Bedbugs and infectious diseases

Abstract

Bedbugs are brown and flat hematophagous insects. The 2 cosmopolite species, Cimex lectularius and Cimex hemipterus, feed on humans and/or domestic animals, and recent outbreaks have been reported in occidental countries. Site assessment for bedbug eradication is complex but can be assured, despite emerging insecticide resistance, by hiring a pest-control manager. The common dermatological presentation of bites is an itchy maculopapular wheal. Urticarial reactions and anaphylaxis can also occur. Bedbugs are suspected of transmitting infectious agents, but no report has yet demonstrated that they are infectious disease vectors. We describe 45 candidate pathogens potentially transmitted by bedbugs, according to their vectorial capacity, in the wild, and vectorial competence, in the laboratory. Because of increasing demands for information about effective control tactics and public health risks of bedbugs, continued research is needed to identify new pathogens in wild Cimex species (spp) and insecticide resistance.

Figure 1.

Increase in the number of PubMed citations for the search words Cimicidae, Cimex, Afrocimex, or Oeciacus over the past 10 years. The medical community's interest in bedbugs (Cimex lecturarius or Cimex hemipterus) has increased dramatically.

Figure 2.

Physical appearance of bedbugs (Cimex lectularius). Bedbugs are hematophagous arthropods that resemble small, brownish, flat, and oval confetti. A, Bedbug nymph; note the bite unit in front of the head (arrow), which is usually folded under the head as for the adult. B, Adult bedbug.

Figure 3.

Life cycle of the bedbug (Cimex lecturarius or Cimex hemipterus). These evolutionary stages and the reproduction biology of the bedbug explain how, over 1 month, an unknown introduction of several bedbugs into a new site leads to their exponential multiplication and sudden infestation.

Figure 4.

Hiding places of begbugs (Cimex lecturarius or Cimex hemipterus). An efficient search-and-destroy operation against bedbugs (A) must start by removing the mattress (B) and box springs (C), then by exploring the floor close to the bed (D) and curtains (E, F) to identify and destroy eggs, nymphs, and adults.

Figure 5.

Presentation of bedbug (Cimex lecturarius or Cimex hemipterus) bites: forms vary from asymptomatic or pauci-symptomatic to purpuric, vesicular, and bullous lesions. The typical skin lesion is a pruritic erythematous maculopapule that is 5 mm to 2 cm in diameter with a central hemorrhagic crust or vesicle at the bite site, similar to other arthropod bites (A). A series of bites in a line is characteristic of bedbug bites (B). Lesion numbers range from a few to numerous, depending on habitat-infestation intensity, and are preferentially located in unclothed zones (C). In some cases, the eruption mimics urticaria (D).