Bedbugs

Bedbug infestations occur throughout the world. The most common bedbugs affecting humans are Cimex lectularis (in temperate climates) and C. hemipterus (mainly in tropical climates).

Bedbugs hide in cracks and crevices of mattresses, other structures (eg, bed frames, cushions, and walls; in areas with less than optimal living conditions such as mud houses and thatched roofs). They multiply exponentially; a few bedbugs multiply to thousands within 2 to 3 months. They move slowly and are attracted to people by warmth and carbon dioxide.

Bedbugs bite exposed skin, usually at night. A feeding is completed in 5 to 10 minutes. Bedbugs are not known to transmit infections to humans (1 Etiology reference Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication... read more ).

Lesions are generally on exposed skin. They develop some time between the morning after and 10 days after being bitten. Lesions can be any of the following:

Lesions may form linear patterns or may be seen in groups (1 Symptoms and signs reference Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication... read more ). Older adults develop symptoms less often than do younger people. Lesions resolve after about 1 week. Secondary infection can develop.

Patients may be anxious about the difficulty and expense of eradicating a bedbug infestation and about the social stigma that can result from infestation. They may isolate themselves to avoid spreading infestation.

Diagnosis based on lesion appearance may be difficult because the appearance is usually nonspecific. However, most bedbug bites are larger and more edematous than other bites (eg, flea bites).

Identification of bedbugs can help confirm the diagnosis. Bedbugs have flat, oval, reddish brown bodies. After a blood meal, the body is less flat and more reddish. Adult C. lectularis are about 5 to 7 mm in length, and C. hemipterus are slightly longer. Bedbug feces or blood may be evident on bed linens or behind wallpaper.

Bedbug bites are treated symptomatically (eg, with topical corticosteroids and/or systemic antihistamines) as needed.

Eradicating bedbugs is difficult and is closely linked to detection. Eradication typically requires a multipronged approach and includes accurate detection and monitoring techniques, nonchemical modalities, and chemical agents. Nonchemical control options include exposure to extreme temperatures, exclusion, and physical removal (1 Treatment references Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication... read more ).

Physical removal includes vacuuming affected areas and laundering suspect articles, then drying them on the dryer's hottest setting. In addition, entire rooms should be treated professionally, when possible, by heating to temperatures ≥ 50° C (122° F) or with multiple insecticides. The use of insecticides is limited largely because of issues with resistance. Bedbugs and eggs on infested items are killed when frozen at -20° C (-4° F) for at least 2 hours; however, placement in most home kitchen freezers is typically insufficient (2 Treatment references Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication... read more ).

Prevention methods include the use of simplified furniture (eg, metal beds). Harborage of bedbugs can be reduced by sealing cracks and crevices. New sleeping areas (eg, hotel rooms) should be inspected prior to use, with particular attention to the mattress and bedding (1 Prevention reference Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication... read more ).