Bed Bug Infestations

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Of all the creepy-crawlies that cause trouble in a household, few are worse than bed bugs. Although poor standards of living and unsanitary conditions have been associated with bed bug infestations, even the cleanest home in the most developed country can harbor these parasites.

Bed bugs were once so common that every house in many urban areas was thought to harbor them in the early 20th century; they declined with the advent of modern pesticides like DDT, but a resurgence of these creatures has been noted in North America, Europe, and even Australia over the last decade or so. Cities such as New York and London have seen 5 times as many cases reported over the last few years. This may have to do with the restriction of DDT-like pesticides or perhaps the general over-use of pesticides leading to resistance.

 Although the Environmental Protection Agency considers bedbugs a true public health hazard, you’ll be glad to know that they don’t transmit diseases like, for example, mosquitoes do with malaria. This is in contrast to body lice and fleas, which has been associated with outbreaks of Typhus, Relapsing fever, and even Plague.

They do, however, cause issues with allergic reactions, which can be severe and even lead to anaphylactic shock in rare cases. Skin infections from scratching can occur, such as impetigo or lymphangitis.  In addition, there’s a mental cost to having bed bugs: many report anxiety and issues with insomnia, leading to a decline in overall health.


The common bed bug (Cimex Lectularius) is a small wingless insect that is thought to have originated in caves where both bats and humans made their homes. Ancient Greeks, such as Aristotle, mentioned them in their writings. They were such a serious issue during WWII that Zyklon, a Hydrogen Cyanide gas infamously used in Nazi concentration camps, was implemented to get rid of infestations.

There are a number of species which are found in differing climates. Unlike lice, bed bugs are not always picky about the species they bite. Cimex hemipterus, a bed bug found in tropical regions, also infests poultry and bats.

Adult bed bugs are light to medium brown and have oval, flat bodies about 4mm long (slightly more after eating). Juveniles are called “nymphs” and are lighter in color, almost translucent. There are several nymph stages before adulthood; to progress to adulthood, a meal of blood is necessary.

How did your home get bed bugs? Bed bugs arrive in various ways, such as:

  • brought in from other infested buildings on a visitor’s clothing or luggage.
  • Infested items such a furniture brought into a home.
  • Through ductwork or other passageways.
  • Transferred from bus or airline seating.

You might have a tendency to blame Fido for the problem, but as bedbugs don’t live on animals, pets aren’t considered to spread infestations. Your pet is just as eligible as you are for bites, however.


Strangely, bed bugs don’t like to live in your clothes, like body lice, or on your skin or hair, like fleas. They apparently don’t care much for heat and prefer to spend more time in your backpack or luggage than your underarm.

That means you have to do a thorough search to find their nests. To achieve this goal, a magnifying glass will help. Look at every seam in your mattress, linens, backpacks, and furniture. Bed bugs will also hide in joints in the wooden parts of headboards and baseboards. You will usually find bed bug “families” of various ages, along with brown fecal markings and, perhaps, even small amounts of dried blood.


Bed bugs, which are mostly (but not exclusively) active at night, bite the exposed skin of sleeping humans to feed on their blood, then retreat to hiding places in seams of mattresses, linens, and furniture. Bites are usually painless, but later on, itchy raised welts on the skin may develop. The severity of the response varies from person to person.

Many confuse the bites of bed bugs with mosquitos or fleas. Most flea bites will appear around the ankles, while bed bugs will bite any area of skin exposed to them during the night. Flea bites often have a characteristic central red spot.

Bed bug bites may resemble mosquito bites; bed bugs, however, tend to bite multiple times in a straight line. This has been referred as the classic “breakfast, lunch, and dinner” pattern. Having said this, the EPA tells us that just the appearance of bites is a poor indicator of a bed bug infestation. Many times, they are confused with rashes like eczema or fungal infections. Some victims don’t seem to have a skin reaction at all.


As bed bugs don’t transmit disease (as far as we know), the main strategy should be directed to alleviating the symptoms. The most common treatment is hydrocortisone cream to treat rashes and inflammation, plus the use of diphenhydramine (Benadryl) for allergic symptoms and itching. The cure, however, is to eradicate the bed bug from your retreat; that’s much harder to do.


Once bed bugs are identified, most will immediately want to treat with chemicals. Pesticides in the pyrethroid family and Malathion have been found to be effective. Propoxur, an insecticide, is highly toxic to bed bugs as well, but is not approved for indoor use in the U.S. due to health risks. If you use chemicals, be sure you cover all areas on the bed, including the frame and slats. Expect several treatments to be required to eliminate the infestation; repeat at least once 10 days after the initial treatment.

You might, quite understandably, be concerned about the effects of pesticides in your home. Some suggest using natural predators, but I find this highly impractical.  The bed bug predator list includes ants, spiders, roaches, and mites; you don’t want any of these as houseguests.

One reasonable option for mattresses that avoids the use of chemicals is the use of bedding covers, a strategy known as “encasing”. Special sheets or padding are used to cover your mattress. This traps bed bugs inside until they starve. If a bed bug can’t reach you to get a meal of blood, it will eventually die.

If you’re home, make sure to place all bedding (and clothes) in a hot dryer for, say, an hour. Usually, washing alone will not kill bed bugs although hot, soapy water over 125 degrees Fahrenheit might work. This strategy, by the way, includes your backpack when you return from a trip.

Extreme cold is also considered an effective treatment. If you live far enough North, 4 or 5 days of bedding exposure to temperatures approaching 0 degrees Fahrenheit should kill them.

 If you have access to a working vacuum, use it on flooring and upholstery. A stiff brush is helpful to scrub mattress seams before vacuuming.


In the past, everything from black pepper to turpentine has been used to eradicate bed bug infestations. Natural remedies used today include dusting seams with diatomaceous earth; as the insects travel over a generous powdering, it tears up their abdomen and over two weeks or so, they die. The reason for the delay is probably that diatomaceous earth doesn’t kill the eggs.  It should be noted that only food-grade diatomaceous earth should be used for this purpose and that those with lung issues like Chronic Obstructive Pulmonary Disease (COPD) should consider other types of treatment.

Many people swear by tea tree oil and rubbing alcohol as well. Here’s a time-honored herbal bedbug treatment:

• 1 Cup Water

• Lavender essential oil (10 drops)

• Rosemary essential oil (10 drops)

• Eucalyptus essential oil (10 drops)

• Clove bud essential oil (optional)

• Place in a fine mist spray bottle

• Shake well before using.

As bed bugs can live for months without a meal, it’s important to maintain long-term diligence in identifying these pests wherever you hang your hat. These bugs may not end your life, but they can certainly make it miserable.

Joe Alton MD

Joe Alton MD

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