and workers of the louse salons not required to be licensed and abide by these same health requirements? Officials from the California Department of Consumer Affairs (the agency that licenses cosmetology facilities, hair salons, barber shops and their employees) and the Department of Public Health were unaware of louse removal salons or of any regulations that might apply to louse removal salons.

Consider also other activities engaged in by personnel of the louse salons, and whether these should also be regulated. During their inspections of a person’s scalp hair, they may find what they believe is their quarry - a louse or louse egg. By proclaiming a client to be ‘with lice’, the workers there essentially are rendering a medical diagnosis. But, do they have the medical credentials to offer such a conclusion? Not likely. Then, why are they permitted to do so?

Do these workers have the expertise and equipment to identify lice and their eggs? Again, most likely they do not. IdentifyUS LLC has received countless samples from clients and workers of many such establishments, and been asked to comment upon what kind of ‘super louse’ was discovered by the salon workers. Not surprisingly, many of these objects are not lice or louse eggs, either in whole or part. Most often, these are bits of debris unrelated to lice, or are creatures of no concern.

Finally, these establishments are often found to be selling or applying diverse kinds of formulations (some knowledgeable folks might refer to these as ‘snake oils’) with astounding claims that these products will kill or repel lice or melt the eggs from the hair. On what basis do they make these claims of efficacy or safety? How is it that they can market or apply products said to kill or repel lice without being subjected to the same standards (and costs) that must be borne by companies that register their pediculicides (anti-louse products) with the FDA or EPA? The testimonials proclaiming the wonders of the salon products flow like water, but objective data are rarely, if ever, available. Hence, these establishments should be scrutinized for many reasons.

Eliminating bona fide lice from the hair certainly seems like a wise endeavor. As far as we know, head lice don’t impart any advantage to a child or adult, and they can cause annoyance to some. Efforts to remove louse eggs (or objects presumed to be nits) are frequent activities, and tend to cause much confusion and angst amongst parents and school authorities. ‘No nit’ policies are, fortunately, falling like dominoes as school and health administrators recognize the folly on which such archaic requirements were formerly based. Not surprisingly, many of those who own louse salons aggressively argue in favor for no-nits policies, and even suggest that ‘outbreaks’ or ‘epidemics’ of head lice will result without their services.

Some parents who desire to have their child(ren) rendered free of lice, nits (and debris) may lack the interest, time, physical ability or visual acuity to attend to this task. If they have the financial resources (often more than $100 per hour) to patronize these providers, and if they understand that such providers may have neither the proper credentials nor skills to attain the goal, then so be it. More troubling are those circumstances when parents feel compelled by school personnel or others to utilize the services of professional nit pickers. The most onerous scenarios arise when school administrators opt (or are strong-armed) to bring such louse- and nit-picking services into the school. What’s next, offering hair cuts, manicures, pedicures and facials within the schools? When will education stop taking a back seat to myth and marketing?

State regulators now know about these burgeoning businesses. If these businesses tread into the highly regulated worlds of medicine and of cosmetology, then they should be shut down or tested and licensed to confirm that they are proficient and abide by sanitary code requirements.

UPDATE: The Martinez Planning Commission must now decide whether the proposed louse removal salon belongs in a category with barbershops and beauty salons or in another category that would include extermination or pest removal businesses (in which case the salon would be permitted only in the Service Commercial District areas). They might also consider whether it is a medical practice. State boards that regulate medical, cosmetology, consumer services and other practices might take this opportunity to review the activities of such salons, as these establishments are likely to spread (probably faster than the lice and pockets they seek to pick).

UPDATE: The Martinez Planning Commission has now granted permission for this louse removal business to move ahead with plans to open on Main Street. Two of the Commissioners expressed their concerns of a lack of current “…oversight of the nascent lice removal salon industry, as operators do not need to get any type of license before working on customers, unlike stylists, barbers or manicurists…. “There is no oversight, there is no training, no consumer protection … I mean I could go and do it … and if someone goes in there and they have a problem, who are they going look to?” We anticipate that the Planning Commission and the State health regulators would take a dim view if a non-medical establishment sought to open their doors and offer services to inspect clients for ticks, scabies mites or pinworms, and then to remove or treat for these conditions. So, why would they turn a blind eye when it comes to head lice?

