Bed bug

The most common skin findings associated with bed bug bites are pruritic, maculopapular, erythematous lesions.[8] Each lesion is about 2–5 mm (0.08–0.2 in) but may be as large as 2 cm (0.8 in) in diameter and there may or may not be the presence of a central punctum.[8] Bites are usually present on areas of exposed skin, especially exposed areas not covered by sheets or blankets, such as arms, legs, feet, face or neck.[8] Individual responses to bites vary, ranging from no visible effect (in about 20–70%),[3][5] to small flat (macular) spots, to the formation of prominent blisters (wheals and bullae) along with intense itching that may last several days.[5] Vesicles and nodules may also form. The lesions due to bites may become secondarily infected due to scratching but systemic effects from bed bug bites are very rare.[8] A central spot of bleeding may also occur due to the release of blood thinning substances in the bug's saliva.[4]

Symptoms may not appear until some days after the bites have occurred.[5] Reactions often become brisker after multiple bites due to possible sensitization to the salivary proteins of the bed bug.[3] Numerous bites may lead to a red rash or hives.[5]

Bedbug bites may cause other symptoms and health issues. Serious allergic reactions including anaphylaxis from the injection of serum and other non-specific proteins have been documented, though rarely.[5][11] As each bite takes a tiny amount of blood, chronic or severe infestation may lead to anemia.[5] Scratching bites may lead to bacterial skin infection.[5][12] Systemic poisoning may occur if the bites are numerous.[13] The bite itself may be painful thus resulting in poor sleep and worse work performance.[5]

Bed bugs can feed on warm-blooded animals other than humans, such as pets. The signs left by the bites are the same as in the case of people and cause identical symptoms (skin irritation, scratching etc.).[14] Bed bugs can infest poultry sheds and cause anemia and a decrease in egg production in hens.[15]

Treatment of bed bug bites requires keeping the person from being repeatedly bitten, and possible symptomatic use of antihistamines and corticosteroids (either topically or systemically).[5] There however is no evidence that medications improve outcomes, and symptoms usually resolve without treatment in 1–2 weeks.[3][4]

It is possible that exposure to bed bugs may trigger an asthma attack via the effects of airborne allergens, although evidence of this association is limited.[5]

Serious infestations and chronic attacks can cause anxiety, stress, and sleep difficulties.[5] Development of refractory delusional parasitosis is possible, as a person develops an overwhelming obsession with bed bugs.[16]

Knowing that symptoms are caused by bedbug bites rather than other causes requires seeking and finding the insect in the sleeping environment, as symptoms are not specific to bedbug bites.[5] Bites by other arthropods cause similar symptoms, even the linear pattern of bites known colloquially as "breakfast, lunch and dinner bites".[8]

Bed bugs can occur singly, but tend to congregate once established. Although strictly parasitic, they spend only a tiny fraction of their lives physically attached to hosts. Once a bed bug finishes feeding, it follows a chemical trail to return to a nearby harborage, commonly in or near beds or couches, where they live in clusters of adults, juveniles, and eggs. These places may include luggage, vehicle interiors, furniture, bedside clutter—even inside electrical sockets or laptop computers. Bed bugs may also lodge near animals that have nested within a dwelling, such as bats, birds,[27] or rodents. They can also survive by feeding on domestic cats and dogs, though humans are the preferred host of C. lectularius.[30]

A severe bedbug infestation can be detected by their characteristic pungent sweet smell, which has been described as like rotting raspberries.[31] Bed bug detection dogs are trained to pinpoint infestations, with a possible accuracy rate between 11% and 83%.[6][2]

Homemade detectors have been developed.[32][33] Bedbug detectors, often referred to as "monitors", "traps" or "interceptors",[34] use the lactic acid or carbon dioxide associated with the presence of a human body, or pheromones, to attract and trap bugs in a container. Bedbug detectors can confirm an infestation, but do not trap enough for eradication.[8]

• 
  Eggs and two adults found inside a dresser
• 
  Fecal spot
• 
  Bed bug on carpet

Other conditions which produce symptoms similar to bedbug bites include scabies, gamasoidosis, allergic reactions, mosquito bites, spider bites, chicken pox and bacterial skin infections.[5]

To prevent bringing home bed bugs from outside the home, people are advised to take precautions after visiting an infested site or traveling on means of transport that may be infested; precautions include checking shoes on leaving the site, changing clothes outside the house before entering, and putting the used clothes in a clothes dryer outside the house. When visiting a new lodging, it is advised to check the bed before taking suitcases into the sleeping area, and putting the suitcase on a raised stand to make bedbugs less likely to crawl in. Clothes should be hung up or left in the suitcase rather than left on the floor.[35] Additional preventative measures include sealing cracks and crevices (where bed bugs often hide), inspecting furniture, and decontaminating clothes and luggage upon returning home.[8] The founder of a company dedicated to bedbug extermination said that 5% of hotel rooms he booked into were infested. He advised people never to sit down on public transport; check office chairs, plane seats, and hotel mattresses; and monitor and vacuum home beds once a month.[36] Close all wall openings or gaps; bed bugs tend to hide in dark places such as cracks in walls. Second-hand furniture may harbour bedbugs.

