Summary
Definition
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][2] 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] Infestations mainly occur within 1-2 meters of a suitable host.[3] Bed bugs are nocturnal (active at night), as they prefer to feed during minimal host activity.[2][4]
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][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].
History and exam
Key diagnostic factors
- bed bug sighting
- irregular curved or linear erythematous papules
- new skin lesions noted in the morning
- pruritus
Other diagnostic factors
- pain or burning
- papular or diffuse urticaria
- bullae
- widespread urticaria/wheezing/stridor/hypotension
- specks of blood or feces on sheets
Risk factors
- high-turnover environment
- recent travel
- secondhand furniture in the home
Diagnostic tests
Tests to consider
- skin scraping of lesion (mineral oil preparation)
- skin biopsy
Treatment algorithm
symptomatic disease
Contributors
Authors
Whitney A. High, MD, JD, MEng
Professor of Dermatology and Pathology
Director of Dermatopathology (Dermatology)
School of Medicine
University of Colorado
Colorado
CO
Disclosures
WAH declares that he has no competing interests.
Acknowledgements
Dr Whitney A. High would like to gratefully acknowledge Dr Julian Trevino, Dr Elizabeth Usedom, Dr Suzanna Dundon, and Dr David Carr, previous contributors to this topic.
Disclosures
JJT, EU, SD, and DRC declare that they have no competing interests.
Peer reviewers
Richard deShazo, MD
Chairman and Professor
Department of Medicine
Professor of Pediatrics
Billy S. Guyton Distinguished Professor
University of Mississippi Medical Center
Jackson
MS
Disclosures
RD declares that he has no competing interests.
Xuan Nguyen, MD
Faculty Physician
Dermatology and Pediatric Dermatology
Phoenix Children's Hospital
Phoenix
AZ
Disclosures
XN declares that she has no competing interests.
Ian F. Burgess, MSc, MPhil
Professor
Director
Medical Entomology Centre
University of Cambridge
Cambridge
UK
Disclosures
IFB has been a consultant to various manufacturers of pharmaceutical products, alternative therapies, and combs for treating louse infections. IFB is an author of a number of references cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7. Abstract
McNeill C, Jarrett A, Shreve DM, et al. Bed bugs: current treatment guidelines. J Nurse Pract. 2017 Jun;13(6): P381-8.Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Insect or spider bite
- Urticaria
- Scabies
More DifferentialsPatient information
Asthma in adults
Scabies
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer