{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:57:20Z","timestamp":1779173840757,"version":"3.51.4"},"reference-count":66,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Due to their mass occurrence in some environments and high aggressiveness, blackflies (Simulium spp.) represent the most bothersome arthropods attacking humans. In this study, we describe the medical effects of blackfly infestations in humans in southeastern Poland. Local and systemic reactions to blackfly bites were monitored in 418 patients (61.24% of females and 38.76% of males) of medical centers. Only skin lesions at the site of the bites were found in 88.52% of the patients, whereas accompanying systemic reactions were diagnosed in 11.48%. The most common signs observed in the area of the bites were pruritus (94.74%), burning (55.02%), edema (44.02%), and erythema (40.91%). The skin lesions, which were most often grouped small papules and papular and purpuric lesions with a varied range, typically persisted for several days, or for several weeks in some patients. Statistical analyses confirmed that the persistence of the skin lesions did not depend on the sex of the patients and the number of blackfly infestations. The systemic reactions to the components of the blackfly saliva were manifested by headache, increased body temperature, arthralgia, lymphadenopathy, and menstrual disorders in the females. The patients were most often attacked simultaneously by many blackflies on exposed parts of the body, mainly the upper limb, lower limb, head, and neck areas. The investigations indicate that blackflies are an important etiological factor of dermatitis and other symptoms in humans; hence, they should be considered in clinical diagnosis.<\/jats:p>","DOI":"10.3390\/jcm10040788","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T08:09:09Z","timestamp":1613462949000},"page":"788","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Skin Lesions and Systemic Reactions in Humans Infested by Blackflies (Diptera: Simullidae) in Recreational Areas in Southeastern Poland"],"prefix":"10.3390","volume":"10","author":[{"given":"Monika","family":"Sitarz","sequence":"first","affiliation":[{"name":"Chair and Department of Conservative Dentistry with Endodontics, Faculty of Medical Dentistry, Medical University of Lublin, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8032-9495","authenticated-orcid":false,"given":"Alicja","family":"Buczek","sequence":"additional","affiliation":[{"name":"Chair and Department of Biology and Parasitology, Faculty of Health Sciences, Medical University of Lublin, 20-080 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weronika","family":"Buczek","sequence":"additional","affiliation":[{"name":"Chair and Department of Biology and Parasitology, Faculty of Health Sciences, Medical University of Lublin, 20-080 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"ref_1","unstructured":"Adler, P.H. (2020, January 01). World Blackflies (Diptera: Simuliidae): A Comprehensive Revision of the Taxonomic and Geographical Inventory. Available online: https:\/\/biomia.sites.clemson.edu\/pdfs\/blackflyinventory.pdf."},{"key":"ref_2","first-page":"475","article-title":"Zur Beurteilung und Bek\u00e4mpfung der Kriebelm\u00fcckensch\u00e4den des Leinegebietes","volume":"63","author":"Enderlein","year":"1931","journal-title":"Arch. Wiss. Prakt. Tierhlk."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1017\/S0007485300017867","article-title":"The medical importance and behaviour of Simulium austeni Edwards (Diptera: Simuliidae) in England","volume":"69","author":"Hansford","year":"1979","journal-title":"Bull. Entomol. Res."},{"key":"ref_4","first-page":"133","article-title":"An outbreak of Boophthora erythrocephala (Diptera, Simuliidae) in Yugoslavia in 1970","volume":"22","author":"Burany","year":"1972","journal-title":"Acta Vet. Beogr."},{"key":"ref_5","first-page":"231","article-title":"Odagmia ornata in der \u00e4rzlichen Praxis","volume":"14","author":"Nohel","year":"1973","journal-title":"Angew. Parasit."},{"key":"ref_6","first-page":"271","article-title":"Simuliaza\u2014Choroba spowodowana uk\u0142uciami owad\u00f3w z rodziny mustykowatych","volume":"28","author":"Nohel","year":"1980","journal-title":"Wiad. Parazytol."},{"key":"ref_7","first-page":"205","article-title":"A faunistic review of the black flies (Simuliidae, Diptera) of the federal state of Sachsen-Anhalt","volume":"27","author":"Werner","year":"2005","journal-title":"Ger. Abh. Ber. Nat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13028-018-0425-1","article-title":"A prospective study on insect bite hypersensitivity in horses exported from Iceland into Switzerland","volume":"60","author":"Torsteinsdottir","year":"2018","journal-title":"Acta Vet. Scand."},{"key":"ref_9","first-page":"209","article-title":"Simulide (Diptera, Simuliidae) koje napadaju ceoveka i domace \u017civotinje","volume":"20","year":"1970","journal-title":"Acta Vet. Beogr."},{"key":"ref_10","unstructured":"Niesio\u0142owski, S., and Bok\u0142ak, E. (2001). Meszki (Simuliidae, Diptera). Fauna S\u0142odkowodna Polski, Zeszyt 11A, Wydawnictwo Uniwersytetu \u0141\u00f3dzkiego."},{"key":"ref_11","first-page":"307","article-title":"Review of blackfly (Diptera: Simuliidae) control in South Africa","volume":"70","author":"Myburg","year":"2003","journal-title":"Onderstepoort J. Vet. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5152\/tpd.2014.3446","article-title":"Economic losses during an outbreak of Simulium (Wilhelmia) species (Diptera: Simuliidae) in the Cappadocia Region of Turkey","volume":"38","author":"Inci","year":"2014","journal-title":"Turk. Parazitol. Dergisi."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1139\/z56-064","article-title":"Observations on the mating, feeding, ovarian development, and oviposition of adult black flies (Simuliidae, Diptera)","volume":"34","author":"Davies","year":"1956","journal-title":"Can. J. Zool."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.20506\/rst.13.4.819","article-title":"Nematocera (Ceratopogonidae, Psychodidae, Simuliidae and Culicidae) and control methods","volume":"13","author":"Braverman","year":"1994","journal-title":"Rev. Sci. Tech. Int. Off. Epizoot."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1590\/S1516-89132006000600014","article-title":"Eggs fertility and biological aspects of the life cycle in natural populations of Simulium (Diptera, Simuliidae)","volume":"49","author":"Petry","year":"2006","journal-title":"Braz. Arch. Biol. Technol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1179\/136485908X337427","article-title":"The onchocerciasis control programme in West Africa (OCP)","volume":"102","author":"Boatin","year":"2008","journal-title":"Ann. Trop. Med. Parasitol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/1756-3305-4-205","article-title":"Onchocerciasis in the Americas: From arrival to (near) elimination","volume":"4","author":"Gustavsen","year":"2011","journal-title":"Parasit. Vectors"},{"key":"ref_18","unstructured":"(2020, January 01). Black Fly. Available online: https:\/\/hortnews.extension.iastate.edu\/black-fly."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1637\/9647-070711-CASE.1","article-title":"Avian simuliotoxicosis: Outbreak in Louisiana","volume":"56","author":"Schnellbacher","year":"2012","journal-title":"Avian Dis."},{"key":"ref_20","first-page":"517","article-title":"Faunistiske og biologiske bidrag til danske Simulier\u2019s Naturhistorie","volume":"80","author":"Ussing","year":"1925","journal-title":"Viden Meddr. Dansk. Naturh. Foren."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/S1081-1206(10)61561-X","article-title":"A patient with severe black fly (Simuliidae) hypersensitivity referred for evaluation of suspected immunodeficiency","volume":"92","author":"Orange","year":"2004","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_22","first-page":"2","article-title":"Occurrence and harmful effects of the black flies in the Schwerin district of East Germany","volume":"17","author":"Grafner","year":"1976","journal-title":"Angew. Parasitol."},{"key":"ref_23","first-page":"41","article-title":"Death of 25 farm animals (including 24 cattle) attributed to the bites of Simuliidae (black flies) in the Vosges","volume":"63","author":"Noirtin","year":"1979","journal-title":"Bull. Mens. Soc. V\u00e9t. Prat. Fr."},{"key":"ref_24","first-page":"209","article-title":"Diptera simuliidae, blackflies","volume":"Volume 2","author":"Nilsson","year":"1997","journal-title":"Aquatic Insect of North Europe. A Taxonomic Handbook"},{"key":"ref_25","unstructured":"Wegner, E. (2006). Mass occurrences of blackflies (Diptera: Simmulidae) and control actions against them in Poland. Acta Ent. Serb., 155\u2013159."},{"key":"ref_26","first-page":"331","article-title":"The blackfly (Diptera, Simuliidae) situation in Germany: Harmful regions, simuliotoxicosis and development trends","volume":"17","author":"Werner","year":"2009","journal-title":"Mitt. Dtsch. Ges. Allgew. Ent."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/00130832-200108000-00011","article-title":"Mosquito bite pathogenesis in necrotic skin reactors","volume":"1","author":"Engler","year":"2001","journal-title":"Curr. Opin Allergy Clin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/S0140-6736(13)61605-0","article-title":"Anaphylaxis caused by mosquito allergy in systemic mastocytosis","volume":"382","author":"Reiter","year":"2013","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/S1081-1206(10)61141-6","article-title":"Deer ked-induced occupational allergic rhinoconjunctivitis","volume":"94","author":"Laukkanen","year":"2005","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_30","first-page":"73","article-title":"Deer ked (Lipoptena cervi) dermatitis in humans\u2014An increasing nuisance in Finland","volume":"45","author":"Laine","year":"2009","journal-title":"Alces J. Devoted Biol. Manag. Moose"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3316","DOI":"10.3390\/ijerph17093316","article-title":"Comparison of skin lesions caused by Ixodes ricinus ticks and Lipoptena cervi deer keds infesting humans in the natural environment","volume":"17","author":"Buczek","year":"2020","journal-title":"Int. J. Environ. Res. Public Health."