Breakfast, lunch, and dinner sign: a hallmark of flea and bedbug bites

Abstract

Human, dog, and cat fleas, as well as bedbugs, feed by biting their victims, causing acute prurigo, which is aggravated in sensitized victims (papular urticaria). The lesions appear in the classic "breakfast, lunch, and dinner" pattern. There are two main explanations: the parasites "map" the skin area in search of the best places to bite, and their removal when victim scratches, and then reattach to the skin. Treatments aim to control pruritus, as well as hypersensitivity reactions when necessary. Prevention is based on environmental control measures. The "breakfast, lunch, and dinner" sign is a definitive marker for diagnosis and the parasite´s identification and control.

New pandemic, old bugs: A case of cimicosis (Bed Bug) in a neglected elderly patient during the coronavirus disease quarantine

“…The “breakfast, lunch, and dinner” pattern of these lesions is characteristic, not just for infestation by bed bugs of Cimex genus but also fleas 2 ( Figure 1 ). Since bed bugs usually seek shelter during the day and become inactive while digesting their blood meal, direct observation of a live bedbug during a consultation (as shown in the image sequence) is an uncommon feature 1 .…”

“…Bed bugs are reddish-brown hematophagous arthropods that parasitize humans as well as other warm-blooded mammals and birds 1 ( Figure 1 ). They commonly inhabit carpets, cracked floor tiles, bedroom furniture, mattresses, and wall cracks 1 , 2 .…”

“…Bed bugs are reddish-brown hematophagous arthropods that parasitize humans as well as other warm-blooded mammals and birds 1 ( Figure 1 ). They commonly inhabit carpets, cracked floor tiles, bedroom furniture, mattresses, and wall cracks 1 , 2 . Approximately seven different species can parasitize humans, including the most common human bed bug Cimex lectularius , distributed worldwide 1 , 2 .…”

“…They commonly inhabit carpets, cracked floor tiles, bedroom furniture, mattresses, and wall cracks 1 , 2 . Approximately seven different species can parasitize humans, including the most common human bed bug Cimex lectularius , distributed worldwide 1 , 2 . During the coronavirus disease (COVID-19) pandemic, there has been a marked increase in reports of elder abuse, including those related to poor hygiene conditions 3 .…”

Linear erythematous papules in a young boy

“…In children, unilateral eyelid swelling, bullous and urticarial reactions are other common signs of bedbug bites. Successive blood meals and prior marking of the skin areas by the parasites using apyrase (an anticoagulant enzyme) favour the mechanism of sequential urticariform papules …”