View source for Bed bug

{{Short description|Type of insect that feeds on human blood}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Other uses}}
{{Use dmy dates|date=November 2019}}
{{Infobox medical condition (new)
| name            = Bed bug
| synonyms        = Cimicosis, bedbugs
| image           = Bed bug, Cimex lectularius.jpg
| alt             =
| caption         = An adult bed bug (''[[Cimex lectularius]]'') with the typical flattened oval shape
| pronounce       =
| field           = [[Family medicine]], [[dermatology]]
| symptoms        = None to prominent [[blisters]], itchiness<ref name=And2006/><ref name=Ib2017/>
| complications   =
| onset           = Minutes to days after the bite<ref name=Ib2017/>
| duration        =
| types           =
| causes          = ''[[Cimex]]'' (primarily ''[[Cimex lectularius]]'' and ''[[Cimex hemipterus]]'')<ref name=JAMA2009/>
| risks           = Travel, second-hand furnishings<ref name=Kolb2009/>
| diagnosis       = Based on finding bed bugs and symptoms<ref name=GP2009/>
| differential    = [[Allergic reaction]], [[scabies]], [[dermatitis herpetiformis]]<ref name=Ib2017/>
| prevention      =
| treatment       = [[Symptomatic treatment|Symptomatic]], [[bed bug eradication]]<ref name=Ib2017/>
| medication      = [[Antihistamines]], [[corticosteroids]]<ref name=Ib2017/>
| prognosis       =
| frequency       = Relatively common<ref name=Dog2012/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Bed bugs''' are [[parasitic]] [[insect]]s from the genus ''[[Cimex]]'', who are [[micropredator]]s that [[haematophagy|feed on blood]], usually at night.<ref name=CDC2017Trans/> Their bites can result in a number of health impacts, including [[skin rash]]es, psychological effects, and [[allergy|allergic]] symptoms.<ref name=GP2009>{{cite journal |vauthors=Doggett SL, Russell R |title=Bed bugs – What the GP needs to know |journal=Aust Fam Physician |volume=38 |issue=11 |pages=880–4 |date=November 2009 |pmid=19893834 }}</ref> Bed bug bites may lead to skin changes ranging from small areas of redness to prominent [[blister]]s.<ref name=And2006>{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal|page=446}}</ref><ref name="Ib2017">{{cite journal |last1=Ibrahim |first1=O |last2=Syed |first2=UM |last3=Tomecki |first3=KJ |date=March 2017 |title=Bedbugs: Helping your patient through an infestation. |journal=Cleveland Clinic Journal of Medicine |volume=84 |issue=3 |pages=207–211 |doi=10.3949/ccjm.84a.15024 |pmid=28322676 |doi-access=free}}</ref> Symptoms may take between minutes to days to appear and [[Pruritus|itchiness]] is generally present.<ref name=Ib2017/> Some individuals may feel tired or have a [[fever]].<ref name=Ib2017/> Typically, uncovered areas of the body are affected.<ref name=Ib2017/> Their bites are not known to transmit any [[infectious disease]].<ref name=GP2009/><ref name=CDC2017Trans>{{cite web|url=https://www.cdc.gov/parasites/bedbugs/faqs.html|title=Bed Bugs FAQs|date=2 May 2017|publisher=[[Centers for Disease Control and Prevention]]|access-date=2 October 2018|archive-date=22 September 2018|archive-url=https://web.archive.org/web/20180922030210/https://www.cdc.gov/parasites/bedbugs/faqs.html|url-status=live}}</ref><ref name="Parola" /> Complications may rarely include [[necrotic|areas of dead skin]] or [[vasculitis]].<ref name=Ib2017/>

<!-- Cause and diagnosis -->
Bed bug bites are caused primarily by two species of insects: ''[[Cimex lectularius]]'' (the common bed bug) and ''[[Cimex hemipterus]]'', found primarily in the tropics.<ref name=JAMA2009>{{cite journal |author1=Jerome Goddard |author2=Richard deShazo |year=2009 |title=Bed bugs (''Cimex lectularius'') and clinical consequences of their bites |journal=[[Journal of the American Medical Association]] |volume=301 |issue=13 |pages=1358–1366 |doi=10.1001/jama.2009.405 |pmid=19336711|doi-access=free }}</ref> Their size ranges between 1 and 7&nbsp;mm.<ref name=CDC2017Trans/> They spread by crawling between nearby locations or by being carried within personal items.<ref name=Ib2017/> [[Infestation]] is rarely due to a lack of [[hygiene]] but is more common in high-density areas.<ref name=Ib2017/><ref name=Hild2009>{{cite journal |vauthors=Hildreth CJ, Burke AE, Glass RM |title=JAMA patient page. Bed bugs |journal=JAMA |volume=301 |issue=13 |pages=1398 |date=April 2009 |pmid=19336718 |doi=10.1001/jama.301.13.1398 |doi-access=free }}</ref> Diagnosis involves both finding the bugs and the occurrence of compatible symptoms.<ref name=GP2009/> Bed bugs spend much of their time in dark, hidden locations like mattress seams, or cracks in a wall.<ref name=Ib2017/>

<!-- Treatment -->
Treatment is [[symptomatic treatment|directed towards the symptoms]].<ref name=Ib2017/> Eliminating bed bugs from the home is often difficult, partly because bed bugs can survive up to approximately 300 days without feeding.<ref name=Dog2012 /><ref name="Parola" /> Repeated treatments of a home may be required.<ref name=Ib2017/> These treatments may include heating the room to {{convert|50|C|F}} for more than 90 minutes, frequent [[Vacuum cleaner|vacuuming]], washing clothing at high temperatures, and the use of various [[pesticide]]s.<ref name=Ib2017/>

<!-- Epidemiology and history -->
Fossils found in Egypt show bed bugs have been known as human parasites for at least 3,500 years.<ref>{{cite journal |last1=Panagiotakopulu |first1=Eva |last2=Buckland |first2=Paul C. |date=December 1999 |title=Cimex lectularius L., the common bed bug from Pharaonic Egypt |journal=Antiquity |language=en |volume=73 |issue=282 |pages=908–911 |doi=10.1017/S0003598X00065674 |s2cid=162701508 |issn=0003-598X}}</ref> Despite being nearly eradicated in developed countries after [[World War II]], infestations have increased since the 1990s and bed bugs are now relatively common in all regions of the globe.<ref name=CDC2017Trans/><ref name=JAMA2009/><ref name=Kolb2009>{{cite journal |vauthors=Kolb A, Needham GR, Neyman KM, High WA |title=Bedbugs |journal=Dermatol Ther |volume=22 |issue=4 |pages=347–52 |year=2009 |pmid=19580578 |doi=10.1111/j.1529-8019.2009.01246.x |s2cid=221648188 |doi-access=free }}</ref><ref name=Dog2012>{{cite journal |last1=Doggett |first1=SL |last2=Dwyer |first2=DE |last3=Peñas |first3=PF |last4=Russell |first4=RC |title=Bed bugs: clinical relevance and control options. |journal=Clinical Microbiology Reviews |date=January 2012 |volume=25 |issue=1 |pages=164–92 |doi=10.1128/CMR.05015-11 |pmid=22232375|pmc=3255965 }}</ref> Experts point to several factors that have contributed to the explosion in infestations over the last three decades: increased immigration and international travel; expanded markets for second-hand goods; a greater focus on control of other pests; the banning of certain pesticides and increased [[resistance to pesticides]] still in use.<ref name=Kolb2009/><ref name="Jacobs">{{cite news |last=Jacobs |first=Andrew |date=2005-11-27 |title=Just Try to Sleep Tight. The Bedbugs Are Back. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2005/11/27/nyregion/just-try-to-sleep-tight-the-bedbugs-are-back.html |access-date=2023-12-27 |issn=0362-4331 |archive-date=27 December 2023 |archive-url=https://web.archive.org/web/20231227235732/https://www.nytimes.com/2005/11/27/nyregion/just-try-to-sleep-tight-the-bedbugs-are-back.html |url-status=live }}</ref><ref name="MDPI">{{cite journal |last1=Akhoundi |first1=Mohammad |last2=Zumelzu |first2=Coralie |last3=Sereno |first3=Denis |last4=Marteau |first4=Anthony |last5=Brun |first5=Sophie |last6=Jan |first6=Julie |last7=Izri |first7=Arezki |date=2023-07-05 |title=Bed Bugs (Hemiptera, Cimicidae): A Global Challenge for Public Health and Control Management |journal=Diagnostics |language=en |volume=13 |issue=13 |pages=2281 |doi=10.3390/diagnostics13132281 |doi-access=free |issn=2075-4418 |pmc=10340649 |pmid=37443675}}</ref>
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==Effects on humans==
[[File:Bedbugb1.JPG|thumb|Bedbug bites]]
[[File:Bedbugb2.JPG|thumb|Bedbug bites]]

Bed bugs infest dwellings and bite people, causing irritation and sometimes other issues.  There is no evidence that bed bugs transmit [[infectious diseases]]<ref name=GP2009/><ref name=CDC2017Trans/> even though they appear physically capable of carrying [[pathogen]]s and this possibility has been investigated.<ref name=JAMA2009/><ref name=GP2009/>

