Agusan del Sur State College of Agriculture and Technology

San Teodoro, Bunawan, Agusan del Sur

College of Teacher Education

" Ectoparasites from Feral Pigeons Affecting

Humans” (A Journal Review)
S112 – Microbiology and Parasitology

Submitted by: Jeremy Nest A. Manulat

BSEd – Science 3A

Submitted to: Dr. Vivian C. Peligro

Instructor
 Abstract
Feral pigeons pose a considerable health risk to the human population. They
are vectors of infectious diseases and source of antigens causing allergic
diseases. Breeding and roosting sites of pigeons harbor parasites that may infest
humans. In the present article, a concomitant parasitization of a young female
with 3 different ectoparasites, the bedbug Cimex lectularius the pigeon tick Argas
reflexus and the red mite Dermanyssus gallinae, is reported. The parasites
invaded the apartment from a balcony used as roost by feral pigeons and infested
the patient continuously over a period of more than 2 months. To our knowledge
this case presents the first record of a coincidental infestation of a single patient
with several ectoparasite species deriving from feral pigeons. Additionally we
report general symptoms in the patient probably caused by the high number of
stings. Dermatologists should be aware of the possibility of an infestation with
ectoparasites deriving from feral pigeons. In a review we give an overview on the
most important ectoparasites transmitted from feral pigeons to humans and
their importance for the dermatologist

Introduction
Feral pigeons (Columba livia Gmelin, 1789) are among the most successful
avian settlers in our cities. They are distributed worldwide and live close to the
human population. The average feral pigeon population is around 1 pigeon per
10–20 city inhabitants. The world population is therefore estimated to be
between 165 and 330 million individuals. Feral pigeons bring pleasure to people
who feed them, but the large food supplies provided by pigeon friends and food
leftovers, together with the absence of enemies, allows the development of large
populations that can cause various problems. An individual feral pigeon
produces around 12 kg of excrement each year soiling buildings and public
areas. Large quantities of droppings accumulate in particular in its roosting and
breeding places. Pigeon feces provide ideal conditions for the growth of mould
fungi that damage construction, as e.g. stone and concrete, leading to erosion of
historic buildings and monuments. The damage caused by an individual feral
pigeon has been estimated to be EUR 23.7– 33.5 per year. In the USA, feral
pigeons cause an estimated USD 1.1 billion per year in damages. These damage
costs do not include the damages associated with their role as reservoirs and
vectors for diseases. Suitable nesting sites are rare in most cities, leading to
intense competition and overcrowding at breeding sites which produces poor
living conditions due to social stress, diseases and parasites.
Feral pigeons can pose various health hazards to man and his domestic
animals. In feral pigeon populations so far 109 different pathogenic agents that
can infest humans have been recorded, but only 7 have in fact been transmitted
to humans, causing a total of 230 reported infections. These were Chlamydophila
psittaci with 101 cases and 2 fatal courses, Histoplasma capsulatum with 91
cases, Cryptococcus neoformans with 11 cases and 2 fatal courses, Aspergillus
sp. with 13 cases and 9 fatal courses, Candida sp. with 12 cases and Toxoplasma
with 1 case. 229 of 230 infections were transmitted by the airborne route and
can therefore be prevented by hygienic precautions in most cases when handling
pigeons and their excrements. Only 1 case has been described where the patient
was infected by the cutaneous route. An HIV-positive former intravenous drug
addict presented with a primary cutaneous Cryptococcus’s after an injury
inflicted by pigeons nesting in an abandoned house. Exposure to pigeons and
their effluents can cause ‘pigeon breeder’s lung’, a hypersensitivity reaction
causing allergic alveolitis provoked by inhaled pigeon antigens. To date a total of
9 cases, 1 with fatal outcome, have been reported due to feral pigeons.
Many wild-living species have a parasitic fauna comparable to the feral
pigeons, but no other species lives as closely to humans. They use various
building structures for roosting and breeding, and therefore their parasites and
pathogens are at close distance to humans, presenting a serious health risk. We
report a case of concomitant infestation with Dermanyssus gallinae, Argas
reflexus and Cimex lectularius due to feral pigeons using a balcony for roosting.
To our knowledge, this is the first reported case where one individual has
concurrently been attacked by 3 different ectoparasites deriving from feral
pigeons. In a review we point out the importance of feral pigeons and their
ectoparasites for dermatologists.

