Sensitivity to bites by the bedbug, Cimex lectularius

Bed Bug Infestation: An Updated Review

In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations. Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions. Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.

Procurement Competence and Framework Agreements for Upgraded Bed Bug Control [Cimex lectularius (Hemiptera: Cimicidae)]

The prevalence of bed bugs (Cimex lectularius L.) is increasing worldwide. Due to this increase, low-income housing owners and managers need an efficient method for controlling the pests without excessive resource use. The quality of pest control efforts is crucial for efficient eradication. Infestations often need to be approached using a variety of strategies through an integrated pest management (IPM) framework. Efficient eradication is often thought to be the responsibility of the pest control contractor alone. However, the purchase and supply management theory suggests that optimal solutions actually involve sound buyer-supplier relations to support the strategic aim of pest eradication. This study illustrates the positive outcomes of elevating pest management competence on the buyer's part. Further, this study outlines a large-scale purchase situation that quantifies bed bug control efforts, in addition to their outcomes. In total, 11,000 apartment units were observed in Oslo, Norway, over a period of six years. The release and implementation of a procurement officer together with a state-of-the-art pest management framework agreement quickly reversed the consistent escalation of bed bug infestations in the observed units. Observations revealed that the study yielded the most success in eradicating bed bugs by increasing both the number of visits to the infested apartment and the overall duration of control efforts. The improved control was achieved at a reduced cost per infested apartment unit, which allowed for the implementation of bed bug preventive measures and building-wide inspections. The observations made in this study have been discussed in the context of the impact of bed bugs in low-income communities, relative to the factors of pest burden, demography, socioeconomics, and the welfare system in Norway.

The Impact of Bedbug (Cimex spp.) Bites on Self-Rated Health and Average Hours of Sleep per Day: A Cross-Sectional Study among Hong Kong Bedbug Victims

Simple Summary

Bedbugs (Cimex spp.) are a nuisance pest of significant public health importance that is on the rise globally, especially in crowded cities such as Hong Kong. Bedbug infestations disproportionately affect underprivileged communities living in crowded and dilapidated housing. This study uses an online survey to investigate the health impacts of bedbug infestations among bedbug victims. This study found that most bedbug victims experienced ≥five bites in the past month, usually on the arms and legs. The most common reaction to bites were itchiness, redness, and swelling of the skin, and difficulties sleeping or restlessness. Bites usually occurred during sleep, impacting the bedbug victim’s mental and emotional health, and sleeping quality most severely. The adverse health outcomes of bedbug infestations were associated with the lower self-rated health and average hours of sleep per day of bedbug victims. This study brings attention to the neglected issue of bedbug infestations by providing evidence on the scope of its health impacts, informing public health interventions including public education and extermination programmes, and supportive laws and policies for adequate housing and hygiene. The successful control of bedbugs in an international city such as Hong Kong can inform the control of the global bedbug resurgence.

Abstract

Bedbugs (Cimex spp.) are a nuisance public-health pest that is on the rise globally, particularly in crowded cities such as Hong Kong. To investigate the health impacts of bedbug infestations among bedbug victims, online surveys were distributed in Hong Kong between June 2019 to July 2020. Data on sociodemographics, self-rated health, average hours of sleep per day, and details of bedbug infestation were collected. Bivariate and multivariable analysis were performed using logistic regression. The survey identified 422 bedbug victims; among them, 223 (52.9%) experienced ≥five bites in the past month; most bites occurred on the arms (n = 202, 47.8%) and legs (n = 215, 51%), and the most common reaction to bites were itchiness (n = 322, 76.3%), redness, and swelling of the skin (n = 246, 58.1%), and difficulties sleeping or restlessness (n = 125, 29.6%). Bites usually occurred during sleep (n = 230, 54.5%). For impact on daily life in the past month, most bedbug victims reported moderate to severe impact on mental and emotional health (n = 223, 52.8%) and sleeping quality (n = 239, 56.6%). Lower self-rated health (aOR < 1) was independently associated with impact on physical appearance (p = 0.008), spending money on medication or doctor consultation (p = 0.04), number of bites in the past month (p = 0.023), and irregular time of bites (p = 0.003). Lower average hours of sleep per day (aOR < 1) was independently associated with impact on mental and emotional health (p = 0.016). This study brings attention to the neglected issue of bedbug infestation by considering bedbugs as an infectious agent instead of a vector and providing empirical evidence describing its health impacts.

Association between bed bugs and allergic reactions

AIMS

To evaluate whether bed bugs are associated with allergic reactions in patients seen in the emergency department (ED).

METHODS AND RESULTS

This retrospective study included data from 9 EDs in Ohio between February 2011 and February 2017. The study comprised 332 patients with bed bug infestation matched 1:15 with 4952 control patients without bed bugs on the basis of age, sex and the presenting ED. Compared with uninfested patients, patients infested with bed bugs were more likely to have an ED or inpatient diagnosis of pruritus, hives or urticaria (odds ratio [OR], 9.12 [95% CI, 3.41-24.42]) and to be treated in the ED with an antihistamine (OR, 3.20 [95% CI, 1.87-5.50]) or albuterol (OR, 1.59 [95% CI, 1.07-2.36]) (P ≤ .02 for all). There were no significant differences in the rates of anaphylaxis and angioedema diagnosed in patients with and without bed bugs, which occurred in <1% in both groups.

CONCLUSION

Bed bug-infested patients are more likely to be diagnosed and treated for itchy cutaneous rashes, but are not clearly associated with more severe allergic reactions.

Human immunoglobulin G responses to Cimex lectularius L. saliva

AIMS

To investigate the immunoglobulin (Ig) G response after being fed upon by Cimex lectularius L.

METHODS AND RESULTS

Participants were fed upon by three male C lectularius insects weekly for a month. Blood was obtained before the feeding and at the last feeding, which was used for immunoblots against bed bug salivary gland extract, with antihuman Immunoglobulin G (IgG) secondary antibodies. No consistent IgG changes developed in 11 humans serially fed upon by C lectularius. Two participants had new IgG responses to proteins at molecular weights of approximately 12-13 kDa, and one had an IgG response to a protein at approximately 40 kDa. At the last study visit, more intense IgG bands to proteins at molecular weights of 12-13 kDa had developed in 55% of participants (6/11) and at molecular weights of ≈30, ≈40 and ≈70 kDa in 45% (5/11) compared with the first study visit. Nitrophorin and apyrase were the most common C lectularius proteins identified with liquid chromatography-tandem mass spectrometry in both crushed bed bug salivary gland extract and post-bed bug feeding extract.

CONCLUSIONS

Human participants did not have consistent IgG responses to crushed C lectularius salivary gland extract.

Cimicosis in Persons Previously Fed Upon by Bed Bugs

Introduction

Bed bug infestations have risen dramatically in many industrialized nations in recent decades. Most people fed upon by bed bugs will develop a pruritic rash although the frequency with which this occurs is not definitively known and may depend on host factors including the duration of the infestation.

Methods

Surveys were completed from 706 emergency department (ED) patients in Cleveland, OH about their current and past exposure with bed bugs. Subjects were asked about any post-bed bug feeding rashes that developed.

Results

There were 24% (169/698) of subjects reporting either a current or past home bed bug infestation, with 37% (253/698) reporting they had previously been fed upon by a bed bug. Of those reporting a previous bed bug feeding, 68% (172/253) reported a pruritic post-bed bug feeding rash and 24% (57/237) reported developing a blister. Overall, 5% (37/705) of ED patients reported currently having a rash, but only 2% (14/698) of ED patients reported currently have bed bugs at home and of those, only 14% (2/14) said they currently had a rash.

Conclusion

While 68% of ED patients reported a pruritic post-bed bug feeding pruritic rash, almost a third of persons did not report developing the rash. Post-bed bug feeding blister reactions are less common. Asking ED patients about a rash had a low sensitivity of 14% (2-43%) and a specificity 95% (93-96%) to identify persons reporting home bed bugs.

Common bed bugs can biosynthesize pheromone components from amino acid precursors in human blood

We have recently shown that the aggregation pheromone of the common bed bug, Cimex lectularius, comprises a six-component blend of dimethyl disulfide (DMDS), dimethyl trisulfide (DMTS), (E)-2-hexenal, (E)-2-octenal, 2-hexanone, and histamine. Here, we tested the hypothesis that bed bugs biosynthesize some pheromone components from amino acid precursors in human blood, namely DMDS and DMTS from L-methionine and histamine from histidine. We tested this hypothesis by (i) allowing bed bugs to feed on and metabolize sheep blood enriched with 13C-labelled histidine or 2H-labelled methionine, (ii) extracting bed bug feces (a source of the aggregation pheromone), and (iii) analyzing feces extracts by GC-MS, HPLC-MS and NMR spectroscopy. The analyses revealed that bed bugs converted 2H-methionine to 2H-DMDS and 2H-DMTS, and 13C-histidine to 13C-histamine. There is not enough histidine in human blood to account for the amount of histamine that bed bugs produce and excrete with their feces, and only a small proportion of the available 13C-histidine was converted to 13C-histamine in our study. Therefore, it is likely that bed bugs biosynthesize histamine, and possibly also DMDS and DMTS, primarily de novo.

Neuropeptidomics of the Bed Bug Cimex lectularius

The bed bug Cimex lectularius is a globally distributed human ectoparasite with fascinating biology. It has recently acquired resistance against a broad range of insecticides, causing a worldwide increase in bed bug infestations. The recent annotation of the bed bug genome revealed a full complement of neuropeptide and neuropeptide receptor genes in this species. With regard to the biology of C. lectularius, neuropeptide signaling is especially interesting because it regulates feeding, diuresis, digestion, as well as reproduction and also provides potential new targets for chemical control. To identify which neuropeptides are translated from the genome-predicted genes, we performed a comprehensive peptidomic analysis of the central nervous system of the bed bug. We identified in total 144 different peptides from 29 precursors, of which at least 67 likely present bioactive mature neuropeptides. C. lectularius corazonin and myosuppressin are unique and deviate considerably from the canonical insect consensus sequences. Several identified neuropeptides likely act as hormones, as evidenced by the occurrence of respective mass signals and immunoreactivity in neurohemal structures. Our data provide the most comprehensive peptidome of a Heteropteran species so far and in comparison suggest that a hematophageous life style does not require qualitative adaptations of the insect peptidome.

Effect of Moxidectin on Bed Bug Feeding, Development, Fecundity, and Survivorship

The common bed bug, Cimex lectularius L. (Hemiptera: Cimicidae), is a blood-feeding ectoparasite which experienced world-wide resurgence during recent decades. The control of bed bugs is often challenging, due to their cryptic nature and resistance to commonly used insecticides. In this study, we evaluated the effect of the antiparasitic drug moxidectin on bed bug survival, reproduction, and development. The LC50 (lethal concentration to kill half the members of a tested population) of moxidectin against bed bug male adults, female adults, and large nymphs were 52.7 (95% CI (confidence interval): 39.5-70.8), 29.3 (95% CI: 20.7-40.5), and 29.1 ng/mL (95% CI: 23.3-35.3), respectively. Moxidectin (≥ 25 ng/mL) reduced egg laying of bed bug females, but showed no significant effect on egg hatching. One time feeding on rabbit blood containing 20 and 40 ng/mL moxidectin showed no negative effects in bed bug feeding and blood meal ingestion, but significantly reduced digestion rates and nymph molting rates. Although moxidectin at concentrations of 20 and 40 ng/mL only caused moderate mortality in bed bugs, it significantly interrupted digestion, development, and oviposition of survived bed bugs for at least one week after feeding. Moxidectin is a promising supplement of the existing bed bug control materials if its use on humans can be approved in the future.

