Medical Significance of Bedbugs

Two species of bedbugs bite people: the common bedbug (Cimex lenticularis) and the tropical bedbug (Cimex hemipterous). These bugs are called udus (उडुस) in Nepali and khatmal (खटमल) in Hindi language. The adult bedbug is the approximate size, shape, and color of an apple seed. They are more commonly associated with conditions of poor hygiene and overcrowding. They hide during the day, usually close to human sleeping quarters, and come out to feed at night. Thier lifespan is 6-7 months and can survive without food for that long. All stages in the lifecycle of bedbugs rely exclusively on blood for nutrition. They reach adulthood in about 1 month. They possess stink glands and emit odor giving distinct odor to heavily infested rooms. They take about 5-10 minutes to obtain a full blood meal.

Medical significance of bedbugs

Skin lesions

Morphology: Typically, pruritic (itchy) erythematous (red) maculopapule, 0.5-2 cm in diameter, with a central hemorrhagic crust or vesicle at the bite site (similar to arthropod bites) 1Delaunay, P., Blanc, V., Del Giudice, P., Levy-Bencheton, A., Chosidow, O., Marty, P., & Brouqui, P. (2011). Bedbugs and Infectious Diseases. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 52(2), 200–210. http://doi.org/10.1093/cid/ciq102

Site: Often concentrated on unclothed zones – arms, legs, face (around eyes) or back

Arrangement: Often in linear arrangement (often aligned 3 in a row, giving rise to colloquialism – breakfast, lunch and dinner) or cluster 2Pediatric Dermatology E-Book By Lawrence A. Schachner, Ronald C. Hansen

Resolution: Lesions resolve in a week if not abraded

Can be complicated by: Excoriations and secondary infections

Others:

1. Localized urticaria (wheals)
2. Vesicles and bulla containing clear or bloody exudate

Psychological or Emotional effects

1. Loss of sleep
2. Anxiety
3. Worsening of existing mental health

Systemic reactions

1. Asthma exacerbation
2. Generalized urticaria
3. Anaphylaxis 3Parasitic Pathogens edited by Dongyou Liu

Anemia

Few studies have shown bedbugs to be possible cause of iron deficiency anemia due to blood loss when the infestation is massive. Anemia due to excessive bedbug bites have been reported in following cases:

1. Infants and children in Hyderabad, India 4Venkatachalam PS, Belavady B. 1962. Loss of haemoglobin iron due to excessive biting by bed bugs. A possible aetiological factor in the iron deficiency anaemia of infants and children. Trans. R. Soc. Trop. Med. Hyg. 56: 218–221.
2. Severe anemia in 60-year-old patient where no other identifiable cause 5Pritchard, M. J., & Hwang, S. W. (2009). Severe anemia from bedbugs. CMAJ : Canadian Medical Association Journal, 181(5), 287–288. http://doi.org/10.1503/cmaj.090482
3. A 60-year-old woman and her 67-year-old male partner, admitted for pneumonia and non-ST elevation myocardial infarction, respectively, had severe anaemia (Hb 5.3 and 5.2 g/dL, respectively), as a result from massive infestation with Cimex lectularius. 6ere anaemia in adults. Parasitol Res. 2012 Jun;110(6):2577-9. doi:10.1007/s00436-011-2777-6. Epub 2011 Dec 22. PubMed PMID: 22190128.

Infectious diseases

Bedbugs have been found naturally infected with >20 diseases such as those causing anthrax, plague, hepatitis, typhus and HIV. However, they have not been implicated in disease transmission so far. However, few researches have shown bed bug to be possible vectors for Chaga’s disease. In a study supported by University of Pennsylvania, bed bugs were shown to acquire T.cruzi and transmit it to susceptible host during cohabitation and through contaminated feces placed on broken host skin by researchers.7Salazar, R., Castillo-Neyra, R., Tustin, A. W., Borrini-Mayorí, K., Náquira, C., & Levy, M. Z. (2015). Bed Bugs (Cimex lectularius) as Vectors of Trypanosoma cruzi. The American Journal of Tropical Medicine and Hygiene, 92(2), 331–335. http://doi.org/10.4269/ajtmh.14-0483