Case Report
A 26-year-old American female student had suffered from a cat dander allergy
and from cat flea Ctenocephalides felis infestation in the past. On April 5, 2009
she moved into an apartment on the 4th floor of an old carelessly renovated
apartment building, where the former tenant had fed a group of 8–10 feral
pigeons on her balcony. The pigeons used the balcony as an overnight roost and
most likely for breeding. The floor of the balcony was completely covered with a
layer of feces and feathers of about 5 cm height that was removed by the former
tenant before the patient moved into the apartment. Ten days later, she awoke
4–5 times with a ‘burning feeling’ on the legs. In the morning she first noticed an
exanthema that consisted of hundreds of small itching papules on the legs,
forearms, loin and abdomen. The next day she found high numbers of insects
she later identified as bedbugs. The following night she suffered from general
symptoms such as fatigue, weakness, dizziness, tachycardia and thoracic
oppression and slept against her habit more than 14 h. The general symptoms
disappeared on the next day. Two days later she presented to her general
practitioner who diagnosed a ‘rash’ and a nodule with a central sting on the
forearm and who prescribed fexofenadine. For the following 2 months she only
noticed sporadic stings.
Preparing a lecture on the feral pigeon problem, she came across articles on
hygienic problems deriving from feral pigeons. By an internet search she
identified insects she found on the floor, on a water bottle and near her clock
radio as bedbugs C. lectularius which she disposed of by vacuum cleaning. Later,
she clearly identified bedbugs from specimens of our parasite collection. In the
morning she noted additional stings in a disseminated distribution that had
occurred during the night. These stings were different from the stings of the first
infestation as they occurred as larger linearly assorted urticarial and papular
stings. During the night she found another 3 bedbug’s C. lectularius beside the
bed that she immediately disposed of by vacuum cleaning. In addition she
discovered a hiding place of bedbugs in her clock radio, which by pushing a
button could be forced to leave this only electric apparatus in the room. She then
disposed of the clock radio including the bugs in a plastic bag.
Her 25-year-old partner who occasionally stayed overnight with her was also
infested with red mites and presumably with bedbugs but not with pigeon ticks.
He showed papules on the legs, abdomen, breast and general symptoms such as
fatigue, weakness, dizziness, dyspnea, palpitations and heat waves that
disappeared within 1 day. He did not consult a physician. On the upper side of
her mattress that lay directly on the floor, she detected pigeon ticks Argas
reflexus that she also disposed of with a vacuum cleaner. She and her partner
moved to the living room for sleeping to escape further stings and because of the
fear of infestation. On April 27, a pest controller performed a disinfestation of
the balcony and the apartment with dichlorvos, deltamethrin and pyrethrum. He
confirmed the presence of pigeon ticks and red mites. On the floor and at the
glazed door between the balcony and the bedroom, hundreds of red mites
crawled about. This glazed door did not fit completely, which allowed parasites
to enter the bedroom from the balcony. A final check was performed 1 week later.
Two weeks later, she applied to one of us (Haag-Wackernagel) for an interview
concerning her lecture on feral pigeons and brought the parasites she had
recovered from the vacuum cleaner. The parasitological determination confirmed
pigeon ticks (Fig. 1) and red mites (fig. 2). One tick (9.36.1 mm) showed remains
of blood and had bursted when aspirated, an unfed tick of 4.93 mm was alive.
Later, she found 8 additional dead pigeon ticks on her balcony, one of them
engorged with blood. The red mites were partly engorged with blood which was
visible from the dark-brown-colored intestine. On her left forearm she had an
excoriated nodule of 7 mm in diameter with a perifocal erythema (fig. 3). On the
legs she still had small excoriated papules caused by the mite stings (fig. 4).
 On May 16, she installed a bird net to prevent the pigeons from using the
balcony as overnight roost. Nine weeks after the first infestation she still found
red mites in the bedroom and living room. Every 3 days she used a pyrethrum
spray around the balcony door to kill invading mites. Since the disinfestation by
the pest controller, the number of stings had decreased but still occurred in
lower numbers, preferentially on the legs. On June 10, after more than 2 months
of parasite attacks, we performed a detailed on-site search. On the balcony we
found living pigeon ticks (fig. 5) and dead red mites in wall chinks and gaps of
the glazed door. We found tick feces around holes and chinks of the wooden
coverings and the walls as well as at the opened bathroom window where 2 feral
pigeons were roosting. All other balconies and window ledges of the house
including the neighboring houses were fouled with pigeon feces and on 2
balconies pigeon nests were present. The 46-day-old pigeon tick sting of the
patient was still painful on palpation and showed a persistent inflammation (fig.
3). As an ad hoc measure, we placed a glue barrier to test whether parasites still
invaded the apartment. We advised the patient to contact her landlord to claim
complete disinfestation and renovation including sealing of all gaps and chinks
and a disinfestation or removal of the canopy covering the balcony. Two weeks
later, she brought 4 living pigeon ticks she had found on the balcony and the
glue tapes placed in front of the glazed door. The 108-cm-long and 6-cmwide
tape contained 60 red mites, confirming a continued invasion from the balcony.
The largest distance a mite covered from the edge before having been caught in
the glue was 23 mm. As a preventive measure she vacuum-cleaned daily to
remove invading red mites and used an insecticide spray around the balcony
door every 3 days. Since our on-site visit, she was not stung any more.

