Bed bugs

Management Strategy

Bed bug infestations are more common due to resistance and/or subsequent banning of the pesticide, dichlorodiphenyltrichloroethane (DDT).

Bed bugs usually bite just before dawn and lie in close proximity to humans’ sleeping quarters. Although the bite of a bed bug is painless, an allergic reaction may ensue in some individuals, resulting in a skin lesion. Bed bugs typically bite exposed surfaces, such as the extremities or head/neck. The insect will not usually venture beneath bedding or bed clothes. A linear arrangement to bites is common.

The insect does not reside or lay eggs upon humans. Treatment focuses upon detection and eradication of the household infestation . Insecticides, growth-regulating agents, and destructive modalities may be employed to kill adults, progeny, and eggs. Many authorities believe that safe and successful eradication requires professional assistance.

Use of insecticides in the United States is regulated by the Environmental Protection Agency. The extended residual effect of DDT resulted in environmental damage; its use was banned. Resistance, first to DDT and later to malathion, may be an issue with its reemergence of bed bugs. More recently, pyrethroids (e.g., deltamethrin) have been utilized in controlling bed bug infestations, but, again, resistance has emerged.

There is interest in use of temperature extremes to eradicate infestations. Steam may be utilized to sterilize a mattress or similar materials for which insecticides are inappropriate, but a target temperature of 160–180°F must be reached over the entirety of the surface.

Commercial whole room/whole home heating , using propane heaters and fans, is available. Most of these systems achieve a target temperature of around 113°F, held for 15–60 min. Although this temperature is less than the thermal death point of bed bugs (118°F), such treatments are often successful, presumably due to powerful convection currents that desiccate the insects. Other comparatively simplistic measures, such as impermeable mattress covers, are also widely employed.

The manipulation of insect pheromones is gaining interest, as bed bugs use pheromones to aggregate for mating and to increase local humidity and avoid desiccation. Ergo, blocking of this pheromone signaling may have disastrous effects upon a bed bug colony.

Treatment of bed bug bites among humans is directed at symptoms. Skin lesions are due to an allergic reaction to the saliva leaked during feeding. Sensitization is not universal, and some individuals will not react to bites.

Symptomatic bed bug bites produce an erythematous wheal, followed by a firm, reddish papule, sometimes with a central hemorrhagic punctum. Papulonecrotic and bullous forms have been described. Bites are often pruritic and are usually present on surfaces that are exposed during sleep, such as the head, neck, and extremities. Bite symptoms are treated with potent topical steroids and antihistamines .

The position of the US Centers for Disease Control and Prevention (CDC), and the bulk opinion of other experts, is that, as of yet, there is no clear evidence of successful transmission of a bloodborne pathogen via bed bug bites. Additional laboratory testing beyond bacterial culture of superinfected bites is not recommended.

Travel is a widely recognized contributing factor to the ‘epidemic’ of bed bug infestations. Hotels and other lodging facilities, regardless of cleanliness or cost, may be infested, and it is possible to bring an infestation home after a stay in infested lodgings.

It is important to inspect lodging facilities upon check-in. Luggage should be kept closed, or even sealed in plastic bags, to be left at the destination upon departing. Use of dressers and bureaus in a hotel room is discouraged. Metal luggage stands are preferable to wooden stands.