CAT INFESTATION AMONG STUDENTS

CASE REPORT

INFESTATION WITH THE , FELIS FELIS (SIPHONAPTERA: PULICIDAE) AMONG STUDENTS IN KUALA LUMPUR, MALAYSIA

Heo Chong Chin1, Nazni Wasi Ahmad2, Lee Han Lim2, John Jeffery3, Azahari Abdul Hadi2, Hidayatulfathi Othman4 and Baharudin Omar4

1Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor; 2Medical Entomology Unit, Institute for Medical Research, Kuala Lumpur; 3Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur; 4Department of Biomedical Sciences, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Abstract. This paper reports six male undergraduate students living at a local uni- versity hostel who were infested with cat (Siphonaptera: Pulicidae: Ctenocepha- lides felis felis) in February 2009. All of them suffered from maculopapular rashes and severe pruritus after the bites. Investigation revealed the presence of a stray cat in the hostel building; five of the students had a history of contact with the cat. Six cat fleas were collected at the hostel and identified as C. felis felis. Most of the stu- dents were not aware of this infestation and did not seek medical treatment. Key words: Ctenocephalides felis felis, cat flea, infestation, Malaysia

INTRODUCTION The cat flea, Ctenocephalides felis Fleas belong to the order Sipho- (Bouché), is the most abundance ectopara- naptera, and consist of 2,500 species and site in cats and dogs. It is associated with subspecies in 230 genera. Only a small allergic dermatitis (Rust, 2005) and acts as number are important pests in humans. an intermediate host for the tapeworm About 94% of known species bite mam- Dipylidium caninum and filarid nematode mals, the remainder are parasitic to birds Dipetalonema reconditum (Georgi, 1985). (Lehane, 2005; Service, 2008). Fleas have a Studies in France found Bartonella quintana, cosmopolitan distribution and are vectors B. koehlerae, B. henselae, B. clarridgeiae, Rick- of several important zoonoses, including ettsia felis and Wolbachia pipientis in cat fleas, plague and murine typhus (Perry and indicating cat fleas may be more important Fetherston, 1997). vectors of human disease than previously thought (Rolain et al, 2003). Shaw et al Correspondence: Prof Dr Baharudin Omar, De- (2004) isolated R. felis, B. hensalae and partment of Biomedical Sciences, Universiti hemoplasma from cat fleas in the United Kebangsaan Malaysia, Jalan Raja Muda Abdul Kingdom. Aziz, 50300 Kuala Lumpur, Malaysia. Tel: +6 (03) 40405194; Fax: +6 (03) 26914304 Noor Hayati et al (2002) reported cases E-mail: [email protected] of cat flea bites in a university student in

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Fig 1–Bite marks (arrows) caused by cat fleas in one of the infested students.

Malaysia. Lee et al (2006) reported ectoparasite specimens received by the Medical Entomology Unit, Institute for Medical Research in- cluded the rat flea, cheopis, and the cat flea, Cteno- cephalides felis; the cat flea has been known to attack people. This pa- per reports the infestation and maculopapular rashes caused by bite of the cat flea, Ctenocephalides felis felis (Siphonaptera: Pulicidae: Archaeopsyllinae) among 6 uni- versity students. Fig 2–Cat flea, Ctenocephalides felis felis (Bouché) with genal and pronotal combs.

CASE REPORT had wandered into the hostel building in early February. Five of the six students had On 17 February 2009 six male univer- a history of close contact with the cat. One sity students living in a university hostel student went for medical treatment at a in Kuala Lumpur age 20-25 years com- clinic complaining of intense pruritus for plained of being bitten by a number of one week. Another student self-medicated small jumping which resulted in with topical anti-fungal cream and a tra- itching and rashes all over the body for ditional herbal ointment. He claimed it seven days (Fig 1). They stated a stray cat was effective in preventing flea bites. The

