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Case Review
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Place de la République
Paris, France
Crowne Plaza Hotel
Photo by Carles Tomás Martí
22 yo male traveling to Europe with parents to celebrate college graduation. Flew late into Paris, took Metro to hotel; slept on pull out couch in same room as parents.
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Next morning noted in shower several bites on left lateral ankle and calf. Pruritic later in day; wore pants/shoes rest of day believing these were mosquito bites. Took Benadryl, which lessened itching.
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Next morning, awoke with similar number of bites on right medial and lateral ankle and calf. Noted this was a dog friendly hotel, and considered the possibility of flea infestation in room?
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Took bedding off and checked for fleas; this is what he saw....
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Bed bugs (Cimex Lectularis)
AKA: chintzes, mahogany flats, red coats, crimson rambles, wall louse
"Good night, sleep tight, don't let the bedbugs bite. If they do, grab a shoe, and whack them 'til they're black and blue"
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Evolved from cave dwelling insects that fed on bats; moved on to feeding on humans over 10K yrs ago; fossilized bugs over 3500 yrs old found in Egypt. Noted in ancient Greek and Latin texts; some say biblical references.
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Worldwide problem including USA through WWII; prior to 1950's most people had natural BB awareness/suspicion whenever faced with new surroundings.
Eventually eradicated with liberal use of DDT and Malathion.
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Worldwide resurgence of BB since late 1990's:
Increased international travel
Pest control strategy changes/laws in effect
Insecticide resistance
BB are cryptic, secretive, active mostly at night
LACK OF PUBLIC AWARENESS
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Appearance:
Oval shaped, paper thin when unfed
plump and reddish brown after blood meal
Adults size of apple seed; juveniles lighter in color and smaller.
Eggs size of poppy seed and white.
Once hatched nymph molts 5 times to maturity; feeding at least once each stage and leaving behind casts as they grow from poppy seed to apple seed in size.
All BB stages require blood meals; females feed more often for egg production. Live up to a year at room temp; once mated female lay up to 500 eggs averaging 3-4 day cementing them into place into crevices/cracks known as harborages. Eggs hatch in 6-17 days and feed immediately, usually once a week. They return to hiding spot, defecating along route
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Solely by Traumatic Insemination:
Males trap mate, pierce abdomen with sharp penis, injecting sperm into the abdominal cavity. In females sperm travel through their hemolymph system to ovaries.
Males omnisexual, and occasionally mate with other species with this process. Leaves an open wound, making them vulnerable to infection until healed.
Sense human proximity by heat/carbon dioxide/antennae smell receptors. Feeding mostly at night, if hungry will feed in daytime. Prefers human blood, but also feed on dogs/cats, rodents, other warm blooded animals/birds. Inject desensitizing anticoagulant fluid (no pain); feed to engorgement 3-5 minutes.
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BB bites:
50% people won't react to bite; 2 people sleeping same bed may have different presentation.
Reaction may be immediate or up to 2 wks later.
May be large or small with central red dot.
May be itchy, swollen/pimple like usually on extremities; dislike hairy areas.
Often in groups of 3-5 bites due to disturbances while feeding (breakfast-lunch-dinner pattern)
Photo by Magalie L'Abbé
Differential diagnoses:
mosquito bites
bat bug bites
tick bites
flea bites
fly bites
mites (scabies)
sucking lice
spider bites
varicella
other dermatitis causes
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Primary goal of treatment: Prevent further bites!
Topical or oral antihistamines/topical cortisone (may need higher steroid potency); calamine lotion, oral NSAIDs.
Usually heals in 1-2 weeks.
No known human diseases transmitted; however sequelae may include secondary infections from excoriations/folliculitis/impetigo/cellulitis and scarring. Rare reports of anemia with severe infestation; asthma/urticaria/anaphylaxis/eczematous dermatitis in sensitized individuals.
