LETTERS Gaëtan Lebrun, Karim Chadda, Cockroaches the air circulation system, or changes Anne-Hélène Reboux, in architectural structures were neces- Olivier Martinet, (Ectobius sary to stop the infestation reported and Bernard-Alex Gaüzère vittiventris) in an here. Author affi liation: Centre Hospitalier Felix Intensive Care Unit, Cockroaches can cause 2 poten- Guyon, Saint-Denis, La Réunion, France 1 tially serious health problems. First, Switzerland they may provoke allergic reactions (3). DOI: 10.3201/eid1503.071482 To the Editor: Ectobius vit- Second, they have been suggested as possible vectors of multidrug-resistant References tiventris (Costa) is a fi eld-dwelling cockroach and 1 of 4,000 cockroach pathogens. In particular, cockroaches 1. Brighton SW, Prozesky OW, de la Harpe species worldwide (1). We describe a that live and breed in hospitals have AL. Chikungunya virus infection. A retro- cockroach infestation of an intensive higher bacterial loads than cockroaches spective study of 107 cases. S Afr Med J. in the community (4–6). Up to 98% of 1983;63:313–5. care unit (ICU). Successful manage- 2. Lam SK, Chua KB, Hooi PS, Rahimah ment required knowledge of the ecolo- these “nosocomial” cockroaches may MA, Kumari S, Tharmaratnam M, et al. gy of cockroaches and highlighted the carry medically important microorgan- Chikungunya infection—an emerging dis- need for species-level identifi cation to isms on their external surfaces or in ease in Malaysia. Southeast Asian J Trop their alimentary tracts (4–9) and may Med Public Health. 2001;32:447–51. tailor control strategies. 3. Mazaud R, Salaun JJ, Montabone H, The University of Geneva Hospi- disseminate these microorganisms by Goube P, Bazillio R. Acute neurologic and tals are a 2,200-bed tertiary healthcare fecal–oral transmission. sensorial disorders in dengue and chikun- center. The 18-bed medical ICU is lo- Cockroaches are capable of har- gunya fever [in French]. Bull Soc Pathol boring Escherichia coli (6,7), Enter- Exot Filiales. 1971;64:22–30. cated on the ground fl oor next to an 4. Gérardin P, Guernier V, Perrau J, Fianu A, outdoor recreational area and admits obacter spp. (6,8,9), Klebsiella spp. Le Roux K, Grivard P, et al. Estimating ≈1,400 patients/year. Smoking inside (6,7,9), Pseudomonas aeruginosa chikungunya prevalence in La Réunion hospital buildings by patients and (6,9), Acinetobacter baumannii (2), Island outbreak by serosurveys: two meth- other nonfermentative bacteria (7,9), ods for two critical times of the epidemic. healthcare workers (HCWs) is strictly BMC Infect Dis. 2008,28;8:99 prohibited. On August 25, 2006, ≈30 Serratia marcescens (7,9), Shigella 5. Centers for Disease Control and Preven- cockroaches were observed in the ICU spp. (6), Staphylococcus aureus (6,7), tion. Arboviral infections of the central hiding inside oxygen masks, moving group A streptococci (6,7,9), Entero- nervous system—United States, 1996– coccus spp. (6,7), Bacillus spp. (7), 1997. MMWR Morb Mortal Wkly Rep. around on the light panels below the 1998;47:517–22 ceilings, or dropping onto intubated various fungi (6–8), and parasites and 6. Hughes RA, Cornblath DR. Guillain-Bar- patients during the night. their cysts (6). An outbreak of extend- ré syndrome. Lancet. 2005;366:1653–66. An outbreak investigation was ed-spectrum β-lactamase–producing DOI: 10.1016/S0140-6736(05)67665-9 Klebsiella pneumoniae in a neonatal 7. Pastorino B, Bessaud M, Grandadam M, initiated. All work areas, including Murri S, Tolou HJ, Peyrefi tte CN. Devel- sinks and material stock areas, were unit was attributed to cockroaches (2). opment of a TaqMan RT-PCR assay with- thoroughly searched for cockroaches. Pulsed-fi eld gel electrophoresis did not out RNA extraction step for the detection External pest control experts identi- distinguish organisms from the insects and quantifi cation of African chikungu- from those colonizing infants or caus- nya viruses, J Virol Methods. 2005;124: fi ed only 1 species, E. vittiventris, 65–71. which had presumably entered the ing clinical disease (2). Unlike other 8. Tsai T. Chikungunya fever. In: Strickland ICU through windows facing the out- investigators, we did not cultivate the GT, editor. Hunter’s tropical medicine and door recreational area. The investiga- cockroaches (6,9). emerging infectious diseases, part II. 8th E. vittiventris cockroaches are ed. Philadelphia: WB Saunders Co.; 2000. tion showed that despite verbal rec- p. 246–8. ommendations and being repeatedly easily confused with Blattella ger- forbidden to do so, HCWs had opened manica (Linnaeus) (the German or Address for correspondence: Gaëtan Lebrun, the windows secretly with screwdriv- croton cockroach), which is probably Hôpital Européen Georges Pompidou, 20 rue ers so that they could smoke dur- the most important cockroach pest Leblanc, 75908 Paris CEDEX 15, France; ing night shifts. The infestation was worldwide (1,9). In contrast to B. ger- email: [email protected] halted within 3 days after information manica (6,9) and other species (online regarding the infestation was provided Technical Appendix, available from to HCWs and all windows were bolted www.cdc.gov/EID/content/15/3/496- shut. In contrast to measures required 1Parts of this research have been presented to deal with a reported infestation in a as a poster at the Annual Meeting of the neonatal ICU (2), no other measures Swiss Society for Infectious Diseases, such as use of insecticides, review of Zurich, Switzerland, June 14, 2007. 