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Diseases

Bed bugs

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • 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.

Bed bug bites showing numerous erythematous papules
Bed bug bites showing numerous erythematous papules
From the contributors' personal teaching collection (Julian J. Trevino, David R. Carr, Suzanne L. Dundon); used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          •                   Cimex lectularius, collected in a hotel in urban Georgia

            Cimex lectularius, collected in a hotel in urban Georgia

          •  Cimex lectularius

            Cimex lectularius

          • Bed bug bites showing numerous erythematous papules

            Bed bug bites showing numerous erythematous papules

          • Linear distribution of papules

            Linear distribution of papules

          Citations

            Key Articles

            • Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7.

            • McNeill C, Jarrett A, Shreve DM, et al. Bed bugs: current treatment guidelines​. J Nurse Pract. 2017 Jun;13(6): P381-8.[Full Text]

            Other Online Resources

            • EPA: Bed bugs: get them out and keep them out​

            Referenced Articles

            • 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.[Abstract][Full Text]

            • 2. Parola P, Izri A. Bedbugs. N Engl J Med. 2020 Jun 4;382(23):2230-7.

            • 3. Goddard J, deShazo R. Bedbugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009 Apr 1;301(13):1358-66.[Abstract][Full Text]

            • 4. Reinhardt K, Siva-Jothy MT. Biology of the bedbugs (Cimicidae). Ann Rev Entomol. 2007 Jan 7;52:351-74.[Abstract]

            • 5. Bernardeschi C, Le Cleach L, Delaunay P, et al. Bed bug infestation. BMJ. 2013 Jan 22;346:f138.

            • 6. Thomas I, Kihiczak GG, Schwartz RA, et al. Bedbug bites: a review. Int J Dermatol. 2004 Jun;43(6):430-3.[Abstract]

            • 7. McNeill C, Jarrett A, Shreve DM, et al. Bed bugs: current treatment guidelines​. J Nurse Pract. 2017 Jun;13(6): P381-8.[Full Text]

            • 8. Heymann WR. Bedbugs: a new morning for the nighttime pests. J Am Acad Dermatol. 2009 Mar;60(3):482-3.[Abstract]

            • 9. Potter M; University of Kentucky College of Agriculture, Food and Environment. Bed bugs. 2020 [internet publication].[Full Text]

            • 10. Delaunay P. Human travel and traveling bedbugs. J Travel Med. 2012 Dec;19(6):373-9.[Abstract][Full Text]

            • 11. Doggett SL, Dwyer DE, Peñas PF, et al. Bed bugs: clinical relevance and control options. Clin Microbiol Rev. 2012 Jan;25(1):164-92.[Abstract][Full Text]

            • 12. Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther. Jul-Aug 2009;22(4):347-52.[Abstract]

            • 13. Doggett SL, Lee CY. Historical and contemporary control options against bed bugs, Cimex spp. Annu Rev Entomol. 2023 Jan 23;68:169-90.[Abstract][Full Text]

            • 14. NYC Environment & Health Data Portal. Adults reporting bed bugs in their home. 2014 [internet publication].[Full Text]

            • 15. ​Anses. Bed bugs are a financial burden and reduce quality of life for many people in France. Jul 2023 [internet publication].[Full Text]

            • 16. Doggett SL. A code of practice for the control of bed bug infestations in Australia. 4th edition. March 2013 [internet publication].[Full Text]

            • 17. Abdel-Naser MB, Lotfy RA, Sayed Ali NM, et al. Patients with papular urticaria have IgG antibodies to bedbug (Cimex lectularius) antigens. Parasitol Res. 2006 May;98(6):550-6.[Abstract][Full Text]

            • 18. Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic reaction caused by Cimex lectularius. J Eur Acad Dermatol Venereol. 2003 Jul;17(4):461-3.[Abstract]

            • 19. Leverkus M, Jochim RC, Schäd S, et al. Bullous allergic hypersensitivity to bedbug bites mediated by IgE against salivary nitrophorin. J Invest Dermatol. 2006 Jan;126(1):91-6.[Abstract][Full Text]

            • 20. Aoki V, Millikan RC, Diaz LA, et al. Environmental risk factors in pemphigus foliaceus (fogo selvagem). J Investig Dermatol Symp Proc. 2004 Jan;9(1):34-40.[Abstract][Full Text]

            • 21. Centers for Disease Control and Prevention. CDC Yellow Book 2024: ​health information for international travel. Section 4: mosquitoes, ticks and other arthropods - bed bugs. May 2023 [internet publication].[Full Text]

            • 22. Krause-Parello CA, Sciscione P. Bedbugs: an equal opportunist and cosmopolitan creature. J Sch Nurs. 2009 Apr;25(2):126-32.[Abstract]

            • 23. United States Environmental Protection Agency. Bed bugs: get them out and keep them out. Jul 2024 [internet publication].[Full Text]

            • 24. Wang C, Gibb T, Bennett GW, McKnight S. Bed bug (Heteroptera: Cimicidae) attraction to pitfall traps baited with carbon dioxide, heat, and chemical lure. J Econ Entomol. 2009 Aug;102(4):1580-5.[Abstract]

            • 25. British Pest Control Association. Pest advice for controlling bed bugs [internet publication].[Full Text]

            • 26. DeShazo RD, Feldlaufer MF, Mihm MC Jr, et al. Bullous reactions to bedbug bites reflect cutaneous vasculitis. Am J Med. 2012 Jul;125(7):688-94.[Abstract][Full Text]

            • 27. Izri A, Marteau A, Ferreira T, et al. Severe anemia due to bed bugs hyperinfestation. Microb Pathog. 2020 Dec;149:104564.[Abstract]

            • 28. Sheele JM, Pritt BS, Libertin CR, et al. Bed bugs are associated with anemia. Am J Emerg Med. 2021 Aug;46:482-8.[Abstract]

            • 29. Elder DE, Elenitsas R, Rosenbach M, et al. Lever's histopathology of the skin. 11th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2014.

            • 30. Davis RF, Johnston GA, Sladden MJ. Recognition and management of common ectoparasitic diseases in travelers. Am J Clin Dermatol. 2009;10(1):1-8.[Abstract]

            • 31. Wang C, Tsai WT, Cooper R, et al. Effectiveness of bed bug monitors for detecting and trapping bed bugs in apartments. J Econ Entomol. 2011 Feb;104(1):274-8.[Abstract]

            • 32. US Environmental Protection Agency. Bed bug clearinghouse by audience [internet publication].[Full Text]

            • 33. Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. J Allergy Clin Immunol. 2006 Jun;117(6):1508-9.[Abstract][Full Text]

            • 34. Moore DJ, Miller DM. Laboratory evaluations of insecticide product efficacy for control of Cimex lentularius. J Econ Entomol. 2006 Dec;99(6):2080-6.[Abstract]

            • 35. Myamba J, Maxwell CA, Asidi A, et al. Pyrethroid resistance in tropical bedbugs, Cimex hemipterus, associated with use of treated bednets. Med Vet Entomol. 2002 Dec;16(4):448-51.[Abstract]

            • 36. Sheele JM, Ridge G, Li X, et al. The benefit of a single oral dose of ivermectin in humans: the adverse effects on cimex lectularius L. populations and fecundity. Cureus. 2019 Nov 8;11(11):e6098.[Abstract][Full Text]

            • 37. Ter Poorten MC, Prose NS. The return of the common bedbug. Pediatr Dermatol. 2005 May-Jun;22(3):183-7.[Abstract]

            • 38. Fletcher CL, Ardern-Jones MR, Hay RJ. Widespread bullous eruption due to multiple bed bug bites. Clin Exp Dermatol. 2002 Jan;27(1):74-5.[Abstract]

            • 39. Ashcroft R, Seko Y, Chan LF, et al. The mental health impact of bed bug infestations: a scoping review. Int J Public Health. 2015 Nov;60(7):827-37.[Abstract][Full Text]

            • 40. Silverman AL, Qu LH, Walker ED, et al. Assessment of hepatitis B virus DNA and hepatitis C virus RNA in the common bedbug (Cimex Lectularius L.) and kissing bug (Rodnius prolixus). Am J Gastroenterol. 2001 Jul;96(7):2194-8.[Abstract]

            • 41. Blow JA, Turell MJ, Walker ED, et al. Stercorarial shedding and transtadial transmission of hepatitis B virus by common bedbugs (Hemiptera: Cimicidae). J Med Entomol. 2001 Sep;38(5):694-700.[Abstract][Full Text]

            • 42. Lowe CF, Romney MG. Bedbugs as vectors for drug-resistant bacteria. Emerg Infect Dis. 2011 Jun;17(6):1132-4.[Abstract][Full Text]

            • 43. Herrera AL, Chaussee MS, Pietri JE. Experimental acquisition, maintenance, and transmission of methicillin-resistant Staphylococcus aureus by the common bed bug, Cimex lectularius. J Infect Dis. 2024 Jan 12;229(1):245-51.[Abstract]

            • 44. Lai O, Ho D, Glick S, et al. Bed bugs and possible transmission of human pathogens: a systematic review. Arch Dermatol Res. 2016 Oct;308(8):531-8.[Abstract][Full Text]

            • 45. Hildreth CJ, Burke AE, Glass RM. JAMA patient page: bed bugs. JAMA. 2009 Apr 1;301(13):1398.[Abstract][Full Text]

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