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Studies primarily concerned with controlling other insects in the home environment, but which peripherally mentioned bed bugs, were excluded. Papers that reported only laboratory assays of pesticides were excluded. A trained medical reference librarian assisted us with the literature search.
Two medical entomologists J. For pest control and eradication information, 1 author J.
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Seventy-five citations were identified regarding the health and medical effects of bed bugs and 39 articles met inclusion criteria and were included in the review Figure 2. Sixty-three articles on pest control and eradication of bed bugs were identified and 14 of them met inclusion criteria and were included in the review. Only 2 clinical trials concerning bed bugs were identified, but they involved pest control interventions and not the health and medical effects. Almost all articles concerning the health and medical effects from bed bugs were case reports of 1 person or a few persons bitten, descriptions of the bite reactions, and treatments given.
Transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence that such transmission has ever occurred Table 2. Human immunodeficiency virus can be detected in bed bugs up to 8 days after ingestion of highly concentrated virus in experimental blood meals. However, no viral replication has been observed within the insects and no virus has been detected in bed bug feces. The best candidate for human disease transmission by bed bugs is HBV. Bed bugs collected from huts in an HBV endemic area in northern Transvaal, South Africa, were hepatitis B surface antigen positive, 43 as were samples collected from Senegal, 42 Egypt, 45 the Ivory Coast, 54 and China.
These insects then took blood meals from chimpanzees, but no infections or seroconversions resulted in the primates. When the same blood used to infect the insects was injected into the chimpanzees, they rapidly developed HBV infection.
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Although evidence for disease transmission by bed bugs is equivocal, issues of vector competence, reactions to insect bites, embarrassment, and mental anguish have been the basis for lawsuits against landlords and lodging corporations. Cutaneous Reactions. Our review of case reports revealed that the usual response to a bed bug bite appears to be no reaction with a barely visible punctum at the location of the bite Table 1.
Quiz Ref ID The most common reactions for which medical attention is sought are 2- to 5-mm pruritic maculopapular, erythematous lesions at bed bug feeding sites, one per insect Figure 3. These usually itch and, if not abraded, resolve within a week. Some patients experience complex cutaneous reactions.
Reports of these include pruritic wheals local urticaria around a central punctum, papular urticaria, and diffuse urticaria at bite sites usually noted on arising.
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Quiz Ref ID The timing of cutaneous reactions to bed bugs may change with multiple exposures. This appears to reflect host immunological responses to salivary proteins. Three salivary proteins have been identified that may play a role in host immunological responses a nitric oxide—liberating heme protein [nitrophorin], 75 a kDa anticoagulant [Factor X], 76 and a kDa apyrase-like nucleotide-binding enzyme One article 12 provides evidence for an immunological response to salivary proteins as the basis for some cutaneous reactions to bed bug bites.
A hotel guest noticed isolated macules after her first visit to a hotel. After a second stay at the same hotel 1 year later, macules again appeared but this time evolved over 3 days into crops of erythematous nodules with blisters. Dermal injection of increasing concentrations of the extract resulted in a dose-related increase in the size of wheal and flare reactions that occurred within 20 minutes of injection.
These wheal and flare reactions developed into papular reactions over 24 hours. The most concentrated salivary solution caused a papule with a blister. In vitro studies demonstrated that the patient had IgE specific to the nitrophorin but not the apyrase protein component of unfractionated salivary extract.
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This article suggests that some responses to bed bug bites are the same IgE-mediated biphasic late-phase reactions we have previously described to insect stings. Systemic Reactions. There are a few studies of systemic reactions from bed bug bites, including asthma, generalized urticaria, and anaphylaxis. Eight months later, after an experimental bed bug bite, he developed a wheal at the bite site with generalized itching that required epinephrine administration to resolve his symptoms. A home evaluation of another man who had asthma revealed bed bugs in his bedding and an intradermal allergy skin test with an extract of bed bugs was positive.
Treatments of common and complex cutaneous reactions are usually symptomatic and not evidence based Table 3. If lesions are pruritic, topical application of over-the-counter or prescription antipruritic agents paroxime, doxepin or intermediate potency corticosteroids triamcinolone may be helpful. Sites that are superinfected may benefit from topical mupirocin or systemic antibiotics.
Systemic reactions to bed bug bites are treated as insect-induced anaphylaxis, 70 , 84 , 85 with treatment including intramuscular epinephrine, antihistamines, and corticosteroids. Steps necessary for bed bug eradication include 1 proper identification of the bed bug species present, because some bat-infesting species may be found inside homes; 2 education of persons involved; 3 thorough inspection of infested and adjacent areas; 4 implementation of chemical and nonchemical control measures; and 5 follow-up to evaluate the success of eradication. The mosquito repellant, oil of lemon eucalyptus, may help.
When sleeping in hotels or other unfamiliar environments, a prudent approach for preventing bites is to check the premises for bed bugs or their excreta.
Important sites to inspect include mattress cords, cracks and crevices in box springs, and the back of headboards. Items purchased at garage sales and resale shops, especially mattresses, box springs, and bedding, should be carefully inspected for bed bugs before they are brought into homes because they may initiate an infestation.
Bed bugs are extremely difficult to eradicate 1 , 86 , 89 and pest control issues relating to bed bugs and eradication procedures have been recently reviewed in detail. Currently, a variety of pesticides are undergoing evaluation for control of bed bugs. In general, the products have not performed as well as against other pests and eradication often requires nonchemical tactics as well. In 1 trial, 55 insecticide spraying of children's dwellings effectively reduced exposure to bed bugs and, in another trial, 91 insecticide-treated bed nets for malaria control helped eliminate bed bugs from infested homes.
There is evidence that pyrethroid-impregnated bed nets used in many tropical countries for malaria control may be moderately effective against bed bugs. Quiz Ref ID Pesticide control of bed bugs is complicated by insecticide resistance, lack of effective products, and health concerns about spraying mattresses with pesticides.
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