},{"key":"ref_32","first-page":"151","article-title":"Tick bites on humans in the agricultural and recreational areas in south-eastern Poland","volume":"18","author":"Bartosik","year":"2011","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/1756-3305-6-362","article-title":"Ixodes ricinus ticks removed from humans in Northern Europe: Seasonal pattern of infestation, attachment sites and duration of feeding","volume":"6","author":"Wilhelmsson","year":"2013","journal-title":"Parasit. Vectors"},{"key":"ref_34","first-page":"447","article-title":"Epidemiological and clinical picture of stings by a certain species of simulids (Boophthora erythrocephala) in the year 1970 in the region of Tisa river","volume":"25","author":"Burany","year":"1972","journal-title":"Med. Pregl."},{"key":"ref_35","first-page":"325","article-title":"Reactions to simuliids and some aspects of medical importance of black flies (Diptera: Simuliidae)","volume":"57","year":"1982","journal-title":"Ceskoslovenska Dermatol."},{"key":"ref_36","first-page":"171","article-title":"Simuliosis. Analysis of dermatological manifestations following blackfly (Simuliidae) bites as observed in the years 1981\u20131983 in Bratislava (Czechoslovakia)","volume":"32","author":"Farkas","year":"1984","journal-title":"Derm. Beruf. Umwelt."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1051\/parasite\/1993682109","article-title":"Observation en France de Simulium erythrocephalum De Geer, 1776 comme agent de simuliidose humaine","volume":"68","author":"Gilot","year":"1993","journal-title":"Ann. Parasitol. Hum. Comp."},{"key":"ref_38","first-page":"424","article-title":"An invasion of insect Simulium columbaczense (Diptera, Simuliidae) described in an old Romanian chronicle","volume":"107","author":"Dancescu","year":"2002","journal-title":"Rev. Med. Chir. Soc. Med. Nat. Iasi."},{"key":"ref_39","unstructured":"Buczek, A., and B\u0142aszak, C. (2002). Zr\u00f3\u017cnicowane zmiany sk\u00f3rne u os\u00f3b zaatakowanych przez paso\u017cytnicze stawonogi z rodzaju Simulium (Insecta: Diptera), Ctenocephalides (Insecta: Siphonaptera) i Argas (Arachnida: Acarina), Stawonogi w Medycynie."},{"key":"ref_40","first-page":"208","article-title":"An outbreak of Simulium erythrocephalum (De Geer, 1776) (Diptera, Simuliidae) in the region of Novi Sad (Serbia) in 2010","volume":"38","year":"2010","journal-title":"Biljni. Lekar."},{"key":"ref_41","first-page":"20","article-title":"Kounis syndrome, two case reports from Kragujevac, Serbia","volume":"4","author":"Davidovic","year":"2014","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13071-017-2115-7","article-title":"Human-landing rate, gonotrophic cycle length, survivorship, and public health importance of Simulium erythrocephalum in Zaragoza, northeastern Spain","volume":"10","year":"2017","journal-title":"Parasit. Vectors"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2298\/MPNS2002059V","article-title":"Cutaneous manifestations caused by Simulium erythrocephalum bites in humans\u2014A case series","volume":"73","author":"Gajinov","year":"2020","journal-title":"Med. Pregl."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"235","DOI":"10.7601\/mez.63.235","article-title":"A human case of black fly bite caused by Simulium quinquestriatum (Shiraki, 1935)","volume":"63","author":"Masaru","year":"2012","journal-title":"Med. Entomol. Zool."},{"key":"ref_45","first-page":"48","article-title":"Dermatitis caused by Simulium (black flies) bite","volume":"3","author":"Youssefi","year":"2008","journal-title":"Iran J. Parasitol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/j.1365-4632.2011.05035.x","article-title":"Clinical and histopathological study of Simulium (blackfly) dermatitis from North-Eastern India\u2014A report","volume":"51","author":"Borah","year":"2012","journal-title":"Int. J. Dermatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.mjafi.2017.02.011","article-title":"Simulum fly bites","volume":"74","author":"Prasad","year":"2018","journal-title":"Med. J. Arm. Forces India"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Tabatabaei, F., Azarmi, S., Afshar, M.J.A., Yarizadeh, H., and Mohtasebi, S. (2020). Blackfly fever and dermatitis caused by Simulium kiritshenkoi a human case report in Iran. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05070-y"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1093\/jmedent\/31.6.908","article-title":"Anticoagulant activity in salivary-gland extracts of black flies (Diptera, Simuliidae)","volume":"31","author":"Abebe","year":"1994","journal-title":"J. Med. Ent."