INFORMATION FOR CANDIDATE: Your next patient in general practice is a 4 years old girl, Claire, who has been

brought in by her father John because the parent noted an itchy rash on her skin which seemed to have followed what looked like bites on her arms and legs which were initially not painful.. YOUR TASK IS TO: Take a further history xamine the patient !iscuss your diagnosis and management with the father

HOPC: Claire"s family are visiting from ngland and staying in a back packer accommodation for # weeks whilst sightseeing around the area. Yesterday they noted some painless bite marks on her arms and legs which during the night seemed to become $uite itchy and with a spreading red colour. PHx. + FHx.: unremarkable SHx: both parents are students and they are travelling around %ustralia with her one daughter, &'%, no medication. EXAMINATION: the picture shows popular urticaria secondary to bed bug bites. &o other pathological findings on physical examination. INVESTIGATIONS: (yistologic findings from bite)site biopsy specimens typically show eosinophilic infiltrates, which are indicative of the allergic nature of the reaction, although this is not a necessary investigation* DIAGNOSIS: Bed Bug Bi e! "#i$e! %e# u%&'i!( +ed bugs are parasitic arthropods from the family Cimicidae, they are typically less than , cm in length and reddish brown in colour. They are found in furniture, floorboards, peeling paint and other small spaces, most commonly in areas of clutter. They come out at night in search of prey upon which they feed, with peak feeding -ust before dawn. They are typically attracted to body heat, carbon dioxide, vibration, sweat and odor. They bit with their mouths and in-ect anticoagulant and anaestetic compounds into the skin either directly targeting superficial capillaries, seen as a linear group of bites along superficial blood vessels or damaging the skin first and then feeding on the accumulated blood. The bed bug bite themselves are typically painless, however, the subse$uent allergic reation can cause intense pruritus due to the in-ection of several pharmacologically active substances, including hyaluronidase, proteases and kinins. These may induce different skin reactions like erythema, wheals, vesicles or haemorrhagic nodules with intense itchyness .macula)papular red lesions/. The local trauma from the bites can lead to secondary bacterial infection with cellulitis or lymphangitis. +ed bugs can also transmit hepatitis +* MANAGEMENT: is supportive0 cleaning the lesions with antiseptic lotions %pplication of anti)pruritic agents like calamine, pine tar lotions or 12araderm cream" Corticosteroid creams 3ral antihistamines *4icensed pest controller for insecticide treatment of furniture and crevices in walls and floors. % home made method with duct tape wrapped around bed legs can prevent bugs from climbing up into beds.