1332 Vol 41 No. 6 November 2010 CAT FLEA INFESTATION AMONG STUDENTS rest ignored the symptoms and did not sent in females. Subspecies of cat fleas in- seek medical treatment. One student had cluded Ctenocephalides felis felis and Cteno- no contact with the infested cat but suf- cephalides felis orientis. The later has a fered from flea bites. He was a frequent shorter, broader, rounded anterior frons visitor to his friend’s room who suffered compared to C. felis felis. from flea bites. He believed the cat fleas were hiding in the patient’s room and fed DISCUSSION on the inhabitant. Fleas frequently bite people on their Three of the students had seen tiny ankles and legs and subsequently cause insects hopping in their room and the sur- dermatitis and allergies in hypersensitive rounding environment. Six fleas were col- individuals (Service, 2008). lected by one student in his room (using The flea bite patients should be treated his hands) and placed in a plastic container with local and oral antihistamines to re- and sent to the first author for identifica- lieve pruritus. Application of benzyl ben- tion. zoate emulsion over the whole body is The insects were preserved in 70% al- useful in treating lesions and stopping cohol and processed as follows. The fleas pruritus (Noor Hayati et al, 2002). Repel- were impaled in the thorax or abdomen lents, such as DEET, benzyl benzoate or using a fine needle; then the specimens permethrin-impregnated clothing, may were cleared in 10% aqueous potassium provide personal protection against flea hydroxide for 4 hours. The specimens bites. Insecticide powders, sprays and were then rinsed several times in distilled shampoos containing insecticides (such as water to remove all traces of caustic solu- malathion or permethrin) can be applied tion. The specimens were then dehydrated to the ’s fur, beds, kennels or other in increasing concentrations of alcohol, places where pets sleep (Service, 2008). cleared in xylene and mounted in Canada Growth Regulators (IGRs), such as Balsam on a glass slide. methoprene, fenoxycarb, pyriproxyfen Microscopic examination of the fleas and lufenuron, have been used to inhibit identified them as the cat flea, Ctenocepha- cat flea larval development (Rust, 2005). lides felisfelis (Bouché, 1835) (Fig 2). Identi- Resistance has been reported in cat fication was made based on the reference fleas, human fleas and rat fleas in various of pictorial keys to common fleas, Medi- parts of the world to insecticide, such as cal Entomology Unit, Institute for Medi- cyclodienes, carbamates, organophos- cal Research (IMR), Kuala Lumpur. The phates and pyrethroids (Rust, 2005). The morphological features were: genal and cat flea is resistant to the greatest number pronotal combs present, eyes present, 8 to of different groups of insecticides (Rust 9 horizontal spines on the genal comb, and Dryden, 1997). Effective insecticides spines i and ii of the genal comb were in combination with IGR, mechanical and nearly equal in length, and there was only biological approaches may provide effec- one short stout bristle between the post- tive flea control (Dryden et al, 2000). median and apical long bristles on dorsal In this paper, we reported cat flea in- margin of the hind tibia. The frons was festation among students living in a hos- elongated and pointed anteriorly. Minute tel. We hope this report enhances the bristles above the antennal fossa were ab- awareness of medical officers and derma-

Vol 41 No. 6 November 2010 1333 SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH tologists about cat flea infestations in pa- Lehane M. The biology of blood-sucking in tients living in community-type accommo- insects. 2nd ed. Cambridge: Cambridge dations (such as hostels) who have a his- University Press, 2005. tory of contact with cats, especially stray Noor Hayati MI, Jeffery J, Anisah N, Yusof S. cats, in their environment. Maculopapular rashes caused by cat flea, Ctenocephalides felis (Siphonaptera: Puli- cidae) bites in a university student. Trop ACKNOWLEDGEMENTS Biomed 2002; 19: 131-4. We thank the Director-General of Perry RD, Fetherston JD. -etio- Health, Malaysia and the Director of In- logic agent of plague. Clin Microbiol Rev stitute for Medical Research, Kuala 1997; 10: 35-66. Lumpur, and also the Dean of Faculty of Rolain JM, Franc M, Davoust B, Raoult D. Mo- Medicine, UiTM, for their permission to lecular detection of Bartonella quintana, B. publish this paper. koehlerae, B. henselae, B. clarridgeiae, Rickett- sia felis, and Wolbachia pipientis in cat fleas, France. Emerg Infect Dis 2003; 9: 338-42. REFERENCES Rust MK. Advances in the control of Cteno- Dryden MW, Denenberg TM, Bunch S. Con- cephalides felis (cat flea) on cats and dogs. trol of fleas on naturally infested dogs and Trends Parasitol 2005; 21: 232-5. cats and in private residences with topi- Rust MK, Dryden MW. The biology, ecology cal spot applications of fipronil or and management of the cat flea. Annu Rev imidacloprid. Vet Parasitol 2000; 93: 69-75. Entomol 1997; 42: 451-73. Georgi JR. Parasitology for veterinarians. 4th Service M. Medical entomology for student. ed. Philadelphia: W.B. Saunders, 1985. 14th ed. Cambridge: Cambridge Univer- Lee HL, Krishnasamy M, Jeffery J, Paramas- sity Press, 2008. varan S. Notes on some ectoparasites re- Shaw SE, Kenny MJ, Tasker S, Birtles RJ. Patho- ceived by the Medical Entomology Unit, gen carriage by the cat flea, Ctenocepha- Institute for Medical Research. Trop Biomed lides felis (Bouché) in the United Kingdom. 2006; 23: 131-2. Vet Microbiol 2004; 102: 183-8.

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