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Bed Bugs

Bed Bugs is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Nocturnal obligate blood parasites residing in furniture and bedding
  • 5 to 7 mm oval, reddish brown, flat, wingless

Epidemiology

Incidence
  • 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

Prevalence
  • 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.

General Prevention

  • 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].

Risk Factors

  • Immunocompromised
  • High hotel turnover
  • Secondhand furniture in home

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Citation

Stephens, Mark B., et al., editors. "Bed Bugs." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/3.2/Bed_Bugs.
Bed Bugs. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/3.2/Bed_Bugs. Accessed July 23, 2019.
Bed Bugs. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/3.2/Bed_Bugs
Bed Bugs [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 23]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/3.2/Bed_Bugs.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bed Bugs ID - 816286 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/3.2/Bed_Bugs PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -