Bed bugs

Background

• Cimex lenticularis
• Bed bug bites are known as 'cimicosis'
• Bed bugs are attracted to CO2, warmth, exposed surfaces
• Tend to hide near beds, cracks, crevices
• Feed at night
• May appear translucent (nymphs,) brown (mature bug,) red (after meal,) black (after digestion)
• Belong to Hemiptera (like kissing bugs) which are vectors for trypanosomiasis (Central and South America)

Clinical Features

Bed bug

Bedbug with classic hemmoragic appearance and punctate center

• Up to 20% of patients do not experience symptoms
• Pain immediately after bite
• Erythematous papules, bullae, and wheals may take days to develop
• Classic line of bites: "breakfast, lunch, and dinner"

Differential Diagnosis

Domestic U.S. Ectoparasites

• Bed bugs
• Lice
• Scabies (Mites)
• Ticks
• Fleas
• Pseudoparasites
• Delusional parasitosis (Ekbom syndrome)

See also travel-related skin conditions

Hand and finger infections

• Bed bugs
• Closed fist infection (Fight Bite)
• Hand cellulitis
• Hand deep space infection
• Hand-foot-and-mouth disease
• Herpetic whitlow
• Felon
• Flexor tenosynovitis
• Paronychia
• Scabies
• Sporotrichosis

Look-Alikes

• Digital mixoid cyst

Evaluation

• Clinical diagnosis, based on history and physical exam.

Management

• Primarily supportive care
• Antihistamine for pruritus
• Consider topical steroids to decrease inflammation
  • No evidence that medications improve outcomes
• Treat systemic reactions similar to anaphylaxis (rare)
• Self-limited 1-2 weeks without treatment
• Eradication using pesticides, hot water washing of bedding

Disposition

• Discharge if no evidence of systemic symptoms or anaphylaxis

See Also

• Parasitic diseases
• Travel medicine