Fig. 1. Pigeon ticks Argas reflexus found in the bedroom selected from the
vacuum cleaner by the patient. The tick below is engorged with blood and burst
when aspirated, the upper starving tick is intact.
Fig. 2. Red mites Dermanyssus gallinae, some engorged with blood (dark
brown intestine)
Fig. 3. (a) 25-day-old sting of the pigeon tick Argas reflexus . (b) The same sting
when 46 days old.

Fig. 4. Red mite stings on the knee of the patient.

Fig. 5. Pigeon tick hiding in the chink of the junction of the floor and the wall
(circle). The black spots are tick feces (arrows), a reliable sign for the presence
of pigeon ticks.

Dermatologically Relevant Ectoparasites from Feral Pigeons

Feral pigeons are a well-known source of zoonotic ectoparasites. We give here
an overview on the most important ectoparasites and their clinical importance.
Epidemiological studies of the parasitic fauna of feral pigeons revealed 17
ectoparasites from 6 orders known to potentially infest humans. These
ectoparasites, presented in table 1, are possible candidates for human
infestations. Of these ectoparasites, 8 have been reported to cause infestations
in humans (table 2). The Pigeon Bug Cimex columbarius and the Bedbug Cimex
lectularius C. lectularius, the common bedbug of man, is distributed throughout
the temperate and tropical regions of the world. Beside man it parasitizes
domestic mammals, bats and birds including pigeons. The common bug of
pigeons is Cimex columbarius (fig. 6) that is restricted to Northwestern Europe.
C. lectularius and C. columbarius are closely related species and difficult to
distinguish. C. columbarius is smaller than C. lectularius and has a relatively
short third antennal segment. The bedbug is almost oval, unfed 4–7 mm long
and fed up to 9 mm. Pigeon bugs are slightly smaller with 3.75–4.75 mm. The
integument is usually covered with short hairs or bristles. Furthermore both
species can parasitize pigeons at the same time. After a blood meal, the bugs
may increase in length by 30–50% and in weight by 150–200%. Adults are
reddish brown in color, whereas immatures are much smaller and may be light
yellow. They have a pyramidshaped head with prominent compound eyes,
slender antennae, and a long proboscis tucked underneath the head and thorax.
Bedbugs sense and seek warmth, a trait that helps them to locate warm-blooded
hosts. They generally avoid light, hide during the day and feed at night. Hiding
places are usually within 1–2 m of suitable hosts and include seams in
mattresses, crevices in box springs, backsides of headboards, spaces under
baseboards or loose wallpapers, and even behind hanging pictures. Adult
bedbugs have a life span of 6–12 months and can survive up to a year without
feeding. Starving periods normally lead to an extension of the lifetime of the
parasite. The bedbug has a unique mode of copulation termed ‘traumatic’
insemination during which the male pierces the female’s abdominal wall with his
external genitalia and inseminates into her body cavity. Most blood feeding
occurs at night, particularly in the hours before dawn, on sleeping victims, but
bedbugs may also feed during the day if conditions are favorable. All Cimex
species have mouthparts that are modified for piercing and sucking. When near
a prospective host, the bug moves toward the host and the tip of the feeding
apparatus is brought into contact with the skin. Fine stylets are extruded and
forced into the tissue, injecting an anticoagulant as well as pharmacologically
active substances, and withdraw blood and liquefied epidermal tissue.
Cutaneous reactions are induced by the injection of substances such as
hyaluronidase, proteases and kinins. Bites usually occur on exposed skin
surfaces. Reactions can range from localized urticarial to bullous reactions and
to anaphylaxis in rare cases.

