The mental health impact of bed bug infestations: a scoping review

Efficiency of MALDI-TOF MS at identifying and discriminating immature stages of cimex lectularius and cimex hemipterus bed bugs

Over the last two decades, an increase in bed bug infestations has been observed worldwide. Although their definitive role as vectors of infectious agents has not yet been demonstrated, bed bugs have a direct effect on human health through dermatological reactions to their bites and psychological disorders linked to domestic infestations. In this study, the effectiveness of using MALDI-TOF MS to correctly identify these two bed bug species at immature stages was assessed, as well as it effectiveness as discriminating between the immature stages (IS) of C. lectularius and C. hemipterus and their associated developmental stages. A total of 305 specimens were subjected to MALDI-TOF MS analysis, including 153 C. lectularius (28 eggs and 25 nymphs per stage from IS1 to IS5) and 152 C. hemipterus (27 eggs and 25 nymphs per stage from IS1 to IS5). ). MALDI-TOF MS analysis enabled us to obtain 84.97% (130/153) of high-quality MS spectra in terms of reproducibility and profile intensity. Twenty-four spectra including two per stage, from egg to IS5, and per bed bug species - were added to our in-house MS reference arthropod spectra database. All specimens were correctly identified at the species level, independently of the developmental stage, with log score values (LSVs) ranging from 1.75 to 2.79 (mean = 2.29 ± 0.12) and 1.81 to 2.71 (mean = 2.37 ± 0.03) for C. lectularius and C. hemipterus, respectively. MALDI-TOF MS correctly classified 53,33% (104/195) of the Cimex at the correct immature stage. Conversely, an accurate comparison of the profiles with a Genetic Algorithm model underlined that grouping the immature stages in two groups, early (IS1-IS2) and late (IS3-IS4-IS5), made it possible to obtain a cross validation (CV) and recognition capability (RC) greater than 92% and 94%, respectively, for both species. This study holds great promise for the management of bed bug infestations.

Scabies, Bedbug, and Body Lice Infestations: A Review

Importance

Scabies, bedbug, and body lice infestations are caused by organisms that live on or in the skin, on clothing, or in the environment and commonly cause pruritus and rash. In 2021, approximately 622 million incident cases of scabies occurred globally. Data on bedbug infestations are limited. Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness worldwide.

Observations

Scabies is caused by mites (Sarcoptes scabiei) that burrow into the epidermis. Transmission primarily occurs from prolonged skin-to-skin contact with an individual who has an infestation. Common scabies is characterized by excoriated pruritic papules, plaques, and pathognomonic burrows on finger/toe web spaces, volar wrists, ankles, axillae, buttocks, male genitalia, and areolae. Permethrin cream and oral ivermectin are first-line treatments for adults, with similar clearance rates by week 2 (74% with permethrin vs 68% with ivermectin; relative risk, 0.91; 95% CI, 0.76-1.08). Treatment failure can occur with oral ivermectin (11.8%; 95% CI, 8.4%-15.4%) and topical permethrin (10.8%; 95% CI, 7.5%-14.5%). Bedbugs (Cimex lectularius, Cimex hemipterus) are insects that live on mattresses and furniture and feed on blood nocturnally, causing linear pruritic erythematous papules. New skin lesions on waking, cohabitants with similar symptoms, and recently residing in a high-occupancy setting should raise suspicion. Treatment requires eradication with pest management. Body lice (Pediculus humanus humanus) are insects found on clothing that travel to the skin for blood meals. Body lice bites cause pruritic excoriated macules/papules and hyperpigmentation in areas where clothing seams contact skin. Treatment and prevention require at least once-weekly bathing and laundering of clothing and bedding.

Conclusions and Relevance

Scabies, bedbug, and body lice infestations are common. Accurate diagnosis requires taking a history, including social drivers of health (eg, housing status, living environment), and physical examination. First-line treatments include scabicides for patients with common scabies and their close contacts. Scabies, bedbug, and body lice infestations should be treated with decontamination measures.