496 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 3, March 2009 LETTERS Techapp.pdf), E. vittiventris cock- Acknowledgments 8. Lemos AA, Lemos JA, Prado MA, Pimen- roaches are considered to be harmless We thank Rosemary Sudan for edito- ta FC, Gir E, Silva HM, et al. Cockroaches as carriers of fungi of medical importance. and have not been associated with hu- rial assistance, the ICU team of the Univer- Mycoses. 2006;49:23–5. DOI: 10.1111/ man disease or transmission of patho- sity of Geneva Hospitals for collaboration, j.1439-0507.2005.01179.x gens. We did not observe any allergic and Manadou Diallo for expert advice. 9. Elgderi RM, Ghenghesh KS, Berbash reactions or an increase in coloniza- N. Carriage by the German cockroach Ilker Uçkay, Hugo Sax, (Blattella germanica) of multiple-antibi- tion or infection rates of multidrug- otic-resistant bacteria that are potentially resistant organisms. B. germanica Sandrine Longet-Di Pietro, pathogenic to humans, in hospitals and cockroaches are nocturnal, cannot fl y, Hannes Baur, households in Tripoli, Libya. Ann Trop are always encountered within human Marie-France Boulc’h, Med Parasitol. 2006;100:55–62. DOI: Christophe Akakpo, 10.1179/136485906X78463 habitations, and require specialized 10. Fédération Suisse des Désinfestateurs measures for eradication (10). Jean-Claude Chevrolet, [cited 2007 Nov 7]. Available from http:// E. vittiventris cockroaches live in and Didier Pittet www.fsd-vss.ch. outdoor areas, do not avoid light, and Author affi liations: University of Geneva are active during daytime. Buildings Hospitals and Faculty of Medicine, Geneva, Address for correspondence: Didier Pittet, are not a natural habitat. In summer, Switzerland (I. Uçkay, H. Sax, S. Longet- Infection Control Program, University of adult insects can fl y inside at night, Di Pietro, M.-F. Boulc’h, C. Akakpo, J.-C. Geneva Hospitals and Faculty of Medicine, but because these cockroaches are un- Chevrolet, D. Pittet); and Natural History 24 Rue Micheli-du-Crest, 1211 Geneva 14, able to reproduce inside buildings (1), Museum, Bern, Switzerland (H. Baur) Switzerland; email: [email protected] stopping entry from outside halts the DOI: 10.3201/eid1503.071484 infestation. Entry can be stopped by closing windows or using mosquito References nets. There is no existing insecticide for eradication of E. vittiventris cock- 1. Baur H, Landau-Lüscher I, Müller G, Schmidt M, Coray A. Taxonomy of the roaches (10), and even if there were, it fi eld-dwelling cockroach Ectobius vit- would not be effective because insects tiventris and its distribution in Switzerland. Cutaneous from untreated areas outside would Rev Suisse Zool. 2004;111:395–424. Anthrax, West enter continuously (1). 2. Cotton MF, Wasserman E, Pieper CH, Theron DC, van Tubbergh D, Campbell Bengal, India, 2007 E. vittiventris cockroaches have G, et al. Invasive disease due to extend- been recently discovered in Geneva ed spectrum beta-lactamase-producing To the Editor: In most of India, (10) and have become the most fre- Klebsiella pneumoniae in a neonatal unit: anthrax is not common, probably be- quently encountered cockroaches in the possible role of cockroaches. J Hosp Infect. 2000;44:13–7. DOI: 10.1053/ cause a large proportion of the popu- urban areas of Switzerland for several jhin.1999.0650 lation is Hindu and does not eat beef. years (1). The reason for this fi nding 3. Tungtrongchitr A, Sookrung N, Munkong However, sporadic cases and out- remains unknown. The summer of N, Mahakittikun V, Chinabut P, Chaicum- breaks have been reported (1–6). 2003 was remarkably hot and dry in pa W, et al. The levels of cockroach aller- gen in relation to cockroach species and On June 8, 2007, a healthcare facil- central Europe, thus representing a allergic diseases in Thai patients. Asian ity reported 12 cases of cutaneous an- subtropical climate that usually favors Pac J Allergy Immunol. 2004;22:115–21. thrax in the Muslim village of Sarkar- the growth and development of cock- 4. Paul S, Khan AM, Baqui MA, Muhibullah para (population 361). On August 4, roach populations (1,7). If this warm- M. Evaluation of the common cockroach Periplaneta americana (L.) as carrier of 2007, another facility 50 km away re- ing trend persists, populations of E. medically important bacteria. J Commun ported 8 cases from the Muslim village vittiventris cockroaches may continue Dis.