Bed bugs are parasites
that feed on the blood of human beings. Climax
lectularius is the commonest bedbug. Bedbug bites can cause
skin rashes, allergic symptoms and even psychological distress. Identification of the clinical manifestations and a proper
differential diagnosis are important for adequate management. The following
article is a summary based on a recently published article in Skin Therapy
Climex lectularius is a hematophagus arthropod i.e. it sucks blood from its host.
Novel pesticides, and improvised sanitary and
economic conditions have played significant roles in controlling the rapid
spread of bedbugs. Bedbug infestations are very common in crowded places such
as hospitals, dormitories, hotels, homeless shelters and cruise ships.
about the diagnosis, entomology, active management and prevention can help the
physician in detecting the affected people and providing timely treatment.
Our dwellings can become the breeding ground of
bedbugs in a variety of ways, such as:
Through visiting pets, that might bring bugs and
their eggs from other infested areas
Through visitors, who can bring bugs and eggs with
Through birds and bats, who might transport bugs or related species like bat
Though the inhabitants of the house, who may have visited crowded places, and
bring the bugs on themselves or their backpacks
Through false ceilings, crevices, ductwork or electrical outlets
Bedbugs are oval-shaped, broad wingless and flat insects
. Adult bugs are brown in
color and are apple-seeded in appearance. A characteristic sweet odor is
associated with them.
usually bite the host at night
. They have a long proboscis and suck human blood for 10 to
20 minutes. There are two tubules in the proboscis. An anesthetizing substance,
enzymes, substances that prevents clotting of blood, and vasodilator substances
(which relax blood vessels) are released by one tubule that makes the bite
painless while blood is sucked through the other tubule simultaneously.
After sucking the blood from the host, these
bugs unusually travel into the crevices. Bedbugs are mostly active in temperate
environment. In order to kill bedbugs, about one hour exposure is needed to
temperatures either below-16°C or above 48°C.
is a popular misconception that poor hygiene is responsible for the prevalence
. Bedbugs are attracted to body heat and carbon dioxide. They
nurture on blood and not on waste or excrement. By reducing their hiding places, bugs can be controlled to a great
The bites are quite identical to that of other
arthropods. They are clustered on the exposed parts of the skin like limbs and
face. The bites may be in a line in a group of three or five.
The bite may be itchy and may appear as a small
bump. A small red dot is present in the centre of the lesion. In some rare
cases, exacerbations of asthma, severe anemia post bedbug bite and allergic
reactions of the skin have also been reported.
A proper diagnosis is needed to avoid
misdiagnosis. Often, bedbug bites are confused with the following:
A recent case report has shown the presence of
bacterial colonies like vancomycin-resistant Enterococcus faecium(VRE) and
methicillin-resistant Staphylococcus aureus (MRSA) in bedbugs. Though bedbugs
are known to carry more than forty different types of microorganisms, yet they
are not seen to transmit diseases.
The management of bedbugs involves the
of bedbugs by effective pesticides such as malathion, pyrethroids and dichlovos
. Over time,
resistance to pesticides has increased and their usage also poses serious
threats to general health and wellness of human beings.
Mechanical approaches like mattress vacuuming
are rapidly becoming popular.
Carbamate pesticide-propoxur is extremely injurious
to bedbugs but it is harmful to children.
The management of the bite of bedbug is symptomatic.
Oral or topical antipruritic agents along with
intermediate corticosteroids can provide relief.
In some case, topical compounds containing
menthol and camphor can provide soothing effect.
To avoid bacterial infection, oral or topical
antibiotics can be given.
Injectable antihistamines and oral
corticosteroids are useful in treating systemic reactions caused by bedbug bites.
Elimination of infestation should be stringently
pursued to avoid further bites. This may be achieved by steps suggested by
Goddard et al in 2009. These include:
1. Careful and
proper identification of bedbug species
Awareness and education of patients and other
occupants regarding the bedbugs
Proper and thorough inspection of neighboring
area and infested area
Implementation of pesticide and non-chemical control measures
follow-up ensuring the control of infestation
creates chaos and anxiety in patients. A proper diagnosis is required followed
by controlling the symptoms of bedbug bite. Corticosteroids and antipruritic
agents are helpful in improving the situation. Concluding, it can be said that
eradication of the insect and prevention of the bite are the main targets of
the therapeutic management.
1. Bedbugs: An Update
on Recognition and Management; Robyn et al; Skin Therapy Letter 2012.