Table 1. Ectoparasites of the feral pigeon known as potentially infesting humans

Order Family and species Incidence

Heteroptera Cimicidae: Cimex lectularius, bedbug occasional

Cimicidae: Cimex columbarius, pigeon bug occasional

Reduviidae: Reduvius personatus, masked hunter very rare

Reduviidae: Triatoma maculata, kissing bug very rare

Anthocoridae: Lyctocoris campestris, debris bug very rare

Siphonaptera Ceratophyllidae: Ceratophyllus columbae, pigeon common

(fleas) flea

Ceratophyllidae: Ceratophyllus gallinae, bird or occasional

hen flea
Brachycera (flies) Hipposcidae: Pseudolyncha canariensis, very rare
hippoboscid fly, pigeon fly

Psocoptera Psocodea: Liposcelis bostrychophila, booklouse very rare

(booklice)

Acari (mites) Dermanyssidae: Dermanyssus gallinae, red mite very

common

Dermanyssidae: Ornithonyssus sylviarum very rare

(Liponyssus sylviarum), northern fowl mite

Glycophagidae: Glycophagus domesticus, house very rare

mite

Acaridae: Tyrophagus dimidiatus very rare

Ixodida (ticks) Argasidae: Argas reflexus, pigeon tick very

common

Argasidae: Argas latus very rare

Argasidae: Argas polonicus very rare

Argasidae: Argas persicus very rare

Table 2. Ectoparasites transmitted from feral pigeons to humans

Parasites Reports Patients

Cimex lectularius, bedbug 1 >2

Cimex columbarius, pigeon bug 2 >6
Ceratophyllus columbae, pigeon flea 7 >11
Dermanyssus gallinae, red mite 29 >74
Ornithonyssus sylviarum, northern fowl mite 1 3
Argas reflexus, pigeon tick 47 >274
Argas latus 1 >2
Argas polonicus 1 >2
Total 89 >374
Numbers of patients are indicated with ‘>’ when the precise
number was not communicated.
Fig. 6. Portrait of the pigeon bug Cimex
columbarius, an ectoparasite specialized on
pigeons, that can cause infestations in
humans. The back-folded proboscis encases
the fine stylets of the feeding apparatus.