Insecticide resistance and resistance mechanisms in bed bugs, Cimex spp. (Hemiptera: Cimicidae)

The worldwide resurgence of bed bugs [both Cimex lectularius L. and Cimex hemipterus (F.)] over the past two decades is believed in large part to be due to the development of insecticide resistance. The transcriptomic and genomic studies since 2010, as well as morphological, biochemical and behavioral studies, have helped insecticide resistance research on bed bugs. Multiple resistance mechanisms, including penetration resistance through thickening or remodelling of the cuticle, metabolic resistance by increased activities of detoxification enzymes (e.g. cytochrome P450 monooxygenases and esterases), and knockdown resistance by kdr mutations, have been experimentally identified as conferring insecticide resistance in bed bugs. Other candidate resistance mechanisms, including behavioral resistance, some types of physiological resistance (e.g. increasing activities of esterases by point mutations, glutathione S-transferase, target site insensitivity including altered AChEs, GABA receptor insensitivity and altered nAChRs), symbiont-mediated resistance and other potential, yet undiscovered mechanisms may exist. This article reviews recent studies of resistance mechanisms and the genes governing insecticide resistance, potential candidate resistance mechanisms, and methods of monitoring insecticide resistance in bed bugs. This article provides an insight into the knowledge essential for the development of both insecticide resistance management (IRM) and integrated pest management (IPM) strategies for successful bed bug management.

Bed Bug (Hemiptera: Cimicidae) Detection in Low-Income, High-Rise Apartments Using Four or Fewer Passive Monitors

Bed bug, Cimex lectularius L., management in low-income, high-rise housing for the elderly and disabled can be difficult. Early detection is key to slowing their spread, and reducing management cost and time needed for control. To determine the minimum number of passive monitors needed to detect low-level bed bug infestations in this environment, we evaluated three monitors placed one, two, or four per apartment in a 3 by 3 experimental design. One sticky monitor, The Bedbug Detection System, and the two pitfall monitors, ClimbUp Insect Interceptors BG and BlackOut BedBug Detectors, were evaluated. Bed bugs were trapped by the ClimbUp Insect Interceptors BG and the BlackOut BedBug Detector in 88% and 79% of apartments, respectively, but only in 39% of the apartments monitored with The Bedbug Detection System. The Bedbug Detection System required significantly longer time to detect bed bugs than either the ClimbUp Insect Interceptor BG or the BlackOut BedBug Detector. With the less effective Bedbug Detection System data removed from analyses, detection rates ranged from 80 to 90%, with no significant differences among one, two, or four monitors per apartment. Results indicate it is especially important to include a bed placement when only placing a few monitors. Future work should compare the combination of cursory visual inspections with various monitor numbers and placements per apartment to determine the most efficient, cost-effective system that will be accepted and implemented in low-income housing.

A Method for Evaluating Insecticide Efficacy against Bed Bug, Cimex lectularius, Eggs and First Instars

Standard toxicity evaluations of insecticides against insect pests are primarily conducted on adult insects. Evaluations are based on a dose-response or concentration-response curve, where mortality increases as the dose or concentration of an insecticide is increased. Standard lethal concentration (LC50) and lethal dose (LD50) tests that result in 50% mortality of a test population can be challenging for evaluating toxicity of insecticides against non-adult insect life stages, such as eggs and early instar or nymphal stages. However, this information is essential for understanding insecticide efficacy in all bed bug life stages, which affects control and treatment efforts. This protocol uses a standard dipping bioassay modified for bed bug eggs and a contact insecticidal assay for treating nymphal first instars. These assays produce a concentration-response curve to further quantify LC50 values for insecticide evaluations.

Bed bug outbreak in a neonatal unit

There has been a worldwide increase in bed bug infestations over the last 10-15 years. A major stigma is placed upon the institutions found to be infested. We report our experience with an outbreak of the tropical bed bug, Cimex hemipterus, in a neonatal unit. The outbreak not only affected the admitted newborns and mothers by causing a wide variety of rashes and inducing sleeplessness, but also impinged upon the health professionals and their families by producing similar symptomology. It is important for healthcare providers to be aware of, and for each healthcare facility to have, bed bug prevention and control policies.

[The worldwide expansion of bed bugs also constitutes a problem in Germany]

Worldwide, reports of the spread of the bed bugs Cimex lectularius and C. hemipterus (in Australia) are increasing. Irrespective of hygiene conditions, the insects can be especially found in hotels and hostels as well as in other holiday accommodation, health facilities, transport and in the secondhand trade. From these localities the insects spread to private households. A bed bug infestation may well have health consequences and constitutes a heavy burden for those affected. The global spread of bed bugs appears to be multifactorially conditioned and the causes are controversially discussed. The spread could be explained, among other things, by the increase in international travel and trade in used goods. The limited availability of insecticides with long-term effects and the development of resistance to available agents could play a crucial role. In the absence of official data it is impossible to quantify the extent of the spread in Germany but pest controllers and public authorities report increasing numbers of cases and problems in control. As in other countries the latter appear to be caused among other things by the development of drug resistance (particularly pyrethroids). Against this background, prevention and thus the education of the public on the habits and dissemination routes of these insects remain crucial in order to counteract the spread of bed bugs.

Field Study of the Comparative Efficacy of Three Pyrethroid/Neonicotinoid Mixture Products for the Control of the Common Bed Bug, Cimex lectularius

Three insecticide mixtures that contain two classes of insecticides (pyrethroid and neonicotinoid) were recently developed to control bed bugs. We evaluated three integrated bed bug management strategies in apartments, each using the same non-chemical control methods and one of the three insecticide mixture products: Tandem (lambda-cyhalothrin + thiamethoxam), Temprid SC (beta-cyfluthrin + imidacloprid), and Transport Mikron (bifenthrin + acetamiprid). No insecticides were applied in the Control apartments. In all apartments, we installed vinyl mattress encasements (if not already present) and applied steam to beds and other infested upholstered furniture. Insecticide sprays were applied in the three treatments. Each treatment and the Control included 8–10 occupied apartments. Re-treatment was conducted during biweekly inspections if necessary. After eight weeks, the mean (± SEM) bed bug count reduction in the Tandem, Temprid SC, Transport Mikron, and Control was 89 ± 9, 87 ± 6, 98 ± 1, and 23 ± 54%, respectively. Only Tandem and Transport Mikron treatments resulted in significantly higher population reduction than the Control at eight weeks. There were no significant differences in mean percent reduction among the three treatments (Tandem, Temprid SC, Transport Mikron) at eight weeks. Tandem spray caused significantly faster bed bug reduction than Temprid SC spray and Transport Mikron spray.

Insecticide Resistance in Eggs and First Instars of the Bed Bug, Cimex lectularius (Hemiptera: Cimicidae)

Two strains of the common bed bug, Cimex lectularius L., eggs and first instars collected from pyrethroid-resistant adults were evaluated for insecticide resistance and compared to a susceptible strain. Dose-response bioassays were conducted using two insecticide formulations (Temprid: imidacloprid/β-cyfluthrin, and Transport: acetamiprid/bifenthrin). The lethal concentration (LC₅₀) for the two resistant egg strains exposed to imidacloprid/β-cyfluthrin ranged from 3 to 5-fold higher than susceptible strain eggs. Resistant strain eggs dipped into formulations of acetamiprid/bifenthrin had LC₅₀ values which were significantly greater (39 to 1,080-fold) than susceptible strain eggs. Similar to eggs, resistant strain first instars exposed to residual applications of imidacloprid/β-cyfluthrin had LC₅₀ values ranging from 121 to 493-fold greater than susceptible strain first instars. When resistant strain first instars were treated with acetamiprid/bifenthrin, they had LC₅₀ values that were 99 to >1,900-fold greater than susceptible strain first instars. To determine differences between egg and first instar resistance, stage resistance ratios (SRR) were compared between the two stages. There was little difference between the egg and first instar stages, indicated by small SRR values ranging from 1.1 to 10.0. This study suggests that insecticide resistance is expressed early during bed bug development.

Bed bug aggregation pheromone finally identified

Bed bugs have become a global epidemic and current detection tools are poorly suited for routine surveillance. Despite intense research on bed bug aggregation behavior and the aggregation pheromone, which could be used as a chemical lure, the complete composition of this pheromone has thus far proven elusive. Here, we report that the bed bug aggregation pheromone comprises five volatile components (dimethyl disulfide, dimethyl trisulfide, (E)-2-hexenal, (E)-2-octenal, 2-hexanone), which attract bed bugs to safe shelters, and one less-volatile component (histamine), which causes their arrestment upon contact. In infested premises, a blend of all six components is highly effective at luring bed bugs into traps. The trapping of juvenile and adult bed bugs, with or without recent blood meals, provides strong evidence that this unique pheromone bait could become an effective and inexpensive tool for bed bug detection and potentially their control.

Evaluation of the murine immune response to Xenopsylla cheopis flea saliva and its effect on transmission of Yersinia pestis

Background/Aims

Arthropod-borne pathogens are transmitted into a unique intradermal microenvironment that includes the saliva of their vectors. Immunomodulatory factors in the saliva can enhance infectivity; however, in some cases the immune response that develops to saliva from prior uninfected bites can inhibit infectivity. Most rodent reservoirs of Yersinia pestis experience fleabites regularly, but the effect this has on the dynamics of flea-borne transmission of plague has never been investigated. We examined the innate and acquired immune response of mice to bites of Xenopsylla cheopis and its effects on Y. pestis transmission and disease progression in both naïve mice and mice chronically exposed to flea bites.

Methods/Principal Findings

The immune response of C57BL/6 mice to uninfected flea bites was characterized by flow cytometry, histology, and antibody detection methods. In naïve mice, flea bites induced mild inflammation with limited recruitment of neutrophils and macrophages to the bite site. Infectivity and host response in naïve mice exposed to flea bites followed immediately by intradermal injection of Y. pestis did not differ from that of mice infected with Y. pestis without prior flea feeding. With prolonged exposure, an IgG1 antibody response primarily directed to the predominant component of flea saliva, a family of 36–45 kDa phosphatase-like proteins, occurred in both laboratory mice and wild rats naturally exposed to X. cheopis, but a hypersensitivity response never developed. The incidence and progression of terminal plague following challenge by infective blocked fleas were equivalent in naïve mice and mice sensitized to flea saliva by repeated exposure to flea bites over a 10-week period.

Conclusions

Unlike what is observed with many other blood-feeding arthropods, the murine immune response to X. cheopis saliva is mild and continued exposure to flea bites leads more to tolerance than to hypersensitivity. The immune response to flea saliva had no detectable effect on Y. pestis transmission or plague pathogenesis in mice.

