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Bed bugs are inside the insect family Cimicidae. There are at the least 91 species worldwide, but many occur only on bats and birds.
However, the regular bed bug, Cimex lectularius Figure, has adapted to human feeding and has now been children associate of humans for millennia. With the creation of DDT as well as other powerful pesticides, these bugs nearly disappeared in developing countries until recently, where, inside past twenty years or so, they are making a progressively rapid comeback. In many areas, in the marketplace . the number one urban pest.
Here I review every one of these potential health effects, discuss diagnosis and treatment, and give comments about future directions during intercourse bug control and public health efforts to regulate the pest.
The primary negative health effects from bed bug biting are certainly not disease transmission, but rather, emotional trauma and also the itching and inflammation nuisance regarding their bites. There is some evidence that bed bug attacks cause insomnia, emotional distress, and anxiety.
Limited evidence and anecdotal reports indicate that bed bug attacks might cause more serious psychological effects a lot like posttraumatic stress disorder.
As for nuisance biting, the most frequent cutaneous reactions are small, pruritic maculopapular, erythematous lesions at bed bug feeding sites, one per insect. These usually begin itching with 72 hours and, or even scratched extensively, resolve following a week or possibly even longer.
For individuals who experience repeated bites, enough time to oncoming of itching generally decreases along with the intensity with the bite reaction increases.
Some people experience more technical, even serious, cutaneous reactions. Reports these have included pruritic wheals local urticaria around a central punctum, papular urticaria, and diffuse urticaria at bite sites usually noted on arising inside the morning.
Bullous lesions, resembling blood blisters, may occur on subsequent biting events days later.
As mentioned, the timing of cutaneous reactions to bedbugs may change with subsequent exposures and appears to reflect host immunological responses to bed bug salivary proteins.
reported by investing in repeated exposure, the latency between bite and skin reaction decreased from 10 days with a few seconds. Interestingly, people that experience subsequent bed bug biting sometimes have old lesions that Р вЂre-inflameР†on new biting anywhere around the body. This Р вЂre-lighting-upР†phenomenon at sites of previous lesions is anecdotally reported previously, but is poorly understood.
Presumably, it comes from antigens that reside in the bite site with an extended period, and readily available antigens answering and adjusting inflammatory mediators circulating to new bites.
Although rare, you can find a few reports of systemic hypersensitivity from bed bug bites, including asthma, generalized urticaria, and anaphylaxis.
One patient awakened during the night for a hotel with severe itching and urticaria on his arm and neck and these bugs were found within his room.
Angioedema and hypotension developed, and also the man was hospitalized along transient anterolateral ischemia by using an ECG. Eight months later, after an experimental bed bug bite, a wheal developed on the bite site in conjunction with generalized itching that required epinephrine administration to end his symptoms. Evaluation of one other man with asthma revealed bedbugs in his bedding, with an intradermal allergy skin test by having an extract of these bugs was positive.
Interestingly, after his bedding was changed, the asthma attacks ceased.
In heavy infestations, hemorrhage from bed bug biting could be significant enough to cause anemia in humans and animals. We have investigated poultry houses infested with these bugs and found some on the birds to become anemic.
As for humans, a person in Canada repeatedly presented for the hospital with anemia, and following a few era of treatment each and every time, was sent home.
Eventually, an inquisitive physician through the hospital produced home visit and located thousands of bed bugs from the manР вЂs mattress and bedding.
The patient reported no bite marks; some people do not react.
Bed bugs happen to be suspected inside the transmission of over 40 disease organisms, like those causing anthrax, plague, hepatitis, and typhus,
and are actually found naturally who have contracted many of such disease agents especially hepatitis B virus.
At on this occasion, however, bedbugs have never been became biologically transmit even one human pathogen.
A recent report of these bugs containing methicillin-resistant Staphylococcus aureus created a significant stir inside the news media, yet, biological transmission and even mechanical transmission has not been proved because report.
The proven fact that blood-sucking insects may get disease agents while feeding will not be surprising; however, the power to subsequently transmit those agents is usually a completely different story.
Bed bugs must be suspected no matter the reason of mysterious biting that comes about primarily in the evening, and/or when itchy erythematous rashes are noted on rising from sleep, no matter some time of day. Although not always true, bed bug bites are predominant around the head, neck, and chest, and they also may appear within a line.
Treatment of cutaneous reactions is normally symptomatic instead of evidence-based. Bite sites must be washed with water and soap, if lesions are pruritic, topical using over-the-counter or prescription antipruritic agents paroxime, doxepin or intermediate-potency corticosteroids triamcinolone can be helpful. Sites that appear to become secondarily infected will benefit from topical mupirocin or systemic antibiotics as appropriate.
