Bedbugs

Bedbugs, including Cimex lectularius, the common bedbug, and C. hemipterus, the tropical bedbug, are flat, brown insects that bite humans to obtain a blood meal. A global resurgence of bedbugs has been observed in the past 30 years. One reason for this resurgence is increasing resistance to insecticides.

Patients typically present with cutaneous lesions that appear to be bites. However, associating these lesions with bedbug bites may be difficult because people may not know their house has become infested. The presence of exoskeletons or bedbug dark fecal spots on the mattress and bedding is a clear sign of infestation.

Bedbug bites are painless and may occur on any exposed part of the body, but most commonly occur on areas not covered by sheets and blankets, such as the arms, legs, feet, face, and neck. Skin lesions may be noticeable immediately upon wakening but sometimes develop over the following days. Typical lesions are 2 to 5 mm in diameter and appear maculopapular and erythematous Other lesions include wheals, vesicles, and, less frequently, bullae and nodules. A central punctum at the bite site may be visible. Scratching of pruritic lesions may lead to secondary infections such as impetigo, ecthyma, folliculitis, or cellulitis.

Bedbugs have been shown to carry more than 45 infectious agents, and some experimental data have suggested they might transmit disease vectors such as Trypanosoma cruzi, that causes Chaga’s disease, Bartonella quintana, that causes louse-borne trench fever, and Borrelia recurrentis, that causes recurrent fever. There are currently no known cases of transmission of any infectious agents by bedbugs to humans.

Reference

Parola P and Izri A. Bedbugs, June 4, 2020, N Engl J Med 2020; 382:2230-2237