Bed bugs

Background

• Cimex lenticularis.
• Bed bug bites known as Cimicosis.
• Attracted to CO2, warmth, exposed surfaces.
• 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

• Pain immediately after bite. Pruritis may take days to develop.
• Hyperpigmented, erythematous papules
• Classic line of bites: "breakfast, lunch, and dinner"

Bed bug

Bedbug with classic hemmoragic appearance and punctate center

Differential Diagnosis

Domestic U.S. Ectoparasites

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

See also travel-related skin conditions

Workup

Clinical diagnosis, based on history and physical exam.

Management

• Antihistamine for pruritis
• 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 and other traditional approaches.

Disposition

Discharge if no systemic sx

See Also

• Parasitic Diseases
• Travel Medicine