The usual response to a bedbug bite appears to be no reaction with a small

punctum at the location of the bite. The most common reactions for which
medical attention is sought are 2- to 5-mm pruritic maculopapular,
erythematous lesions that resolve within a week. Some patients experience
complex cutaneous reactions including pruritic wheals around a central
punctum and popular urticarial at bite sites. Reinhardt et al. could demonstrate
that 18 of 19 persons showed a skin reaction after bedbug bites, but in most
cases only after repeated exposure. With repeated exposure, the latency between
bite and skin reactions decreased from approximately 10 days to a few seconds.
Bullous rashes may occur subsequent to biting events days later. In some cases
these reactions evolve into pruritic papules or nodules that may become
superinfected after scratching and persist for weeks. Secondary complications
may result in folliculitis, cellulitis or eczematoid dermatitis.
There are few studies of systemic reactions from bedbug bites, including
asthma, generalized urticarial and anaphylaxis. Treatment of common and
complex cutaneous reactions is usually symptomatic with application of
antipruritic agents or intermediate-potency corticosteroids; systemic reactions
are treated as insect-induced anaphylaxis. Anxiety and lack of sleep may be
associated with infestations. Transmission of more than 40 human diseases has
been attributed to bedbugs, but there is little evidence that such transmission
has ever occurred. Minimal symptomatic treatment and good hygiene to prevent
itching and secondary infections are usually sufficient in most cases. Topical
steroid creams with or without systemic anti-H 1 receptor antihistamines may
be given in severer cases. In the case of an infestation a thorough on-site
inspection of crevices in walls and bed cases, with particular attention paid to
the corners of bed nets and mattresses, should be performed. Speck-like masses
of blood containing dung may be found behind wallpaper and at other sites when
there is a heavy infestation. Bedbugs are extremely difficult to eradicate, and
pest control is complicated due to insecticide resistance, lack of effective
products, and health concerns about spraying mattresses with pesticides.
Nonchemical methods include vacuuming and heat or steam treatments. So far,
one case has been described where feral pigeons were the source of a bedbug
infestation. The parasites invaded human habitations from an attic where feral
pigeons lived and caused an unknown number of infestations in humans. Pigeon
bugs deriving from feral pigeons on the other hand caused several infestations
in Hamburg. Prisoners fed feral pigeons on the windowsills and were then bitten
by pigeon bugs. In a second case pigeon bugs invaded a hotel from feral pigeons
breeding in the courtyard. The bugs entered the room by funnels coming from
outside that were only wallpapered. Several hotel guests and a female pest
controller were bitten by the pigeon bugs.
The Pigeon Flea Ceratophyllus columbae the original flea of the pigeon is the
pigeon flea Ceratophyllus columbae, which is a frequent ectoparasite of feral
pigeons (fig. 7). The male is approximately 2.5 mm long, the female 3.2 mm. For
a reliable identification, the form of the females’ receptaculum seminis, the
lengths of the bristles of the 8th sternite and the number of the barbs of the first
breast ring can be used. In all known cases of pigeon flea infestations due to
feral pigeons, the parasites invaded from pigeon nests. In Ham burg, Krall found
the parasite in 60% of the inspected feral pigeon nests. Pigeon fleas are regularly
found in the feral pigeon lofts of the ‘Pigeon Action Basel’. The spread of the fleas
occurs actively by emigration or passively with pigeons. A large part of young
pigeons leave their parents a few weeks after fledging and try to join another
breeding colony. Since pigeon fleas stick their eggs on the plumage of pigeons,
the parasites can be passively distributed by emigrating pigeons. In cases of a
heavy infestation, in one nest hundreds to thousands of pigeon fleas occur and
can lead to the emigration of the bothered birds. The lack of their natural host
subsequently leads to the emigration of the fleas searching for new hosts. Larvae
of the pigeon flea are able to starve for weeks, adults even for 11 months. A flea
