PAPULAR URTICARIA
 
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From: MHKAY1@aol.com
 
I wish I could add an answer to this inquiry but i thought I might add my 
ownquestion. Lately I am noticing bite like eruptions on my nursing home and
regular patients which I can not easily explain.

There are usually too few to be papular hives. They are usually not in
typical scabies locations and often do not itch anywhere as much a scabies 
or fleas would. These patients are not exposed to animals in the home but 
often both husband and wife have them. I can assure you I have been unable 
to find scabies on any of them and they get no improvement with anti-scabies 
meds.

I usually blame mites of non human origin as I did find an epidemic of bird
mites a few years ago in L.A. which affected my family and a few patient's
families. I also discuss the possibility of mice or rat mites. Since these
occur off season for mosquitos and do not look like and are not in the
typical locations for flea bites I feel rather foolish. Do we have a bug 
bite
expert out there?


 Marty Kay

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From: jcp@cts.com (James C. Powers)

Not a bug expert (though I know a lot about fleas from my two dogs), but
sounds suspicious for bed bugs (Cimex lectularius).

>From Rook:  (very abbreviated)

        some species travel on birds, get into house from nests under eaves

        can also be found on domestic chickens, esp in southwest US/Mexico

        Can invade house from swallow's nests/chicken runs

        Not uncommonly found in poorly maintained dwellings

        Feed for five minutes, drop off engorged.  Usually does not wake 
host.

        Gregarious, "heavy attacks common"

        Clinically, bites common on face and neck, hands or arms, often two
or three in a line, occasionally generalized. (Note:  I had one patient who
had multiple bites in lower back area.  Was never able to catch a bed bug,
but professional extermination in house eliminated symptoms in this
patient.)

        "In individual not sensitized by previous exposure there may be no
symptoms at any stage, and only a purpuric macule indicates the site of the
bite.  The stages of sensitization follow the usual pattern and in
sensitized subjects intensely irritating weals or papules surrounded by
hemorrhagic puncta are the characteristic reaction.....

        The bites of other Cimicidae are essentially similar, but their
distribution depends on the time and method of exposure."

 
James Powers MD