Annual incidence of general practice consultations related, according to the general practitioner, to bed bugs and description of cases, 2019-2020, France

Bed bug infestations have been increasing worldwide since the 2000s. Their consequences for health range from skin reactions to major psychological distress. However, epidemiological data is still lacking. This study estimated the incidence of general practice consultations related to bed bugs in France and evaluated factors associated with repercussions on everyday life. We conducted a prospective observational study from March 2019 to April 2020 among 217 GPs in France. Annual and monthly GP consultations related to bed bugs were estimated from the reported cases. Descriptive analyses were performed, and factors associated with repercussions on everyday life were assessed using a logistic regression model. The annual incidence rate of GP consultations related to bed bugs was estimated at 109 per 100,000 inhabitants [95%CI: 92-126]. Bed bug-related consultations occurred in all regions, peaking in the summer. Moderate-to-severe repercussions on everyday life were reported by 39% of the patients. The associated factors with this level of repercussions were: having seen bed bugs (OR = 4.02 [95%CI: 1.6-10.73]), having lesions from scratching (OR = 5.25 [1.65-19.92]), having lesions on the head and the neck (OR = 3.97 [1.52-10.95]) and reporting psychological distress (OR = 6.79 [2.47-20.42]). This study provides new knowledge on GP consultations related to bed bugs in France. These data will help tailor public health programs to the population's needs, including information and training for primary healthcare professionals.

Trends in poisoning associated with the use of insecticides for bed bug infestations: a 20-year retrospective study in France

Bed bugs are pervasive global pests that have reemerged in the last 20 years as a significant public health concern, especially in densely populated urban areas. Beyond financial losses, expenses, inconvenience, and psychological distress, bed bug infestations often necessitate chemical management, posing poisoning risks to those with an infestation. The French Poison Control Centers recorded 1056 cases of exposure to bed bug insecticide products between 1999 and 2021. This study followed cases over 2007-2021, with a notable surge in reports of adverse reactions from 2016 onwards. Data revealed an increased recurrent misuse of insecticides, including substances banned or not approved for this use. Our findings underscore the growing public reliance on chemical insecticides for home bed bug management. With this is the concern of increased poisoning risks, and potential long-term health consequences from non-professional efforts by the public to manage bed bugs in their homes. This escalating trend emphasizes the need for safer and more sustainable pest management strategies in urban environments.

'When the bedbugs come, that's another problem': exploring the lived experiences of bedbug infestations among low-income older adults and service providers who support them

AIMS

Older adults in low-income housing communities are more vulnerable to bedbug infestations. Prior research, however, has predominately focused on the effectiveness of integrated pest-management strategies, with little attention given to the lived experiences of tenants struggling with infestations. We used a qualitative approach to explore what it is like to live with and treat bedbug infestations from the perspectives of low-income older adults and service providers.

METHODS

Participants included low-income older adults (n = 58) and service providers (n = 58) who offer supports directly in the buildings. Semi-structured qualitative interviews and focus groups were used to explore the challenges of preparing and treating units for bedbugs, and examine how bedbugs impact access to support services.

RESULTS

Bedbugs were a widespread issue, and underlying physical, mental, social, and financial challenges made it difficult for older tenants to prepare their units and access treatment. Tenants also faced bedbug stigma from community services, as many were unwilling to provide services in infested units. Although some service providers utilized strategies to minimize exposure, many were concerned these strategies created additional stigma.

CONCLUSION

Our findings highlight an urgent need to increase public health funding to support older adults with the costs of bedbug elimination and to enhance pest-management strategies through partnerships with health and social service agencies to improve outcomes for older adults.

The effect of educational intervention on efficacy of 1% permethrin shampoo and 4% dimeticone lotion to treat head lice infestation using propensity score matching (PSM)

BACKGROUND

Head lice are a main public health problem and the most important human ectoparasites and the use of pediculicides is the most common way to control it. One of the possible causes of treatment failure is the lack of improper application of pediculicide. The aim of this study was to assess the effect of education on efficacy of 1% permethrin or 4% dimeticone lotion to treat head lice infestation.

METHODS

This quasi-experimental study included 100 individuals with head lice infestation from comprehensive urban health centers in Ardabil as the intervention group, and 400 individuals from East Azerbaijan and West Azerbaijan provinces as the control group, from April to March 2019. The data collection tools included a demographic questionnaire and an examination recording sheet, which documented the presence of adult lice or nits. Due to the inability to perform random assignment and control for numerous observed covariates, propensity score matching (PSM) was used.

RESULTS

The outcome of treatment included elimination of head lice infestation on is 7, and in the case of recurrence, it was considered on days 14 and 30 after treatment. The results showed that the educational intervention program had a significant positive effect on the efficacy of both treatments. The likelihood of improvement was approximately three times greater in the intervention group compared to the control group.

