Etiology
The three species of bed bugs that bite humans are Cimex lectularius, Cimex hemipterus, and Leptocimex boueti.[1] The most prevalent species in temperate climates is C lectularius, also known as the common bed bug. C hemipterus is generally found in tropical areas, and L boueti is found in western Africa.
In the home, bed bugs preferentially inhabit crevices of walls and mattresses, box springs, bed headboards, and behind baseboards.[2] Infestation is more common in social environments with a high turnover of occupants (e.g., hotels, hostels, homeless shelters, aircraft).[2][3][6] Infestations in hospitals, cinemas, and transportation vehicles such as cars, buses, and trains have also been reported.[16][Figure caption and citation for the preceding image starts]: Cimex lectularius, collected in a hotel in urban GeorgiaCourtesy of the CDC [Citation ends].
[Figure caption and citation for the preceding image starts]: Cimex lectulariusCourtesy of the CDC [Citation ends].
Pathophysiology
Bed bugs are obligate hematophagous (feeding only on blood) parasites.[1][3] Feeding occurs at night to minimize host response.[2][4] Reactions range from an absent or minimal response, to a more typical reaction presenting as pruritic, erythematous macules and papules, or a less-common urticarial and anaphylactic response. These skin reactions are most likely to be due to the host's immunologic response to the parasite's salivary proteins.[6] Some individuals do not mount a response and do not develop lesions, in contrast to other communicable human infestations such as scabies where nearly all persons bitten manifest cutaneous lesions. Papular urticarial reactions are reported to be mediated via an immunoglobulin (Ig) G antibody response to salivary proteins.[3][17] Bullous reactions, although rare, may be caused by an IgE-mediated hypersensitivity to nitrophorin, the substance that transports nitric oxide in bed bug saliva.[3][7][8][18][19]
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