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- Nocturnal obligate blood parasites residing in furniture and bedding
- 5 to 7 mm oval, reddish brown, flat, wingless
- Bed bug infestations increasing and difficult to treat, more so than cockroaches, termites, and ants (1)
- Resurgence due to changes in pesticide, increased travel, use of secondhand furniture, and high turnover rates of hotel guests
- Infestations are increasing across the United States.
- Bed bugs have increased 10–30% in public places (schools, hospitals, hotels/motels, aircraft) over the past decade (2).
- The global population of bed bugs (Cimex lectularius and Cimex hemipterus, family Cimicidae) has undergone a significant resurgence since the late 1990s. This is likely due to an increase in global travel, trade, and the number of insecticide-resistant bed bugs. The global bed bug population is estimated to be increasing by 100–500% annually (3).
Etiology and Pathophysiology
- Insect family Cimicidae
- Three species bite humans: C. lectularius, C. hemipterus, and Leptocimex boueti (2)[B].
- Most prevalent species is C. lectularius (2)[B].
- Found in tropical and temperate climates
- Hide in crevices of mattresses, box springs, headboards, and baseboards
- Infestations occur in hotels/motels, hospitals, cinemas, vehicles, aircraft, and homes.
- Unlike other infestations, they are not associated with hygienic deficiencies.
- Reactions range from an absent or minimal response to the typical pruritic, erythematous maculopapular rash. Less commonly, there is an urticarial or anaphylactoid response.
- Skin reactions are due to host immunologic response to parasite salivary proteins.
- Urticarial reactions are mediated via immunoglobulin (Ig) G antibody response to salivary proteins (4)[B].
- Bullous reactions caused by an IgE-mediated hypersensitivity to nitrophorin in bug saliva (4)[B]
- Bugs are attracted to body warmth and exhaled carbon dioxide (5).
- Bites do not transmit other known pathogens.
- Traps typically use carbon dioxide and heat to attract and trap bugs but can be cost prohibitive (6)[B].
- Vector control: Vacuum regularly, reduce clutter, seal cracks in walls, inspect luggage and clothing.
- Launder all bedding and clothing in >130°F (50°C) for 2 hours or place in 20°F (−5°C) or cooler environment for at least 5 days.
- If present in the home, eradicate using professional extermination services. Some pest control companies use canines to detect live bed bugs and eggs based on pheromones from the bed bugs (6)[B].
- High hotel turnover
- Secondhand furniture in home