The saliva of blood-feeding arthropods contains a variety of components that prevent blood clotting and interfere with the immune system of the vertebrate host. These properties have been shown to enhance or inhibit the transmission of different pathogens transmitted by arthropods. Yersinia pestis, the bacterial agent of plague, is maintained in nature by flea to rodent transmission cycles. Most rodents live in close association with fleas and are constantly being bitten by them, but the influence this has on plague transmission is unknown - previous studies used laboratory animals which have never experienced a flea bite. We found that flea bites caused a mild inflammatory response in mice, and eventually an antibody response to components of flea saliva, but did not significantly affect pathogenesis. The transmission of Y. pestis by infected fleas and the incidence rate of bubonic plague mortality were the same in mice that had been exposed to frequent uninfected flea bites and mice with no prior exposure to fleas. Therefore, in contrast to what has been shown for many other arthropod-borne disease systems, vector saliva did not enhance or inhibit Y. pestis infection in mice, regardless of the immune status of the host to flea saliva.

Bed bugs, their blood sources and life history parameters: a comparison of artificial and natural feeding

A blood-feeding system that utilizes a small amount of whole heparinized human blood in parafilm bags is described in detail, and similarities and differences between artificially fed and naturally rodent-fed bed bugs (Hemiptera: Cimicidae) are discussed. Blood with high levels of heparin (10%) was unsuitable for artificial colony rearing, whereas bed bugs fed on 1% heparinized blood and those that naturally ingested rat blood completed their lifecycle with similar stage structures over time, with no significant differences in mortality. No differences in feeding efficiency or fertility were found in a direct comparison of bed bugs maintained under each of these two treatments, but analysis of the full lifecycle revealed that artificially fed bed bugs became significantly smaller and laid fewer eggs than rodent-fed bed bugs. The level of membrane stretching regulated the number of bed bugs that fed. When the membrane was stretched to twice its length and width, 96% of bed bugs successfully fed through the parafilm. Whole heparinized blood that was stored at 6 °C for ≥ 14 days failed to retain its nutritional value and the amount of blood consumed and number of consecutive moults were significantly reduced.

Bed bug detection: current technologies and future directions

Technologies to detect bed bugs have not kept pace with their global resurgence. Early detection is critical to prevent infestations from spreading. Detection based exclusively on bites is inadequate, because reactions to insect bites are non-specific and often misdiagnosed. Visual inspections are commonly used and depend on identifying live bugs, exuviae, or fecal droplets. Visual inspections are inexpensive, but they are time-consuming and unreliable when only a few bugs are present. Use of a dog to detect bed bugs is gaining in popularity, but it can be expensive, may unintentionally advertise a bed bug problem, and is not foolproof. Passive monitors mimic natural harborages; they are discreet and typically use an adhesive to trap bugs. Active monitors generate carbon dioxide, heat, a pheromone, or a combination to attract bed bugs to a trap. New technologies using DNA analysis, mass spectrometry, and electronic noses are innovative but impractical and expensive for widespread use.

Bugging forecast: unknown, disliked, occasionally intimate. Bed bugs in Germany meet unprepared people

Bed bugs appear to be feared more than vector insects and other household pests. The reasons for this exaggerated fear are not fully understood. One hypothesis is that the folk knowledge on recognising and controlling bed bugs decreased as bed bugs became rarer in the 1960s and led to irrational perceptions. Here, we examine people’s ability to recognise a bed bug and their response what to do in case of an infestation. We found that 13% of a sample of 391 people in four large German cities recognised a bed bug; 15% of all respondents would call a pest controller in case of bed bug infestation. This results in the pessimistic estimate that 97% of all early-stage infestations could go untreated. We discuss additional scenarios. The effectiveness of efforts to educate people about the presence of bed bugs has never been tested, but our sample is useful to guide future studies. We found three sources of information were associated with increased recognition rates of bed bugs: a) previous contacts with bed bugs (60% recognition), b) knowledge from friends or relatives (25%) and school or education courses (15%). By contrast, people who heard of bed bugs from television, print media or the Internet showed reduced recognition rates. We propose that the former factors be tested for educational interventions. In Germany, the bed bug is an estranged creature to many people, a fact that seems to hinder rational approaches to their control.

Prevention, identification, and treatment options for the management of bed bug infestations

In the past decade, bed bug infestations have been increasing worldwide. Historically, studies have failed to provide evidence for the transmission of human diseases through bed bugs, but recent evidence is lacking. Although physical reactions to bed bug bites continue to be documented, evidence regarding the mental health effects arising from bed bug infestations is limited to anecdotes and case reports. This report provides an update and summary of the bed bug management strategies discussed during a workshop at the 2010 Canadian Public Health Association Conference. “Best practices” regarding prevention, identification, and treatment options are presented, using evidence from existing evaluative studies. Awareness of bed bug behaviour and proper building maintenance can prevent transfer of bed bugs from belongings, including second-hand items, and reduce entry points and harbourage sites. In addition to inspection by trained professionals, early recognition of clinical symptoms and environmental signs of an infestation are important to avoid further spread of bed bugs and to allow implementation of safe and effective treatment options. Early findings may indicate a need for special support for vulnerable individuals with mental health issues potentially exacerbated by bed bug infestations. Preparing units for treatment, including the removal of clutter, is essential. However, physical and financial limitations are challenges for managing bed bug infestations, especially for vulnerable populations. Current treatment options such as application of heat or pesticides can be effective when properly implemented, but there are concerns with pesticide resistance. An Integrated Pest Management approach is recommended and should include ongoing monitoring and prevention that are essential for positive treatment outcomes. Regulatory officials, building management, and pest management professionals are encouraged to collaborate using a systematic approach to address bed bug infestations.

Bed bugs: they are back! The role of the school nurse in bed bug management

Recently there has been a resurgence of bed bugs in all facets of our society. Bed bugs have even been found in schools, causing unnecessary exclusion of students and unfounded hysteria. School nurses are again called upon to be front-line sources of information to quell the hysteria and confusion related to this unsavory condition. By arming themselves with the best evidence regarding proper identification of bed bugs and their bites and information about integrated prevention measures to control transmission of infestations, school nurses can contribute to the control and management of bed bugs and aid in the overall battle against this "new and improved" invasion of the bed bugs.