Systemic hypersensitive reactions to bed bug bites must be treated every other insect-induced anaphylaxis.
That treatment can include intramuscular epinephrine first, then antihistamines and corticosteroids when appropriate. Patients with previous generalized reactions must be referred to an allergist and as well taught to work with an epinephrine auto-injector device, which really should be kept readily accessible.
For most physicians, the principal issues related to these bugs are understanding how to recognize possible bite reactions although you'll find no facets of bed bug bites which might be pathognomonic, treating symptomatically, and possibly directing patients to appropriate pest management information and/or bug control professionals.
Unfortunately, bed bug control just isn't possible using over-the-counter remedies and insecticides, and professional guidance is necessary. Eradication in the pests involves intensive inspection and treatment, having a variety of pest control management techniques including pesticides. Bed bug infestations are quickly to become public health or Р вЂsocial justiceР†issue, together with the poor and underserved populations disproportionately affected. Physicians would likely play a vital role by treating affected patients and pointing them to your right governmental agency for help and intervention.
1. Reinhardt K, Siva-Jothy MT. Biology from the bed bugs. Ann Rev Entomol. 2007;52:351-374.
2. Usinger RL. Monograph of Cimicidae. College Park, MD: Entomological Society of America, Thomas Say Foundation; 1966:17.
3. Potter MF. The perfect storm: a part view on bedbugs. Am Entomol. 2006;52:102-104.
4. Doggett S, Russell RC. The resurgence of these bugs, Cimex spp, in Australia: experiences from down under. Proceedings in the 6th International Conference on Urban Pests; July 13-16, 2008; Budapest, Hungary.
5. Potter MF. The business of these bugs: Pest Management Professional Magazine. January 2008:24-29.
6. Potter MF, Rosenberg B, Henriksen M. Bugs without borders: defining the worldwide bed bug resurgence. Pest World. 2010:Sept/Oct:8-20.
7. Benac N. Bed bug bites becoming bigger battle. CMAJ. 2010;182:1606.
8. Doggett S, Dwyer DE, Penas PF, Russell RC. Bed bugs: clinical relevance and control options. Clin Microbiol Rev. 2012;25:164-192.
9. Potter MF, Haynes KF, Deutsch M, et al. The senstivity spectrum: human reactions to bed bug bites. Pest Control Technology Magazine. Feb 2010:70-75.
10. Goddard J, de Shazo RD. Psychological outcomes of bed bug attacks Cimex lectularius L. Am J Med. 2012;125:101-103.
11. Kemper H. Die bettwanze und ihre bekampfung. Schriften uber Hygienische Zoologie Z. Kleintierk. Pelztierk. 1936;12:1-107.
12. Ryckman RE. Dermatological reactions on the bites of four years old species of triatominae hemiptera: reduviidae and Cimex lectularius L. hemiptera: cimicidae. Bull Soc Vector Ecol. 1985;10:122-125.
13. Masetti M, Bruschi F. Bedbug infestations recorded in Central Italy. Parasitol Int Mar. 2007;56:81-83.
14. Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic reaction brought on by Cimex lectularius. J Eur Acad Dermatol Venereol. 2003;17:461-463.
15. Bartley JD, Harlan HJ. Bed bug infestation: its control and management. Mil Med. 1974;139:884-886.
16. Cestari TF, Martignago BF. Scabies, pediculosis, and stinkbugs: uncommon presentations. Clin Dermatol. 2005;23:545-554.
17. Alexander JO. Arthropods and Human Skin. Berlin: Springer-Verlag; 1984.
18. Brasch J, Schwarz T. 26-year-old male with urticarial papules. J Dtsch Dermatol Ges. 2006;4:1077-1079.
19. 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;21:268-271.
20. Honig PJ. Arthropod bites, stings, and infestations: their prevention and treatment. Pediatr Dermatol. 1986;3:189-197.
21. Rook AJ. Papular urticaria. Pediatr Clin North Am. 1961;8:817-820.
22. Cooper DL. Can bedbug bites cause bullous erythema? J Am Med Assoc. 1948;138:1206.
23. Hamburger F, Dietrich A. Lichen urticatus exogenes. Acta Paediatr. 1937;22:420.
24. Kemper H. Beobachtungen ueber den Stech-und Saugakt der Bettwanze und seine Wirkung auf die menschliche Haut. Zeitschr f Desinfekt. 1929;21:61-65.
25. Kinnear J. Epidemic of bullous erythema on legs on account of bed-bug. Lancet. 1948;255:55.
26. Patton WS, Evans A. Insects, Ticks, and Venomous Animals of Medical and Veterinary Importance, Part I. Croydon, UK: HR Grubb Ltd; 1929.
