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Bed Bugs and Disease By now, just about everyone has heard about the bed bug epidemic. These nearly ubiquitous bloodsucking insects infest bed linens and mattresses in hotels, motels, hospitals, nursing homes, jails, and furnished apartments all over the world, especially in densely populated large cities. In the twenty-first century, bed bugs have become a major bane of renters and travelers. Bed bugs bite, of course, but they also cause allergic reactions and spread disease. Knowing how to recognize the symptoms of the diseases bed bugs cause is a necessity to healthy living on holiday and when lifestyle requires living in locations that bed bugs frequent. A Tiny Biting Machine Bed bugs are often described as resembling confetti. They are small (4 to 7 mm/1/4 to 1/3 of an inch across), round, wingless, and reddish brown. Two species of bed bugs, Cimex lectularius and Cimex hemipterus, feed on humans, while 11 other species of bed bugs suck the blood of birds and bats. Everything about a bed bug is geared for biting. Even a bed bug nymph, its larval stage of development, has a retractable “bite unit” that eventually grows into its head. Bed bugs reproduce by “traumatic insemination,” the male bed bug puncturing the body of the female to fertilize her eggs, often missing its target and killing its mate. Bites, Blood, and Bed Bug Sex Bed bugs emit pheromones that tell other bed bugs when they have fed on blood as a signal for sexual intercourse. Each female bed bug lays 20 to 50 eggs (not 500, as sometimes reported in the popular literature), which hatch in 4 to 10 days. The newly hatched nymphs are just 1 mm (1/25th of an inch) across. They are translucent, invisible to the naked eye. Each nymph must feed on blood every time it molts and loses its outer shells, the proteins in the blood providing the building materials for its “cocoon” and eventually its adult body. How often bed bugs bite depends on how often male bed bugs initiate sexual intercourse. When it is not having sex, a bed bug may live as long as a year off a single blood meal from its human host lasting just 10 to 20 minutes. In that year, the bed bug may walk across the room to position itself for its next meal, or travel literally around the world in suitcases, clothes, and stolen towels and linen. Recognizing Bed Bugs How can you know there are bed bugs in your bed? You are more likely to see evidence of your own blood than you are to see the bed bugs themselves. On dark sheets and pillowcases, you may be able to see tiny flakes of the bugs' shed skin or even the nymphs themselves. The adult bodies of bed bugs may be detectible on springs and underneath mattresses. Bed bugs often defecate on the edges of the undersides of mattresses, causing the buildup of “bug manure” to noticeable amounts after years of infestation. Some pest control companies have specially trained “bed bug dogs” that can sniff out a bed bug infestation. Bed bugs secrete a sickly-sweet smelling liquid when as they flee danger, but humans typically can only detect the odor if the infestation involves massive numbers of bugs. If you don't have access to a pest control company, however, chances are you will only recognize bed bug infestations by

