Abstract

Introduction

Species Implicated in Human Infestations

Biology and Life Cycle

Epidemiology of C. lectularius and C. hemipterus

Clinical Relevance

Control

Laboratory Collection, Identification, and Reporting

Specimen collection and handling

Morphologic features of adults and nymphs

Identification of the species of cimicids reported from humans

Reporting

References

Abstract

The world has experienced a major global resurgence of bed bug infestations over the past 2 decades. While bed bugs do not serve as vectors of disease, their bites and household infestations result in significant psychological distress, clinical manifestations, and economic costs. Most human bed bug infestations are caused by the “common bed bug,” Cimex lectularius, or the “tropical bed bug,” C. hemipterus. Zoonotic cimicids also occasionally feed on humans. Bites are the most commonly reported manifestation of infestations, although findings may be subtle and overlooked for some time. The bugs can be submitted to the laboratory for identification, and therefore, clinical microbiologists should be familiar with their key identifying features and how they can be differentiated from similar-appearing arthropods. This review covers the biology and epidemiology of bed bugs; aspects of laboratory collection, identification, and reporting; and the clinical implications of bed bug infestations.

Introduction

“Good night, sleep tight; don’t let the bed bugs bite.” This version of the well-known rhyme was first published in 1896 in the book What They Say in New England by Clifton Johnson, but variations of this verse can be found in the literature in the decades before [1]. While a seemingly innocent bedtime rhyme, it reflects the reality of life in colonial New England, in which residents went to bed hoping not to be bitten by these blood-sucking pests while they were sleeping. We now know that bed bugs have long been associated with human habitats, being found in references throughout history and from archaeological sites dating back 3,500 years [2]. Bed bugs were thought to have spread throughout Asia and Europe in the early centuries of the Common Era, and later traveled to the Americas aboard ships of early European sailors [3]. By the 1900s, bed bugs were estimated to be in 1/3 of the dwellings in European cities and disproportionately affected those living in poor, crowded neighborhoods. While bed bugs do not serve as vectors of disease, their bites and household infestations result in psychological distress, a range of unpleasant clinical manifestations, property loss, and other substantial economic costs [4, 5, 6]. It was only with the widespread household use of dichloro-diphenyl-trichloroethane (DDT) and other potent long-lasting pesticides throughout the 1940s to 1960s that the prevalence of bed bug infestations significantly decreased worldwide [3].
Unfortunately, the world is now experiencing a major resurgence in bed bug infestations, with an explosion of reports beginning around the turn of the century [4, 7]. Although the exact cause of this resurgence is unknown, it is thought to be due to multiple factors, including widespread resistance to commonly used pesticides, increased domestic and international travel, and the decline in public health pest control programs that occurred in the latter half of the 1900s [8].