Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. Some patients experience complex cutaneous reactions. Two authors with expertise in the diagnosis, treatment, and eradication of bed bugs reviewed the clinical articles. Meek F. Ban bed bugs: how to prevent and identify infestations. The return of the common bed bug. Insecticide treated nets: impact on vector populations and relevance of initial intensity of transmission and pyrethroid resistance.  et al. Newly hatched bed bugs are about 1 mmlong and are colorless to cream colored. © 2020 American Medical Association. However, no viral replication has been observed within the insects and no virus has been detected in bed bug feces.32,33 Mechanical transmission of human immunodeficiency virus has not been demonstrated using an artificial system of feeding bed bugs through membranes.33, The best candidate for human disease transmission by bed bugs is HBV. Attempts to transmit hepatitis B virus to chimpanzees by arthropods. Generally, bed bugs are most active at … A home evaluation of another man who had asthma revealed bed bugs in his bedding and an intradermal allergy skin test with an extract of bed bugs was positive.81 When his bedding was changed, the asthma symptoms ceased. Goddard J. Steps necessary for bed bug eradication include (1) proper identification of the bed bug species present, because some bat-infesting species may be found inside homes; (2) education of persons involved; (3) thorough inspection of infested and adjacent areas; (4) implementation of chemical and nonchemical control measures; and (5) follow-up to evaluate the success of eradication.86,87 Prevention of bed bug bites is best achieved with avoidance, because no repellents for the insects have been demonstrated conclusively to be effective. One author evaluated the pest control articles. Bed bugs are likely to be more problematic in the future due to travel, immigration, and insecticide resistance. The most common reactions for which medical attention is sought are 2- to 5-mm pruritic maculopapular, erythematous lesions at bed bug feeding sites, one per insect.  et al. Kinnear J. These wheal and flare reactions developed into papular reactions over 24 hours. Only 2 clinical trials concerning bed bugs were identified and tested the ability of pest control interventions to eradicate bed bugs. Curtis CF, Jana-Kara B, Maxwell CA. Author(s): Huntley, Arthur C, MD. Potter MF. Elston DM, Stockwell S. What's eating you? Human immunodeficiency virus can be detected in bed bugs up to 8 days after ingestion of highly concentrated virus in experimental blood meals. Bed bugs (cimex lectularius) are tiny wingless parasitic insects that feed on the blood of humans and other warm blooded mammals. Adult bed bugs have an average life span of 6 to 12 months and can survive up to a year without feeding. The bed bug is shown on a scale of 1 mm per interval. A novel inhibitor of factor X activation from the salivary glands of the bed bug, Valenzuela JG, Charlab R, Galperin MY, Ribeiro JM. Mayans MV, Hall AJ, Inskip HM, These usually itch and, if not abraded, resolve within a week.8,9,56 The size and pruritus associated with these common reactions may increase in some individuals who experience repeated bites.6,14,57 There are no data to establish how frequently common reactions occur. Cimex lectularius has been known as a human parasite for thousands of years, but scientific studies of this insect are recent and limited.1,2 International travel, immigration, changes in pest control practices, and insecticide resistance may have contributed to a recent resurgence of this blood-sucking insect in developed countries.1,3 Bed bug infestations have been reported increasingly in homes, apartments, hotel rooms, hospitals, and dormitories in the United States since 1980 (Table 1).1,21,22 For example, reports of bed bug infestations in San Francisco doubled between 2004 and 2006.23 The resurgence affects other countries as well. J-11504 by the Mississippi Agriculture and Forestry Experiment Station, Mississippi State University, Mississippi State. Goddard J, deShazo R. Bed Bugs (Cimex lectularius) and Clinical Consequences of Their Bites. No evidence-based interventions to eradicate bed bugs or prevent bites were identified. Bed bugs collected from huts in an HBV endemic area in northern Transvaal, South Africa, were hepatitis B surface antigen positive,43 as were samples collected from Senegal,42 Egypt,45 the Ivory Coast,54 and China.44 Hepatitis B surface antigen has also been shown to persist in bed bugs for more than 7 weeks after experimental feeding, but no replication of HBV was detected in the insects.34,36 Polymerase chain reaction assays have detected HBV DNA in bed bugs and their excrement up to 6 weeks after