27. Churchill TP. Urticaria because of bed bug bites. J Am Med Assoc. 1930;95:1975-1976.
28. Elston DM, Stockwell S. WhatР вЂs eating you? Bed bugs. Cutis. 2000;65:262-264.
29. Hect O. Die hautreaktionen auf insektenstiche als allergische erscheinungen. Zool Anz. 1930;87:94, 145, 231.
30. Ryckman RE. Host reactions to bug bites hemiptera, homoptera: a literature review and annotated bibliography, Part I. California Vect Views. 1979;26:1-24.
31. Ryckman RE, Bently DG. Host reactions to bug bites: a literature review and annotated bibliography, Part II. California Vect Views. 1979;26:25-49.
32. Reinhardt K, Kempke RA, Naylor RA, Siva-Jothy MT. Sensitivity to bites from the bedbug, Cimex lectularius. Med Vet Entomol. 2009;23:163-166.
33. Goddard J, Edwards KT, de Shazo RD. Observations on continuing development of cutaneous lesions from bites by the most popular bed bug, Cimex lectularius L. Midsouth Entomol. 2011;4:49-52.
34. McKiel JA, West AS. Nature and causation of insect bite reactions. Pediatr Clin North Am. 1961;8:795-814.
35. Bircher AJ. Systemic immediate allergy symptoms to arthropod stings and bites. Dermatology. 2005;210:119-127.
36. Jimenez-Diaz C, Cuenca BS. Asthma made by susceptibility to unusual allergens. J Allergy. 1935;6:397-403.
37. Sternberg L. A case for asthma brought on by the Cimex lectularius. Med J Rec. 1929;129:622.
38. Parsons DJ. Bed bug bite anaphylaxis misinterpreted as coronary occlusion. Ohio State Med J. 1955;51:669.
39. Cater J, Hubbard SA, Magee D, et al. Severe infestation of bed bugs in the broiler-breeder house. J Am Vet Med Assoc. In press.
40. Pritchard MJ, Hwang SW. Severe anemia from these bugs. CMAJ. 2009;181:287-288.
41. Burton GJ. Bed bugs with regards to transmission of human diseases. Public Health Rep. 1963;78:513-524.
42. Delaunay P, Blanc V, Del Giudice P, et al. Bedbugs and infectious diseases. Clin Infect Dis. 2011;52:200-210.
43. El-Masry SA, Kotkat AM. Hepatitis B surface antigen in Cimex lectularius. J Egyptian Public Health Assoc. 1990;55:230-236.
44. Jupp PG, Lyons SF. Experimental assessment of bedbugs and mosquitoes as vectors of human immunodeficiency virus. AIDS. 1987;1:171-174.
45. Jupp PG, McElligott SE. Transmission experiments with hepatitis B surface antigen as well as the common bed bug. S Afr Med J. 1979;56:54-57.
46. Jupp PG, Prozesky OW, McElligott SE, Van Wyk LA. Infection in the common bed bug with hepatitis B virus in South Africa. S Afr Med J. 1978;53:598-600.
47. Goddard J, de Shazo RD. Bed bugs Cimex lectularius and clinical consequences in their bites. JAMA. 2009;301:1358-1366.
48. Lowe CF, Romney MG. Bedbugs as vectors for drug-resistant bacteria. Emerg Infect Dis. 2011;17:1132-1134.
49. Oswalt ML, Kemp SF. Anaphylaxis: office management and prevention. Immunol Allergy Clin North Am. 2007;27:177-191.
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reported utilizing repeated exposure, the latency between bite and skin reaction decreased from 10 days to some few seconds. Interestingly, folks who experience subsequent bed bug biting sometimes have old lesions that re-inflame on new biting anywhere for the body. This re-lighting-up phenomenon at sites of previous lesions continues to be anecdotally reported previously, but is poorly understood.
Eventually, an inquisitive physician from your hospital created a home visit and discovered thousands of bed bugs from the mans mattress and bedding.
Unfortunately, bed bug control will not be possible using over-the-counter remedies and insecticides, and specialist help is necessary. Eradication on the pests involves intensive inspection and treatment, by using a variety of pest management techniques including pesticides. Bed bug infestations are quickly to become public health or social justice issue, while using poor and underserved populations disproportionately affected. Physicians would probably play a huge role by treating affected patients and pointing them on the right governmental agency for help and intervention.
25. Kinnear J. Epidemic of bullous erythema on legs caused by bed- bug. Lancet. 1948;255:55.
27. Churchill TP. Urticaria caused by bed bug bites. J Am Med Assoc. 1930;95: 1975 - 1976.
28. Elston DM, Stockwell S. Whats eating you? Bed bugs. Cutis. 2000;65:262-264.
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