infestation can therefore occur weeks or months after pigeons have been absent
from the breeding sites. Preferable bite sites of fleas are the extremities, face,
neck, hips and shoulders.
During the feeding which takes 2–6 min, the mouthparts pierce the host’s skin
to siphon blood, while saliva is secreted to prevent coagulation. Flea saliva is
highly antigenic, producing pruritic papules often seen in clusters and rarely
hemorrhagic blisters. Infestations with pigeon fleas may lead to important
psychological stress. Over a period of 2 months, a couple was repeatedly invaded
by pigeon fleas. The source of the fleas was a single breeding pair of feral pigeons.
The nest was located in the attic immediately above the couple’s apartment, and
the fleas entered along an unsealed heating pipe. The man noted on his hip
vesicular skin lesions of 1 mm in diameter, surrounded by erythematous patches
of approximately 1.5 cm in diameter. Almost every morning he found 8–10 new
bite marks on each leg, typically ordered in lines each of 3 or 4 marks. At the
bite sites, red indurated itching papules developed, surrounded by erythema that
persisted for up to 2 weeks. Gradually, urticarial reactions to the bites developed
in the form of wheals of approximately 1 cm in diameter, surrounded by
erythema. With invasions repeated almost every night, the man gradually
developed an allergic urticarial reaction. The patient suffered from generalized
pruritus and on his arms and legs urticarial wheals appeared, which were not
preceded by flea bites in these areas. Additionally, the patient experienced
intense itching at the sites of previous bites. The information of infestation by
fleas resulted in phobia and insomnia. Despite the successful removal of the
fleas and the pigeons, his parasitophobia persisted for 4 months. To remove the
source of infestation, nests and nest debris including the larvae have to be
removed, the area formerly occupied by the pigeons has to be disinfested and a
future access for the pigeons has to be prevented. Because pupal stages form
about 10% of the flea population, disinfestation has to be repeated after 2 weeks
to prevent an infestation with newly hatched imagos.
The Red Mite Dermanyssus gallinae Dermanyssus gallinae (red mite, red poultry
mite, chicken mite, fowl mite, roost mite) is the most common mite associated
with feral pigeons and seems to be widely distributed in feral pigeon breeding
sites (fig. 8). Red mites are able to starve for up to 8.5 months so that the
para site can emigrate from pigeon breeding sites a long time after their original
hosts have disappeared. D. gallinae has 8 legs in adult and nymph stages, and
moves rapidly with a speed of up to 120 m/h. This allows the mites to roam over
large distances when searching for new hosts. The adult female is, depending on
nutritional status, 0.75–1 mm long and 0.35–0.4 mm wide and has stiletto-
shaped chelicerae adapted for piercing and sucking that are retracted into the
body during the resting state. The male is somewhat smaller with 0.6–0.7 mm
length, and its chelicerae are scissor-shaped. This bloodsucking mite is red to
black in color when gorged with blood, and yellow-brown when unfed. It may
infect a variety of birds worldwide including various domestic bird. During the
daytime it is usually hidden in the nesting material and in close proximity to the
nest. Attacks on humans occur usually at night but infestations have also been
reported during the daytime. D. gallinae strikes rapidly and is able to bite in less
than. Cutaneous reactions in man are uncharacteristic and therefore difficult to
diagnose. Usually, the mites cannot be found on the human host as they leave
quickly after their blood meal. Clinical manifestations in humans include pruritic
papules and occasionally vesicles, urticaria and erythema. Stings are usually
found on the trunk and limbs, but not in interdigital spaces, genitals or skin
folds. The stings of red mites are irritating, but typically harmless.
 Fig. 7. The pigeon flea Fig. 8. The red mite Dermanyssus Fig. 9. The pigeon tick Argas
Ceratophyllus columbae is very gallinae with its long legs is able to reflexus rep resents the most
similar to the widespread cover large distances when significant health hazard.
chicken flea Ceratophyllus searching for new hosts.
gallinae. posed by feral pigeons.