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Other issues:
frustration
anxiety
irritability
anger
depression
insomnia
post traumatic stress
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Eradication:
Clean up clutter, reduce harborages
Keep personal items off beds/floors/upholstered furniture
Place clothing in hot dryer highest setting ideally 60
minutes
Vacuum regularly (doesn't remove eggs)
-Use a dedicated vacuum, remove bags and seal in plastic before discarding; keep vacuum in plastic bag between uses
Use steam wand on fabric/upholstery that can't be washed
Ambient dry heat blown in-113F/1 hr or 104F/24 hrs
Freezing with dry ice/liq CO2 (Europe)- or sealed in regular freezer for 4 days
Encasement of mattress for 1.5 yrs
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Pesticides-spray or dust:
Bait used for roaches won't work; no chewing mouthparts
Pyrethrins-much resistance; botanical derived from chrsyanthemums
Desiccants- destroy waxy coating, dehydrate and die. No resistance issues- diatomaceous earth
Neonicatinoids- synthetic nicotine
Causes nerves to fire constantly until they fail; doesn't kill eggs, no resistance issue
Neem oil- from tropical tree, safe insecticidal active at all stages
Photo by essgee51
Bedbug Detection:
Bed bugs climb/crawl/cling-don't fly/jump/burrow
Use bright light (phone app)/forceps/probe/zip lock bag
Look for cast skins/black-brown-red fecal stains/small white eggs/live bugs
Focus on bed/sleeping spaces
Headboard, bed frames, mattress seams, sheets, cracks/crevices
Occasionally in heavy infestation will note sweet musty odor
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Advice to help travelers make good choices
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Knowledge is key to defending yourself and prevent spread by taking them home with you.
Hotels/hostels/tea houses/dorms are high risk due to high turnover rate of people from diverse populations.
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Leave luggage/belongings outside of room or in the middle of bedroom floor or bathtub while you do quick inspection. Consider using duffel/soft backpack as these can be washed/dried if needed.
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Check the internet before you book the trip (controversial)
www.badbedbugs.com
bedbuglookup.com
www.bedbugregistry.com
registry.bedbugs.net
Even an Apple app
Photo by William Brawley
Keep belongings in original bag, don't place into drawers. Don't place anything on bed, upholstered furniture, near walls, keep shoes up high. May wish to keep luggage in bathtub or bathroom where bugs easily spotted; keep light on in bathroom.
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Consider using neem oil spray on bedding; safe/environmentally friendly and effective against eggs-nymphs-adult bugs
Photo by Tatters ❀
Consider buying/making a sleep sack out of single queen/full sheet...sew up one side, slip into it between sheets. Can be dried without washing on high heat to kill bugs if needed.
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On your return home, unpack luggage in garage or outside. Dirty clothes can be washed/dried; clean clothes can be dried only for at least 15 minutes on high heat. Dry cleaning kills them too.
Photo by Tony Crider
Notify management if infested-
Ideally collect any evidence you can/be able to show them your findings in the room.
Change to room that does not share wall with present room.
Consider changing lodging and requesting refund if possible.
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Untitled Slide
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Bibliography:
Abdel-Nasar, MB et al. 2006. Patients with papular urticaria have IgG antibodies to bedbug antigens. Parasitology 98:550-556.
Berg, R. 2010. Bedbugs: the pesticides dilemma. J. Environmental Health 72:32-49
Cassels, C. May 14, 2011. Impact of bedbugs much more than skin deep. Medscape Today News.
Cleary, CJ Buchanan, D. 2004. Diagnosis and management of bedbugs. Nurse Practitioner. 29:47-48.
DeLauney, P et al. 2011. Bedbugs and infectious disease. Clinical Infectious Disease 52:200-210.
Goddard, J. 2009. Bedbugs and clinical consequences of their bites. JAMA 301:1358-1366.
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Bibliography (cont.):
Haynes, KF et al. 2010. Bedbug deterrence. BMC Biology 8:117.
Hildreth, CS et al. 2010. Bedbugs. JAMA 301:1398
Kolb, A. et al 2009. Bedbugs. Dermatology Ther. 22:347-352.
Paul, J. 2000. Is infestation with common bedbugs increasing? BMJ 320:1141.
Potter, MF 2011. The history of bedbug management. American Entomology 57:14-25.
Potter, MF 2010. The sensitivity spectrum: human reactions to bed bug bites. Pest Control Technology 38:70-74, 100.
Wanzhen, F. Kaishong, Y. 1995. Relationship between bedbug antigen and allergic asthma. Chinese Journal of Vector Biological Control 6:54-57.
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Questions/Comments?
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