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/0022-1910(95)00039-W","article-title":"Simulidin: A black fly (Simulium vittatum) salivary gland protein with anti-thrombin activity","volume":"41","author":"Abebe","year":"1995","journal-title":"J. Insect Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1603\/0022-2585-37.5.743","article-title":"Simulium vittatum (Diptera: Simuliidae) and Lutzomyia longipalpis (Diptera: Psychodidae) salivary gland hyaluronidase activity","volume":"37","author":"Ribeiro","year":"2000","journal-title":"J. Med. Ent."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1021\/pr8008429","article-title":"Insight into the sialome of the Black Fly, Simulium vittatum","volume":"8","author":"Andersen","year":"2009","journal-title":"J. Proteome Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"14341","DOI":"10.1074\/jbc.M113.466995","article-title":"Salivary antigen-5\/CAP family members are Cu2+-dependent antioxidant enzymes that scavenge O2\u2212 and inhibit collagen-induced platelet aggregation and neutrophil oxidative burst","volume":"288","author":"Ma","year":"2013","journal-title":"J. Biol. Chem."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.actatropica.2019.03.026","article-title":"Proteomes of the female salivary glands of Simulium nigrogilvum and Simulium nodosum, the main human-biting black flies in Thailand","volume":"194","author":"Hempolchom","year":"2019","journal-title":"Acta Trop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1007\/s00436-019-06383-x","article-title":"Characterization of IgE-binding proteins in the salivary glands of Simulium nigrogilvum (Diptera: Simuliidae)","volume":"118","author":"Hempolchom","year":"2019","journal-title":"Parasitol. Res."},{"key":"ref_56","first-page":"263","article-title":"Pathological symptoms and skin changes in humans caused by the bites of insects from the Simuliidae family","volume":"72","author":"Wach","year":"1985","journal-title":"Przegl. Dermatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1001\/archderm.1954.01540230059007","article-title":"Acute and chronic reactions to black fly (Simulium Fly)","volume":"70","author":"Gudgel","year":"1954","journal-title":"AMA Arch. Derm. Syphilol."},{"key":"ref_58","first-page":"311","article-title":"Allergy to the bites of blood-sucking insects: Clinical manifestations","volume":"31","author":"Lavaud","year":"1999","journal-title":"Allerg. Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"241","DOI":"10.4269\/ajtmh.1994.50.241","article-title":"Vasodilative activity in black fly salivary glands","volume":"50","author":"Cupp","year":"1994","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1242\/jeb.201.10.1553","article-title":"Analyses of cDNA and recombinant protein for a potent vasoactive protein in saliva of a blood-feeding black fly, Simulium vittatum","volume":"201","author":"Cupp","year":"1998","journal-title":"J. Exp. Biol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3109\/1547691X.2013.809038","article-title":"Immunomodulating effects and hypersensitivity reactions caused by Northeast Indian black fly salivary gland extract","volume":"11","author":"Chattopadhyay","year":"2014","journal-title":"J. Immunotoxicol."},{"key":"ref_62","unstructured":"Buczek, A., and B\u0142aszak, C. (2003). Czynniki anty-hemostatyczne w \u015blinie komar\u00f3w (Culicidae) i meszek (Simuliidae)\u2014Hematofagicznych much\u00f3wek (Diptera) o r\u00f3\u017cnym sposobie \u017cerowania. Stawonogi i \u017bywiciele, Koliber."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Tsujimoto, H., Kotsyfakis, M., Francischetti, I.M.B., Eum, J.H., Strand, M.R., and Champagne, D.E. (2012). Simukunin from the salivary glands of the black fly Simulium vittatum inhibits enzymes that regulate clotting and inflammatory responses. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0029964"},{"key":"ref_64","first-page":"3","article-title":"Kawasaki disease with retropharyngeal edema following a blackfly bite","volume":"2014","author":"Watanabe","year":"2014","journal-title":"Case Rep. Pediatr."},{"key":"ref_65","unstructured":"Mullen, G.R., and Durden, L.A. (2019). Black flies (Simuliidae). Medical and Veterinary Entomology, Elsevier. [3rd ed.]."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.alit.2015.11.005","article-title":"Simuliosis\u2014A dermatosis caused by black flies","volume":"65","author":"Chiriac","year":"2016","journal-title":"Allergol. Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/788\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:24:44Z","timestamp":1760160284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/4\/788"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,16]]},"references-count":66,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jcm10040788"],"URL":"https:\/\/doi.org\/10.3390\/jcm10040788","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,16]]}}}