Another update (March 27, 2012): The local paper launched an online poll to gauge public opinion as to whether the city should decide what businesses - and in particular this louse removal salon - may be located near restaurants and clothing shops. This has generated a flurry of comments from folks who readily display the extent of their misinformation and biases. Still no word from those who should decide if these salons are providing a medical, pest control or cosmetology services.

The saga continues (May 3, 2012): Martinez officials have now ruled that the louse salon that planned to open on Main Street is not consistent with current code requirements. The salon owners can apply for a conditional permit, and the city council may consider amending their zoning regulations to permit such a business to operate. This still begs the issue as to whether such establishments should be regulated by health or cosmetology service providers.

Many who believe they’re dealing with head lice will benefit (and potentially save considerable funds) by viewing the information provided online by IdentifyUS LLC.

Headlice rumor mongering

Wed, 16 Nov 2011 11:31:00 -0500

Rumors and misinformation spread far more quickly and effectively than can any real infection, and electronic media further accelerate the spread of such virtual epidemics. An example of a virtual outbreak (and a Keystone Kops response) is currently underway at the Woodridge Primary School, and serves as a poster child on what not to do. The issue revolves around parents’ perceived or claimed right to know.

Should parents be alerted whenever a transmissible or contagious infection or infestation is detected at their child’s school? Most parents would probably utter ‘sure’ without giving it much thought. But, let’s consider the spectrum of issues.

At one extreme, it seems obvious that parents should be alerted whenever their child has been in very close contact with a child diagnosed with certain viral or bacterial meningitis infections. Parents might then more closely monitor their child’s health, and consult with their pediatrician to discuss the vaccination status of their child and to gain other insight. This all makes good sense because some of these infections are quite serious, some are preventable, and the health burden can be markedly reduced when the infection is diagnosed and treated without delay. Most schools would likely notify parents of such an incident when it occurs in their child’s classroom or play group.

At the other extreme, consider athlete’s foot, a fungal infection of the skin and feet. Parents should be aware of this relatively common condition. Although there are steps one might take to reduce risk of infection, there seems little, if any, need or justification to notify parents every time a case is detected on a child in the school.

What about infections by cold and influenza viruses? Although these highly transmissible infections cause measurable (and sometimes serious) health burdens and result in lost school days for many children, few schools would bother to notify parents. Is there any need to alert parents of each such incident? Why, and how would such notifications be of any value?

Now, what about head lice? Head lice are an occasional malady that most frequently visit children of the younger elementary school ages. They are acquired mainly by direct head-to-head contact with an infested child, and rarely by other means (such as by sharing combs, brushes, etc.). Most objects presumed to be a head louse or egg (nit) are - in reality - merely bits of debris misconstrued to be a sign of a parasite. Head louse cases, then, are far less prevalent than most people seem to believe. Furthermore, most bona fide cases of head lice are incredibly mild and pose little measurable burden to the child. Furthermore, a child with head lice poses only a tiny risk to anyone else. Those who solely sport nits (but not live lice) pose no risk, whatsoever. So, what’s this current controversy all about?

Some parents believe that they should be alerted every time a child in the classroom or school is presumed to be ‘with head lice’. These parents wrongly believe that head lice are serious threats to life and limb, are readily transmitted by inanimate objects (such as helmets, head phones, desks, pools, etc.), and can infest school buildings, buses and homes. Their gross misconceptions and fears then incite them to demand that schools adopt unfounded policies that seek to search out and destroy all vestiges of head lice in the community. School administrators often then take the easy route to avoid the controversy, bow down to such misguided pressure and adopt and enforce unjustified, costly and invasive ‘no louse’ or ‘no nit’ policies. Reasoned arguments against such policies are many and are readily available here.