===Bites===
The most common skin findings associated with bed bug bites are [[pruritic|itching]], [[maculopapular|flat and bumpy]], [[erythematous|reddish]] [[Lesion|lesions]].<ref name="Parola" /> Each lesion is about {{Convert|2-5|mm|abbr=on|sigfig=1}} but may be as large as {{convert|2|cm|||abbr=on|sigfig=1}} in diameter and there may or may not be a central spot (punctum).<ref name="Parola" /> Bites are usually present on areas of exposed skin, especially exposed areas not covered by sheets or blankets, such as arms, legs, feet, face or neck.<ref name="Parola" /> Individual responses to bites vary, ranging from no visible effect (in about 20–70%),<ref name=JAMA2009/><ref name=GP2009/> to small [[Skin condition#Primary lesions|flat (macular)]] spots, to the formation of prominent [[Cutaneous conditions#Morphology|blisters (wheals and bullae)]] along with intense [[itching]] that may last several days.<ref name=GP2009/> [[Vesicle (dermatology)|Vesicle]]s and nodules may also form. The lesions due to bites may become secondarily infected due to scratching but systemic effects from bed bug bites are very rare.<ref name="Parola" /> A central spot of [[bleeding]] may also occur due to the release of [[anticoagulant|blood thinning substances]] in the bug's saliva.<ref name=Kolb2009/>

Symptoms may not appear until some days after the bites have occurred.<ref name=GP2009/> Reactions often become brisker after multiple bites due to possible sensitization to the salivary proteins of the bed bug.<ref name=JAMA2009/> Numerous bites may lead to a [[erythematous rash|red rash]] or [[urticaria|hives]].<ref name=GP2009/>

Bedbug bites may cause other symptoms and health issues. Serious [[allergy|allergic reactions]] including [[anaphylaxis]] from the injection of serum and other non-specific proteins have been documented, though rarely.<ref name=GP2009/><ref>{{cite journal |last=Bircher |first=Andreas J. |title=Systemic Immediate Allergic Reactions to Arthropod Stings and Bites |journal=Dermatology |volume=210 |issue=2 |pages=119–127 |pmid=15724094|year=2005 |doi=10.1159/000082567 |s2cid=11060759}}</ref> As each bite takes a tiny amount of [[blood]], chronic or severe infestation may lead to [[anemia]].<ref name=GP2009/> Scratching bites may lead to [[bacterial]] skin infection.<ref name=GP2009/><ref name="UCIPM">{{cite web |publisher=UC IPM Online (Statewide Integrated Pest Management Program, UC Davis) |title=How to Manage Pests Pests of Homes, Structures, People, and Pets |url=http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7454.html |access-date=26 June 2010 |archive-date=5 March 2016 |archive-url=https://web.archive.org/web/20160305073646/http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7454.html |url-status=live }}</ref> Systemic poisoning may occur if the bites are numerous.<ref>Encyclopedia Americana, 1996 ed., v. 3, p. 431</ref> The bite itself may be painful thus resulting in poor sleep and worse work performance.<ref name=GP2009/>

Bed bugs can feed on warm-blooded animals other than humans, such as pets. The signs left by the bites are the same as in the case of people and cause identical symptoms (skin irritation, scratching etc.).<ref>{{cite journal |last1=Clark |first1=Sandy |last2=Gilleard |first2=John S. |last3=McGoldrick |first3=James |date=2002-09-14 |title=Human bedbug infestation of a domestic cat |journal=The Veterinary Record |volume=151 |issue=11 |pages=336 |issn=0042-4900 |pmid=12356240}}</ref> Bed bugs can infest poultry sheds and cause anemia and a decrease in egg production in hens.<ref>{{cite journal |last1=Cater |first1=Jason |last2=Magee |first2=Danny |last3=Edwards |first3=Kristine T. |date=2011-10-01 |title=Severe infestation of bedbugs in a poultry breeder house |journal=Journal of the American Veterinary Medical Association |volume=239 |issue=7 |pages=919 |doi=10.2460/javma.239.7.919 |issn=1943-569X |pmid=21961628}}</ref>

====Treatment====
Treatment of bed bug bites requires keeping the person from being repeatedly bitten, and possible symptomatic use of [[antihistamine]]s and [[corticosteroid]]s (either [[topically]] or systemically).<ref name=GP2009/> There however is no evidence that medications improve outcomes, and symptoms usually resolve without treatment in 1–2 weeks.<ref name=JAMA2009/><ref name=Kolb2009/>

===Other effects of infestation===
It is possible that exposure to bed bugs may trigger an [[asthma]] attack via the effects of airborne allergens, although evidence of this association is limited.<ref name=GP2009/>

Serious infestations and chronic attacks can cause anxiety, stress, and [[insomnia|sleep difficulties]].<ref name=GP2009/> Development of refractory [[delusional parasitosis]] is possible, as a person develops an overwhelming obsession with bed bugs.<ref name="injury">{{cite web |author=Susan C. Jones |url=http://www.cuyahogabedbugs.org/wp-content/uploads/2016/06/Bed-Bug-Factsheet-OSU-Extension.pdf |title=Extension Fact Sheet "Bed Bugs, Injury" |date=January 2004 |publisher=[[Ohio State University]] |access-date=25 October 2018 |archive-date=18 July 2017 |archive-url=https://web.archive.org/web/20170718232426/http://www.cuyahogabedbugs.org/wp-content/uploads/2016/06/Bed-Bug-Factsheet-OSU-Extension.pdf |url-status=live }}</ref>

==Description==
{{Main|Cimex lectularius|Cimex hemipterus}}
[[File:BedBugwithMeasure.jpg|thumb|An adult bed bug is about 4 to 5 mm long.]]
Bed bug infestations are primarily the result of two species of insects from genus ''Cimex'': ''Cimex lectularius'' (the common bed bug) and ''Cimex hemipterus'' (the tropical bed bug).<ref name=JAMA2009/> These insects feed exclusively on blood and, at any stage of development, may survive up to 70 days without feeding.<ref name="Parola" /> Adult ''Cimex'' are light brown to reddish-brown, flat, oval, and have no hind wings. The front wings are [[vestigial]] and reduced to pad-like structures. Adults grow to {{convert|4|-|5|mm|in|abbr=on}} long and {{convert|1.5|–|2|mm|in|abbr=on}} wide. Female common bed bugs can lay 1–10 eggs per day and 200–500 eggs in their lifetime, whereas female tropical bed bugs can lay about 50 eggs in their lifetime.<ref name="Parola" />

Bed bugs have five immature nymph life stages and a final sexually mature adult stage.<ref>{{cite web |author1=Xavier Bonnefoy |author2=Helge Kampen |author3=Kevin Sweeney |url=http://www.euro.who.int/__data/assets/pdf_file/0011/98426/E91435.pdf |title=Public Health Significance of Urban Pests |publisher=[[World Health Organization]] |page=136 |access-date=1 December 2016 |archive-date=22 February 2017 |archive-url=https://web.archive.org/web/20170222111554/http://www.euro.who.int/__data/assets/pdf_file/0011/98426/E91435.pdf |url-status=dead }}</ref> Bed bugs need at least one blood meal in order to advance to the next stage of development.<ref name="Parola"/> They shed their skins through [[ecdysis]] at each stage, discarding their outer exoskeleton.<ref name="Shukla 2009 73">{{cite book |title=Economic Zoology |last1=Shukla |last2=Upadhyaya |edition=4th |year=2009 |page=73 |publisher=Rastogi |isbn=978-81-7133-876-4 }}</ref> Newly hatched [[Nymph (biology)|nymphs]] are translucent, lighter in color, and become browner as they [[ecdysis|moult]] and reach [[sexual maturity|maturity]]. Bed bugs may be mistaken for other insects, such as [[booklice]], small [[cockroach]]es, or [[Dermestidae|carpet beetle]]s; however, when warm and active, their movements are more ant-like, and like most other [[true bugs]], they emit a characteristic disagreeable odor when crushed.

Bed bugs are obligatory [[hematophagy|bloodsuckers]]. They have mouth parts that saw through the skin and inject saliva with [[anticoagulant]]s and painkillers. Sensitivity of humans varies from extreme allergic reaction to no reaction at all (about 20%). The bite usually produces a swelling with no red spot, but when many bugs feed on a small area, reddish spots may appear after the swelling subsides.<ref name=birc.org/> Bedbugs prefer exposed skin, preferably the face, neck, and arms of a sleeping person.