The re-emergence of the bed bug as a nuisance pest: implications of resistance to the pyrethroid insecticides

A global resurgence of bed bugs (Hemiptera: Cimicidae) has led to renewed scientific interest in these insects. The current bed bug upsurge appears to have started almost synchronously in the late 1990 s in Europe, the U.S.A. and Australia. Several factors have led to this situation, with resistance to applied insecticides making a significant contribution. With a growing number of insecticides (DDT, carbamates, organophosphates etc.) being no longer available as a result of regulatory restrictions, the mainstay chemistry used for bed bug control over the past few decades has been the pyrethroid insecticides. With reports of increasing tolerance to pyrethroids leading to control failures on the rise, containing and eradicating bed bugs is proving to be a difficult task. Consequently, several recent studies have focused on determining the mode of action of pyrethroid resistance in bed bug populations sourced from different locations. Correct identification of the factor(s) responsible for the increasing resistance is critical to the development of effective management strategies, which need to be based, wherever possible, on firm scientific evidence. Here we review the literature on this topic, highlighting the mechanisms thought to be involved and the problems currently faced by pest control professionals in dealing with a developing pandemic.

Bullous reactions to bedbug bites reflect cutaneous vasculitis

BACKGROUND

There has been a worldwide resurgence of bedbug infestations. Bites by these insects may cause mild or severe cutaneous reactions, and anaphylaxis has been reported. Little is known about the most severe cutaneous reactions, termed bullous or complex reactions.

OBJECTIVE

To study the time course and histopathologic findings of complex (bullous) cutaneous reactions to bedbugs in order to determine the optional treatment for them.

DESIGN, SETTING, AND PARTICIPANTS

We prospectively photographed bullous reactions to observed bedbug bites at 30 minutes; 6, 12, 24, 36, 48, and 72 hours; 1, 2, 3, and 4 weeks, and biopsied reactions at 30 minutes, and 6, 12, and 24 hours. We also reviewed Internet postings and the available medical literature on bullous reactions after bedbug bites.

MAIN OUTCOMES AND MEASURES

Correlations between clinical and histologic findings using both routine and immunofluorescent techniques.

RESULTS

Bullous reactions to bedbugs are not rare. Of 357 photographs of bedbug bites posted on the Internet, 6% were bullous. In an individual with previous bullous reactions, experimental bedbug bites were associated with a progression of cutaneous responses at bite sites from immediate, pruritic, edematous lesions to a late-in-time macule, which evolved into bullous reactions by 24 hours. Bullous lesions eventually lysed but took weeks to heal. Histopathologic evaluation of bullous reactions showed a polymorphous picture with histologic evidence of an urticarial-like reaction early on that rapidly developed into a hybrid leukocytoclastic vasculitis. This vasculitis was initially neutrophilic but developed into a destructive, necrotizing, eosinophil-rich vasculitis with prominent infiltration of CD 68+ histiocytes and collagen necrobiosis. This histologic picture is similar to the dermal vasculitis in patients with Churg-Strauss vasculitis.

CONCLUSION

Historically, bedbug bite reactions have been considered to be of minor medical significance. However, the findings presented here demonstrate that the not-uncommon bullous reactions to bedbug bites reflect the presence of a local, highly destructive, cutaneous vasculitis. The histologic features of these reactions resemble those occurring in the Churg-Strauss syndrome. Therefore, efforts to prevent further bites and monitor for evidence of systemic vasculitis should be made in patients with bullous reactions to bedbug bites. Topical treatment with high potency corticosteroids may be useful in the treatment of bullous reactions.

Artificial infection of the bed bug with Rickettsia parkeri

Although a variety of disease agents have been reported from bed bugs, the mechanical and biological disease transmission potential of bed bugs remains unelucidated. In this study we assayed survivability of the mildly pathogenic spotted fever group rickettsia, Rickettsia parkeri, in bed bugs after feeding on R. parkeri-infected chicken blood. Two groups of 15 adult bed bugs each were fed on infected or noninfected blood, and two groups of fourth-instar bed bugs also were fed on either infected or noninfected blood. One group of 15 adult bed bugs received no bloodmeal and was included as an additional control. Two weeks postfeeding, two pools of five live bed bugs from each group were surface sterilized, macerated, and placed in Vero cell cultures in an attempt to grow live organism. The remaining five individual bed bugs from each group were dissected, their salivary glands were removed for immunofluorescence assay (IFA) staining, and the remaining body parts were processed for polymerase chain reaction (PCR) analysis. Results indicated that no immature (now molted to fifth instar) bed bugs were positive for R. parkeri by IFA or PCR, indicating that organisms did not survive the molting process. After 4 wk of cell culture, no organisms were seen in cultures from any of the treatment or control groups, nor were any cultures PCR positive. However, two of the adult bed bugs were IFA positive for rickettsia-like organisms, and these two specimens were also PCR positive using R. parkeri-specific primers. These IFA and PCR results indicate that remnants of Rickettsia parkeri (possibly whole organisms) survived in the bugs for 2 wk, but the viability of the organisms in these two specimens could not be determined.

Bed bugs: clinical relevance and control options

Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.

Human fine body hair enhances ectoparasite detection

Although we are relatively naked in comparison with other primates, the human body is covered in a layer of fine hair (vellus and terminal hair) at a relatively high follicular density. There are relatively few explanations for the evolutionary maintenance of this type of human hair. Here, we experimentally test the hypothesis that human fine body hair plays a defensive function against ectoparasites (bed bugs). Our results show that fine body hair enhances the detection of ectoparasites through the combined effects of (i) increasing the parasite's search time and (ii) enhancing its detection.

