Bed bugs

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Key diagnostic factors

common

bed bug sighting

Patients may report witnessing small brown bugs in sites common for bed bugs in their environment (e.g., crevices of mattresses, box springs, bed headboards, and behind baseboards). Ink dot-like spots on headboards and mattresses or blood stains on sheets are clues to bed bug infestations in the bedroom.[25] When asked, however, patients will often deny knowledge of any recent insect bite.[Figure caption and citation for the preceding image starts]: Cimex lectularius, collected in a hotel in urban GeorgiaCourtesy of the CDC [Citation ends]. com.bmj.content.model.Caption@325b1e9f [Figure caption and citation for the preceding image starts]: Cimex lectulariusCourtesy of the CDC [Citation ends].

irregular curved or linear erythematous papules

Most skin lesions are erythematous papules, 1-5 mm in size, arranged in an irregular curved or linear pattern on skin exposed during sleep (e.g., face, neck, arms, legs, and shoulders).[7] A small central hemorrhagic punctum may be seen.[3][12]

Lesions may occur hours to days after being bitten.[7] The interval between bite and reaction may decrease as the host is repeatedly exposed.[8][Figure caption and citation for the preceding image starts]: Bed bug bites showing numerous erythematous papulesFrom the contributors' personal teaching collection (Julian J. Trevino, David R. Carr, Suzanne L. Dundon); used with permission [Citation ends]. com.bmj.content.model.Caption@7116818f [Figure caption and citation for the preceding image starts]: Linear distribution of papulesFrom the contributors' personal teaching collection (Julian J. Trevino, David R. Carr, Suzanne L. Dundon); used with permission [Citation ends].

new skin lesions noted in the morning

Patients often report new lesions in the morning.[7] Bed bugs are nocturnal and prefer to feed during minimal host activity.[4]

pruritus

Patients often describe an intense pruritus.

Other diagnostic factors

uncommon

pain or burning

Rarely, patients may describe pain or burning of the lesions.

papular or diffuse urticaria

Less commonly, lesions may present as a papular or diffuse urticaria.[3]

bullae

Less commonly, bullous lesions may be present.[3][7]

widespread urticaria/wheezing/stridor/hypotension

Rarely, patients may present with anaphylaxis.[3]

specks of blood or feces on sheets

Patients may report specks of blood or feces on their bed sheets or mattress.

Risk factors

weak

high-turnover environment

Locations such as hotels, hostels, and homeless shelters may have higher rates of infestations as people coming and going frequently allows for easy spread of bed bugs.[4][9][20]

recent travel

Bed bugs are thought to be spread by means of luggage and clothing.[9] This may explain an increase in bed bug infestations in hotels and the increased incidence of infestations in homes after a history of recent travel.[10]

secondhand furniture in the home

Bed bugs hide in items such as furniture and mattresses.[9] In the home, bed bugs preferentially inhabit crevices of walls and mattresses, box springs, bed headboards, and behind baseboards.[2][3][6]

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