Bed bug bites

Bed bugs are flat, oval-shaped insects that measure up to a few millimetres in length and belong to the Cimex genus. These bugs possess rudimentary front wings (and no back wings) and thus can not fly and have to rely on other carriers, like animals and humans, in order to be transmitted from one place to another. Although bed bugs are obligatory bloodsuckers, they can survive for up to a year without a blood meal. However, they do require at least a single blood feed in order to mature to the next stage of development, i.e. from immature nymphs to the sexually mature adult stage, in order to complete their life cycles and propagate. Contrary to popular belief, bed bugs rarely manifest as a result of poor hygiene. Insects of the Cimex genus actively seek out hosts only when starving and are attracted to humans primarily by carbon dioxide release, secondarily by body warmth and lastly by some other chemicals. These conditions are best met at night while the human hosts are sleeping. Mattresses, bedding, furniture (including beds as the name suggests), carpeting, clothing, and other personal belongings can act as reservoirs for these pests. Bed bug infestation usually occurs due to close proximity with other infested dwellings, items, or people visiting from such areas. It is important to be able to visually identify bed bugs; other pests, like spider beetles, carpet beetles, booklice, cockroach nymphs (immature cockroaches), fleas and ticks can be confused for bed bugs because of similarities in their appearance. 

(Read more: Skin allergy)

In order to attain the sexually mature adult stage of development, bed bugs need to complete at least a single blood meal. Nighttime is the perfect opportunity for the pests to feed. With the help of sharp jagged-edged mouthparts, the bed bug bites sleeping humans and injects its anticoagulant (to reduce the viscosity of blood in order to make feeding easier) and some pain-killing chemicals (in order to not alert or wake the host and continue feeding inconspicuously). Although not all humans display hypersensitive reactions towards these injected bed bug chemicals, many are susceptible to developing allergic reactions that can vary from mild to severe. Bed bugs do not spread any diseases but can produce varying symptoms of inflammation and allergy in different people. While a single bed bug bite does not produce red spots, multiple bug bites in the same spot lead to the appearance of red spots once the swelling subsides. Additionally, bed bugs prefer exposed skin to skin folds and crevices to feed on, meaning they bite more frequently on a sleeping person’s face, neck and arms. 

Bed bugs are not associated with the standards of hygiene and sanitation. Infestation is possible in any viable space that is warm enough to support sustenance. Bedbugs are more common in crowded lodgings that experience high turnover in occupancy, such as:

• Hotels
• Hostels
• Apartment complexes
• Dorm rooms
• Homeless shelters
• Hotels
• Cruise ships
• Trains
• Buses
• Refugee camps

Therefore, while staying at or using these facilities, a quick survey should be made if possible. There are no other specific factors that make a person more or less susceptible to being bitten by bed bugs. However, it is advisable to wear clothing that provides extra coverage while travelling or availing temporary accommodation to prevent bed bug bites. 

Different people present with bed bug bites differently, depending on their susceptibility to allergic reactions in response to the immunogenic component of the insect’s saliva. 

• Red spots: The bed bug bites themselves can be asymptomatic and appear as red spots. Generally, bed bug bites are arranged in a linear pattern or clusters, with multiple bites grouped together. Many times patients present with bed bug bites in the form of an unidentifiable skin rash. These bites are generally present on parts of the body that are exposed while sleeping, like the face, neck, arms, hands, etc. 
• Itching: Bed bug bites can be associated with symptoms of itching. Itching these red spots can result in introduction of bacteria in the damaged skin and produce infectious cellulitis. 
• Swelling: A minor allergic reaction can present with noticeable swelling in the region of the bite. Sometimes, if it is pronounced, it may even be red, warm and tender. 
• Pain and tenderness: Due to inflammation at the site of the bed bug bite brought about by the allergic reaction, swelling, pain and tenderness may be experienced. If severe, pain might need symptomatic management by ice pack application or pain killers. 
• Blisters: The red spots and the surrounding skin can also blister and present as clear fluid-filled papules. If bacterial infection occurs, pus may be present inside these blisters. 
• Hives: Hives or urticaria, is a particular kind of allergic rash that occurs around the site of the bed bug bite. The skin becomes red, raised and bumpy. The lesion may even begin to dry and peel. Urticaria generally resolves on its own and usually does not leave a scar but oral antihistamines may be required in some cases. 
• Cellulitis: A common complication of bed bug bites is cellulitis. Due to scratching of the fragile inflamed itchy skin, bacteria are introduced through fingernail scrapings. Infection can be established and typically presents with pus.
• Anaphylactic shock: In rare cases, severe allergic reaction to the bed bug saliva may occur in the bitten individual. Such cases are regarded as medical emergencies and necessitate urgent hospital treatment. 

(Read more: Burning sensation on skin)

The doctor begins by taking a proper medical history, including the particulars of the individual’s accommodation status and travel whereabouts, after which a thorough physical examination is carried out. Various insect bites can be distinguished from one another on the basis of the location, pattern and other presenting symptomatology. Bed bug bites generally present in a linear or clustered pattern on exposed surfaces of the body like face, neck, arms and hands. Laboratory investigations are not necessary as the diagnosis is usually a clinical one.