When schools notify parents of a case of head lice, they usually do so by sending home printed notes to parents and care-givers. Such notes can be counterproductive because they perpetuate notions that head lice are readily transmissible at school, and they exaggerate the significance of the associated medical and public health burdens. Many parents then treat their children on presumptive or prophylactic bases, neither of which is warranted nor wise. On the bright side, relatively few of the printed notes sent via the children or the USPS are likely read by the recipients.

Now, we learn of a new strategy that truly boggles the mind. Here we have a case where the school administrators exploited an electronic emergency alert system to ‘blast’ a lousy message to district residents. Have these folks been spending too much time watching movies of disease outbreaks? Are their trigger fingers so itchy that they had to find a reason to test their emergency broadcast system? One might argue that the arrival of Ebola in town would justify such an effort. But head lice? Really? To further add insult to injury, school system officials have reaffirmed their ‘no-nit’ policy and their plans to ‘sanitize’ the school.

Much of this nonsense can be minimized by ensuring that a presumed louse is really a louse, and a presumed nit is really a viable louse egg. Those objects can be sent or digital images uploaded to IdentifyUS LLC for rapid, independent, confidential and expert evaluation. Most such objects tend to be something far more innocuous than initially believed. The educational information and the evaluation report can markedly and effectively tone down the level of hysteria. So, why are educators often the most difficult ones to re-educate about such issues?

A mosquito 'epidemic' from NYC sewers?

Fri, 04 Nov 2011 11:42:00 -0400

CBS reports on a a growing ‘insect invasion terrorizing’ and causing misery and danger for NYC homeowners. Every resident of a stretch of 84th Street is said to be slapping, scratching and suffering, and the mosquitoes are said to be ‘rare’, ‘extra blood-thirsty’ and ‘active year-round’. Does this report seem reasonable, or might it be a post-Halloween scare story?

These ‘rare’ mosquitoes, identified as Culex pipiens molestus, are relatives of the northern house mosquitoes, Culex pipiens. These two close relatives tend to differ a bit in their genetics, physiology, ecology and public health significance. The northern house mosquitoes are fairly ubiquitous in the northern parts of the US, and tend to thrive best in man-made habitats containing organically-polluted water. The catch basins (those storm sewers that line our streets), as well as roof gutters, are each nearly ideal bits of heaven for these mosquitoes. Culex pipiens are not native to North America. Their ancestors likely arrived swimming in the bilge water of the earliest sailing vessels that plied the Atlantic, and they obviously found the New World to their liking. The adult females of the northern house mosquitoes require a blood meal to produce each batch of eggs. They tend to be most attracted to birds, but they’ll occasionally feed on people and other mammals as the opportunity presents. Northern house mosquitoes acquired new public health significance in 1999 when West Nile virus arrived in North America (initially in NYC). These mosquitoes serve as vectors that acquire, amplify and transmit the West Nile virus from bird to bird, and also occasionally to people and other animals.

Their relative, the molestus variety, is an interesting cousin of the northern house mosquito. Unlike the northern house mosquito, females of the molestus variety tend not to require blood to produce their first batch of eggs. If there was a ‘good’ mosquito, then it is this one. They seem quite content to perpetuate, year after year, often in isolated environments where they do not have access to blood sources. Whereas they may occasionally be found in catch basins and other such sites, they tend to be most often found developing in the water contained within sumps in basements and other subterranean sites, and at any time of year. Although they may occasionally encounter a rodent or person, they don’t need to blood feed - except, perhaps, to provide nutriment to allow them to develop their second or subsequent batches of eggs. Blood feeding reduces their likelihood of survival (they may get eaten or swatted), so being able to perpetuate without blood can be a good strategy. Because the molestus variety tend not to blood feed, and thereby have little opportunity to acquire West Nile virus or other pathogens, these mosquitoes pose virtually no public health risk. Obviously, when they become abundant in a home, they can be annoying.

So, what’s the real problem here? From a practical perspective, the presence of the molestus variety (or of any other kind of mosquito) in the home suggests an opportunity to install or repair window screens and to pursue other efforts to restrict access by mosquitoes and other insects (including sewer flies, another common denizen of those habitats) from entering the home. Similarly, sumps should be drained or screened, and penetrations in the foundation should be sealed. Those steps are far more practical and effective than trying to somehow treat the sewers and other sites where these mosquitoes thrive - and will continue to thrive - despite efforts to eliminate them.