CONCLUSION

Participants who received the training intervention (OR = 3.29; CI 95%: 2.21-4.88) were more likely to have a successful treatment than control group. In the case of providing proper training on the use of pediculicides and observing hygiene tips to patients with pediculosis, could help to successful treatment of pediculosis.

Bed Bug Infestation: An Updated Review

In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations. Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions. Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.

The common bed bug Cimex lectularius synthesizes hemozoin as an essential defense against the toxic effects of heme

The common bed bug Cimex lectularius (Linnaeus 1758) is an ectoparasite that feeds preferably on human blood, being considered an important public health issue. Blood-feeding is a challenging process for hematophagous organisms, and one of the inherent risks with this kind of diet is the liberation of high doses of free heme after the digestion of hemoglobin. In order to deal with this potent cytotoxic agent, such organisms have acquired different defense mechanisms. Here, we use UV-visible spectrophotometry and infrared spectroscopy to show that C. lectularius crystalizes free heme to form the much less dangerous compound, hemozoin. According to our results, the peak of formation of hemozoin in the intestinal contents occurred 4-5 days after the blood meal, primarily in the posterior midgut. The quantification of the rate of conversion of heme to hemozoin revealed that at the end of digestion all the heme was in the form of hemozoin. Inhibition of the synthesis of hemozoin using the anti-malarial drug quinine led to an increase in both catalase activity in the intestinal epithelium and the mortality of the bed bugs, indicating that the insects were unable to cope with the oxidative stress generated by the overload of free heme. The data presented here show for the first time how C. lectularius deals with free heme, and how the process of formation of hemozoin is essential for the survival of these insects. Since resistance to insecticides is a common feature among field populations of bed bugs, there is an urgent need to develop alternative control methods. Thus, targeting the synthesis of hemozoin emerges as a possible novel strategy to fight bed bugs.

Groundbreaking outpatient activity in medical entomology in France: An eight-year experience in a french university hospital

INTRODUCTION

Arthropods are known to impair human health in various manners, acting as infectious disease vectors, or as simple nuisances. Even though considerable research is being produced in medical entomology, no reports on patient management in clinical entomology units are available in the literature.

PATIENTS AND METHODS

We retrospectively surveyed all the records from patients having consulted in our outpatient clinical entomology unit in Nice University Hospital from 2012 to 2020. For each patient, physical examination findings and treatment data were analyzed.

RESULTS

A total of 518 patients were analyzed in this study. Most were diagnosed with arthropod infestation (55.8%), the most common being Sarcoptes scabiei (35%), bedbugs (23%), Pyemotes dermatitis (17.6%) and flea infestation (15.9%). Along with symptomatic treatments, targeted environmental measures could be proposed for infested patients. For many of our patients, on the other hand, active infestation was ruled out.

CONCLUSION

Given today's lack of expertise in medical entomology, we advocate for the creation of medical entomology units in university hospitals, not only allowing fair and proportionate multidisciplinary management of patients in whom arthropod infestation is suspected, but also generating cost savings.

Perception, attitudes, and knowledge on infestation and management of bed bugs in major cities of Indonesia: A cross-sectional online survey

The resurgence of bed bugs is a global phenomenon, but until now reports on bed bug infestations in Indonesia are rare. The success of bed bug control is affected by people's knowledge and awareness. Stigma against bed bugs in Indonesia discourages the public from reporting infestations and therefore knowledge of their impact on public health is scarce. Herein, this study investigates the public's perception, attitudes, and knowledge on bed bug-related issues in several major cities in Indonesia through an online survey. Despite low case reports, three in five respondents (n = 600) have encountered bed bugs at least once; mostly in their homes (74.1%). Approximately half of the respondents correctly identified bed bugs, whereas mites were often misidentified for bed bugs (26.3%). Bite marks were not a useful indicator for detecting bed bugs. We found age, gender, and level of education affects the public's perception toward various bed bug-related issues. Regarding bed bug treatment, above 50% respondents are unaware of the availability of bed bug-specific insecticidal products and are unwilling to pay pest management professionals to control infestation. This study provides the first overview of the public's awareness and perception of bed bug infestations in some major cities of Indonesia, which can be useful for designing public health policies for bed bug management. The reported data represents the perspectives of online users, most likely from metropolitan regions. A bigger monitoring program encompassing pest professionals and hospitality businesses would give a more thorough overview of the bed bug impact in Indonesia.