For an infestation, the parasite has to cover the distance to the human
host. There a two principal ways. In the first case the patient actively comes in
contact with the source of infestation. All reported cases of such human activity
leading to an infestation with feral pigeon parasites concerned the red mite D.
gallinae. For example, Przybilla et al. described a young woman who was stung
by red mites when removing a feral pigeon nest from a toilet, and Baselga et al.
reported a case where a young woman brought a radio with red mites from the
attic where feral pigeons lived. She and her brother were subsequently infested
with the mites. One of us (Haag-Wackernagel) was attacked by hundreds of red
mites shortly after a pigeon loft keeper had put a plastic bag with pigeon feces
harboring the parasites in front of his office. In all other cases the parasite
actively covered the distance to the human host from feral pigeon breeding or
resting sites. Auger et al. [42] reported a hospital infection in 10 patients by D.
gallinae from feral pigeon nests on galleries, window ledges and air conditioners.
The patients acquired the stings while walking in the galleries.
Winkler reported a hospital infection where D. gallinae entered the patients’
rooms through ventilation openings and attacked 12 patients, one suffering over
500 bites. Cafiero et al. reported several cases from Southern Italy where
humans were attacked by red mites which all derived from abandoned feral
pigeon nests. In Zurich (Switzerland) in 1930, many inhabitants panicked when
an article in a local newspaper reported an outbreak of an infestation caused by
the red blood mite. The feral pigeons were shot and the human population was
advised not to feed pigeons as it was believed that even feeding pigeons might
lead to infestations. The parasite can be easily removed from the patient by
showering or a full bath. In most cases, medical treatment is not necessary. If
treatment of mite bites is needed, antihistamines and mild topical corticosteroids
typically bring rapid relief. Elimination of the mite from the patient’s environment
is usually curative since they are only temporary visitors to the human skin and
incapable of living and reproducing on the human host. Roaming mites in
human living space can easily be removed with a vacuum cleaner or treated with
a nontoxic insecticide spray as e.g. pyrethroids.
Pigeon nests should be completely removed and treated with insecticides
before disposal to prevent further infestations as the parasites may leave the
waste bins. To prevent further nesting and roosting, access to buildings should
be obstructed, and ledges and other structures should be protected with pigeon
deterrent systems or structural restrictions. The Northern Fowl Mite
Ornithonyssus sylviarum the northern fowl mite is a common, bloodsucking
parasite that occurs on the plumage of the chicken in temperate regions
throughout the world. It also affects pigeons and many wild birds. The northern
fowl mite is very similar to D. gallinae and therefore often confused with it. The
entire life cycle of Ornithonyssus sylviarum usually takes place on the host.
Under high infestations the parasite can also be found in nest debris from where
it can emigrate to human habitations. Up to date only 1 case has been reported
where the mite emigrated from an abandoned feral pigeon nest together with D.
gallinae and caused a nosocomial infection in a hospital. The Pigeon Tick Argas
reflexus the most important ectoparasite, even the most significant health hazard
posed by feral pigeons, is the soft tick A. reflexus (fig. 9). It is a temporary,
bloodsucking ectoparasite of pigeons occurring in various parts of Europe, the
Near East and the USA. This originally Mediterranean tick species was probably
introduced to central Europe by humans together with the domestic pigeon. A.
reflexus is a widely present tick at breeding sites of feral pigeons and is harbored
by most feral pigeon populations. The tick is brownish, and unfed 4–15 mm long,
6–8 mm wide and 1–2 mm thick (fig. 9). It’s typical habitat comprises pigeon
nesting sites where the ticks seek shelter in crevices of walls or in slits in wood
in the vicinity.
Discussion
We describe a case where a female patient was concurrently attacked by 3
different ectoparasites deriving from feral pigeons. Pigeon ticks and red mites
were determined by us, bedbugs by the patient. The symptoms of stings
described by the patient are consistent with stings of bedbugs. She recognized
the bedbugs by an internet search and from specimens of our collection, so her
identification can be considered to be confirmed. The patient and her partner
suffered from hundreds of red mite stings simulating a generalized exanthema.
It is well known that these mites infest humans by hundreds. A report described
a hospital infection with red mites where a patient suffered from 500 stings. The
general symptoms described are difficult to interpret. Most likely it is an
inflammatory response of the organism to foreign proteins. In this case the cause
of the dermatosis could only accidentally be diagnosed as a zoonosis due to feral
pigeons. The ectoparasites of feral pigeons attack their human hosts preferably
during the night and hide following their blood meal. Patients show nonspecific
clinical signs that are very difficult to assign due to the problems of detection of
the parasites and accurate identification of the species as well as relating the
