Bed bugs are nocturnal, obligate blood-feeding parasites that take refuge in furniture and bedding.
Reports of bites are increasing in prevalence. 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, haematophagous (feeding only on blood) parasites approximately 5 mm to 7 mm in length. 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. They are visible with the human eye and generally hide in the crevices of mattresses, bed bases, and bed headboards and behind skirting boards. Bed bugs are nocturnal (active at night), as they prefer to feed during minimal host activity. Typical lesions are erythematous, pruritic papules on skin exposed while sleeping. Lesions may appear hours to days after being bitten. Bed bugs are unlikely vectors of disease; therefore, the goal of treatment is symptom control and avoidance of the parasite.
History and exam
Key diagnostic factors
- presence of risk factors
- bed bug sighting
- irregular linear erythematous papules
- new skin lesions noted in the morning
Other diagnostic factors
- pain or burning
- papular or diffuse urticaria
- widespread urticaria/wheezing/stridor/hypotension
- specks of blood or faeces on sheets
- high-turnover environment
- recent travel
- second-hand furniture in the home
Investigations to consider
- skin scraping of lesion (mineral oil preparation)
- skin biopsy
- Insect or spider bite
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