Spotting bedbug bites in primary care

LAS VEGAS – Until recently, bedbugs were a distant memory – the stuff of children's rhymes – but an increasing number of patients are seeking care in primary care clinics for skin lesions caused by the parasite's bites, according to a speaker at the American Academy of Nurse Practitioners 26th Annual NP meeting.

Bedbug infestations have increased 10-fold since 1999, with reports of the parasite in 28 states and four Canadian provinces since 2003, according to Douglas Sutton, EdD, ARNP, ANP-C, ACNS-BC, an assistant professor at Florida Atlantic Unversity's Christine Lynn College of Nursing in Boca Raton, Fl. But that number is likely a gross underestimate, he warned.

Because bedbugs pose no communicable disease risk to public health, infestations are not reportable to the CDC. “This makes it difficult to track the real incidence and it's probably much higher than reported,” Sutton said.

Once considered eradicated in the 1950s and 60s, bedbugs have mounted a comeback since the United States pulled the pesticide dichlorodiphenyltrichloroethane (DDT) off the market in the early 1970s due to toxicity concerns.

But bedbugs are not just a problem in the United States. “No one is exempt,” Sutton said.

In the United Kingdom, reported infestations have quadrupled annually. Hotels are frequently the hardest-hit because of the influx of travelers from developing nations, but infestations have been reported in residential and office buildings, cruise ships and retail shops.

Between nocturnal feedings on sleeping humans, bedbugs take shelter in bedding, curtains, clothing, carpets, furniture and even children's toys. “Any dark location to wait out the day, usually close to beds,” Sutton said.

Bedbug bites look similar to scabies, but bedbugs do not live on their hosts, so clinicians are unlikely to spot a one of the blood suckers on a patient – a characteristic that can help clinicians differentiate between this parasite and other insects.

Bedbug bites can also resemble those of mosquitoes or fleas. “Their bites are painless but can trigger subsequent painful and irritating skin reactions and pruritus. Tell-tale blood spotting at the site of bites result from natural anticoagulants in the insect's saliva,” Sutton said.

If you suspect that a patient has been bitten by a bedbug advise him or her to inspect household bedding and look behind headboards for the insects, which are usually brown or red depending on the time of their last blood meal, and resemble an appleseed in shape and size. Small dark stains on the mattress and bedding – evidence of blood meal feces – are other indicators of infestation.

Remember that bedbugs are equal-opportunity parasites and do not prefer hosts of a particular socioeconomic status, ethnicity or age. A warm body expiring carbon dioxide seems to be the only criteria, according to Sutton, though movement and perspiration can also get their attention.

“Once lesions are confirmed to be bedbug bites, the priority becomes one of containment to minimize further spread,” Sutton said, adding that patients should be discouraged from using pesticides on their bedding or clothes.

Bedbugs thrive in the cold but are killed by heat and sunlight. An “old-time eradication” strategy is to “just drag your mattresses and bedding out into the sunshine for an afternoon,” Sutton said.

But that strategy will not kill the parasites living under the baseboards or in closets. “What's really required is an extensive eradication effort by professional exterminators,” Sutton said.

Sutton reported no conflicts of interest.

Sutton D. “Bedbug Invasion: Ramifications in Primary Care.” Presented at: 26th Annual American Academy of Nurse Practitioners Conference, 2011: Las Vegas, Nevada.  

Bryant Furlow is a medical writer and award-winning investigative healthcare journalist based in Albuquerque, New Mexico.

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