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Bedbug infestations occur throughout the world. The most common bedbugs affecting humans are Cimex lectularis (in temperate climates) and C. hemipterus (mainly in tropical climates).

Bedbugs hide in cracks and crevices of mattresses, other structures (eg, bed frames, cushions, and walls; in areas with less than optimal living conditions such as mud houses and thatched roofs). They multiply exponentially; a few bedbugs multiply to thousands within 2 to 3 months. They move slowly and are attracted to people by warmth and carbon dioxide.

Bedbugs bite exposed skin, usually at night. A feeding is completed in 5 to 10 minutes. Bedbugs are not known to transmit infections to humans (1).

Lesions are generally on exposed skin. They develop some time between the morning after and 10 days after being bitten. Lesions can be any of the following:

• Puncta only

• Purpuric macules

• Erythematous macules, papules, or wheals, often pruritic, each with a central hemorrhagic punctum

• Bullae

Lesions may form linear patterns or may be seen in groups (1). Older adults develop symptoms less often than do younger people. Lesions resolve after about 1 week. Secondary infection can develop.

Bedbug Bites

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Patients may be anxious about the difficulty and expense of eradicating a bedbug infestation and about the social stigma that can result from infestation. They may isolate themselves to avoid spreading infestation.

• Clinical evaluation

Diagnosis based on lesion appearance may be difficult because the appearance is usually nonspecific. However, most bedbug bites are larger and more edematous than other bites (eg, flea bites).

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Image courtesy of CDC/DPDx.

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Image courtesy of CDC/Harvard University, Dr. Gary Alpert, Urban Pests–Integrated Pest Management (IPM); Dr. Harold Harlan; and Richard Pollack via the Public Health Image Library of the Centers for Disease Control and Prevention.

Identification of bedbugs can help confirm the diagnosis. Bedbugs have flat, oval, reddish brown bodies. After a blood meal, the body is less flat and more reddish. Adult C. lectularis are about 5 to 7 mm in length, and C. hemipterus are slightly longer. Bedbug feces or blood may be evident on bed linens or behind wallpaper.

• Symptomatic treatment

• Eradication and prevention of infestations

Bedbug bites are treated symptomatically (eg, with topical corticosteroids and/or systemic antihistamines) as needed.

Eradicating bedbugs is difficult and is closely linked to detection. Eradication typically requires a multipronged approach and includes accurate detection and monitoring techniques, nonchemical modalities, and chemical agents. Nonchemical control options include exposure to extreme temperatures, exclusion, and physical removal (1).

Physical removal includes vacuuming affected areas and laundering suspect articles, then drying them on the dryer's hottest setting. In addition, entire rooms should be treated professionally, when possible, by heating to temperatures ≥ 50° C (122° F) or with multiple insecticides. The use of insecticides is limited largely because of issues with resistance. Bedbugs and eggs on infested items are killed when frozen at -20° C (-4° F) for at least 2 hours; however, placement in most home kitchen freezers is typically insufficient (2).

Prevention methods include the use of simplified furniture (eg, metal beds). Harborage of bedbugs can be reduced by sealing cracks and crevices. New sleeping areas (eg, hotel rooms) should be inspected prior to use, with particular attention to the mattress and bedding (1).