the effects of their bites. The bite may or may not cause some oozing of blood that shows up on sheets or bed clothes, but the after-effects of bed bug bites are much more noticeable. Allergic Reactions to Bed Bugs Bed bug saliva contains anesthetics that keep the bite from being felt until the bug has time to get away. The saliva also contains an anticoagulant to make blood flow more freely into its mouth, proteolytic enzymes (literal meat tenderizers) that break down human tissues around the bite, and vasodilators that act on the same principle as Viagra, Levitra, and Cialis to increase the flow of blood into the wound. This toxic stew of chemicals in the bug's saliva triggers allergic reactions. Each site of a bite can erupt into a purple blister. The reaction is usually more severe the second time someone is bitten by bed bugs, and repeated bed bug bites can trigger hives and even autoimmune anemia. Forty-Five Infectious Diseases Spread by Bed Bugs The medical literature documents 45 different kinds of infections spread through bed bug bites and/or bed bug feces. The saliva can carry staph infections, leprosy, and a disease previously confined to the tropics known as leishimaniasis. The feces can transmit anthrax, brucellosis, Q fever, tularemia, Salmonella, hepatitis B, and yellow fever. Bed bugs can carry Lyme disease, and they have been documented as carrying hepatitis C, hepatitis E, reoviruses, and, in one unconfirmed study, HIV. Because bed bugs reproduce by a particularly traumatic form of sex, germs easily spread from bug to bug. The diseases they cause are also easily spread from bed bugs to people, probably far more often than public health officials previously realized. How Likely Are You to Suffer an Infection Transmitted by a Bed Bug? The US Centers for Disease Control estimate that 1 in 5 Americans has been bitten by bed bugs. Rates of bed bug bites are similarly high around the world. In the USA, pest control services estimate that the greatest number of bed bug infestations occur in New York, Cincinnati, Detroit, Philadelphia, Denver, Washington, D.C., Los Angeles, Boston, San Francisco, Columbus (Ohio), Dayton, Baltimore, Louisville, and Dallas. How to Recognize Bed Bug Bites Bed bug bites usually occur in groups of three, as if their human host were providing breakfast, lunch, and dinner. Groups of bed bugs typically coordinate their bites in a line or row, usually up or down an arm or leg. Allergic reactions to bed bug bites, manifesting themselves as itching, swelling, and/or skin discoloration, may take anywhere from 3 hours to 10 days to be visible, while skin infections take 3 days to 3 weeks. Any infection spread by a bed bug is made worse by scratching. Even when bed bugs don't cause skin reactions, they often cause insomnia. Just the thought of being in the bed with bugs is enough to keep most people awake. What You Can Do to Treat Bed Bug Bites Severe allergic reactions to bed bug bites may require emergency medical treatment. See a doctor when bed bug bites are followed by:

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Shortness of breath, Wheezing, Chest pain, Tightness in the chest or throat, Swollen tongue, Swollen lips, Dizziness, Fainting, Itching all over the body, Spreading of redness around the bed bug bite, or Fever

When the main problem is itching, however, a gentle antiphlogistic cream such as Simicort or a mild antihistamine such as diphenhydramine (Benadryl) may do the trick. The discomfort of bed bug bites is relieved by the application of a warm moist cloth—but take care not to scratch. Scratching spreads infection and leads to more and more itch. What You Can Do to Prevent Bed Bug Bites As bed bug experts tell us, there is a lot you can do to prevent bed bug bites both at home and on holiday. Here are the key pointers. •

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When you check into a motel or hotel, check the mattress for build up of brown matter on the edges of the mattress. This may be bed bug feces. Look for reddish-brown smears from “smashed” bed bugs. If you see signs of an infestation, let management know and ask for a different room. Keep your suitcases closed when they are not in use, so bed bugs won't hitch a ride home with you. Take care to inspect any mattresses, box springs, sofa cushions, pillows, and bed linens you bring into your home. Check you own bed for bed bugs with a flash light just before dawn, when they are returning to their daytime resting places. Wear pajamas to cover as much skin as possible to prevent bed bug bites. Reduce clutter in the bedroom to eliminate hiding places for the bugs. Wash infested bed linens or clothing in hot water (at least 110-120 degrees F/45-50 degrees C), followed by at least 10 to 20 minutes in the dryer on medium to high heat. Vacuum mattresses and box springs to remove invisible bed bug infestations. Don't forget to dispose of the vacuum cleaner bag immediately after vacuuming. Avoid heat treatments for killing bed bugs. These typically just send the bugs into cooler locations only to reemerge when the heat is turned off. Encase your mattress and box springs in a special impermeable mattress cover. Discard infested mattresses if necessary.

Or try bed bug trapping. Bed bugs are attracted to warmth, humidity, and carbon dioxide (CO2). Commercial traps using small CO2 generators are extremely effective at controlling bed bug infestations.

A Frequently Overlooked Reason for Controlling Bed Bugs Getting rid of bed bugs for good, obviously, takes some real effort. It's easy to just to shrug your shoulders and decide the problem really isn't that bad. But there's a good reason for exterminating bed bugs that doesn't readily meet the eye. Bed bugs don't just feed on people. They also feed on mice and rats. This means that any bed bug that bites you could have bitten a rodent first, and every disease carried by the rodent is also carried by the bed bug. Bed bug extermination and rodent control go hand in hand. It doesn't do a lot of good to do one without doing the other. The best methods of trapping mice and rats will indirectly help with your bed bug problem, and exterminating bed bugs will greatly reduce the risk of contracting mouse- and rat-borne ailments.

Bed Bugs and Disease