Bed bugs are attracted to their hosts primarily by [[carbon dioxide]], secondarily by warmth, and also by certain chemicals.<ref name=Kolb2009/><ref name=anderson09>{{cite journal |last1=Anderson |first1=J. F. |last2=Ferrandino |first2=F. J. |last3=McKnight |first3=S. |last4=Nolen |first4=J. |last5=Miller |first5=J. |year=2009 |title=A carbon dioxide, heat and chemical lure trap for the bed bug, ''Cimex lectularius'' |url=https://www.insect-interceptor.com/anderson.pdf |url-status=live |journal=Medical and Veterinary Entomology |volume=23 |issue=2 |pages=99–105 |doi=10.1111/j.1365-2915.2008.00790.x |pmid=19499616 |s2cid=19294476 |archive-url=https://web.archive.org/web/20170816233931/https://www.insect-interceptor.com/anderson.pdf |archive-date=16 August 2017 |access-date=27 May 2010}}</ref><ref>{{cite journal |last1=Singh |first1=Narinderpal |last2=Wang |first2=Changlu |last3=Cooper |first3=Richard |last4=Liu |first4=Chaofeng |year=2012 |title=Interactions among Carbon Dioxide, Heat, and Chemical Lures in Attracting the Bed Bug, ''Cimex lectularius'' L. (Hemiptera: Cimicidae) |journal=[[Psyche (entomology journal)|Psyche]] |volume=2012 |pages=1–9|doi=10.1155/2012/273613|doi-access=free}}</ref><ref>{{cite journal |last1=Wang |first1=Changlu |last2=Gibb |first2=Timothy |last3=Bennett |first3=Gary W. |last4=McKnight |first4=Susan |date=August 2009 |title=Bed bug (Heteroptera: Cimicidae) attraction to pitfall traps baited with carbon dioxide, heat, and chemical lure |journal=[[Journal of Economic Entomology]] |volume=102 |issue=4 |pages=1580–1585 |pmid=19736771 |url=https://extension.entm.purdue.edu/bedbugs/pdf/BedBugTrap.pdf |doi=10.1603/029.102.0423 |s2cid=23502680 |access-date=26 October 2018 |archive-date=20 September 2020 |archive-url=https://web.archive.org/web/20200920052533/https://extension.entm.purdue.edu/bedbugs/pdf/BedBugTrap.pdf |url-status=live }}</ref> There is strong evidence that bed bugs can respond and orient towards human odors, independently of all other host cues.<ref>{{cite journal |last1=DeVries |first1=Zachary C |last2=Saveer |first2=Ahmed M |last3=Mick |first3=Russell |author4-link=Coby Schal |last4=Schal |first4=Coby |date=2019-02-25 |title=Bed Bug (Hemiptera: Cimicidae) Attraction to Human Odors: Validation of a Two-Choice Olfactometer |url=https://academic.oup.com/jme/article/56/2/362/5174721 |journal=Journal of Medical Entomology |language=en |volume=56 |issue=2 |pages=362–367 |doi=10.1093/jme/tjy202 |issn=0022-2585 |pmc=7182910 |pmid=30423171}}</ref> ''Cimex lectularius'' feeds only every five to seven days, which suggests that it does not spend the majority of its life searching for a host. When a bed bug is starved, it leaves its shelter and searches for a host. It returns to its shelter after successful feeding or if it encounters exposure to light.<ref>{{cite journal |last1=Reis |first1=Matthew D. |last2=Miller |first2=Dini M. |year=2011 |title=Host Searching and Aggregation Activity of Recently Fed and Unfed Bed Bugs (''Cimex lectularius'' L.) |journal=Insects |volume=2 |issue=4 |pages=186–194 |pmid=26467621 |pmc=4553457 |doi=10.3390/insects2020186 |doi-access=free}}</ref> ''Cimex lectularius'' aggregate under all life stages and mating conditions. Bed bugs may choose to aggregate because of predation, resistance to desiccation, and more opportunities to find a mate. Airborne pheromones are responsible for aggregations.<ref>{{cite journal |author1=Margie Pfiester |author2=Philip G. Koehler |author3=Roberto M. Pereira |year=2009 |title=Effect of Population Structure and Size on Aggregation Behavior Of(Hemiptera: Cimicidae) |journal=Journal of Medical Entomology |volume=46 |issue=5 |pages=1015–020 |doi=10.1603/033.046.0506 |pmid=19769030 |doi-access=free}}</ref>

==Infestation==
Infestation is rarely caused by a lack of [[hygiene]].<ref name=Hild2009/> Transfer to new places is usually in the personal items of the human they feed upon.<ref name=JAMA2009/> Dwellings can become infested with bed bugs in a variety of ways, such as:
* Bugs and eggs inadvertently brought in from other infested dwellings on a visiting person's clothing or luggage;
* Infested items (such as furniture especially beds or couches, clothing, or backpacks) brought into a home or business;
* Proximity of infested dwellings or items, if easy routes are available for travel, e.g. through ducts or false ceilings;
* Wild animals (such as bats or birds)<ref name="UKY">{{cite web |publisher = University of Kentucky College of Agriculture |title = BED BUGS |last1 = Potter | first1 = Michael F. |url = http://www.ca.uky.edu/entomology/entfacts/ef636.asp |access-date = 27 June 2010 | archive-url= https://web.archive.org/web/20100702114716/http://www.ca.uky.edu/entomology/entfacts/ef636.asp| archive-date= 2 July 2010 | url-status=live}}</ref><ref name="avianadvice.uark.edu">Steelman, C.D. 2000. [http://www.avianadvice.uark.edu/AA%20PDFs/avian_advice2no2.pdf Biology and control of bed bugs] [https://web.archive.org/web/20111005011925/http://www.avianadvice.uark.edu/AA%20PDFs/avian_advice2no2.pdf Archive], ''Cimex lectularius'', in poultry houses. Avian Advice 2: 10,15.</ref> that may also harbour bed bugs or related species such as the [[bat bug]];
* People visiting an infested area (e.g. dwelling, means of transport, entertainment venue, or lodging) and carrying the bugs to another area on their clothing, luggage, or bodies. Bedbugs are increasingly found in air travel.<ref>{{cite web|url=https://www.forbes.com/sites/melaniehaiken/2011/11/21/bed-bugs-on-airplanes-how-to-fly-bed-bug-free/|title=Bed Bugs on Airplanes?! Yikes! How to Fly Bed Bug-Free|first=Melanie|last=Haiken|website=Forbes|access-date=21 May 2020|archive-date=11 April 2019|archive-url=https://web.archive.org/web/20190411215037/https://www.forbes.com/sites/melaniehaiken/2011/11/21/bed-bugs-on-airplanes-how-to-fly-bed-bug-free/|url-status=live}}</ref>

Though bed bugs will opportunistically feed on pets, they do not live or travel on the skin of their hosts, and pets are not believed to be a factor in their spread.<ref name="PAWS SF">{{cite web|publisher=PAWS SF |title=The Truth About Bedbugs: Debunking the Myths |url=http://www.pawssf.org/document.doc?id=16 |access-date=13 October 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131014175351/http://www.pawssf.org/document.doc?id=16 |archive-date=14 October 2013 }}</ref>

===Detection===
Knowing that symptoms are caused by bedbug bites rather than other causes requires seeking and finding the insect in the sleeping environment, as symptoms are not [[Sensitivity and specificity|specific]] to bedbug bites.<ref name=GP2009/> Bites by other arthropods cause similar symptoms, even the linear pattern of bites known colloquially as "breakfast, lunch and dinner bites".<ref name="Parola" />

Bed bugs can occur singly, but tend to congregate once established. Although strictly parasitic, they spend only a tiny fraction of their lives physically attached to hosts. Once a bed bug finishes feeding, it follows a chemical trail to return to a nearby harborage, commonly in or near beds or couches, where they live in clusters of adults, juveniles, and eggs. These places may include luggage, vehicle interiors, furniture, bedside clutter—even inside electrical sockets or laptop computers. Bed bugs may also lodge near animals that have nested within a dwelling, such as bats, birds,<ref name=avianadvice.uark.edu/> or [[rodent]]s. They can also survive by feeding on domestic cats and dogs, though humans are the preferred host of ''C.&nbsp;lectularius''.<ref name=WoodwardQuinn2011>{{cite book |author1 = Susan L. Woodward |author2 = Joyce A. Quinn |title = Encyclopedia of Invasive Species: From Africanized Honey Bees to Zebra Mussels: From Africanized Honey Bees to Zebra Mussels |url = https://books.google.com/books?id=KOGfKRZ0YFIC&pg=PA124 |access-date = 15 August 2013 |date = 30 September 2011 |publisher = ABC-CLIO |isbn = 978-0-313-38221-5 |page = 124 |archive-date = 14 January 2023 |archive-url = https://web.archive.org/web/20230114141615/https://books.google.com/books?id=KOGfKRZ0YFIC&pg=PA124 |url-status = live }}</ref>

A severe bedbug infestation can be detected by their characteristic pungent sweet smell, which has been described as like rotting [[raspberry|raspberries]].<ref>{{cite journal |last = Anderson |first = AL |author2 = Leffler, K |title = Bedbug infestations in the news: a picture of an emerging public health problem in the United States |journal = Journal of Environmental Health |date = May 2008 |volume = 70 |issue = 9 |pages = 24–7, 52–3 |pmid = 18517150 |url = https://www.neha-ecommerce.org/imispublic/members/pdf/JEH/archive/2008/4.May.08/JEH5.08_Feature_Bedbugs.pdf |url-status=dead |archive-url = https://web.archive.org/web/20120426075229/https://www.neha-ecommerce.org/imispublic/members/pdf/JEH/archive/2008/4.May.08/JEH5.08_Feature_Bedbugs.pdf |archive-date = 26 April 2012 |df = dmy-all }}</ref> [[Bed bug detection dogs]] are trained to pinpoint infestations, with a possible accuracy rate between 11% and 83%.<ref name=Dog2012 /><ref name=Ib2017/>

Homemade detectors have been developed.<ref>{{cite web |url = http://abc7ny.com/archive/7212643/ |title = 7 On Your Side: Get rid of bed bugs for less than $15 |access-date = 1 December 2016 |archive-date = 2 December 2016 |archive-url = https://web.archive.org/web/20161202165313/http://abc7ny.com/archive/7212643/ |url-status = live }}</ref><ref>{{cite web |url = https://njaes.rutgers.edu/pubs/fs1117/ |title = Detecting Bed Bugs Using Bed Bug Monitors (from Rutgers NJAES) |access-date = 1 December 2016 |archive-date = 2 December 2016 |archive-url = https://web.archive.org/web/20161202040225/https://njaes.rutgers.edu/pubs/fs1117/ |url-status = live }}</ref> Bedbug detectors, often referred to as "monitors", "traps" or "interceptors",<ref>{{cite web |author=[[US EPA OCSPP]] |date=2013-03-07 |title=Do-it-yourself Bed Bug Control |url=https://www.epa.gov/bedbugs/do-it-yourself-bed-bug-control |access-date=2022-10-01 |website=[[US EPA OCSPP]] |language=en}}</ref> use the  lactic acid or carbon dioxide associated with the presence of a human body, or [[pheromone]]s, to attract and trap bugs in a container. Bedbug detectors can confirm an infestation, but do not trap enough for eradication.<ref name="Parola">{{cite journal |last1=Parola |first1=Philippe |last2=Izri |first2=Arezki |title=Bedbugs |journal=New England Journal of Medicine |date=4 June 2020 |volume=382 |issue=23 |pages=2230–2237 |doi=10.1056/NEJMcp1905840|pmid=32492304 |s2cid=219315855 }}</ref>
<gallery>
File:Bedbugs1.jpg|Eggs and two adults found inside a dresser
File:BedBugFeces.jpg|Fecal spot
File:Bed Bug On Carpet.jpg|Bed bug on carpet
</gallery>

====Differential detection====
Other conditions which produce symptoms similar to bedbug bites include [[scabies]], [[gamasoidosis]], [[allergic reactions]], [[mosquito bites]], [[spider bite]]s, [[chicken pox]] and bacterial skin infections.<ref name=GP2009/>

===Prevention===
To prevent bringing home bed bugs from outside the home, people are advised to take precautions after visiting an infested site or traveling on means of transport that may be infested; precautions  include checking shoes on leaving the site, changing clothes outside the house before entering, and putting the used clothes in a [[clothes dryer]] outside the house. When visiting a new lodging, it is advised to check the bed before taking suitcases into the sleeping area, and putting the suitcase on a raised stand to make bedbugs less likely to crawl in. Clothes should be hung up or left in the suitcase rather than left on the floor.<ref name=sciam12>{{cite web|url=https://www.scientificamerican.com/article/bed-bug-expert-explains-defend-yourself/|title=Bed Bug Confidential: An Expert Explains How to Defend against the Dreaded Pests|newspaper=Scientific American|date=23 January 2012|author=Kate Wong|access-date=19 August 2018|archive-date=19 August 2018|archive-url=https://web.archive.org/web/20180819182133/https://www.scientificamerican.com/article/bed-bug-expert-explains-defend-yourself/|url-status=live}}</ref> Additional preventative measures include sealing cracks and crevices (where bed bugs often hide), inspecting furniture, and decontaminating clothes and luggage upon returning home.<ref name="Parola" /> The founder of a company dedicated to bedbug extermination said that 5% of hotel rooms he booked into were infested. He advised people never to sit down on public transport; check office chairs, plane seats, and hotel mattresses; and monitor and vacuum home beds once a month.<ref name=obs18au18>{{cite news |url=https://www.theguardian.com/uk-news/2018/aug/19/bedbugs-heatwave-sparks-plage-pest-infestation |title=Bedbugs plague hits British cities |newspaper=The Observer |date=19 August 2018 |access-date=19 August 2018 |last1=Sherwood |first1=Harriet |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423045138/https://www.theguardian.com/uk-news/2018/aug/19/bedbugs-heatwave-sparks-plage-pest-infestation |url-status=live }}</ref> Close all wall openings or gaps; bed bugs tend to hide in dark places such as cracks in walls. Second-hand furnishings may harbour bedbugs.

===Management===
{{Main|Bed bug control techniques}}
Avoiding repeated bites can be difficult since it usually requires [[Bed bug control techniques|eradicating bed bugs]] from a home or workplace; eradication is most effective using non-chemical control methods.<ref name="Parola" /> Non-chemical control methods include vacuuming carpet and furniture (often with scraping) into a disposable bag which is then sealed into a plastic bag to prevent re-infestation.<ref name="Parola" /> Other methods include removing textile materials from an area and washing them in hot water (at least 60 degrees Celsius) or freezing them at {{convert|-20|C|F}}.<ref name="Parola" /> Most consumer-grade freezers are inadequate to kill bedbugs because they cannot create sufficiently low temperatures.<ref name="Parola" /> Unremovable textiles such as mattresses can be steamed to at least {{convert|60|C|F}} and this method can penetrate deep into the textile to effectively kill bed bugs in, potentially, under one minute.<ref name="Parola" /> Heating tents or chambers can be used for infested materials or entire rooms can be heated to at least {{convert|55|C|F}} to effectively eradicate infestation.<ref name="Parola" />

There is no evidence to indicate that a combination of non-chemical methods plus insecticides is more effective than non-chemical methods alone with regards to eradication of bed bug infestations.<ref name="Parola" />

Insecticides are mostly ineffective for the eradication of bedbug infestations as most bedbugs are resistant to insecticides, including pyrethroids which are found in approximately 90% of commercial grade insecticides.<ref name="Parola" /> Furthermore, insect foggers (known as "bug bombs") are ineffective in the eradication of bed bug infestation as they are unable to penetrate bed bug harborages.<ref name="Parola" /> Resistance to pesticides has increased significantly over time, and there are concerns about [[Health effects of pesticides|harm to health]] from their use.<ref name=JAMA2009/>

Once established, bed bugs are extremely difficult to get rid of,<ref name=JAMA2009/> particularly  in buildings with multiple dwellings, as they may be present in other parts of the building than the dwelling being treated,<ref name="Parola" /> and can re-establish populations by moving from infested to decontaminated areas.

<!--Mechanical -->
Mechanical approaches, such as vacuuming up the insects and heat-treating or wrapping mattresses, are effective.<ref name=JAMA2009 /><ref name=Dog2012/> An hour at a temperature of {{convert|45|C|F}} or over, or two hours at less than {{convert|-17|C|F}} kills them.<ref name=Dog2012 /> This may include a domestic [[clothes drier]] for fabric or a commercial steamer. Bed bugs and their eggs will die on contact when exposed to surface temperatures above {{convert|180|F|C}} and a steamer can reach well above {{convert|230|F|C}}.<ref name=birc.org>{{cite journal|last=Quarles|first=William|date=March 2007|title=Bed Bugs Bounce Back|journal=IPM Practitioner|volume=24|issue=3/4|pages=1–8|url=http://www.birc.org/MarApril2007.pdf|access-date=27 May 2010|archive-date=11 November 2013|archive-url=https://web.archive.org/web/20131111193218/http://www.birc.org/MarApril2007.pdf|url-status=live}}</ref><ref>{{cite web| url=https://www.bedbugs.umn.edu/bed-bug-control-in-residences/steamers| title=Using Steamers to Control Bed Bugs| date=22 June 2016| access-date=4 March 2018| archive-date=26 July 2020| archive-url=https://web.archive.org/web/20200726165853/https://www.bedbugs.umn.edu/bed-bug-control-in-residences/steamers| url-status=live}}</ref> A study found 100% mortality rates for bed bugs exposed to temperatures greater than {{convert|50|C|F}} for more than 2 minutes. The study recommended maintaining temperatures of above {{convert|48|C|F}} for more than 20 min to effectively kill all life stages of bed bugs, and because in practice treatment times of 6 to 8 hours are used to account for cracks and indoor clutter.<ref name=PropaneStudy>{{cite report |last=Hulasare |first=Raj |title=Fundamental Research on the Efficacy of Heat on Bed Bugs and Heat Transfer in Mattresses|date=September 2007 – April 2009 |id=PERC docket 12221}}</ref> This method is expensive and has caused fires.<ref name=Dog2012/><ref name=birc.org/> Starving bedbugs is not effective, as they can survive without eating for 135 to 300 days, depending on temperature.<ref name=Dog2012 /><ref name="Parola" />

<!--Insecticides -->
After the withdrawal of most [[Insecticide#Organochlorides|organochlorine insecticides]], {{As of|2012|alt=it was stated in 2012}} that no truly effective insecticides were available.<ref name=Dog2012/><!-- Quote = "widespread insecticide resistance, the current lack of effective insecticidal products" --> Insecticides that have historically been found effective include [[pyrethroid]]s, [[dichlorvos]], and [[malathion]].<ref name=Kolb2009 /> Resistance to pesticides has increased significantly in recent decades.<ref name=JAMA2009 /> The [[carbamate]] insecticide [[propoxur]] is highly toxic to bed bugs, but it has potential toxicity to children exposed to it, and the [[US Environmental Protection Agency]] has been reluctant to approve it for indoor use.<ref>[https://www.nytimes.com/2010/09/05/opinion/05sun3.html "In Search of a Bedbug Solution"] {{Webarchive|url=https://web.archive.org/web/20210309063958/http://www.nytimes.com/2010/09/05/opinion/05sun3.html |date=9 March 2021 }}. ''The New York Times''. (4 September 2010).</ref> [[Boric acid]], sometimes applied as a safe indoor insecticide against pests such as [[Blattoidea|cockroaches and termites]], is not effective against bed bugs<ref>{{cite web |url=https://lancaster.unl.edu/pest/resources/341BBSteps.pdf |title=Got Bed Bugs? Don't Panic! |access-date= 27 August 2018}}</ref> because they do not groom.<ref name=miller>{{cite book|editor=John L. Capinera|last = Miller |first = Dini|title=Encyclopedia of Entomology|chapter = Bed bugs (hemiptera: cimicidae: ''Cimex'' spp.)|chapter-url=https://books.google.com/books?id=i9ITMiiohVQC&pg=PA414|date=11 August 2008|publisher=Springer Science & Business Media|isbn=978-1-4020-6242-1|page=414}}</ref>

==Distribution==
{{Main|Epidemiology of bed bugs}}

Bed bugs are found everywhere in the world.<ref name=Heu09>{{cite journal |title=Bed bugs, leeches and hookworm larvae in the skin |pmid=19362691 |year=2009 |vauthors=Heukelbach J, Hengge UR |journal=Clinics in Dermatology |volume=27 |issue=3 |pages=285–290 |doi=10.1016/j.clindermatol.2008.10.008}}</ref> Before the 1950s about 30% of houses in the United States had bedbugs;<ref name=Ib2017/> this percentage has fallen, which is believed to be partly due to the use of [[DDT]] to kill cockroaches.<ref name="Nurse09">{{cite journal |vauthors=Krause-Parello CA, Sciscione P |date=April 2009 |title=Bedbugs: an equal opportunist and cosmopolitan creature |journal=J Sch Nurs |volume=25 |issue=2 |pages=126–132 |doi=10.1177/1059840509331438 |pmid=19233933 |s2cid=5441148}}</ref> The invention of the [[vacuum cleaner]] and simplification of furniture design may have also played a role in the decrease.<ref name="Nurse09"/> Others believe it might simply be the cyclical nature of the organism.<ref>{{cite web |author1=Xavier Bonnefoy |author2=Helge Kampen |author3=Kevin Sweeney |title=Public Health Significance of Urban Pests |publisher=[[World Health Organization]] |page=131 |url=http://www.euro.who.int/__data/assets/pdf_file/0011/98426/E91435.pdf |access-date=1 December 2016 |archive-date=22 February 2017 |archive-url=https://web.archive.org/web/20170222111554/http://www.euro.who.int/__data/assets/pdf_file/0011/98426/E91435.pdf |url-status=dead }}</ref>{{Vague|date={{CURRENTMONTHNAME}} {{CURRENTYEAR}}}}

However, rates of infestation in [[developed countries]] have increased dramatically since the 1980s.<ref name="JAMA2009"/><ref name="Kolb2009"/><ref name=Heu09/> This is thought to be due to greater foreign travel; increased immigration from the developing world to the developed world; more frequent exchange of second-hand furnishings among homes; a greater focus on control of other pests, resulting in neglect of bed bug countermeasures; and the banning of effective pesticides coupled with increased resistance to those pesticides still permitted.<ref name=Kolb2009 /><ref name=Romero_et_al>{{cite journal |vauthors=Romero A, Potter MF, Potter DA, Haynes KF |title=Insecticide Resistance in the Bed Bug: A Factor in the Pest's Sudden Resurgence? |journal=Journal of Medical Entomology |volume=44 |issue=2 |pages=175–178 |year=2007 |pmid=17427684 |s2cid=29722288 |doi=10.1603/0022-2585(2007)44[175:IRITBB]2.0.CO;2 |issn=0022-2585}}</ref> The decrease in [[cockroach]] populations due to [[insecticide]] use may have aided bed bugs' resurgence, since cockroaches eat bedbugs.<ref>{{cite journal |last=Gulati |first=A. N. |date=1930 |title=Do Cockroaches eat Bed Bugs? |journal=Nature |language=en |volume=125 |issue=3162 |pages=858 |doi=10.1038/125858a0 |issn=1476-4687 |bibcode=1930Natur.125..858G |s2cid=4134223|doi-access=free }}</ref><ref name="Jacobs" /><ref name="MDPI" /> Increasing resistance to DDT and other potent pesticides may have also contributed, along with [[DDT ban|bans on DDT]].<ref>{{cite web |last=Bankhead |first=Charles |date=27 August 2015 |archive-url=https://web.archive.org/web/20150828173328/http://www.medpagetoday.com/MeetingCoverage/AAD/53277 |archive-date=28 August 2015 |title=Bed Bug Resurgence a Multifactorial Issue: Hygiene, insecticide bans, globalization all contribute |work=Meeting Coverage |publisher=MedPage Today |url=http://www.medpagetoday.com/MeetingCoverage/AAD/53277 |access-date=28 August 2015}}</ref><ref>{{cite journal |last1=Davies |first1=T. G. E. |last2=Field |first2=L. M. |last3=Williamson |first3=M. S. |date=2012|title=The re-emergence of the bed bug as a nuisance pest: implications of resistance to the pyrethroid insecticides |journal=Medical and Veterinary Entomology |language=en |volume=26 |issue=3 |pages=241–254 |doi=10.1111/j.1365-2915.2011.01006.x |pmid=22235873 |s2cid=9862896 |issn=1365-2915 |doi-access=free}}</ref>

The U.S. [[National Pest Management Association]] reported a 71% increase in bed bug calls between 2000 and 2005.<ref name="voiland">{{cite journal|author=Voiland, Adam|date=16 July 2007|title=You May not be Alone|journal=U.S. News & World Report |volume=143|issue=2|pages=53–54 |url=http://health.usnews.com/usnews/health/articles/070708/16bedbug.htm|url-status=dead|archive-url=https://web.archive.org/web/20111107010535/http://health.usnews.com/usnews/health/articles/070708/16bedbug.htm|archive-date=7 November 2011}}</ref> The number of reported incidents in [[New York City]] alone rose from 500 in 2004 to 10,000 in 2009.<ref name="nytakeover">{{cite news|url=http://newsfeed.time.com/2010/08/19/are-bedbugs-taking-over-new-york-city/|title=Are Bedbugs Taking Over New York City?|author=Megan Gibson|date=19 August 2010|magazine=[[Time (magazine)|Time]]|access-date=29 December 2012|archive-date=1 December 2016|archive-url=https://web.archive.org/web/20161201040832/http://newsfeed.time.com/2010/08/19/are-bedbugs-taking-over-new-york-city/|url-status=live}}</ref> In 2013 [[Chicago]] was listed as the US city with most bedbug infestation.<ref>{{cite news |url=http://www.tenants-rights.org/chicago-council-passes-bed-bug-ordinance/ |title=Chicago Council passes Bed Bug Ordinance |author=Metropolitan Tenants Organization |date=16 July 2013 |work=Metropolitan Tenants Organization website |access-date=31 August 2015 |archive-date=28 July 2020 |archive-url=https://web.archive.org/web/20200728232043/https://www.tenants-rights.org/chicago-council-passes-bed-bug-ordinance/ |url-status=live }}</ref> In response the [[Chicago City Council]] passed a bed bug control ordinance to limit spread. Additionally, bed bugs are reaching places in which they never established before, such as southern South America.<ref>{{cite journal |author=Faúndez E. I. |author2=Carvajal M. A. |year=2014 |title=Bed bugs are back and also arriving is the southernmost record of ''Cimex lectularius'' (Heteroptera: Cimicidae) in South America|journal=Journal of Medical Entomology |volume=51|issue=5|pages=1073–1076 |doi=10.1603/me13206|pmid=25276939|s2cid=26829030}}</ref><ref>{{cite journal|author=Faúndez E. I. |year=2015|title=Primeros registros de la chinche de cama ''Cimex lectularius'' Linneo, 1755 (Hemiptera: Cimicidae) en la Isla Tierra del Fuego (Chile)|journal=Arquivos Entomolóxicos |volume=14 |pages=279–280}}</ref>

The rise in infestations has been hard to track because bed bug infestation is not an easily identifiable problem, and  also people do not talk about it. Most  reports have been collected from pest-control companies, local authorities, and hotel chains,<ref name="boase">Boase, Clive J., "Bed-bugs – reclaiming our cities", ''Biologist'', vol. 51, pp. 1-4, accessed 7 June 2010</ref> and the problem may be more severe than is currently believed from reports.<ref name="urticaria">{{cite journal  |title=Bedbug bites masquerading as urticaria |year = 2006 |journal =[[Journal of Allergy and Clinical Immunology]] |pages=1508–1509 |volume=117 |issue=6 |last1=Scarupa |first1=M.D. |last2=Economides |first2=A. |doi=10.1016/j.jaci.2006.03.034|pmid=16751024}}</ref>

==Species==
The common bed bug (''[[Cimex lectularius]]'') is the species best adapted to human environments<ref name="UCR-CISR">{{cite web | title=Bed bugs | url=https://cisr.ucr.edu/invasive-species/bed-bugs | website=Center for Invasive Species Research | publisher=[[University of California Riverside]]}}</ref> but is also known from [[bird]]s, [[Chiroptera]], ''[[Gallus (genus)|Gallus]]'' (chickens and relatives), ''[[Myotis myotis]]'', and [[sheep]] (''Ovis aries'').<ref name="lectularius-CABI-ISC">{{cite journal | title=''Cimex lectularius'' (bed bug) | website=[[Invasive Species Compendium]] (ISC) | publisher=CABI ([[Centre for Agriculture and Bioscience International]]) | date=2022 | doi=10.1079/cabicompendium.13507 | url=https://www.cabi.org/isc/datasheet/13507 | access-date=2022-04-22 | archive-date=26 July 2024 | archive-url=https://web.archive.org/web/20240726162420/https://www.cabidigitallibrary.org/doi/10.1079/cabicompendium.13507 | url-status=live }}</ref><ref name="UCR-CISR" /> It is found in [[temperate]] climates throughout the world. Other species include ''[[Cimex hemipterus|C.&nbsp;hemipterus]]'', found in [[tropics|tropical regions]],<ref name="hemipterus-CABI-ISC">{{cite web | title=''Cimex hemipterus'' | website=[[Invasive Species Compendium]] (ISC) | publisher=CABI ([[Centre for Agriculture and Bioscience International]]) | date=2019-11-20 | url=http://www.cabi.org/isc/datasheet/88515 | access-date=2022-04-22}}</ref><ref name="UCR-CISR" />  which also infests poultry (including ''Gallus'')<ref name="hemipterus-CABI-ISC" /><ref name="UCR-CISR" />  and bats,<ref name="UCR-CISR" /> and ''[[Leptocimex boueti]]'', a relative of ''C.&nbsp;lectularius'' adapted for the tropics of West Africa and South America, which infests bats and humans.<ref name="UCR-CISR" /> ''[[Cimex pilosellus|C.&nbsp;pilosellus]]'' and ''[[Cimex pipistrella|C.&nbsp;pipistrella]]'' primarily infest bats, while ''[[Haematosiphon inodora]]'', a species of North America, primarily infests poultry.<ref>{{cite web |last1 = Cranshaw |first1 = W.S. |last2 = Camper |first2 = M. |last3 = Peairs |first3 = F.B. |title = Bat Bugs and Bed Bugs |publisher = Colorado State University Extension |date = Feb 2009 |url = https://extension.colostate.edu/topic-areas/insects/bat-bugs-bed-bugs-and-relatives-5-574/ |access-date = 27 May 2010 |archive-date = 6 October 2015 |archive-url = https://web.archive.org/web/20151006231917/http://extension.colostate.edu/topic-areas/insects/bat-bugs-bed-bugs-and-relatives-5-574/ |url-status = live }}</ref>

== Evolution ==
[[Cimicidae]], the ancestor of modern bed bugs, first emerged approximately 115 million years ago, more than 55 million years before bats—their previously presumed initial host—first appeared. From unknown ancestral hosts, a variety of different lineages evolved which specialized in either bats or birds. The common (''C.&nbsp;lectularius'') and tropical bed bug (''C.&nbsp;hemipterus'') split 40 million years before [[Homo#Evolution|''Homo'' evolution]]. Humans became hosts to bed bugs through host specialist extension (rather than switching) on three separate occasions.<ref>{{cite journal |last1=Reinhardt |first1=Klaus |last2=Willassen |first2=Endre |last3=Morrow|first3=Edward H. |last4=Simov |first4=Nikolay |last5=Naylor |first5=Richard |last6=Lehnert |first6=Margie P. |last7=McFadzen |first7=Mary |last8=Khan |first8=Faisal Ali Anwarali |last9=Faundez |first9=Eduardo I. |date=3 June 2019|title=Bedbugs Evolved before Their Bat Hosts and Did Not Co-speciate with Ancient Humans |journal=Current Biology |language=en |volume=29 |issue=11 |pages=1847–1853.e4 |doi=10.1016/j.cub.2019.04.048 |issn=0960-9822 |pmid=31104934 |doi-access=free|bibcode=2019CBio...29E1847R }}</ref><ref>{{cite journal |last1=Reinhardt |first1=Klaus |last2=Willassen |first2=Endre |last3=Morrow |first3=Edward H. |last4=Simov |first4=Nikolay |last5=Naylor |first5=Richard |last6=Khan |first6=Faisal Ali Anwarali |last7=Lehnert |first7=Margie P. |last8=McFadzen |first8=Mary |last9=Faundez |first9=Eduardo I. |date=11 July 2018 |title=A molecular phylogeny of bedbugs elucidates the evolution of host associations and sex-reversal of reproductive trait diversification |journal=bioRxiv |language=en |pages=367425 |url=https://www.biorxiv.org/content/10.1101/367425v1 |doi=10.1101/367425 |doi-access=free |access-date=12 August 2019 |archive-date=2 August 2020 |archive-url=https://web.archive.org/web/20200802082803/https://www.biorxiv.org/content/10.1101/367425v1 |url-status=live }}</ref>

==Historical reports==
[[File:Getzadvert.jpg|thumb|upright=0.8|1870s–1890s advertisement for a bed bug exterminator. It reads "Use Getz cockroach and bed bug exterminators, sold by all druggists."]]
[[File:Parts of Bed-Bug.jpg|thumb|1860 engraving of bed bug parts: ''A''. Intestines – ''B''. Antenna of the male – ''C''. Eye – ''D''. Haustellum, or sucker, closed – ''E''. Side view of sucker – ''F''. Under part of head – ''G''. Under lip – ''GG''. Hair of the tube, and outside cases – ''H''. Egg-bag – ''I''. Larva emerging from the eggs]]

Bed bugs were first mentioned in ancient Greece as early as 400 BC, and later by [[Aristotle]]. [[Pliny's Natural History|Pliny's ''Natural History'']], first published ''circa'' AD 77 in Rome, claimed bed bugs had medicinal value in treating ailments such as snake bites and ear infections. Belief in the medicinal use of bed bugs persisted until at least the 18th century, when [[Guettard]] recommended their use in the treatment of [[hysteria]].<ref>{{cite book |url = https://books.google.com/books?id=41oMAAAAYAAJ |title = A dictionary of Greek and Roman antiquities – Sir William Smith – Google Boeken |access-date = 11 November 2013 |year = 1847 |last1 = Smith |first1 = William |archive-date = 14 January 2023 |archive-url = https://web.archive.org/web/20230114141615/https://books.google.com/books?id=41oMAAAAYAAJ |url-status = live }}</ref>

Bed bugs were also mentioned in Germany in the 11th century, in France in the 13th century, and in England in 1583,<ref name="Lance2002">{{cite book|title=Medical and Veterinary Entomology|last1=Mullen|first1=Gary R.|last2=Durden|first2=Lance A.|date=8 May 2009|publisher=Academic Press|isbn=978-0-12-372500-4|edition=Second|page=80}}</ref> though they remained rare in England until 1670. Some in the 18th century believed bed bugs had been brought to London with supplies of wood to rebuild the city after the [[Great Fire of London]] (1666). [[Giovanni Antonio Scopoli]] noted their presence in [[Carniola]] (roughly equivalent to present-day Slovenia) in the 18th century.<ref>{{cite book |title=A Treatise of Buggs |author=John Southall |date=1730 |location=London |publisher = J Roberts |pages=16–17 |url=https://archive.org/details/atreatisebuggss00soutgoog}}</ref><ref>{{cite web |title = According to Scopoli's 2nd work (loc. cit.), found in Carniola and adjoining regions. According to Linnaeus' second work on exotic insects (loc. cit.), before the era of health, already in Europe, seldom observed in England before 1670. |author1 = Johann Friedrich Wolff |author2 = Johann Philip Wolff |publisher = Icones Cimicum descriptionibus illustratae |quote = fourth fascicle (1804) |page = 127 |url = https://archive.org/details/iconescimicumdes00wolf |access-date = 1 December 2016 }}</ref>

Traditional methods of repelling or killing bed bugs include the use of plants, fungi, and insects (or their extracts), such as [[black pepper]];<ref>George Orwell, ''[[Down and Out in Paris and London]]'', 1933</ref> [[black cohosh]] (''[[Actaea (plant)|Actaea]] racemosa''); ''Pseudarthria hookeri''; ''Laggera alata'' (Chinese ''yángmáo cǎo'' | 羊毛草);<ref name=birc.org/> ''[[Eucalyptus saligna]]'' oil;<ref>{{cite book |last1 = Schaefer |first1 = C.W. |last2 = Pazzini |first2 = A.R. |title = Heteroptera of Economic Importance |publisher = CRC Press |date = 28 July 2000 |location = Boca Raton, FL |page = 525 |url = https://books.google.com/books?id=AVcBI0GL-fQC&q=eucalyptus&pg=PA525 |isbn = 978-0-8493-0695-2 }}</ref><ref>{{cite journal |last1 = Kambu | first1 = Kabangu |last2 = Di Phanzu | first2 = N. |last3 = Coune | first3 = Claude |last4 = Wauters | first4 = Jean-Noël |last5 = Angenot | first5 = Luc |title = Contribution à l'étude des propriétés insecticides et chimiques d'Eucalyptus saligna du Zaïre (Contribution to the study of insecticide and chemical properties of Eucalyptus saligna from Zaire ( Congo)) |journal = Plantes Médicinales et Phytothérapie |volume = 16 | issue = 1 | pages = 34–38 | year = 1982 |hdl=2268/14438 }}</ref> [[henna]] (''Lawsonia inermis'' or camphire);<ref>{{cite web |url = http://grubstreet.rictornorton.co.uk/bedbugs.htm |title = Getting Rid of Bed-Bugs |publisher = Grubstreet.rictornorton.co.uk |access-date = 11 November 2013 |archive-date = 17 November 2016 |archive-url = https://web.archive.org/web/20161117195213/http://grubstreet.rictornorton.co.uk/bedbugs.htm |url-status = live }}</ref> "infused oil of ''[[Melolontha]] vulgaris''" (presumably [[cockchafer]]); [[fly agaric]] (''Amanita muscaria''); [[tobacco]]; "heated oil of [[Pistacia terebinthus|Terebinthina]]" (i.e. true [[turpentine]]); [[Mentha arvensis|wild mint]] (''Mentha arvensis''); [[Lepidium|narrow-leaved pepperwort]] (''Lepidium ruderale''); ''[[Myrica]]'' spp. (e.g. bayberry); [[Robert geranium]] (''Geranium robertianum''); [[Cimicifuga|bugbane]] (''Cimicifuga'' spp.); "herb and seeds of ''[[Cannabis]]''"; "opulus" berries (possibly [[maple]] or [[Viburnum opulus|European cranberrybush]]); [[masked hunter]] bugs (''Reduvius personatus''), "and many others".<ref>{{cite web |url = https://archive.org/stream/iconescimicumdes00wolf#page/n163/mode/2up |title = Icones Cimicum descriptionibus illustratae |access-date = 11 November 2013 }}</ref>

