Bedbugs - Diagnosis and Management

The diagnosis of bedbugs hinges on the symptoms of the bites and evidence of bedbugs living in the environment of the individual. If a diagnosis is made, the bedbugs should be eradicated from the area and the symptoms managed appropriately, as described below.

Diagnosis

There are two key factors that may indicate that an individual has bed bugs: evidence of bites on the body and of bedbugs in bedding.

Bites from bedbugs typically cause itchy welts, which appear in a zigzag pattern on the skin. Some skin conditions can sometimes be confused with bedbug bites, such as skin rashes, hives, measles, or chickenpox, which can make accurate diagnosis more difficult.

Bed Bug - Image Copyright: jareynolds / Shutterstock

It is unlikely to see the actual bedbugs unless they are present in vast numbers. As the bed bugs are not usually visible, many people assume they have been bitten by other insects such as mosquitos, fleas, or spiders. To confirm that the bites are caused by bedbugs, it is essential to check for signs of the presence of bedbugs.

Signs that may indicate the presence of bedbugs include:

• Musty odor: Bedbugs produce chemicals as a method of communication and these chemicals have a sweet, musty smell.
• Blood on bedding or upholstered furniture: Specks of blood on the mattress, bedding or soft furniture, particularly near the seams, may be an indication of bedbugs.
• Evidence of exoskeletons: As bedbugs progress through their complex lifecycle, they shed a series of exoskeletons from their body. These shell-like outer layers may be left behind and seen on bedding or other soft surfaces.
• Evidence of feces: Tiny, black specks may be visible on bedding due to the excrement of the bedbugs.
• Evidence of eggs: Tiny white oval eggs may be found in cracks and crevices of the bedding, such as in the seams of the mattress, from when the female bedbug lays eggs.

Management

Bedbugs are not a serious medical concern, although they can lead to significant anxiety and disturbed sleep in affected individuals. All bedding and soft surfaces in the home environment should be well cleaned and vacuumed. The bites should be washed with soap and water to prevent infection and reduce itchiness. Most bites usually heal within a few weeks without treatment.

To manage symptoms of itching, an oral antihistamine medication is often effective. Additionally, corticosteroid cream can be applied topically to reduce itch. Patients with severe symptoms related to bedbug bites should be referred to a dermatologist who is experienced in treating the infection and relieving the symptoms of the bites.

In some cases, an antibiotic or antiseptic medication may be required to treat or prevent an associated infection. For patients who have experienced an allergic reaction to the bedbug bites, an injection may be required to abate this.  An antihistamine or corticosteroid injection is commonly used for mild reactions, or epinephrine for more severe reactions.

Eradicating the bedbugs from the environment is the only way to successfully stop being bitten by bedbugs. The use of bug spray is not recommended as it has poor efficacy on bedbugs; a pest-control agency is usually the best option.

References

• https://www.aad.org/public/diseases/itchy-skin/bedbugs#treatment
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/bedbugs
• http://www.nhs.uk/conditions/bed-bugs/Pages/Introduction.aspx