Who May Be a Real “Super Bug”? Don’t Let the Bedbugs Bite!

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Are bedbugs considered disease vectors?

A cursory search of “bedbugs” on PubMed and “Emerging Infectious Diseases” (from the CDC) resulted in 437 and 386 “hits,” respectively. Now here is a super bug to contend with! Did you know (I did not) that bedbugs have been present through-out recorded history?¹ An adult female of the species Cimex lectularius lays anywhere from 200 to 500 eggs over her lifetime. The hardy bedbug can live 2 years without feeding and can survive despite the loss of one-third total body water content. This predator’s bite contains nitric oxide to vasodilate, an anticoagulant to block conversion of factor X into Xa, and anesthetic agents so that the prey sleeps through pesky bites and blood ingestion (Figure). Since entomology is not at issue here, what does this impressive array of bedbug attributes have to do with medical practice?

BEDBUGS MAKE A COMEBACK
Bedbugs were not a significant problem throughout most of the 20th century. Since 1996, however, use of less effective insecticides, resistance to insecticides, international travel, and communal living for homeless persons have launched a resurgence.^1,2 Patients with pruritic, urticarial, secondarily infected lesions, and even bullae as consequences of bedbug feeding will be seeing their primary care provider for unexplained skin complaints. What should we know?

KNOW THE ENEMY
Bedbug bites look like many other insect bites.³ They present on exposed body parts, that is, uncovered at night by blankets and pajamas. The bites occasionally follow short treks over the skin (called linear or cluster progression), and as result, may be described as “breakfast, lunch, and dinner” for the blood sucker.^1,3 The pathology occurs at night and may produce fecal smears (from the bedbug’s excrement) and flecks of blood on bedsheets.¹ Although treatment is usually symptomatic, the diagnosis and removal of the offending bugs must be vigorously pursued.

Cracks and crevices in walls (peeling paint or wallpaper for instance) and furniture are great hiding places for bedbugs. Obviously, so are mattresses and box springs. How can patients rid their home of these varmints? All bed linens should be laundered, all furniture vacuumed, and if in doubt, call an exterminator.¹ Bedbugs can only bite and suck open skin. Tight-fitting pajamas, covering as much surface as possible, are a good idea.

BEDBUGS AND SUPER BUGS
There is some good news. Although 40 diseases have been purportedly transmitted by bedbugs (from plague to hepatitis to HIV infection), none have ever been proven.⁴ There is a caveat to this claim, however. A recent study demonstrated that methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus prosper in the GI tracts of bedbugs.² No “cause and effect” has been proven in this regard, but in communal shelters, this association may add transmission of other “super bugs” to bedbugs’ growing list of complications.

Rashes that I tended to dismiss have recently been biopsy-proven bedbug bites. If major journals such as The New England Journal of Medicine and the Journal of the American Medical Association have addressed their enigmatic resurgence, bedbugs are not only more common that we may think, but also dangerous if forgotten. ■