- Dirk M Elston, MD
Dirk M Elston, MD
- Professor and Chair, Department of Dermatology and Dermatologic Surgery
- Medical University of South Carolina
- Stephen Kells, PhD
Stephen Kells, PhD
- Associate Professor of Entomology
- University of Minnesota
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Bedbugs are obligate, blood-feeding insects that infest human dwellings and inflict bites that can cause local skin reactions in humans (picture 1A-E). Management involves confirmation and eradication of the infestation. Antipruritic agents and psychologic support for victims also may be needed.
The clinical features, diagnosis, and management of bedbug infestations will be reviewed here.
Bedbugs (also written as "bed bugs") are true bugs of the order Hemiptera and family Cimicidae. Cimicids commonly infest human, bird, and bat habitats. As parasites, cimicids are unique because they are obligate blood feeders but do not remain on the host to complete their life cycle. Rather, they hide in the surrounding habitat. Cimex lectularius and Cimex hemipterus are the two bedbug species that most commonly affect humans. (See 'Life cycle' below.)
Correct identification of bedbugs is important for implementing proper control measures. Bat bugs (Cimex adjunctus and other species) and swallow bugs (Oeciacus vicarius) are other members of the Cimicidae family that may be mistaken for bedbugs and may incidentally bite humans (picture 2).
Bedbugs have flat, red-brown, oval bodies and are similar in size to a dog tick (picture 1A). The eyes are widely separated, and the mouthparts are retroverted with the labium slender and elongated, forming a three-segmented rostellum (rostrum). The wings are reduced to hemelytral pads, with membranous hindwings vestigial or absent. The pronotum (a plate-like structure covering the dorsal thorax) has a concave anterior margin that receives the head. Bristles project laterally along the margins of the pronotum, starting behind the eye and continuing along the lateral edge (picture 2). Bristles can also be present on the dorsal surface. The antennae have four segments, with the distal three antennal segments being long and slender. The abdomen has eleven segments, which expand during feeding, exposing intersegmental membranes.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic reaction caused by Cimex lectularius. J Eur Acad Dermatol Venereol 2003; 17:461.
- www.cdc.gov/parasites/bedbugs/biology.html (Accessed on November 05, 2014).
- Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical consequences of their bites. JAMA 2009; 301:1358.
- Saenz VL, Santangelo RG, Vargo EL, Schal C. Group living accelerates bed bug (Hemiptera: Cimicidae) development. J Med Entomol 2014; 51:293.
- Thomas I, Kihiczak GG, Schwartz RA. Bedbug bites: a review. Int J Dermatol 2004; 43:430.
- Olson JF, Eaton M, Kells SA, et al. Cold tolerance of bed bugs and practical recommendations for control. J Econ Entomol 2013; 106:2433.
- Kells SA. Bed bugs: a systemic pest within society. Am Entomol 2006; 52:107.
- Gbakima AA, Terry BC, Kanja F, et al. High prevalence of bedbugs Cimex hemipterus and Cimex lectularis in camps for internally displaced persons in Freetown, Sierra Leone: a pilot humanitarian investigation. West Afr J Med 2002; 21:268.
- www.pctonline.com/article/pct1002_bedbugs/ (Accessed on August 03, 2017).
- Cleary CJ, Buchanan D. Diagnosis and management of bedbugs: an emerging U.S. Infestation. Nurse Pract 2004; 29:46.
- Fletcher CL, Ardern-Jones MR, Hay RJ. Widespread bullous eruption due to multiple bed bug bites. Clin Exp Dermatol 2002; 27:74.
- deShazo RD, Feldlaufer MF, Mihm MC Jr, Goddard J. Bullous reactions to bedbug bites reflect cutaneous vasculitis. Am J Med 2012; 125:688.
- Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. J Allergy Clin Immunol 2006; 117:1508.
- Abdel-Naser MB, Lotfy RA, Al-Sherbiny MM, Sayed Ali NM. Patients with papular urticaria have IgG antibodies to bedbug (Cimex lectularius) antigens. Parasitol Res 2006; 98:550.
- Sansom JE, Reynolds NJ, Peachey RD. Delayed reaction to bed bug bites. Arch Dermatol 1992; 128:272.
- Paulke-Korinek M, Széll M, Laferl H, et al. Bed bugs can cause severe anaemia in adults. Parasitol Res 2012; 110:2577.