On the bright side, those battling these mosquitoes might count their blessings. The minor and readily rectified annoyance they suffer pales in comparison to the mosquito and mosquito-borne disease burden that others suffer throughout the world. Then again, they might be preoccupied with bed bugs. Many residents suffer bites by bed bugs, fleas, ticks, biting mites and diverse other pests. Before taking evasive action, it is always good to know thine enemy and to know how best to intervene. Methods that are appropriate against one kind of pest may be wasteful if applied against another. How can one learn what’s ‘bugging’ them? Simple. Capture and send specimens or digital images to IdentifyUS LLC.

Hotel responses for bed bug incidents

Thu, 03 Nov 2011 07:45:00 -0400

Nary a day passes without a report in the news about bed bug encounters (real or imagined) in a hotel or elsewhere in the hospitality industry. Almost invariably, the hotel manager or owner is said to deny the problem without doing due diligence to even check whether or not bed bugs were present, and then ignores the earnest (and sometimes exaggerated) claims of the guests. Such a response (or lack thereof) fails not only the guests but also the personnel of that facility. It also gives the entire hospitality industry a black eye.

Here’s a case where guests who alleged a bed bug problem at a hotel did receive compensation (from the hotel’s insurance company) for laundry and certain other expenses. Characteristically, the hotel in question is said to deny the existence of a bed bug problem. Whereas it is impressive that guests were reimbursed (this was likely in lieu of a much more costly legal challenge), many opportunities were apparently missed here.

What should have been done?

1) The hotel management should have had (and may have had) a good bed bug training program in place for the housekeeping staff. Ideally, the housekeepers will spot a problem before it comes to the attention of the guests and will summon appropriate resources to deal with the issue.

2) At the first instance of a bed bug sighting or complaint, the room should be thoroughly examined for bed bugs or signs of bed bugs. If a problem is confirmed, the room should be immediately closed, all adjacent rooms should be inspected, and a licensed pest control professional should arrive within the day (if possible) to treat as appropriate. Affected rooms should be maintained closed until it is fairly certain that the bugs have been eliminated.

3) Guests in any affected rooms should immediately be offered an apology and a new room (if the guests are continuing their stay) or reasonable reimbursement for the night(s) they stayed. Guests should be advised to have their clothing laundered before returning home or traveling to other facilities, and also urged to carefully inspect their luggage and personal effects. To this end, the hotel manager should offer to immediately launder all the clothes of the affected guests, or provide reasonable compensation for such laundering elsewhere.

Whereas it is comforting to learn that these guests were compensated, it is not clear whether they received proper and timely guidance. How many of them may then have inadvertently transported bed bugs from the hotel to their own homes or to other hotels? Only the bed bugs will know this for sure…

The issue remains as to whether bed bugs really existed in the rooms or were merely imagined. Most reports of bed bug sightings seem well-intentioned, but are fatally flawed. This is why the various registry sites for posting presumed bed bug incidents are of little, if any, value. The observed ‘bug’ may have been a cockroach, carpet beetle or even a bit of lint on the bed linen. In such a case, this is much ado about nothing. This highlights another opportunity for hotel manager and guest, alike. The suspected bed bug or other villain should be captured and evaluated by a third party who has expertise and no commercial agenda as to whether the object is a bed bug or not. How can this be done? Simple. The bug (dead or alive, smashed or not) can be captured on tape or swept into a plastic bag and sent to IdentifyUS LLC for a rapid, independent, confidential and expert evaluation. Even faster, the likeness of the bug can be captured using a digital camera, camera phone or our IDmyBUG mobile solution, an inexpensive dedicated digital magnifier. Images can be captured in seconds and uploaded to our secure server for a fast, confidential review. This process can quickly resolve an uncomfortable situation, defuse anger, lessen worry and save considerable cost. Imagine if the images help confirm that the suspected bed bugs were, indeed, bits of lint? The current strategies - of denial and subsequent legal challenge - are far more costly to a hotel’s bottom line and to their reputation.