In the mid-19th century, smoke from [[peat]] fires was recommended as an indoor domestic fumigant against bed bugs.<ref>{{cite journal|journal=Scientific American|url=https://books.google.com/books?id=P680AQAAMAAJ&pg=PA307|date=17 June 1848|title = Peat and peat mosses|volume=3|issue=39|pages=307|doi = 10.1038/scientificamerican06171848-307b}}</ref>

Dusts have been used to ward off insects from grain storage for centuries, including plant ash, lime, dolomite, certain types of soil, and [[diatomaceous earth]] or Kieselguhr.<ref name=hillde>{{cite journal |last = Hill |first = Stuart B. |title = Diatomaceous Earth: A Non Toxic Pesticide |journal = Macdonald J. |volume = 47 |issue = 2 |pages = 14–42 |date = May 1986 |url = http://eap.mcgill.ca/publications/eap4.htm |access-date = 26 May 2010 |archive-url = https://web.archive.org/web/20100526041417/http://eap.mcgill.ca/publications/eap4.htm |archive-date = 26 May 2010  |url-status=live }}</ref> Of these, diatomaceous earth in particular has seen a revival as a non-toxic (when in amorphous form) residual [[pesticide]] for bed bug abatement. While diatomaceous earth often performs poorly, silica gel may be effective.<ref name=pct_de>{{cite journal |author1 = Michael F. Potter |author2 = Kenneth F. Haynes |author3 = Chris Christensen |author4 = T. J. Neary |author5 = Chris Turner |author6 = Lawrence Washburn |author7 = Melody Washburn |title = Diatomaceous Earth: Where Do Bed Bugs Stand When the Dust Settles? |date = December 2013 |journal = Pest Control Technology |number = 12 |page = 72 |issn = 0730-7608 |url = http://www.pctonline.com/article/pct1213-Diatomaceous-earth-study |access-date = 13 September 2015 |archive-date = 1 August 2020 |archive-url = https://web.archive.org/web/20200801143300/https://www.pctonline.com/article/pct1213-diatomaceous-earth-study/ |url-status = live }}</ref><ref name=pct_silicagel>{{cite journal |author1 = Michael F. Potter |author2 = Kenneth F. Haynes |author3 = Jennifer R. Gordon |author4 = Larry Washburn |author5 = Melody Washburn |author6 = Travis Hardin |title = Silica Gel: A Better Bed Bug Desiccant |date = August 2014 |journal = Pest Control Technology |number = 8 |page = 76 |issn = 0730-7608 |url = http://www.pctonline.com/Digital/201408/index.html |access-date = 13 September 2015 |archive-date = 16 March 2015 |archive-url = https://web.archive.org/web/20150316002939/http://www.pctonline.com/Digital/201408/index.html |url-status = live }}</ref>

Basket-work panels were put around beds and shaken out in the morning in the UK and in France in the 19th century. Scattering leaves of plants with microscopic hooked hairs around a bed at night, then sweeping them up in the morning and burning them, was a technique reportedly used in Southern Rhodesia and in the Balkans.<ref name=Boase2001>{{cite journal |title = Bedbugs – back from the brink |year = 2001 |pages = 159–162 |volume = 12 |issue = 4 |last = Boase |first = C. |journal = Pesticide Outlook |doi = 10.1039/b106301b }}</ref>

[[Phaseolus vulgaris|Bean]] leaves have been used historically to trap bedbugs in houses in [[Eastern Europe]]. The [[trichome]]s on the bean leaves capture the insects by impaling the feet ([[Tarsomere#Tarsus|tarsi]]) of the insects. The leaves are then destroyed.<ref name=Szyndler>{{cite journal |author1 = Szyndler, M.W. |author2 = Haynes, K.F. |author3 = Potter, M.F. |author4 = Corn, R.M. |author5 = Loudon, C. |year = 2013 |title = Entrapment of bed bugs by leaf trichomes inspires microfabrication of biomimetic surfaces |journal = Journal of the Royal Society Interface |volume = 10 |issue = 83 |issn = 1742-5662 |doi = 10.1098/rsif.2013.0174 |pmid = 23576783 |page = 20130174 |pmc = 3645427 }}</ref>

=== 20th century ===
Until the mid-20th century, bed bugs were very common. According to a report by the [[UK Ministry of Health]], in 1933, all the houses in many areas had some degree of bed bug infestation.<ref name=boase/> The increase in bed bug populations in the early 20th century has been attributed to the advent of electric heating, which allowed bed bugs to thrive year-round instead of only in warm weather.<ref name=Potter>{{cite journal |url = http://entsoc.org/PDF/2011/AE-Potter-spring2011.pdf |year = 2011 |last = Potter |first = Michael F. |title = The History of Bed Bug Management – With Lessons from the Past |journal = [[American Entomologist (Oxford University Press journal)|American Entomologist]] |volume = 57 |pages = 14–25 |doi = 10.1093/ae/57.1.14 |doi-access = free |access-date = 28 June 2012 |archive-date = 29 July 2020 |archive-url = https://web.archive.org/web/20200729000205/https://entsoc.org/PDF/2011/AE-Potter-spring2011.pdf |url-status = dead }}</ref>

Bed bugs were a serious problem at US military bases during [[World War II]].<ref name=EntWW2>{{cite journal |url = https://apps.dtic.mil/sti/pdfs/ADA506261.pdf |archive-url = https://web.archive.org/web/20121007040155/http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA506261&Location=U2&doc=GetTRDoc.pdf#page=25 |url-status = live |archive-date = 7 October 2012 |title = Entomologists in World War II |journal = Proceedings of the DOD Symposium, 'Evolution of Military Medical Entomology', Held 16 November 2008, Reno, NV. Annual Meeting of the Entomological Society of America |author = Gerberg, Eugene J. |date = 16 November 2008 |access-date = 11 November 2013 }}</ref>  Initially, the problem was solved by fumigation, using [[Zyklon B|Zyklon Discoids]] that released [[hydrogen cyanide]] gas, a rather dangerous procedure.<ref name=EntWW2/>  Later, DDT was used to good effect, though bedbugs have since become largely resistant to it.<ref name=EntWW2/><ref>{{cite web|url=http://pct.texterity.com/pct/200707/?pg=50 |title=Pest Control Technology Magazine&nbsp;— July 2007 |publisher=Pct.texterity.com|date=17 July 2007 |access-date=2010-09-01| archive-url= https://web.archive.org/web/20100813010414/http://pct.texterity.com/pct/200707/?pg=50| archive-date= 13 August 2010 | url-status= live}}</ref><ref>{{cite journal |author1=C. Dayton Steelman |author2=Allen L. Szalanski |author3=Rebecca Trout |author4=Jackie A. McKern |author5=Cesar Solorzano |author6=James W. Austin |s2cid=42748989 |year=2008 |title=Susceptibility of the bed bug ''Cimex lectularius'' L. (Hemiptera: Cimicidae) to selected insecticides |journal=Journal of Agricultural and Urban Entomology |volume=25 |issue=1 |pages=45–51|doi=10.3954/1523-5475-25.1.41}}</ref>

The decline of bed bug populations in the 20th century is often credited to potent [[pesticide]]s that had not previously been widely available.<ref name=newsweek0910>{{cite web |url = http://www.newsweek.com/2010/09/08/conservatives-blame-environmentalists-for-bedbugs.html |author = Newsweek |title = The Politics of Bedbugs |website = [[Newsweek]] |date = 8 September 2010 |access-date = 28 October 2010 |archive-url = https://web.archive.org/web/20101021040754/http://www.newsweek.com/2010/09/08/conservatives-blame-environmentalists-for-bedbugs.html |archive-date = 21 October 2010  |url-status=live |author-link = Newsweek }}</ref> Other contributing factors that are less frequently mentioned in news reports are increased public awareness and [[slum clearance]] programs that combined pesticide use with steam disinfection, relocation of slum dwellers to new housing, and in some cases also follow-up inspections {{how|date=June 2019}} for several months after relocated tenants moved into their new housing.<ref name=Potter/>