Bedbugs (Cimicidae infestation): the worldwide renaissance of an old partner of human kind

Bedbugs have been known as a human parasite for thousands of years, but scientific studies about this insect are recent and limited. Cimex lectularius, the common bedbug, was a well-known parasite in human dwellings until the end of the Second World War. Nowadays, bedbugs are considered uncommon in the industrialized world. Anecdotal reports suggest that bedbugs are getting more common in the United States, Canada, and United Kingdom. In Brazil, there are few reports about bedbug infestations in the literature. The aim of this article was to alert physicians, especially in Brazil, about this ectoparasitosis, including aspects of the bedbug biology, their parasitism in human host, treatment and prophylaxis.

Bedbugs and infectious diseases

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.

Stress Tolerance of Bed Bugs: A Review of Factors That Cause Trauma to Cimex lectularius and C. Hemipterus

Recent emergence of bed bugs (Cimex spp.) has prompted a significant expansion of research devoted to this pest. The ability to survive and recover from stress has significant implications on the distribution and survival of insects, and bed bugs are no exception. Research on bed bug stress tolerance has shown considerable progress and necessitates a review on this topic. Bed bugs have an extraordinary ability to resist dehydration between bloodmeals, and this represents a critical factor allowing their prolonged survival when no host is available. High relative humidities are detrimental to bed bugs, leading to reduced survival in comparison to those held at lower relative humidities. Continual exposure of bed bugs, eggs and mobile stages, to temperatures below freezing and short term exposure (=1 h) to temperatures below -16 to -18 °C results in mortality. The upper thermal limit for short term exposure of eggs, nymphs and adults is between 40-45 °C for the common (Cimex lectularius) and tropical (C. hemipterus) bed bugs. Long-term exposure to temperatures above 35 °C results in significant reduction in survival of mobile bed bugs. Eggs for C. lectularius and C. hemipterus are no longer viable when held below 10 °C or above 37 °C throughout embryogenesis. Blood feeding, although necessary for survival and reproduction, is discussed as a stress due to thermal and osmotic fluctuations that result from ingesting a warm bloodmeal from a vertebrate host. Cold, heat, water stress and blood feeding prompted the expression of heat shock proteins (Hsps). Pesticide application is a common human-induced stress for urban pests, and recent studies have documented pesticide resistance in many bed bug populations. High levels of traumatic insemination (mating) of bed bugs has been linked to reduced survival and fecundity along with possibly exposing individuals to microbial infections after cuticular penetration by the paramere (=male reproductive organ), thus represents a form of sexual stress. Additionally, less common stress types such as microbial infections that have been documented in bed bugs will be discussed. Overall, this review provides a current update of research related to bed bug stress tolerance and how their ability to resist stressful conditions has lead to their expansion and proliferation.

Metabolic Resistance in Bed Bugs

Blood-feeding insects have evolved resistance to various insecticides (organochlorines, pyrethroids, carbamates, etc.) through gene mutations and increased metabolism. Bed bugs (Cimex lectularius) are hematophagous ectoparasites that are poised to become one of the major pests in households throughout the United States. Currently, C. lectularius has attained a high global impact status due to its sudden and rampant resurgence. Resistance to pesticides is one factor implicated in this phenomenon. Although much emphasis has been placed on target sensitivity, little to no knowledge is available on the role of key metabolic players (e.g., cytochrome P450s and glutathione S-transferases) towards pesticide resistance in C. lectularius. In this review, we discuss different modes of resistance (target sensitivity, penetration resistance, behavioral resistance, and metabolic resistance) with more emphasis on metabolic resistance.

Effectiveness of bed bug monitors for detecting and trapping bed bugs in apartments

Bed bugs, Cimex lectularius L., are now considered a serious urban pest in the United States. Because they are small and difficult to find, there has been strong interest in developing and using monitoring tools to detect bed bugs and evaluate the results of bed bug control efforts. Several bed bug monitoring devices were developed recently, but their effectiveness is unknown. We comparatively evaluated three active monitors that contain attractants: CDC3000, NightWatch, and a home-made dry ice trap. The Climbup Insect Interceptor, a passive monitor (without attractants), was used for estimating the bed bug numbers before and after placing active monitors. The results of the Interceptors also were compared with the results of the active monitors. In occupied apartments, the relative effectiveness of the active monitors was: dry ice trap > CDC3000 > NightWatch. In lightly infested apartments, the Interceptor (operated for 7 d) trapped similar number of bed bugs as the dry ice trap (operated for 1 d) and trapped more bed bugs than CDC3000 and NightWatch (operated for 1 d). The Interceptor was also more effective than visual inspections in detecting the presence of small numbers of bed bugs. CDC3000 and the dry ice trap operated for 1 d were equally as effective as the visual inspections for detecting very low level of infestations, whereas 1-d deployment of NightWatch detected significantly lower number of infestations compared with visual inspections. NightWatch was designed to be able to operate for several consecutive nights. When operated for four nights, NightWatch trapped similar number of bed bugs as the Interceptors operated for 10 d after deployment of NightWatch. We conclude these monitors are effective tools in detecting early bed bug infestations and evaluating the results of bed bug control programs.

Transcriptomics of the bed bug (Cimex lectularius)

BACKGROUND

Bed bugs (Cimex lectularius) are blood-feeding insects poised to become one of the major pests in households throughout the United States. Resistance of C. lectularius to insecticides/pesticides is one factor thought to be involved in its sudden resurgence. Despite its high-impact status, scant knowledge exists at the genomic level for C. lectularius. Hence, we subjected the C. lectularius transcriptome to 454 pyrosequencing in order to identify potential genes involved in pesticide resistance.

