Letters

Is infestation with the common bedbug increasing?

EDITORIn recent decades the common bedbug, Cimex lectularius, has been so scarce in the United Kingdom that new finds have been considered worthy of publication.¹ In 1998 specimens from only one infestation were submitted to Brighton Public Health Laboratory Service for identification, none having been submitted during the previous three years. From February to October 1999 specimens from four separate infestations were referred to the service; this suggests that bedbugs are becoming more common.

Interestingly, in all four examples there was circumstantial evidence to suggest the transfer of bugs in luggage or furnishings. One infestation occurred in a hospital residence, where two healthcare workers who occupied a room serially were bitten. Many healthcare workers who used the room arrived with luggage from overseas for short term work. Other infestations concerned a patient who was bitten after sleeping on a bed imported from the United States and patients bitten after arriving with luggage from Australia. A fourth infestation concerned a healthcare worker whose home became infested despite no recent history of travel, acquisition of furniture or furnishings, or report of infestation in neighbouring dwellings. The infestation was successfully treated with insecticides. Three months later the patient's parents, resident at a different location, were bitten, which suggests that bugs transferred with personal effects had taken three months to become apparent. Bedbugs can live for six months without feeding.²

(Credit: DAVID SCHARF/SCIENCE PHOTO LIBRARY) View larger version (74K): [in this window] [in a new window]   Coming soon to a bed near you?

Many doctors are unfamiliar with bedbugs (figure) and their bites. The bugs feed on sleeping patients and hide during the day. They are apparent only if a special search is made at night. Superficially they resemble lentils, being round and flat. Awareness of the possibility of infestation is important because otherwise patients may be misdiagnosed as having scabies or other skin conditions or may be dismissed as being parasitophobic.

As data on infestations are not systematically collected it is not possible to relate the increase in cases reported here to an overall trend, but it does raise the possibility of a real increase, which may be associated with international trade and travel. For patients presenting with nocturnally acquired bites or itchy rashes without obvious cause, bedbugs should be considered as a possible explanation and a search recommended. Infestation is managed by applying insecticides to their hiding places.

John Paul, consultant microbiologist. 
Brighton Public Health Laboratory, Royal Sussex County Hospital, Brighton BN2 5BE tetrix{at}pavilion.co.uk

Janice Bates, consultant microbiologist. 
Worthing Hospital, Worthing, West Sussex BN11 2DH