symptom to be due to a parasitization. Most dermatologists are aware of
dermatoses associated with burrowing parasites as e.g. Sarcoptes scabiei, but if
the dermatitis is caused by zoonotic ectoparasites it is often misdiagnosed. In
the cases reported by Cafiero et al, diagnoses were consistently generic and even
when the eruption was attributed to acariasis, the possibility of zoonosis was not
suspected. The patients often received symptomatic therapy, e.g. cortisone and
tranquilizers, without a proper diagnosis.
Additionally, none of the consulted physicians advised patients to inspect their
homes for parasites. Physicians should be aware of the possibility of an
infestation with parasites deriving from feral pigeons. In cases with dermatosis
of unclear etiology of patients living in urban areas, a zoonosis caused by feral
pigeon ectoparasites should always be considered. Patients should be carefully
interrogated to ask for feral pigeons close to their habitation, especially when
they live in the uppermost apartment or directly under the roof. In the case of a
suspicion, parasites can be caught for determination by a glue barrier that can
be placed around the bed, e.g. with double-sided adhesive tape normally used to
affix carpets. If the parasites are identified, a careful search in the living space
of the patient, including house facade, balconies and ledges, ventilation
openings, air conditioner inlets etc., should be performed. Inside buildings
particular electrical devices and other warm areas are preferred by pigeon
parasites, as they are adapted to the pigeon’s body temperature of 42 ° C.
Ectoparasites are able to cover relatively large distances. Hence, adjoining
houses and backyards have also to be considered as areas where feral pigeons
could live as a source for ectoparasites. Even feral pigeons that only stay
temporarily in an area can be a source of a parasitic infestation. Williams
reported a case where feral pigeons congregated to drink from small pools on an
uneven flat roof where water accumulated following rain. Red mites emigrated
from the pigeons and invaded an apartment where 2 women were in fasted. If
the source is localized, the whole area has to be disinfested by a pest controller.
To prevent feral pigeons from further using a building, bird proofing by
appropriate deterrent systems or architectural measures has to be carried out.
A first measure often applied is the aspiration of the parasites with a vacuum
cleaner. As shown in figure 1 engorged ticks do not survive aspiration because
of bursting whereas starving ticks remain sound and could be able to leave the
vacuum cleaner and could lead to infestation. Survival of aspiration and leaving
the vacuum cleaner is known from bedbugs, whereas red mites are too delicate
to resist. Aspiration of parasites without immediate disinfestation or safe
disposal of the content of the cleaner bag bears the risk of reinfestation. In cases
where the source of an ectoparasite infestation is not detectable and
reinfestations occur, the patients have to leave their habitation as an ultimate
measure. This has to be recommended when recurrent anaphylactic reactions
due to pigeon tick infestations occur. Miadonna et al. escribed a case where a
patient changed his residence after having developed an anaphylactic shock
consisting of dyspnea and hypotension due to pigeon tick bites. Till now more
than 370 infestations of humans due to feral pigeons have been reported. In 71%
of these cases, the sources of infestations were nests on the building shell or
inside buildings. In the present case, the pigeons used a balcony after having
been attracted by food provided by the former tenant. To support a population
of ectoparasites, a continuous supply of hosts must be guaranteed. Buildings
infested with feral pigeons for longer than 1 year or breeding sites populated with
more than 50 feral pigeons are at high risk of harboring pigeon ticks. Hence, it
is surprising that only few pigeons using a small balcony were the source of
infestations with 3 parasite species. To our knowledge only 1 case has been
reported where more than 1 parasite species were transmitted from feral pigeons
to humans. Vargo et al. described a hospital infection with 2 mite species, D.
gallinae and O. sylviarum, which originated from an abandoned pigeon nest.
Even a single abandoned feral pigeon nest can be the cause for the emigration
of ectoparasites and infestation of humans as demonstrated for red mites and
pigeon fleas. From domestic pigeons it is known that the birds leave their
breeding sites when parasite populations are very high. Such emigrating
individuals transport parasites to new places. Emigrating young birds occupying
new breeding sites additionally play an important role in the dissemination of
parasites. Feral pigeon colonies close to human habitations bear a latent risk of
parasitic infestations and are difficult to prevent. The real cause of the problem
is the high feral pigeon populations in our cities due to a large food basis provided
deliberately by pigeon feeding or accidentally by discarded food. Infestations of
humans with feral pigeon parasites are therefore only one side of the problem
linked with the overpopulation by these birds in our cities. Sustainable solutions
can only be reached by integrative measures as e.g. public edu cation and
feeding restrictions.
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