feeding on infected blood.38,39 Despite these findings, a 2-year bed bug eradication project in Gambia had no effect on rates of HBV infection, despite 100% reduction of bed bug numbers.55, To our knowledge, no study to date has demonstrated bed bug “vector competence” (the ability to acquire, maintain, and transmit an infectious agent), and an attempt to demonstrate vector competence for HBV failed in an experiment with chimpanzees.40 In that experiment, bed bugs were fed HBV-infected blood through an apparatus containing artificial skin-like membranes. Cimex is a genus of insects in the family Cimicidae. Quiz Ref IDPesticide control of bed bugs is complicated by insecticide resistance, lack of effective products, and health concerns about spraying mattresses with pesticides.1,3,88 Nonchemical methods for bed bug control include vacuuming, heat or steam treatments, mattress and box spring encasements, and discarding furnishings such as mattresses and box springs. Not all persons bitten by bed bugs display cutaneous lesions. Ectoparasites, part III: bed bugs and kissing bugs. Eight months later, after an experimental bed bug bite, he developed a wheal at the bite site with generalized itching that required epinephrine administration to resolve his symptoms. Adult bed bugs are about 5 mmwhen unfed (about the size of an apple seed) and are a deep brown orreddish brown color. This appears to reflect host immunological responses to salivary proteins. You mostly hear about them in … Ms Wright did not receive any compensation for her contribution. Rashi Minocha, Changlu Wang, Kai Dang, Cameron Ewart Webb, Pablo Fernández‐Peñas, Stephen Lindsay Doggett, Systemic and erythrodermic reactions following repeated exposure to bites from the Common bed bug Cimex lectularius (Hemiptera: Cimicidae), Austral Entomology, 10.1111/aen.12250, 56, 3, (345-347), (2016). Quiz Ref IDThe most common reactions for which medical attention is sought are 2- to 5-mm pruritic maculopapular, erythematous lesions at bed bug feeding sites, one per insect (Figure 3). Criteria used to select studies about bed bug prevention, control, and eradication were (1) documentation of bed bugs in the environment, and (2) documentation that a prevention or eradication measure quantitatively decreased or prevented bed bugs in a specific environment. The Cimicidae of the Americas and Oceanic Islands: a checklist and bibliography. Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic reaction caused by. Bedbug bites are small, red lesions that usually grow to no more than 5mm wide. Additional Contributions: Leigh Wright, BS (Department of Medicine, University of Mississippi Medical Center), offered invaluable help in the literature searches and preparation of the manuscript. Fletcher MG, Axtell RC. What Are The Natural Predators of Bed Bugs? Quiz Ref IDThere are few data to support bed bugs as vectors for transmission of human disease agents. They hide near places where people sleep and come out to feed at night. Quiz Ref IDThey resemble unfed ticks or small cockroaches and are easily visible, even to the untrained eye. After a blood meal, the bugs may increase in length by 30% to 50% and in weight by 150% to 200% (Figure 1B).27. JAMA. Sixty-three articles on pest control and eradication of bed bugs were identified and 14 of them met inclusion criteria and were included in the review. The common human bedbug, Cimex lectularius, is distributed worldwide [1,2].The bedbug bite is painless and the skin reaction varies from small macules to significant bullous eruptions [3-5].Bedbug infestations are common in the developing world, occurring in settings of unsanitary living conditions and … Dermal injection of increasing concentrations of the extract resulted in a dose-related increase in the size of wheal and flare reactions that occurred within 20 minutes of injection. Corresponding Author: Jerome Goddard, PhD, Department of Entomology and Plant Pathology, Mississippi State University, Box 9775, Mississippi State, MS 39762 ( Jupp PG, Prozesky OW, McElligott SE, Van Wyk LA. Blow JA, Turell MJ, Silverman AL, Walker ED. After feeding on an infectious blood meal, bed bugs excrete hepatitis B surface antigen in their feces and could be a possible source of HBV infection by contamination of skin lesions or mucosal surfaces, or by inhalation of dust. 2 Apart from concerns about disease transmission, bedbugs are annoying, difficult to control, anxiety producing, and cause … Infection of the common bedbug (Cimex lectularius L ) with hepatitis B virus in South Africa. Accessibility Statement. However, the descriptions of the “urticaria” in 1 study suggests erythema multiforme.83 In another study, a man staying in a hotel awakened during the night with severe itching and urticaria on