Top ten tips for keeping bed bugs at bay

Loyola University Health SystemJan 30 2013

Bed bugs are on the rise and $1,000 per day ordinances are being suggested in cities like Chicago to enforce combat of the pests. "Know thy enemy," says Jorge Parada, MD, medical director, infection control, Loyola University Health System. "There are lots of myths out there about bed bugs and people may be getting caught up over nothing."

Dr. Parada offers these top ten tips for keeping bed bugs at bay.

Bed bugs are attracted by warmth and carbon dioxide. "If you are alive, warm and breathing then you are a bed bug magnet," says Parada.

Just because you don't see them doesn't mean they're not there. "Look closely because bed bugs are very hard to see. Bed bugs love to hide in the cracks and crevices associated with mattresses, cushions, bed frames and other structures. They are rarely seen out in the open or on the resting surface of beds or chairs," says Parada, who also is a medical spokesperson for the National Pest Management Association. "Bed bugs are champions of hide-and-seek. It is not uncommon to miss the bed bugs altogether, so also look for tell tale signs of bed bug infestation. These may be suspected if specks of blood or feces are found on the linens, mattresses or behind wallpaper."

What does a bed bug look like? "There is more than one type of bed bug and in the United States the vast majority of infestations are due to Cimex lectularius. These bed bugs have flat oval bodies, are reddish-brown in color and are similar in size to a dog tick," says Parada. "Bed bugs are sometimes described as appearing like an apple seed. Adult bedbugs range in size from 5-7 mm (<1/4 inch), while nymphs (juveniles) may be a small is 1.5 mm (1/16 of an inch). With feeding, they enlarge, or engorge, with blood. The adults turn from more brown to more red in color, while the translucent nymphs may become bright red."

Bed bugs typically bite at night on exposed areas of skin (such as the face, neck, hands, and arms.) "The bite itself is painless and usually goes undetected at the time," says Parada. " Bed bugs inject anticoagulant (a blood thinner) as they feed (which usually takes 5-10 minutes) which both makes feeding easier for the bed bug and less detectable to you. "

Bed bug bites can look a lot like other insect bites. "Clues that can suggest the presence of bed bugs include finding red, itchy bites upon awakening - especially if the bites line up in a row on the skin," says Parada. "However, while some people develop a bite reaction immediately, others may take two to three days before a reaction becomes noticeable, and not all people react to bites. A bed bug bite can appear as a tiny puncture wound without a surrounding reaction, and can easily be missed (30% of individuals living in bed bug-infested dwellings report a lack of bites or skin reactions). This appears to be more common amongst the elderly. On the other hand, other people have exuberant reactions, with large, red, raised and itchy welts. This is especially true if one becomes sensitized to bed bug bites, so that with repeated bites there may be an exaggerated reaction to the bite."

In infestations, with persistent exposures, bed bug bites may appear in crops. "Given that bed bug bites usually take three to six weeks to heal, as long as the infestation is still present, new bites may accumulate even as the older ones disappear," says Parada. " Thus, people may have various bite reactions in various stages of evolution at the same time."

Bed bug bites do not typically require treatment. "Clean the bite site(s) with soap and water and avoid scratching so as to prevent infection. If secondary infection occurs it should be managed with antibiotics as appropriate," says Parada. "Progressive swelling, warmth, tenderness, and sometimes (albeit rarely) fever may be signs of secondary infection. Much more common are complaints of itching. For severe itching it is reasonable to try topical steroid creams or oral antihistamines for relief."

Unlike mosquitoes and ticks, bed bugs are not associated with disease transmission. "It is bad enough if you get bed bugs. At least it is good you won't get anything else from them!" says Parada. While some pathogens have been detected in and on bed bugs - including hepatitis B, and exotic organisms such as Trypanosoma cruzi (cause of Chaga's Disease, not found in the United States) or Wolbachia species - bed bugs have not been found to transmit disease.

Bed bugs do not transmit MRSA. "There have been reports of persons developing methicillin resistant Staphylococcus aureus (MRSA) infections, such as a boil or abscess, associated with bed bugs bites, but it turns out the bed bugs really weren't at fault," says Parada. " Rather, MRSA infections associated with bed bug bites are actually an example of scratching leading to minor skin trauma and subsequent secondary bacterial infection. In these cases, people who are carriers of MRSA scratch at the bites and provide a port of entry for the MRSA (which was already present on their skin) to get in and under the skin and cause the secondary infection. The bed bug can be blamed for the itch, but not for the infection."

Some people experience anxiety, sleeplessness, and unease as a result of having had bed bugs. "Bed bug infestations are understandably significant psychosocial stressors, and some people may experience sleeplessness as they worry about bugs biting them or their family members," says Parada. " People have been known to self-isolate, avoiding family and friends out of concern for spreading the infestation, or (if word gets out that they had bed bugs) they may be avoided by friends or others in the community, or find they have problems at work. As a result, victims of bed bug infestations may experience moderate to severe levels of stress, anxiety, and depression and should seek treatment as required."

Finally, when it comes to controlling bed bugs this is definitely not a case of "do it yourself."

"Bed bugs are notoriously difficult to eradicate and there is good reason to get professional help," says Parada. In fact, the Centers for Disease Control and Prevention endorses that appropriate control of bed bug infestation requires an experienced pest management professional and recommends that victims be advised against attempting control measures themselves.