Flea bites look very similar to bed bug bites and are equally itchy. However, they generally appear in warm skin creases around joints or the lower body. Common sites for flea bites are feet, legs, armpits, and the inside of elbows or knees. Bed bug bites could also be confused with the following conditions on occasion: 

• Scabies
• Mosquito bites
• Spider bites
• Skin infections
• Allergic reactions
• Miliaria
• Dermatitis herpetiformis
• Delusions of parasitosis

While most bed bug bite symptoms are self-limiting and short-lived, sometimes supportive symptomatic therapy and oral antihistamine (anti-allergic) medicines are prescribed. Severe allergic reactions can need more potent drugs like steroids. 

(Read more: Eat these 5 foods daily to reduce swelling)

Supportive treatment 

The following home remedies can be tried in an effort to soothe bitten areas and alleviate discomfort:

• Try ice pack or cold cloth application 
• Apply a thin paste of baking soda and water
• Emollients like camphor can help

However, hygiene at the site should be maintained to prevent cellulitis. 

Medical treatment 

The following may be prescribed on a case to case basis to relieve symptoms:

• Calamine lotion can soothe the irritated skin. 
• Oral antihistamines like diphenhydramine or loratadine can be useful. 
• Oral corticosteroids like prednisone can be administered as a short course in case of severe and persistent inflammation. 
• Over the counter NSAIDs like paracetamol can be taken for pain relief 
• Oral antibiotics may be needed in case of skin infection (cellulitis). 

Bed bug bites are relatively harmless but could, in some cases, result in the following complications: 

• When the weakened skin at the site of the bed bug bite is broken upon scratching with fingernails, bacteria are introduced within, leading to cellulitis. Purulent pustules can present and antibiotic therapy becomes necessary. 
• Anaphylaxis or severe allergic reactions can also occur.

Although bed bug bites are not a debilitating medical concern, it is best to prevent them and avoid associated complications. 

• Preventing bites
  • Covering up: Bed bugs do not burrow under clothing and therefore wearing full sleeve shirts and longer pyjamas to bed can provide protection. This measure is especially advisable whilst travelling or lodging in an accommodation with a high turnover rate of occupants. 
  • Bug spray: Special insect repellent spray designed to work against bed bugs can be used domestically or while travelling. However, if a bed bug problem is identified, it is best to get professional extermination carried out in the dwelling. 
  • Mosquito netting: Bed nets impregnated with the pesticide permethrin show some promise to protect people from bed bug bites while sleeping. However, this practice may be helping bedbugs develop resistance to this pesticide as well.

(Read more: How to keep mosquito bites from itching)

• Preventing infestations

  • Secondhand items: while purchasing second hand items or receiving hand me downs (especially in the case of furniture and other upholstered items), one must carefully inspect and ascertain the absence of pests before bringing them into their home. 

  • Hotel precautions: while staying at a hotel, irrespective of their level of cleanliness, bed mattress seams should be checked for bed bug excrement. Luggage should be kept on a surface after inspection of the same. 

  • Birds and bats: Birds and bats can act as reservoirs and carriers for bed bugs and thus their neighbouring habitats should be removed from the vicinity of homes.  

Once a locus of infestation of bed bugs is identified, it is necessary to prevent further spread. In such a situation, a licensed pest control service should be contacted and called in. Complete eradication of bed bugs can be achieved with a mix of physical and chemical removal techniques. Sometimes, multiple rounds of extermination may be needed to eliminate the bed bug problem entirely. The principles of bed bug eradication are as follows:

• Proper identification of the bed bug species present
• Education of persons involved
• A thorough inspection of infested and adjacent areas
• Implementation of chemical and non-chemical control measures
• A follow-up to evaluate the success of eradication

Physical eradication

Eradication can be done physically in the following ways: 

• Vacuuming: Daily or alternate day vacuuming is necessary to remove well hidden bed bugs from nooks and crannies of upholstery and furniture. Afterwards, the vacuum bag should be placed in another bag and disposed of. Routine vacuuming may not be enough. 
• Steam cleaning: Extreme temperature can kill bed bugs and their eggs. However, it may not be as effective as vacuuming to thoroughly comb out all hiding bed bugs. Bedding, linen, upholstery and clothing can be washed in warm soapy water and then dried thoroughly for at least twenty minutes in a hot dryer. Regular dry cleaning is not recommended. 
• Placing mattresses in mattress casings: As bed bugs can survive for up to one year in the absence of blood meals, mattresses should be placed in covers and kept sealed for at least an entire year. 
• Freezing: Articles that can not be cleaned easily should be kept in the deep freezer for at least four days as bed bugs can not survive in extremely cold temperatures either. 
• Sealing discarded items: Items meant to be discarded should be sealed in bags and labelled as bed-bug infested. 

(Read more: How to get rid of bed bugs)

Chemical eradication

Upon confirmation of the presence of bed bugs, a professional pest control service should be called in to exterminate with the use of pesticides. Pesticides such as diatomaceous earth, eugenol, imiprothrin, permethrin, pyrethrins, resmethrin and tralomethrin have been found to be effective against bed bugs and should be generously applied on cracks and crevices. In order to minimise and prevent toxic exposure to human inhabitants, the pesticidal application should be minimised on mattresses and furniture, all insecticide-treated linen should be changed and washed and all occupants must vacate during extermination only to return upon complete elimination of bed bugs.