- PARSONS DJ. Bedbug bite anaphylaxis misinterpreted as coronary occlusion. Ohio State Med J 1955; 51:669.
- Jupp PG, McElligott SE, Lecatsas G. The mechanical transmission of hepatitis B virus by the common bedbug (Cimex lectularius L.) in South Africa. S Afr Med J 1983; 63:77.
- Jupp PG, McElligott SE. Transmission experiments with hepatitis B surface antigen and the common bedbug (Cimex lectularius L). S Afr Med J 1979; 56:54.
- Ogston CW, Wittenstein FS, London WT, Millman I. Persistence of hepatitis B surface antigen in the bedbug Cimex hemipterus (Fabr.). J Infect Dis 1979; 140:411.
- Silverman AL, Qu LH, Blow J, et al. Assessment of hepatitis B virus DNA and hepatitis C virus RNA in the common bedbug (Cimex lectularius L.) and kissing bug (Rodnius prolixus). Am J Gastroenterol 2001; 96:2194.
- Jörg ME. [Cimex lectularius L. (the common bedbug), the vector of Trypanosoma cruzi]. Rev Soc Bras Med Trop 1992; 25:277.
- Salazar R, Castillo-Neyra R, Tustin AW, et al. Bed bugs (Cimex lectularius) as vectors of Trypanosoma cruzi. Am J Trop Med Hyg 2015; 92:331.
- Lowe CF, Romney MG. Bedbugs as vectors for drug-resistant bacteria. Emerg Infect Dis 2011; 17:1132.
- Barbarin AM, Hu B, Nachamkin I, Levy MZ. Colonization of Cimex lectularius with methicillin-resistant Staphylococcus aureus. Environ Microbiol 2014; 16:1222.
- Brouqui P, Raoult D. Arthropod-borne diseases in homeless. Ann N Y Acad Sci 2006; 1078:223.
- Ho D, Lai O, Glick S, Jagdeo J. Lack of evidence that bedbugs transmit pathogens to humans. J Am Acad Dermatol 2016; 74:1261.
- Weedon D. Arthropod-induced diseases. In: Weedon's Skin Pathology, 3rd ed, Elsevier Limited, 2010. p.651.
- Tharakaram S. Bullous eruption due to Cimex lecticularis. Clin Exp Dermatol 1999; 24:241.
- Vaidyanathan R, Feldlaufer MF. Bed bug detection: current technologies and future directions. Am J Trop Med Hyg 2013; 88:619.
- Hinkle NC. Ekbom syndrome: a delusional condition of "bugs in the skin". Curr Psychiatry Rep 2011; 13:178.
- www.nytimes.com/2005/11/27/nyregion/27bugs.html (Accessed on February 05, 2008).
- Centers for Disease Control and Prevention (CDC). Acute illnesses associated with insecticides used to control bed bugs--seven states, 2003--2010. MMWR Morb Mortal Wkly Rep 2011; 60:1269.
- www.who.int/water_sanitation_health/resources/vector237to261.pdf (Accessed on September 12, 2017).
- Kells SA, Goblirsch MJ. Temperature and Time Requirements for Controlling Bed Bugs (Cimex lectularius) under Commercial Heat Treatment Conditions. Insects 2011; 2:412.
- Cooper R, Wang C, Singh N. Effects of Various Interventions, Including Mass Trapping with Passive Pitfall Traps, on Low-Level Bed Bug Populations in Apartments. J Econ Entomol 2016; 109:762.
- Raab RW, Moore JE, Vargo EL, et al. New Introductions, Spread of Existing Matrilines, and High Rates of Pyrethroid Resistance Result in Chronic Infestations of Bed Bugs (Cimex lectularius L.) in Lower-Income Housing. PLoS One 2016; 11:e0117805.
- Rukke BA, Hage M, Aak A. Mortality, fecundity and development among bed bugs (Cimex lectularius) exposed to prolonged, intermediate cold stress. Pest Manag Sci 2017; 73:838.
- LIFE CYCLE
- CLINICAL MANIFESTATIONS
- Skin reactions
- When to suspect bedbug infestation
- Confirming the diagnosis
- DIFFERENTIAL DIAGNOSIS
- Treatment of bites
- Psychologic support
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS