Bed bug (Cimex lectularius) infestations are rapidly increasing worldwide. Health
consequences include nuisance biting and cutaneous and systemic reactions. The potential
for bed bugs to serve as disease vectors and optimal methods for bed bug pest control
and eradication are unclear.
To present current knowledge of the health and medical effects of bed bugs and to
explore key issues in pest control and eradication efforts.
A search of MEDLINE and EMBASE databases (1960-October 2008) for articles using the
keywords bed bugs, Cimex lectularius, humans, parasitology, pathogenicity, and drug
effects. For pest control, PubMed and Toxline searches (1960-October 2008) were performed
using the keywords bed bugs, Cimex, control, prevention, and eradication. Manual searches
of older journals, textbooks, pest control trade journals, and newspapers (1892-October
2008) were also performed.
Original accounts or investigations of bed bugs, clinical responses with sufficient
detail of cause and effect between the bed bug bite and clinical response, and convincing
evidence of substantiated presence of bed bug exposure. For pest control, documentation
that an eradication measure quantitatively decreased bed bugs.
A trained medical reference librarian assisted with the literature search. Two authors
with expertise in the diagnosis, treatment, and eradication of bed bugs reviewed the
clinical articles. One author evaluated the pest control articles.
Fifty-three articles met inclusion criteria and were summarized. Only 2 clinical trials
concerning bed bugs were identified and tested the ability of pest control interventions
to eradicate bed bugs. Although transmission of more than 40 human diseases has been
attributed to bed bugs, there is little evidence that they are vectors of communicable
disease. A variety of clinical reactions to bed bugs have been reported, including
cutaneous and rarely systemic reactions. A wide range of empirical treatments, including
antibiotics, antihistamines, topical and oral corticosteroids, and epinephrine, have
been used for bite reactions with varying results. No evidence-based interventions
to eradicate bed bugs or prevent bites were identified.
Treatment options for cutaneous and systemic reactions from bed bug bites have not
been evaluated in clinical trials and there is no evidence that outcomes differ significantly
from those receiving no treatment. Evidence for disease transmission by bed bugs is
lacking. Pest control and eradication is challenging due to insecticide resistance,
lack of effective products, and health concerns about spraying mattresses with pesticides.