Bed bugs

Bed bugs are nocturnal, obligate, blood-feeding parasites that take refuge in furniture and bedding.

Bites are painless, but cause discomfort owing to the associated reactions.

Characteristic lesions are pruritic papules in an irregular linear pattern, typically found on body surfaces exposed during sleeping such as face, neck, arms, legs, and shoulders.

Treatment is symptomatic and includes antihistamines, topical antipruritics, and topical corticosteroids. In severe cases, systemic corticosteroids may be necessary.

Elimination from the home is essential and may require professional extermination.

Transmission of blood-borne infection is highly unlikely.

Bed bugs (Cimex lectularius, Cimex hemipterus, and Leptocimex boueti) are reddish-brown, wingless, obligate hematophagous (feeding only on blood) parasites approximately 5-7 mm in length.​​​[1]Akhoundi M, Sereno D, Durand R, et al. Bed bugs (Hemiptera, Cimicidae): overview of classification, evolution and dispersion. Int J Environ Res Public Health. 2020 Jun 25;17(12):4576. https://www.mdpi.com/1660-4601/17/12/4576 http://www.ncbi.nlm.nih.gov/pubmed/32630433?tool=bestpractice.com [2]Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7. http://www.ncbi.nlm.nih.gov/pubmed/32492304?tool=bestpractice.com ​​​ The "common bed bug" (C lectularius) is more prevalent in temperate climates, whereas C hemipterus is generally found in tropical areas, and L boueti is found in western Africa.

Bed bugs are visible with the unaided human eye and generally hide in the crevices of mattresses, box springs, bed headboards, and behind baseboards.[2]Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7. http://www.ncbi.nlm.nih.gov/pubmed/32492304?tool=bestpractice.com ​ Infestations mainly occur within 1-2 meters of a suitable host.[3]Goddard J, deShazo R. Bedbugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009 Apr 1;301(13):1358-66. http://jama.jamanetwork.com/article.aspx?articleid=183643 http://www.ncbi.nlm.nih.gov/pubmed/19336711?tool=bestpractice.com ​ Bed bugs are nocturnal (active at night), as they prefer to feed during minimal host activity.[2]Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7. http://www.ncbi.nlm.nih.gov/pubmed/32492304?tool=bestpractice.com [4]Reinhardt K, Siva-Jothy MT. Biology of the bedbugs (Cimicidae). Ann Rev Entomol. 2007 Jan 7;52:351-74. http://www.ncbi.nlm.nih.gov/pubmed/16968204?tool=bestpractice.com ​​​​

While not all persons bitten manifest a skin reaction, typical lesions are erythematous, pruritic papules on skin exposed while sleeping. Lesions may appear hours to days after being bitten.[5]Bernardeschi C, Le Cleach L, Delaunay P, et al. Bed bug infestation. BMJ. 2013 Jan 22;346:f138. http://www.ncbi.nlm.nih.gov/pubmed/23341545?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Cimex lectularius, collected in a hotel in urban GeorgiaCourtesy of the CDC [Citation ends].[Figure caption and citation for the preceding image starts]: Cimex lectulariusCourtesy of the CDC [Citation ends].[Figure caption and citation for the preceding image starts]: Bed bug bites showing numerous erythematous papulesFrom the contributors' personal teaching collection (Julian J. Trevino, David R. Carr, Suzanne L. Dundon); used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Linear distribution of papulesFrom the contributors' personal teaching collection (Julian J. Trevino, David R. Carr, Suzanne L. Dundon); used with permission [Citation ends].