Cimex

Background

Microbiology

• Cimex species (primarily Cimex lectularius and Cimex hemipterus) cause bed bug infestations
• Insect with well-developed eyes and head with a flat, round body, that can become engorged and round after feeding

Epidemiology

• Almost eradicated from developed countries due to widespread use of DDT, but is now reemerging
• Have never been confirmed to carry infection, though some unconfirmed hypotheses that can transmit hepatitis B and E
• Night feeding, feeding for 5 to 10 minutes before leaving to digest
• Can hide essentially anywhere in any dark crevice, even telephones, cracks in walls, drawers, baseboards, etc

Clinical Manifestations

• Bites are typically on exposed areas, such as face, neck, and hands or arms
• May have hemorrhagic puncta
• Sometimes three linear bites ("breakfast, lunch and dinner")

Differential Diagnosis

• Cimex adjunctus (bat bugs): develops in colonies of roosting bats (e.g. in attics or walls of building), and can transiently infest human areas; bug appears similar, but without the bats they cannot reproduce
• Oeciacus vicarius (swallow bugs): swallow nests, with bites usually in late winter or early spring where they transiently move into human habitat and bite humans

Diagnosis

• Diagnosis is made by seeing bedbugs in the environment

Management

• There is no treatment, except to supportively treat the pruritus (topical corticosteroids, crotamiton, or antihistamines)
• Environment needs to be decontaminated, so call an exterminator

Prevention

• Place legs of legs in water or paraffin to prevent bugs from crawling into bed
• Permethrin-impregnated bednet, which must be carefully tucked under the mattress
• Environmental insecticides