METHODOLOGY AND PRINCIPAL FINDINGS

Using 454 pyrosequencing, we obtained a total of 216,419 reads with 79,596,412 bp, which were assembled into 35,646 expressed sequence tags (3902 contigs and 31744 singletons). Nearly 85.9% of the C. lectularius sequences showed similarity to insect sequences, but 44.8% of the deduced proteins of C. lectularius did not show similarity with sequences in the GenBank non-redundant database. KEGG analysis revealed putative members of several detoxification pathways involved in pesticide resistance. Lamprin domains, Protein Kinase domains, Protein Tyrosine Kinase domains and cytochrome P450 domains were among the top Pfam domains predicted for the C. lectularius sequences. An initial assessment of putative defense genes, including a cytochrome P450 and a glutathione-S-transferase (GST), revealed high transcript levels for the cytochrome P450 (CYP9) in pesticide-exposed versus pesticide-susceptible C. lectularius populations. A significant number of single nucleotide polymorphisms (296) and microsatellite loci (370) were predicted in the C. lectularius sequences. Furthermore, 59 putative sequences of Wolbachia were retrieved from the database.

CONCLUSIONS

To our knowledge this is the first study to elucidate the genetic makeup of C. lectularius. This pyrosequencing effort provides clues to the identification of potential detoxification genes involved in pesticide resistance of C. lectularius and lays the foundation for future functional genomics studies.

Semiochemicals of the common bed bug, Cimex lectularius L. (Hemiptera: Cimicidae), and their potential for use in monitoring and control

The recent resurgence of the common bed bug, Cimex lectularius L., has driven an increase in research into the biology and behaviour of this pest. Current control is reliant on the application of insecticides, but, owing to the development of insecticide resistance, there is a need for new tools and techniques. Semiochemicals (behaviour- and physiology-modifying chemicals) could be exploited for management of bed bugs. The aim of this review was to evaluate studies undertaken in bed bug chemical ecology to date, with particular reference to how the research could be exploited for monitoring and control. Bed bugs, like many other insects, have a complex olfactory system. Recent studies have characterised the olfactory sensilla, located on the terminal segment of the antennae, to functional classes by electrophysiological screening. Behavioural studies have revealed the presence of an alarm pheromone and potential airborne aggregation semiochemicals, but it is not yet understood if bed bugs use a sex pheromone during mating. Host location cues have been investigated, and carbon dioxide has been found to be highly attractive both in laboratory and in field studies. Recent field trials have tested blends of other potential kairomones, which have been shown to have an additive effect when used in a heated bed bug trap with carbon dioxide. The trap, which combines heat and kairomones, is the only trap currently available with proven efficacy in the field. In order for semiochemicals to be useful for bed bug management, an increased knowledge and understanding of the biology, behaviour and chemical ecology of this insect is essential.

Insight into the Sialome of the Bed Bug, Cimex lectularius

The evolution of insects to a blood diet leads to the development of a saliva that antagonizes their hosts' hemostasis and inflammation. Hemostasis and inflammation are redundant processes, and thus a complex salivary potion composed of dozens or near 100 different polypeptides is commonly found by transcriptome or proteome analysis of these organisms. Several insect orders or families evolved independently to hematophagy, creating unique salivary potions in the form of novel pharmacological use of endogenous substances and in the form of unique proteins not matching other known proteins, these probably arriving by fast evolution of salivary proteins as they evade their hosts' immune response. In this work we present a preliminary description of the sialome (from the Greek Sialo = saliva) of the common bed bug Cimex lectularius, the first such work from a member of the Cimicidae family. This manuscript is a guide for the supplemental database files http://exon.niaid.nih.gov/transcriptome/C_lectularius/S1/Cimex-S1.zip and http://exon.niaid.nih.gov/transcriptome/C_lectularius/S2/Cimex-S2.xls.

Estimating the feeding rate of the bedbug Cimex lectularius in an infested room: an inexpensive method and a case study

The common bedbug, Cimex lectularius L. (Hemiptera: Cimicidae), is a globally re-emerging pest that is playing an increasing role in legal disputes and compensation claims as a result of its unpleasant feeding activity. However, there is little information about the feeding frequency of bedbugs outside controlled laboratory cultures. Here, we present a simple method of estimating the average time since the last bloodmeal of individual female bedbugs in a single sampling event, applicable to a single bedbug harbourage or an entire room. Using the temperature-dependent rate of decrease in the abdomen size of the bedbug after a bloodmeal, we found that, in a highly infested room kept at a constant temperature of 26 degrees C, females fed every 2.5 days on average. Our method corrects for variations in body size across different populations and determines the shrinkage that occurs when individuals are preserved in ethanol. This method should, therefore, be widely applicable. It is cheap, rapid and, if coupled with information on the total number of bedbugs present in a room, allows for the estimation of the minimum number of times persons lodging in a room have been bitten by bedbugs. This method can also be used to calculate the feeding rate of other blood-sucking insects on their hosts. The sex ratio in the infestation was female-biased. Finally, our case study suggests that individual female bedbugs within a harbourage do not seem to feed at a regular rate, but tend to synchronize feeding patterns.

4-oxo-aldehydes from the dorsal abdominal glands of the bed bug (Hemiptera: Cimicidae)

Analyses of the dorsal abdominal glands of fourth- and fifth-instar nymphs of the bed bud, Cimex lectularius L. (Hemiptera: Cimicidae), indicated the predominant constituents were (E)-2-hexenal and (E)-2-octenal, with lesser amounts of 4-oxo-(E)-2-hexenal and 4-oxo-(E)-2-octenal. The latter two compounds have not been reported previously as occurring in bed bugs. There were no differences in the chemical composition of the dorsal abdominal glands excised from exuviae left behind by either male or female adults, nor from glands excised from fourth-instar exuviae. Because the two oxo-aldehydes made up at least 16% of the gland contents, further study of the functional role of these chemicals seem advisable.