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When what's bugging you isn't a bug

Here at the District, we examine hundreds of samples every year that are submitted by residents in response to some kind of irritation – a bite, a rash, or some other skin reaction. An entomologist from the District laboratory will work with the responding technician to find the culprit of the bites and help the resident develop a plan to stop the infestation. But what happens when those samples come back bug-free and no evidence of an infestation can be found?

Many people don’t know that there is a difference between what we feel (what our body senses) and what our brain interprets from those feelings. For example, just below the surface of your skin, there are thousands of tiny nerve receptors called sensory nerves which report to us feelings of pressure or pain. When the sensory nerves in the skin malfunction, they can create feelings of numbness, pins-and-needles, pain, tingling or even burning. The sensations feel real because, essentially, they are! It is the exact same message that would be sent to the brain if you really were on fire. Even under normal circumstances, the sensory nerves are constantly transmitting information to the brain on everything from changes in air currents (a light pressure) to impact from a flying grain of sand (a quick itch).

But for some people, perhaps after a traumatic event, an infestation, an infection, or a change in medication, the brain will lose the ability to filter through this constant stream of information. As a result, every sensation becomes significant and patients may report feeling unusual sensations – like that there are insects crawling underneath the skin. The condition can become debilitating, creating a constant fear of tiny organisms that the patient can feel but no one else can see. Patients may begin to dig or cut at their skin or apply topical treatments that are harmful or that may intensify the crawling sensation. They may also become isolated from family and friends, leading to depression and anxiety.

Many arthropods can cause an occasional bite, but regular continuous biting of humans is only caused by mites, bed bugs, fleas and lice.  If a home has been thoroughly inspected and none of these organisms have been found to be a culprit, other things that can cause a sensation of itchiness, crawling on the skin, or a skin problems  include allergic reactions, medication or drugs, medical conditions and chemicals in the home.  It can be worthwhile to eliminate other household causes of reactions, such as laundry detergents, fabrics, etc., and other changes can be explored in consultation with a medical professional.

Sometimes biting arthropods can be very hard to catch, but if biting sensations persist over many months without an identifiable culprit, residents should at least consider the possibility that the discomfort is real, but the insects aren’t.

If you believe you have an infestation of parasites in your body, please consult a medical doctor. The District is not a medical facility and so we are unable to look at samples taken from your body. However, our entomologists can help residents determine if there is an insect infestation in their homes. We accept samples in plastic bags or small containers but if the insect is too small to be picked up, it can be collected using a piece of tape or a lint roller. You may also place sticky traps (which you can request from a technician or purchase from a garden supply or hardware store) in rooms or other areas where you feel you are being bitten. Wait a week, and then submit them to the laboratory for an insect identification.

The best thing to do if a person believes they have an infestation of an organism but entomologists and pest control experts cannot detect anything, is to go to see his primary care physician.  A doctor or nurse can then coordinate appropriate treatments, whether dermatological, parasitological, mental health, or a combination. 

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