Avoiding repeated bites can be difficult since it usually requires eradicating bed bugs from a home or workplace; eradication is most effective using non-chemical control methods.[8] Non-chemical control methods include vacuuming carpet and furniture (often with scraping) into a disposable bag which is then sealed into a plastic bag to prevent re-infestation.[8] Other methods include removing textile materials from an area and washing them in hot water (at least 60 degrees Celsius) or freezing them at −20 °C (−4 °F).[8] Most consumer-grade freezers are inadequate to kill bedbugs because they cannot create sufficiently low temperatures.[8] Unremovable textiles such as mattresses can be steamed to at least 60 °C (140 °F) and this method can penetrate deep into the textile to effectively kill bed bugs in, potentially, under one minute.[8] Heating tents or chambers can be used for infested materials or entire rooms can be heated to at least 55 °C (131 °F) to effectively eradicate infestation.[8]

There is no evidence to indicate that a combination of non-chemical methods plus insecticides is more effective than non-chemical methods alone with regards to eradication of bed bug infestations.[8]

Insecticides are mostly ineffective for the eradication of bedbug infestations as most bedbugs are resistant to insecticides, including pyrethroids which are found in approximately 90% of commercial grade insecticides.[8] Furthermore, insect foggers (known as "bug bombs") are ineffective in the eradication of bed bug infestation as they are unable to penetrate bed bug harborages.[8] Resistance to pesticides has increased significantly over time, and there are concerns about harm to health from their use.[3]

Once established, bed bugs are extremely difficult to get rid of,[3] particularly in buildings with multiple dwellings, as they may be present in other parts of the building than the dwelling being treated,[8] and can re-establish populations by moving from infested to decontaminated areas.

Mechanical approaches, such as vacuuming up the insects and heat-treating or wrapping mattresses, are effective.[3][6] An hour at a temperature of 45 °C (113 °F) or over, or two hours at less than −17 °C (1 °F) kills them.[6] This may include a domestic clothes drier for fabric or a commercial steamer. Bed bugs and their eggs will die on contact when exposed to surface temperatures above 180 °F (82 °C) and a steamer can reach well above 230 °F (110 °C).[19][37] A study found 100% mortality rates for bed bugs exposed to temperatures greater than 50 °C (122 °F) for more than 2 minutes. The study recommended maintaining temperatures of above 48 °C (118 °F) for more than 20 min to effectively kill all life stages of bed bugs, and because in practice treatment times of 6 to 8 hours are used to account for cracks and indoor clutter.[38] This method is expensive and has caused fires.[6][19] Starving bedbugs is not effective, as they can survive without eating for 135 to 300 days, depending on temperature.[6][8]

After the withdrawal of most organochlorine insecticides, it was stated in 2012 that no truly effective insecticides were available.[6] Insecticides that have historically been found effective include pyrethroids, dichlorvos, and malathion.[4] Resistance to pesticides has increased significantly in recent decades.[3] The carbamate insecticide propoxur is highly toxic to bed bugs, but it has potential toxicity to children exposed to it, and the US Environmental Protection Agency has been reluctant to approve it for indoor use.[39] Boric acid, sometimes applied as a safe indoor insecticide against pests such as cockroaches and termites, is not effective against bed bugs[40] because they do not groom.[41]

Until the mid-20th century, bed bugs were very common. According to a report by the UK Ministry of Health, in 1933, all the houses in many areas had some degree of bed bug infestation.[54] The increase in bed bug populations in the early 20th century has been attributed to the advent of electric heating, which allowed bed bugs to thrive year-round instead of only in warm weather.[77]

Bed bugs were a serious problem at US military bases during World War II.[78] Initially, the problem was solved by fumigation, using Zyklon Discoids that released hydrogen cyanide gas, a rather dangerous procedure.[78] Later, DDT was used to good effect, though bedbugs have since become largely resistant to it.[78][79][80]

The decline of bed bug populations in the 20th century is often credited to potent pesticides that had not previously been widely available.[81] Other contributing factors that are less frequently mentioned in news reports are increased public awareness and slum clearance programs that combined pesticide use with steam disinfection, relocation of slum dwellers to new housing, and in some cases also follow-up inspections for several months after relocated tenants moved into their new housing.[77]

In 2010, bed bugs infestation was reported in New York's houses, retail stores, cinemas, offices and schools especially in Brooklyn and Queens.[82] In early 2023, Orkin reported that Chicago, New York, Philadelphia, Cleveland and Los Angeles were the top five cities in the United States with most bed bugs infestations.[83]

In France, these insects re-emerged, despite having disappeared from daily life in the 1950s, due to nomadic lifestyles, consumption of second-hand purchases, and bug's resistance to insecticides,[84] in addition to increased traveling and tourism following the COVID-19 lockdowns.[85] Between 2017 and 2022, 11% of French households were infested by bed bugs, according to a report from the National Agency for Food, Environmental and Occupational Health Safety (ANSES).[84] In summer 2023, reports emerged of bed bug infestation spread in the capital city of Paris, when it was first seen in cinemas, then it expanded to homes, trains, schools and even hospitals.[86] Treatment of this outbreak has been costing France an estimated €230m annually.[87] In the meantime, the United Kingdom witnessed a 65% increase in year-on-year infestations across the country, according to Rentokil.[88]

Bed bugs are an increasing cause for litigation.[89] Courts have, in some cases, exacted large punitive damage judgments on some hotels.[90][91][92] Many of New York City's Upper East Side homeowners have been afflicted, but they tend to remain publicly silent in order not to ruin their property values and be seen as suffering a blight typically associated with "lower social class."[93] Local Law 69 in New York City requires owners of buildings with three or more units to provide their tenants and potential tenants with reports of bedbug history in each unit. They must also prominently post these listings and reports in their building.[94]

• "Good night, sleep tight, don't let the bed bugs bite," is a traditional saying.[95]

• The Bedbug (Russian: Клоп, romanized: Klop) is a play by Vladimir Mayakovsky written in 1928–1929.
• How the Bed Bug Infiltrated Our Bedrooms and Took Over the World was written by Brooke Borel.