his arm and neck; bed bugs were found in the room.84 He developed angioedema and hypotension, was hospitalized, and his electrocardiogram showed transient anterolateral ischemia. Conclusions Treatment options for cutaneous and systemic reactions from bed bug bites have not been evaluated in clinical trials and there is no evidence that outcomes differ significantly from those receiving no treatment. Bites on the arms and legs are also a tell-tale sign of bed bugs. The image of a Cimex lectularius is shown courtesy of the US Centers for Disease Control and Prevention (CDC). Data Sources A search of MEDLINE and EMBASE databases (1960-October 2008) for articles using the keywords bed bugs, Cimex lectularius, humans, parasitology, pathogenicity, and drug effects. Transmission experiments with hepatitis B surface antigen and the common bedbug (. The insect family Cimicidae contains species commonly called bed bugs, bat bugs, and swallow bugs. Potential for insect transmission of HIV: experimental exposure of, Ogston CW, Wittenstein FS, London WT, Millman I. Persistence of hepatitis B surface antigen in the bedbug. One article12 provides evidence for an immunological response to salivary proteins as the basis for some cutaneous reactions to bed bug bites. No study designs were described in the treatment approaches. 2009;301(13):1358–1366. Experimental assessment of bedbugs (Cimex lectularius and Cimex hemipterus ) and mosquitoes (Aedes aegypti formosus ) as vectors of human immunodeficiency virus. Treatments of common and complex cutaneous reactions are usually symptomatic and not evidence based (Table 3). Romero A, Potter MF, Potter DA, Haynes KF. Although transmission of more than 40 human diseases has been attributed to bed bugs, there is little evidence that they are vectors of communicable disease. Cooper DL. Lindsay SW, Snow RW, Armstrong JR, Greenwood BM. The resurgence of the common bedbug Cimex lectularius in this decade is well documented. Author Contributions: Dr Goddard had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The mosquito repellant, oil of lemon eucalyptus, may help.88 Bed bugs and their fecal matter are easily visible (Figure 4). Cestari TF, Martignago BF. bed bugs. Insecticide resistance in the bed bug: a factor in the pest's sudden resurgence? Physical description and life cycle of tropical bed bugs. All Rights Reserved. For pest control and eradication information, 1 author (J.G.) Manual searches of older journals, textbooks, pest control trade journals, and newspapers (1892-October 2008) were also performed. Stercorarial shedding and transtadial transmission of hepatitis B virus by common bed bugs (Hemiptera: Cimicidae). The most crucial need for research is in determining its vector competence.1,2,48 Development of effective repellents and public education about bed bugs are also important goals. Additional Information: This article has been approved for publication as manuscript No. Harlan, HJ. Silverman AL, Qu LH, Blow J, Zitron IM, Gordon SC, Walker ED. Rothberg AD, Pick W. Do bedbugs transmit hepatitis B? For pest control, documentation that an eradication measure quantitatively decreased bed bugs. to download free article PDFs, Ryckman RE, Bently DG, Archbold EF. Excretion of hepatitis B surface antigen by the bedbug Cimex hemipterus Fabr . Bed bugs 101: the basics of Cimex lectularius. Ryckman RE. We also required that the description of the clinical reaction had to be sufficiently detailed (ie, dermal vs systemic, characteristics of the dermatological response, or symptoms from the systemic response) to establish that an untoward event actually occurred. 2009;301(13):1358. Allington HV, Allington RR. Systemic reactions to bed bug bites are treated as insect-induced anaphylaxis,70,84,85 with treatment including intramuscular epinephrine, antihistamines, and corticosteroids. The most common bedbug species is Cimex lectularius.Bedbugs remain in the same room as long as there is constant blood supply. The largest series described an experience with only 17 patients. 117(6):1508-9. . and R.D.) The Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture (USDA) all consider bed bugs a public health pest. Currently, a variety of pesticides are undergoing evaluation for control of bed bugs. Systemic immediate allergic reactions to arthropod stings and bites. Jupp PG, Purcell RH, Phillips JM, Shapiro M, Gerin JL. Bedbugs (or Cimex lectularius and Cimex hemipterus, their scientific names) are blood-feeding parasites that can be found all around the world. 