The first recent case of Cimex hemipterus (Hemiptera: Cimicidae) with super-kdr mutations in the Republic of Korea

With the increase in international travel and trade, in conjunction with the development of insecticide resistance, infestations of Cimex lectularius (L.) and Cimex hemipterus (F.) (Hemiptera: Cimicidae) have resurged globally in the last 2 decades. Recently, it was reported that C. hemipterus was also found in temperate regions, indicating the possibility of its expansion outside tropical regions. Cimex hemipterus has not been officially recorded in Korea since its initial description in 1934. Here, we report the first recent case of C. hemipterus in Korea based on morphological and molecular identification. Partial sequencing of the voltage-sensitive sodium channel gene revealed super-kdr mutations (M918I and L1014F) that are associated with pyrethroid resistance. This case report serves as a warning to intensify the bed bug surveillance system in Korea regarding the presence of C. hemipterus and to prepare effective alternative insecticides for pyrethroids.

Perspective on Biology and Management of Bed Bugs: Introduction

Bed bugs are an important group of medical and urban insect pests. They are obligate blood-feeders. Their bites may cause skin irritation and allergic reactions and, under some circumstances, may lead to mental and other health issues. Despite numerous discoveries on the biology of these obnoxious pests and progress in control strategies over the last two decades, bed bugs continue to preferentially plague those from low socioeconomic communities because the poor generally could not afford effective control options. As a result, such infestations in poorer communities serve as a reservoir for wider society. This Special Collection of the Perspective on Biology and Management of Bed Bugs presents nine original research papers on bed bug detection, insecticide performance and resistance, nonchemical treatment, fungal biopesticides, and pest management procurement and contracts. We hope that these investigative findings will spur research on safer, more affordable, and effective control options in the future.

Historical and Contemporary Control Options Against Bed Bugs, Cimex spp

Bed bugs (Hemiptera: Cimicidae) are an important group of obligate hematophagous urban insect pests. The global resurgence of bed bugs, involving the common bed bug, Cimex lectularius L., and the tropical bed bug, Cimex hemipterus (F.), over the past two decades is believed to be primarily due to the development of insecticide resistance, along with global travel and poor pest management, which have contributed to their spread. This review examines and synthesizes the literature on bed bug origins and their global spread and the literature on historical and contemporary control options. This includes bed bug prevention, detection and monitoring, nonchemical and chemical control methodologies (and their limitations), and potential future control options. Future research needs are highlighted, especially the factors behind the modern resurgence, the necessity of identifying differences between the two bed bug species relevant to control, and the need to improve insecticide test protocols and management strategies.

Spatiotemporal trends in bed bug metrics: New York City

Bed bug outbreaks pose a major challenge in urban environments and cause significant strain on public resources. Few studies have systematically analyzed this insect epidemic or the potential effects of policies to combat bed bugs. Here we use three sources of administrative data to characterize the spatial-temporal trends of bed bug inquiries, complaints, and reports in New York City. Bed bug complaints have significantly decreased (p < 0.01) from 2014–2020, the absolute number of complaints per month dropping by half (875 average complaints per month to 440 average complaints per month); conversely, complaints for other insects including cockroaches and flies did not decrease over the same period. Despite the decrease of bed bug complaints, areas with reported high bed bug infestation tend to remain infested, highlighting the persistence of these pests. There are limitations to the datasets; still the evidence available suggests that interventions employed by New York City residents and lawmakers are stemming the bed bug epidemic and may serve as a model for other large cities.

Procurement Competence and Framework Agreements for Upgraded Bed Bug Control [Cimex lectularius (Hemiptera: Cimicidae)]

The prevalence of bed bugs (Cimex lectularius L.) is increasing worldwide. Due to this increase, low-income housing owners and managers need an efficient method for controlling the pests without excessive resource use. The quality of pest control efforts is crucial for efficient eradication. Infestations often need to be approached using a variety of strategies through an integrated pest management (IPM) framework. Efficient eradication is often thought to be the responsibility of the pest control contractor alone. However, the purchase and supply management theory suggests that optimal solutions actually involve sound buyer-supplier relations to support the strategic aim of pest eradication. This study illustrates the positive outcomes of elevating pest management competence on the buyer's part. Further, this study outlines a large-scale purchase situation that quantifies bed bug control efforts, in addition to their outcomes. In total, 11,000 apartment units were observed in Oslo, Norway, over a period of six years. The release and implementation of a procurement officer together with a state-of-the-art pest management framework agreement quickly reversed the consistent escalation of bed bug infestations in the observed units. Observations revealed that the study yielded the most success in eradicating bed bugs by increasing both the number of visits to the infested apartment and the overall duration of control efforts. The improved control was achieved at a reduced cost per infested apartment unit, which allowed for the implementation of bed bug preventive measures and building-wide inspections. The observations made in this study have been discussed in the context of the impact of bed bugs in low-income communities, relative to the factors of pest burden, demography, socioeconomics, and the welfare system in Norway.

The Impact of Bedbug (Cimex spp.) Bites on Self-Rated Health and Average Hours of Sleep per Day: A Cross-Sectional Study among Hong Kong Bedbug Victims

Simple Summary

Bedbugs (Cimex spp.) are a nuisance pest of significant public health importance that is on the rise globally, especially in crowded cities such as Hong Kong. Bedbug infestations disproportionately affect underprivileged communities living in crowded and dilapidated housing. This study uses an online survey to investigate the health impacts of bedbug infestations among bedbug victims. This study found that most bedbug victims experienced ≥five bites in the past month, usually on the arms and legs. The most common reaction to bites were itchiness, redness, and swelling of the skin, and difficulties sleeping or restlessness. Bites usually occurred during sleep, impacting the bedbug victim’s mental and emotional health, and sleeping quality most severely. The adverse health outcomes of bedbug infestations were associated with the lower self-rated health and average hours of sleep per day of bedbug victims. This study brings attention to the neglected issue of bedbug infestations by providing evidence on the scope of its health impacts, informing public health interventions including public education and extermination programmes, and supportive laws and policies for adequate housing and hygiene. The successful control of bedbugs in an international city such as Hong Kong can inform the control of the global bedbug resurgence.

Abstract

Bedbugs (Cimex spp.) are a nuisance public-health pest that is on the rise globally, particularly in crowded cities such as Hong Kong. To investigate the health impacts of bedbug infestations among bedbug victims, online surveys were distributed in Hong Kong between June 2019 to July 2020. Data on sociodemographics, self-rated health, average hours of sleep per day, and details of bedbug infestation were collected. Bivariate and multivariable analysis were performed using logistic regression. The survey identified 422 bedbug victims; among them, 223 (52.9%) experienced ≥five bites in the past month; most bites occurred on the arms (n = 202, 47.8%) and legs (n = 215, 51%), and the most common reaction to bites were itchiness (n = 322, 76.3%), redness, and swelling of the skin (n = 246, 58.1%), and difficulties sleeping or restlessness (n = 125, 29.6%). Bites usually occurred during sleep (n = 230, 54.5%). For impact on daily life in the past month, most bedbug victims reported moderate to severe impact on mental and emotional health (n = 223, 52.8%) and sleeping quality (n = 239, 56.6%). Lower self-rated health (aOR < 1) was independently associated with impact on physical appearance (p = 0.008), spending money on medication or doctor consultation (p = 0.04), number of bites in the past month (p = 0.023), and irregular time of bites (p = 0.003). Lower average hours of sleep per day (aOR < 1) was independently associated with impact on mental and emotional health (p = 0.016). This study brings attention to the neglected issue of bedbug infestation by considering bedbugs as an infectious agent instead of a vector and providing empirical evidence describing its health impacts.

Pesticides Misused for Bed Bug Control: Comparing Professional and Nonprofessional Applications Reported to the National Pesticide Information Center, 2013-2017

Objectives. To compare outcomes when pesticides are used to control bed bugs by professionals and nonprofessionals. Methods. All US National Pesticide Information Center inquiries from 2013 to 2017 were assessed to identify scenarios involving bed bugs and pesticide applications. Cases were evaluated with respect to types of applicators, misapplications, and human pesticide exposures. Results. Misapplications were more than twice as likely to be reported in cases involving nonprofessional applications (14%) as in cases involving professional applications (5%). Human exposures to pesticides were reported more often when pesticides were misapplied (70%) than when there were no apparent misapplications (31%). Conclusions. Both professionals and nonprofessionals may misuse pesticides to control bed bugs, which may increase the risks of exposure and adverse outcomes. Policy interventions may reduce pesticide incidents related to bed bug control by promoting professional involvement and adherence to product label instructions.

Associations Between Bed Bugs and Mental Illness Among Emergency Department Patients

Background Bed bugs are common urban pests associated with stress, anxiety, depression, and some reports of suicidality. The emergency department (ED) treats patients with both acute mental illness and bed bug infestations. There have been few studies examining associations between bed bug infestations and mental illness. Methods A case-control study involving 332 adult ED patients infested with bed bugs and 4,952 uninfested control patients matched on sex, age (±1 year at the time of the ED visit), and the specific ED was completed. All clinic encounters occurred in northeast Ohio between February 1, 2011, and February 1, 2017, from a single health system. Univariable and multivariable regression analysis looked for associations between bed bug infestation and different psychiatric diagnoses and medications. Results Bed bug infested patients were more likely than uninfested patients to screen positive for an unsafe home and needing an abuse consult at ED triage (P≤.03 for both). ED psychiatric evaluations were not significantly more common among those with (2.4%) and without (1.3%) bed bugs (P=.14). Bed bug infested patients were significantly more likely to have an ED or inpatient diagnosis of alcohol abuse and psychosis (P≤.03 for both), but not for depression or suicidality. On univariable analysis, among ED patients not admitted to the hospital, bed bug infested patients were more likely to be diagnosed with psychosis or schizophrenia/schizoaffective disease (P≤.02) than uninfested patients. Among ED patients that received an ED or inpatient psychiatric evaluation and were admitted to the hospital, bed bug infested patients were significantly less likely to be diagnosed with depression and suicidality (P≤.03 for both). However, they were not significantly more likely to have insomnia or anxiety. Discussion Among ED patients, bed bug infestations were not associated with an ED or inpatient diagnosis of depression or suicidality. On univariable analysis, some mental health diagnoses such as anxiety and insomnia were more common among ED patients with bed bugs, but these associations were no longer significant on multivariable analysis. These associations likely reflect the complex relationships between socioeconomic factors, health disparities, mental illness, and having a bed bug infestation.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: an emerging tool for studying the vectors of human infectious diseases

Arthropod vectors have historically been identified morphologically, and more recently using molecular biology methods. However, both of these methods are time-consuming and require specific expertise and equipment. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, which has revolutionized the routine identification of microorganisms in clinical microbiology laboratories, was recently successfully applied to the identification of arthropod vectors. Since then, the robustness of this identification technique has been confirmed, extended to a large panel of arthropod vectors, and assessed for detecting blood feeding behavior and identifying the infection status in regard to certain pathogenic agents. In this study, we summarize the state-of-the-art of matrix-assisted laser desorption ionization time-of-flight mass spectrometry applied to the identification of arthropod vectors (ticks, mosquitoes, phlebotomine sand-flies, fleas, triatomines, lice and Culicoides), their trophic preferences and their ability to discriminate between infection statuses.

Behavioral Responses of the Common Bed Bug to Essential Oil Constituents

Simple Summary

Bed bugs (Cimex lectularius L.) are blood-sucking insects that have emerged worldwide in the last two decades causing serious public health and economic impact. Today, control of bed bug infestations relies on the use of synthetic insecticides, but their frequent use has led to the development of resistance in bed bug populations. Therefore, there is a growing demand for the development of safer, green, and more effective tools for bed bug control. Plant-derived pesticides are part of the proposed “green” methods for bed bug control. We evaluated behavioral responses of bed bugs to essential oil constituents (EOCs) and detected that bed bugs did not rest on areas treated with geraniol, eugenol, citronellic acid, and carvacrol. Barriers of these constituents did not deter bed bugs from reaching warmed blood meal and feeding. Our results show that novel formulations of natural product insecticides that include geraniol, eugenol, carvacrol, or citronellic acid have potential to repel bed bugs. However, little benefit of protection against bed bug bites can be expected when EOC-based products are applied to items present in close proximity to a sleeping host such as mattress covers, liners, or around the bed.

Abstract

Botanical-derived pesticides have arisen as an attractive alternative to synthetic insecticides to effectively manage infestations of bed bugs (Cimex lectularius L.). While information on contact, residual, and fumigant toxicity of plant-essential oils against bed bugs have been recently published, there is a gap of information regarding the repellent activity of these products and their constituents. Identification of essential oil constituents (EOCs) with repellent activity will help develop potentially efficacious essential oil-based formulations for use in bed bug management programs. In this study, we first screened fresh and 24 h-aged residues of geraniol, eugenol, carvacrol, thymol, citronellic acid, linalool, menthone, trans-cinnamaldehyde, α-pinene, β-pinene, and limonene for avoidance behavior from individual bed bugs with a video-tracking system. Six EOCs, geraniol, eugenol, citronellic acid, thymol, carvacrol, and linalool were further evaluated overnight in choice tests to determine whether 24-h aged residues were still avoided by groups of bed bugs. While bed bugs avoided resting on filter papers treated with 24-h aged residues of geraniol, eugenol, citronellic acid, and carvacrol, bed bugs aggregated in areas treated with linalool-aged residues. Barriers of EOCs did not prevent bed bugs from reaching a warmed blood source and acquiring blood meals. Our results show that novel formulations of natural product insecticides that include geraniol, eugenol, carvacrol, or citronellic acid have potential to repel bed bugs. The presence of host-associated cues might interfere with these responses.

MALDI-TOF MS identification of Cimex lectularius and Cimex hemipterus bedbugs

Bedbugs (Cimex lectularius and C. hemipterus) have reemerged as a major public health problem around the world. Their bites cause various skin lesions as well as discomfort and anxiety. Their role as potential vectors of various infectious agents is discussed. Accordingly, all suspected cases of bedbug infestations need to be documented thoroughly, with an unequivocal identification of the arthropods involved, if any are present. Although morphological identification is easily and quickly performed by entomologists or professionals, it can be challenging otherwise. Also, distinguishing Cimex lectularius and C. hemipterus requires entomological expertise. MALDI-TOF mass spectrometry has been recently presented as an additional tool for arthropod identification. In this study, we assess the use of MALDI-TOF MS for the identification of laboratory and wild strains of C. lectularius and C. hemipterus. Several body parts of laboratory reared C. lectularius specimens were used to develop a MALDI-TOF MS protocol for bedbug identification, which was later validated using five other laboratory and wild populations of C. hemipterus and C. lectularius. A total of 167C. lectularius and C. hemipterus bedbug specimens (98 laboratory specimens and 69 wild specimens) were submitted to MALDI-TOF MS analysis. 143/167 (85.63%) provided high quality MS spectra. The in-lab database was then upgraded with a total of 20 reference spectra from all bedbug populations and the rest of the MS spectra (123 bedbugs) were blind tested. All specimens were properly identified to the species level using MALDI-TOF MS and 86,25% (69/80) were aptly identified according to their origin with LSVs ranging from 1.867 to 2.861. MALDI-TOF MS appears as a reliable additional tool for the identification of these two anthropophilic species.

Susceptibility Status of Bedbugs (Hemiptera: Cimicidae) Against Pyrethroid and Organophosphate Insecticides in Dar es Salaam, Tanzania

Cimex hemipterus resistance to residual insecticides is a growing public health concern worldwide. Herein, we report the susceptibility status of C. hemipterus against pyrethroid (permethrin) and organophosphate (dichlorvos) insecticides in Dar es Salaam. The knockdown efficacy of dichlorvos (99%) was greater than that of permethrin (43%), and mortality at the end of 24 h was also greater for dichlorvos than for permethrin. Mortality in recommended concentration of permethrin was lower than manufacturer's expectations. In contrast, similar concentrations in dichlorvos resulted into mortality of 100% at the end of 24 h. LC50 and LC95 values for permethrin were 3.36 (2.356-4.364) and 2,887.39 (2,886.37-2,888.39), respectively, whereas those of dichlorvos were 7.91 (3.85-11.97) and 44.39 (40.33-48.45). Dar es Salaam city has high coverage and usage of long-lasting insecticidal nets (LLINs) for prevent malaria. The resistance in bedbugs to permethrin may be related to the widespread use of the insecticide in LLINs. We recommend of the change from pyrethroids dichlorvos for the control of bedbugs.

Dynamics of bed bug infestations and control under disclosure policies

Bed bugs are household pests that bite humans and cause myriad medical, psychological, social, and economic problems. Infestation levels have resurged across the United States in recent decades, and cities and states are debating strategies to deal with them. Here, we introduce a mathematical model to study the spread of bed bugs and predict the costs and benefits of policies aimed at controlling them. In particular, we evaluate disclosure, a policy that requires landlords to notify potential tenants of recent infestations in a unit. While disclosure aims to protect individual tenants, our results suggest that these policies also reduce infestation prevalence market-wide. Disclosure results in some initial cost to landlords but leads to significant savings in the long term.