=== 21st century ===
In 2010, bed bug infestations were reported in [[New York City|New York]] houses, retail stores, cinemas, offices and schools, especially in [[Brooklyn]] and [[Queens]].<ref>{{cite web |last=Decker |first=Geoffrey |url=https://www.nytimes.com/2010/09/25/nyregion/25bedbugs.html |title=Bedbugs Finding a Way Into New York's Schools |work=The New York Times |date=24 September 2010 }}</ref> In early 2023, [[Orkin]] reported that [[Chicago]], New York, [[Philadelphia]], [[Cleveland]] and [[Los Angeles]] were the top five cities in the United States with most bed bug infestations.<ref>{{cite web |url=https://www.orkin.com/press-room/2023-top-bed-bug-cities-list |title=The Windy City can't blow bed bugs away: Chicago ranks #1 for third consecutive year on Orkin's bed bug cities list |publisher=Orkin |date=9 January 2023 }}</ref>

In France, these insects re-emerged, despite having disappeared from daily life in the 1950s, due to nomadic lifestyles, consumption of second-hand purchases, and bugs' resistance to insecticides,<ref name="auto1"/> in addition to increased traveling and tourism following the [[COVID-19 lockdowns]].<ref>{{cite web |url=https://www.lemonde.fr/en/environment/article/2023/10/03/bedbugs-in-france-they-can-be-found-wherever-people-go_6145485_114.html |title=Bedbugs in France: 'They can be found wherever people go' |publisher=Le Monde |date=3 October 2023 }}</ref> Between 2017 and 2022, 11% of French households were infested by bed bugs, according to a report from the [[Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail|National Agency for Food, Environmental and Occupational Health Safety]] (ANSES).<ref name="auto1">{{cite web |url=https://archive.wikiwix.com/cache/index2.php?url=https%3A%2F%2Fwww.lemonde.fr%2Fplanete%2Farticle%2F2023%2F07%2F19%2Fles-punaises-de-lit-touchent-11-des-menages-francais-independamment-du-milieu-social-selon-l-anses_6182593_3244.html#federation=archive.wikiwix.com&tab=url |title=Les punaises de lit touchent 11 % des ménages français indépendamment du milieu social, selon l'Anses |publisher=Le Monde |language=fr |date=19 July 2023 }}</ref> In the middle of 2023, reports emerged of a [[2023 Paris bedbug infestation|bed bug infestation spread in the capital city]] of [[Paris]], when it was first seen in cinemas, then it expanded to homes, trains, schools and even hospitals.<ref>{{cite web |url=https://www.wsj.com/world/paris-bed-bug-outbreak-22b6e915 |title='Punaise!' Paris Battles Bedbug Outbreak, Real or Imagined |publisher=The Wall Street Journal |date=4 October 2023 }}</ref> Treatment of this outbreak has cost France an estimated €230m annually.<ref>{{cite web |url=https://www.theguardian.com/world/2023/sep/04/coming-soon-to-a-cinema-near-you-the-return-of-the-bed-bug |title=Coming soon to a cinema near you? The return of the bed bug |work=The Guardian |date=4 September 2023 |access-date=8 October 2023 |archive-date=26 July 2024 |archive-url=https://web.archive.org/web/20240726162521/https://www.theguardian.com/world/2023/sep/04/coming-soon-to-a-cinema-near-you-the-return-of-the-bed-bug |url-status=live }}</ref> In the meantime, the [[United Kingdom]] witnessed a 65% increase in year-on-year infestations across the country, according to [[Rentokil]].<ref>{{cite web |url=https://www.independent.co.uk/news/uk/home-news/bed-bugs-epidemic-pest-control-b2393197.html |title=A bed bugs epidemic is sweeping the UK – this is why |work=The Independent |date=15 August 2023 }}</ref> In November 2023, it was reported that [[South Korea]] was experiencing a bed bug infestation.<ref>{{cite web |last=Shan |first=Lee Ying |date=2023-11-09 |title=South Korea is battling against a bedbug outbreak |url=https://www.cnbc.com/2023/11/09/south-korea-has-a-bedbug-breakout-and-locals-are-avoiding-theaters.html |access-date=2023-11-09 |website=CNBC |language=en |archive-date=26 July 2024 |archive-url=https://web.archive.org/web/20240726162520/https://www.cnbc.com/2023/11/09/south-korea-has-a-bedbug-breakout-and-locals-are-avoiding-theaters.html |url-status=live }}</ref>

==Society and culture==
=== Legal action ===
Bed bugs are an increasing cause for litigation.<ref name="initi">Initi, John (14 January 2008). "Sleeping with the Enemy". ''[[Maclean's]]''. '''121''' (1): 54–56.</ref> Courts have, in some cases, exacted large [[punitive damage]] judgments on some hotels.<ref>{{cite news | url=https://www.nytimes.com/2003/12/25/garden/sleeping-with-the-enemy.html | title=Sleeping with the Enemy | author=Kimberly Stevens | access-date=16 January 2010 | work=The New York Times | date=25 December 2003 | archive-date=26 October 2009 | archive-url=https://web.archive.org/web/20091026221727/http://www.nytimes.com/2003/12/25/garden/sleeping-with-the-enemy.html | url-status=live }}</ref><ref>[https://web.archive.org/web/20080309212407/http://www.projectposner.org/case/2003/347F3d672 Archive] Burl Mathias and Desiree Mathias, Plaintiffs-Appellees/Cross-Appellants</ref><ref>{{citation|url=http://www.harvardlawreview.org/issues/120/march07/shavell.pdf |access-date=16 January 2010 |last=Shavell |first=Steven |title=On the Proper Magnitude of Punitive Damages: ''Mathias v. Accor Economy Lodging, Inc.'' |journal=Harvard Law Review |volume=120 |pages=1223–1227 |year=2007 |url-status=dead |archive-url=https://web.archive.org/web/20080827181303/http://www.harvardlawreview.org/issues/120/march07/shavell.pdf |archive-date=27 August 2008 }}</ref> Many of New York City's [[Upper East Side]] homeowners have been afflicted, but they tend to remain publicly silent in order not to ruin their property values and be seen as suffering a blight typically associated with "[[lower social class]]."<ref>{{cite news | url=http://nymag.com/news/features/65733/ | title=Bedbugs in the Duvet: An infestation on the Upper East Side | author=Marshall Sella | access-date=11 June 2010 | work=[[New York (magazine)|New York]] | date=2 May 2010 | archive-date=22 March 2018 | archive-url=https://web.archive.org/web/20180322104414/http://nymag.com/news/features/65733/ | url-status=live }}</ref> Local Law 69 in New York City requires owners of buildings with three or more units to provide their tenants and potential tenants with reports of bedbug history in each unit. They must also prominently post these listings and reports in their building.<ref>{{cite web|url=https://www.huffpost.com/entry/the-newest-new-york-city-real-estate-laws-that-property_b_5a5e44c9e4b0d8c653bbfffb|title=The Newest New York City Real Estate Laws That Property Owners and Occupants Must Know in 2018|first1=Adam Leitman|last1=Bailey|date=16 January 2018|website=HuffPost|access-date=21 May 2020|archive-date=26 July 2020|archive-url=https://web.archive.org/web/20200726174541/https://www.huffpost.com/entry/the-newest-new-york-city-real-estate-laws-that-property_b_5a5e44c9e4b0d8c653bbfffb|url-status=live}}</ref>

===Idiom===
* "Good night, sleep tight, don't let the bed bugs bite," is a traditional saying.<ref>{{cite journal |last = Berg |first = Rebecca |title = Bed Bugs: The Pesticide Dilemma |journal = Journal of Environmental Health |volume = 72 |issue = 10 |year = 2010 |pages = 32–35 |pmid = 20556941 }}</ref>

== References ==
{{Reflist}}

==Further reading==
* {{cite journal |last1=Doggett |first1=Stephen L. |last2=Lee |first2=Chow-Yang |date=2023-01-23 |title=Historical and Contemporary Control Options Against Bed Bugs, Cimex spp. |journal=Annual Review of Entomology |language=en |volume=68 |issue=1 |pages=169–190 |doi=10.1146/annurev-ento-120220-015010 |pmid=36198396 |issn=0066-4170|doi-access=free }}

== External links ==
<!-- Links that are spammed here repeatedly will be quickly blacklisted -->
* [http://entomology.ifas.ufl.edu/creatures/urban/bed_bug.htm Bed bug] on the [[University of Florida]]/[[Institute of Food and Agricultural Sciences|IFAS]] Featured Creatures Web site
* {{YouTube|WfKCcSPCOQo|National Geographic segment on Bed bugs}}
* [http://medent.usyd.edu.au/bedbug/ ''Bed bugs''] {{Webarchive|url=https://web.archive.org/web/20100804013609/http://medent.usyd.edu.au/bedbug/ |date=4 August 2010 }} – University of Sydney and Westmead Hospital Department of Medical Entomology

{{Medical resources
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|  ICD11           = {{ICD11|1G06}}
|  ICD10           =
|  ICD9            =
|  ICDO            =
|  OMIM            =
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|  MedlinePlus     = 000033
|  eMedicineSubj   = article
|  eMedicineTopic  = 1088931
|  eMedicine_mult  =
|  MeshID          = D001511
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{{SleepSeries2}}
{{Pediculosis, acariasis and other infestations}}
{{Animal bites and stings}}
{{Portal bar|Medicine}}
{{Authority control}}

[[Category:Bed bug| ]]
[[Category:Cimicidae]]
[[Category:Delusional parasitosis]]
[[Category:Hematophages]]
[[Category:Household pest insects]]
[[Category:Parasitic arthropods of humans]]
[[Category:Parasitic bugs]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Insect common names]]