2007. Scarupa MD, Economides A. Bedbug bites masquerading as … Additional keywords included Cimex lectularius, humans, parasitology, pathogenicity, bite reactions, hypersensitivity, skin, cutaneous, and drug effects. The aim of the study was case report of the patient with systemic reaction after a bed bug (Cimex lectularius) bite.A 23-year-old female, previously healthy, reports systemic reaction, including rash on her corpus and limbs, itching, nausea, conciseness disorder, forcing her to call the ambulance. Other articles where Cimex lectularius is discussed: bedbug: Cimex lectularius, which occurs in temperate regions, and C. hemipterus, which is common in the tropics, attach to humans. Purification, cloning, and expression of an apyrase from the bed bug. The perfect storm: an extension view on bed bugs. This appears to reflect host immunological responses to salivary proteins.8,61,70-74 Usinger27 fed a colony of bed bugs on himself weekly for 7 years and noted that his reactions progressed from delayed to immediate, with no evidence of desensitization. Bed bugs are suspected to carry leprosy, oriental sore, Q-fever, and brucellosis (Krueger 2000) but have never been implicated in the spread of disease to humans (Dolling 1991). However, their transmission of a human disease is yet to be firmly established. For pest control, PubMed and Toxline searches (1960-October 2008) were performed using the keywords bed bugs, Cimex, control, prevention, and eradication. The criteria used to select studies of the health and medical effects of bed bug bites were (1) accounts or investigations that were original, (2) clinical responses with sufficient detail to allow for a reasonable conclusion of cause and effect between the bed bug bite and clinical response, and (3) convincing evidence that the reactions described were unlikely to have resulted from other insects. 124.11). Abdel-Naser MB, Lotfy RA, Al-Sherbiny MM, Sayed Ali NM. deShazo RD, Griffing C, Kwan TH, Banks WA, Dvorak HF. Jupp PG, Lyons SF. Fletcher CL, Ardern-Jones MR, Hay RJ. Die hautreaktionen auf insektenstiche als allergische erscheinungen [German]. Transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence that such transmission has ever occurred (Table 2).47,48 Older scientific literature postulated that bed bugs may be vectors of plague, yellow fever, tuberculosis,49 relapsing fever, leprosy, filariasis,31kala azar (leishmaniasis),50 cancer,51 smallpox,52 yellow fever, and Chagas disease (Trypanasoma cruzi).41,53 Recently, the possibility of human immunodeficiency virus and hepatitis B virus (HBV) transmission by bed bugs has been investigated. McKiel JA, West AS. Adults are reddish brown (chestnut) in color, whereas immatures are much smaller and may be light yellow. JAMA Dermatol. The potential for bed bugs to serve as disease vectors and optimal methods for bed bug pest control and eradication are unclear. Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin. The relation between. Brotman B, Prince AM, Godrey HR. Cimex species are ectoparasites that typically feed on the blood of birds and mammals. Adults are reddish brown (chestnut) in color, whereas immatures are much smaller and may be light yellow. Bed bug bites (Cimex lectularius) with targetoid lesions on initial presentation. sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959),,, JAMAevidence: The Rational Clinical Examination, JAMAevidence: Users' Guides to Medical Literature, FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. When the same blood used to infect the insects was injected into the chimpanzees, they rapidly developed HBV infection.40, Although evidence for disease transmission by bed bugs is equivocal, issues of vector competence, reactions to insect bites, embarrassment, and mental anguish have been the basis for lawsuits against landlords and lodging corporations.48. Objectives To present current knowledge of the health and medical effects of bed bugs and to explore key issues in pest control and eradication efforts. Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. Hiding places are usually within 1 to 2 meters of suitable hosts and include seams in mattresses, crevices in box springs, backsides of headboards, spaces under baseboards or loose wallpaper, and even behind hanging pictures.  et al. There are few data to support bed bugs as vectors for transmission of human disease agents. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. Delayed reaction to bed bug bites. Newberry K, Mchunu ZM, Cebekhulu SQ. Pesticide control of bed bugs is complicated by insecticide resistance, lack of effective products, and health concerns about spraying mattresses with pesticides. Reproduced with permission from Harold Harlan, PhD. The species C. pilosellus lives on bats and, although known as a bat bug, will bite humans and is sometimes found living in human dwellings. Bugs may also migrate from one apartment or hotel room to another through holes in walls, water pipes, or gutters.29,30. Valenzuela JG, Ribeiro JM. Terms of Use| Privacy Policy| We focused our computer-assisted literature search on (1) the medical and health effects of bed bugs, and (2) pest control and eradication aspects of the bed bugs. The timing of cutaneous reactions to bed bugs may change with multiple exposures. evaluated the articles. Bed bugs sense and seek warmth, a trait that helps them locate warm-blooded hosts.27 They generally avoid light, hide during the day, and feed at night. Context Bed bug (Cimex lectularius) infestations are rapidly increasing worldwide. We sought information using manual searches to identify pertinent articles in sources frequently not included in computer databases. After the development an… Our search strategy was limited to English language papers and used the Medical Subject Heading (MeSH) term bedbugs. Sites that are superinfected may benefit from topical mupirocin or systemic antibiotics. INTRODUCTION. Appearance of Bed Bugs (Cimex lectularius L.) Two adult bed bugs in a petri dish (courtesy of Kim Jung) Adult bed bugs, in general, are: about the size of an apple seed (5-7 mm or 3/16 - 1/4 inch long); long and brown, with a flat, oval-shaped body (if not fed recently); Studies failing to document the presence of bed bugs, cast skins, or bed bug excreta in the environment where the reaction occurred and studies failing to identify the clinical characteristics of the reaction were excluded. The most concentrated salivary solution caused a papule with a blister. New York, NY: John Wiley & Sons; 1936, Croydon, United Kingdom: HR Grubb Ltd; 1929, Mechanicsville, MD: Pinto & Associates; 2008, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2009;301(13):1358-1366. doi:10.1001/jama.2009.405. Bed Bug Bites Vs Contact dermatitis: How to tell the difference. Host reactions to bug bites: a literature review and annotated bibliography, part II. Anaphylaxis: office management and prevention. Cimex lectularius vs Cimex hemipterus These two species of bed bugs can be easily distinguished by looking at the prothorax, the first segment of the thorax. Cutaneous Reactions. Almost all articles concerning the health and medical effects from bed bugs were case reports of 1 person or a few persons bitten, descriptions of the bite reactions, and treatments given. I t can take two to three days for these bites to appear, allowing the infestation to grow. Common Bed Bugs – Cimex Lectularius Bites History of common bed bugs. If lesions are pruritic, topical application of over-the-counter or prescription antipruritic agents (paroxime, doxepin) or intermediate potency corticosteroids (triamcinolone) may be helpful. Widespread bullous eruption due to multiple bed bug bites. Bartley JD, Harlan HJ. Reports of these include pruritic wheals (local urticaria) around a central punctum, papular urticaria, and diffuse urticaria at bite sites usually noted on arising.5,16,58-60 Bullous rashes may occur subsequent to biting events days later.61-65 In some cases, these reactions evolve into pruritic papules or nodules that may become superinfected (impetiginous) after scratching and persist for weeks.9,14,58,66-68 Secondary infection also may result in folliculitis, cellulitis, or an eczematoid dermatitis.67,69, Quiz Ref IDThe timing of cutaneous reactions to bed bugs may change with multiple exposures. We also reviewed reference lists from retrieved articles and textbooks to identify additional articles of interest. Latency of skin reactions to bites of the bedbug Cimex lectularius in 24 volunteers. They have a pyramid-shaped head with prominent compound eyes, slender antennae, and a long proboscis tucked underneath the head and thorax. Temu EA, Minjas JN, Shiff CJ, Majala A. Bedbug control by permethrin-impregnated bednets in Tanzania. Masetti M, Bruschi F. Bedbug infestations recorded in Central Italy. Ryan N, Peters B, Miller P. A survey of bedbugs in short-stay lodges. Epidemic of bullous erythema on legs due to bed-bug. Sharma SK, Upadhyay AK, Haque MA, Role of arthropods in transmission of hepatitis-B virus in the tropics. Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical consequences of their bites. Our review of the medical literature on this topic along with our clinical experience suggests that a useful classification of reactions should be based on local cutaneous vs systemic symptoms. with expertise in the diagnosis, treatment, and eradication of bed bugs reviewed the clinical articles selected. Patients with papular urticaria have IgG antibodies to bedbug (. The prothorax of the common bed bug is more expanded laterally and the extreme margins are more flattened than that of the tropical bed bug . Nelson GS. Bedbugs in relation to transmission of human diseases: review of the literature. King F, Dick I, Evans P. Bed bugs in Britain.