Bed Bugs
Basics
Description
- Nocturnal obligate blood parasites residing in furniture and bedding
- 5 to 7 mm oval, reddish brown, flat, wingless morphology
- Microscopic evidence suggests a mature bed bug Cimex lectularius is approximately the size of an apple seed (1).
Epidemiology
Incidence
- Bed bug infestations are increasing in incidence and becoming more difficult to treat (2).
- Resurgence due to changes in pesticide, increased travel, use of secondhand furniture, and high turnover rates of hotel guests
Prevalence
- Infestations have increased by 10–30% across the United States (1) in public places (schools, hospitals, hotels/motels, aircraft) over the past decade.
- The global population of bed bugs (C. 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 increasing annually.
- There are over 75 species of Insecta: Hemiptera: Cimicidae (“bed bugs”) with the two genera and species implicated in human infestations being C. lectularius and C. hemipterus (1).
- C. lectularius lives in urban environments and C. hemipterus lives in tropical climates.
Etiology and Pathophysiology
- Insect family Cimicidae
- Three species bite humans: C. lectularius, C. hemipterus, and Leptocimex boueti.
- Most prevalent species is C. lectularius.
- 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, bed bug infestations are not associated with alterations in personal hygiene.
- 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.
- Bullous reactions caused by an IgE-mediated hypersensitivity to nitrophorin in bug saliva
- Bugs are attracted to body warmth and exhaled carbon dioxide.
- Bites do not transmit other known pathogens.
Risk Factors
- Immunocompromise
- High hotel turnover
- Secondhand furniture in home
General Prevention
- Traps typically use carbon dioxide and heat to attract and trap bugs but can be cost prohibitive.
- 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.
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Citation
Domino, Frank J., et al., editors. "Bed Bugs." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/all/Bed_Bugs.
Bed Bugs. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/all/Bed_Bugs. Accessed October 9, 2024.
Bed Bugs. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/all/Bed_Bugs
Bed Bugs [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 09]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816286/all/Bed_Bugs.
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