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The Bedbug Epidemic – Not Just an Itchy Rash

The bedbug has been known as a human parasite for thousands of years.  The discovery of bedbug specimens in Egyptian tombs suggests that bedbugs have been infesting human habitats for at least 3550 years (Usinger, 1966).  After World War II, bedbugs became uncommon in developed countries due to social and economic progress and insecticide development (J Paul, 2000).  Infestations in underdeveloped countries have never decreased.

Infected arthropod bite

Infected Bedbug Bite

Over the last 10 years the number of reported cases of bedbug infestations is rising rapidly.  Cases have been reported in most major cities on all continents.  Rapid turnover of residents, crowded conditions and high human density make it easier for bedbugs to spread.  Spread of bedbugs depends on their human hosts for movement from one location to another (Newberry, 1991).  Bedbugs move by way of furniture, clothing, suitcases, used mattresses and other personal belongings.  They can hitch a ride in your luggage while you are staying at a hotel or may travel from one apartment or office to another through holes in walls, air ducts, water pipes or gutters.

Bedbugs are reddish-brown, flat, wingless, oval (4-7 mm) insects.  Two species, Cimex lectularius and Cimex hemipterus, feed on humans and/or domestic animals.  Both sexes are blood-eating (hematophagous) and can live up to 12 months without feeding or even longer in colder conditions (Delaunay, 2011).

Bedbugs seek heat and carbon dioxide, which helps them find their warm-blooded hosts. They avoid light and are only active at night.  During the day they hide in mattress seams, crevices in box springs, backsides of headboards, behind hanging pictures or under loose baseboards or wallpaper.  They stay within several feet of their hosts.

Bedbug bites occur in linear or curved groups (breakfast, lunch and dinner) or clusters on exposed skin surfaces.  Bites occur usually during sleep but are not felt due to the anesthetic substance released during the bite.  Generally the person becomes aware of the bite several hours later.

Human reactions occur in approximately 30% of people bitten.  So the most common reaction to a bedbug bite is no reaction at all.  When there are reactions, they range from small, red, itchy papules to hives (urticaria) to systemic reactions, like asthma and anaphylaxis.  Because the bites are itchy, the lesions are often scratched and superinfected with bacteria.  Although rare, systemic reactions to bedbug bites can be life-threatening.

Treatment of skin reactions is usually symptomatic.  If the lesions are itchy, over-the-counter or prescription anti-pruritic agents such as calamine lotion, pramoxine or topical steroid preparations are sometimes, but not always helpful.  For systemic reactions, treatments may include oral antihistamines and/or corticosteroids or intramuscular epinephrine in cases of anaphylaxis.

The one good thing, if there is a good thing, that we have always known about bedbugs is that they don’t transmit disease.  This question of whether bedbugs can transmit infection has been studied numerous times.  Delauney et al (Delaunay, 2011) reviewed 45 candidate pathogens potentially transmitted by bedbugs, but found no report that has unequivocally demonstrated that they are infectious disease vectors.

Recently Time.com reported that scientists in Vancouver, British Columbia found MRSA, the superbacteria resistant to many antibiotics in bedbugs isolated from three hospitalized patients who were residents of Vancouver’s poor Downtown Eastside.  It was not clear from the study whether the patients transmitted the MRSA to the bedbugs or vice versa, but this finding is worrisome as both the bedbug populations and the MRSA infection rates in Downtown Eastside are on the rise.  The capacity of the bedbugs to transmit MRSA still remains to be determined.

Bedbugs are notoriously difficult to get rid of.  Multiple approaches are necessary for eradications (Goddard, 2009).  Goddard et al propose the following measures:

  1. Proper identification of bedbug species present, because bat-infesting species may be found inside homes.
  2. Patient education
  3. Thorough inspection of infested and adjacent areas
  4. Implementation of chemical and non-chemical control measures
  5. Follow-up to evaluate the success of eradication

Since insect repellents are not effective against bedbugs, the best prevention is avoidance of bites altogether.  Bedbugs and their fecal material are easily visible.  Any new sleeping environment, such as hotel rooms, needs to be closely inspected for the presence of bedbugs.  Taking them home with you in your clothing or luggage may lead to the infestation of your house or apartment.  Same close inspection must be applied to any used furniture or clothing items purchased.

When you suspect a bedbug infestation of your home, both chemical and non-chemical methods of eradication must be employed.  Insecticides do not perform well by themselves, so they must be used in conjunction with vacuuming, washing bedding and clothes in hot, soapy water, mattress and box spring encasements that will not allow remaining bedbugs to feed through the material and discarding infested furniture.


Delaunay, P. (2011). Bedbugs and Infectious Diseases. CID , 200-210.

Goddard, J. (2009). Bed Bugs (Cimex lectularius) and Clinical Consequences of Their Bites. JAMA , 1358-1366.

J Paul, J. B. (2000). Is infestation with the common bedbug increasing? British Medical Journal , 1141.

Newberry, K. (1991). Bed bug reinfestation rates in rural Africa. Med Vet Entomol , 503-505.

Usinger, R. (1966). Monograph of Cimicidae (Hemiptera-Heteroptera). Volume 7. College Park: Entomological Society of America.

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