Bed bugs have reemerged in the United States and worldwide over recent decades, presenting a major challenge to both public health practitioners and housing authorities. A number of municipalities have proposed or initiated policies to stem the bed bug epidemic, but little guidance is available to evaluate them. One contentious policy is disclosure, whereby landlords are obligated to notify potential tenants of current or prior bed bug infestations. Aimed to protect tenants from leasing an infested rental unit, disclosure also creates a kind of quarantine, partially and temporarily removing infested units from the market. Here, we develop a mathematical model for the spread of bed bugs in a generalized rental market, calibrate it to parameters of bed bug dispersion and housing turnover, and use it to evaluate the costs and benefits of disclosure policies to landlords. We find disclosure to be an effective control policy to curb infestation prevalence. Over the short term (within 5 years), disclosure policies result in modest increases in cost to landlords, while over the long term, reductions of infestation prevalence lead, on average, to savings. These results are insensitive to different assumptions regarding the prevalence of infestation, rate of introduction of bed bugs from other municipalities, and the strength of the quarantine effect created by disclosure. Beyond its application to bed bugs, our model offers a framework to evaluate policies to curtail the spread of household pests and is appropriate for systems in which spillover effects result in highly nonlinear cost–benefit relationships.

Trypanosoma cruzi Infection Does Not Decrease Survival or Reproduction of the Common Bed Bug, Cimex lectularius

Although not presently implicated as a vector of human pathogens, the common bed bug, Cimex lectularius, has been suspected of carrying human pathogens because of its close association with humans and its obligate hematophagy. Recently, we characterized the vectorial competence of C. lectularius for the parasite Trypanosoma cruzi, the causative agent of Chagas disease. We observed that C. lectularius can acquire T. cruzi infection when fed on T. cruzi-carrying mice, and subsequently transmit T. cruzi to uninfected mice. This led us to ask why has C. lectularius not been implicated in the transmission of T. cruzi outside of the laboratory? We hypothesized that T. cruzi reduces C. lectularius fitness (i.e., survival and/or reproduction) as an explanation for why C. lectularius does not to transmit T. cruzi in natural settings. We tested this hypothesis by comparing the survival and reproduction of uninfected and T. cruzi-infected C. lectularius. We observed that T. cruzi had a variable effect on C. lectularius survival and reproduction. There were negligible differences between treatments in juveniles. Infected adult females tended to live longer and produce more eggs. However, no effect was consistent, and infected bugs showed more variation in survival and reproduction metrics than control bugs. We did not observe any negative effects of T. cruzi infection on C. lectularius survival or reproduction, suggesting that decreased fitness in T. cruzi-infected C. lectularius is not why bed bugs have not been observed to transmit T. cruzi in natural settings.

The Common bed bug (Cimex lectularius) in metropolitan France. Survey on the attitudes and practices of private- and public-sector professionals

The Common bed bug, Cimex lectularius, had virtually disappeared from France in the 1950s; however, a worldwide resurgence of bed bugs (C. lectularius and C. hemipterus) has been observed since the 1990s. To document modern pest control activities for the management of bed bugs, a survey was conducted in metropolitan France among the two main categories of professionals regularly called upon to deal with the control of infestations: Municipal Health and Safety Services (MHSSs) and private Pest Management Companies (PMCs). These professionals responded to a questionnaire targeting their knowledge, attitude and practices related to the process for diagnosing a bed bug infestation and the processes taken to actually control an infestation. There were 68 responses received from MHSSs and 51 from the PMCs. The responses indicate that every single département (French administrative division) in metropolitan France has witnessed at least one intervention for bed bugs. Among the criteria considered sufficient to confirm a bed bug infestation, direct observation of bugs was the most commonly cited response. Faced with an infestation, most PMCs used a combination of non-chemical and chemical methods, and systematically performed two treatments. This survey is the first of professionals involved in bed bug control in metropolitan France and confirms the growing importance of bed bugs as a public health pest. Establishing a database to monitor this emerging pest would improve the understanding of the distribution of these insects, help guide educational requirements, identify research needs and assist in ensuring that the most appropriate control practices are undertaken.