Intended for healthcare professionals

Clinical Review

Bed bug infestation

BMJ 2013; 346 doi: (Published 22 January 2013) Cite this as: BMJ 2013;346:f138

This article has a correction. Please see:

  1. Celine Bernardeschi, dermatologist1,
  2. Laurence Le Cleach, dermatologist1,
  3. Pascal Delaunay, parasitologist-entomologist2,
  4. Olivier Chosidow, professor of dermatology13
  1. 1AP-HP, Groupe Hospitalier Henri-Mondor, Department of Dermatology, Créteil, France
  2. 2Laboratoire de Parasitologie-Mycologie, Hôpital de l’Archet, Centre Hospitalier Universitaire de Nice-Université de Nice-Sophia Antipolis/Inserm U1065, Nice, France
  3. 3UPEC-Université Paris Est-Créteil Val-de-Marne, France
  1. Correspondence to: O Chosidow, Service de Dermatologie, Hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil Cedex, France olivier.chosidow{at}
  • Accepted 3 January 2013

Summary points

  • Bed bug infestation seems to be re-emerging worldwide

  • The diagnosis of bed bug infestation starts with consultation for clinical reactions to bites but symptoms vary greatly

  • Suspect bed bug bites whenever a patient consults for papules positioned in groups of three or four bites forming a “breakfast-lunch-dinner” curve or line

  • Eradication requires patient education and the help of pest eradication professionals to identify pests and perform non-chemical and chemical interventions

Bed bugs are bloodfeeding insects that seem to be resurging in developed countries,1 possibly due to international travel and changes in pest control practices.2 Diagnosis of bed bug infestation relies on clinical manifestations of bites and direct observation of the arthropod, which is rarely recognised by those who are bitten.3 Evidence is lacking on the bed bug’s capacity to transmit disease, management of eradication, and the economic impact of infestations. This summary of the available evidence on the diagnosis and management of bed bug infestation aims to help general practitioners identify the clinical signs of bed bug bites and help patients identify and manage infestations.

Sources and selection criteria

We focused on articles published since October 2008 to update Goddard and colleagues’ systematic review.2 We searched PubMed and Embase databases until July 2012, using the search terms “bedbugs [Mesh] OR bed bugs OR bed bug OR Cimex”. We also manually searched textbooks, newspapers, and websites, mainly those listed by the Centers for Disease Control and Prevention ( Our selection criteria were case reports on more than five patients, and results related to humans in the field of prevention and elimination of bed bugs or clinical manifestations of their bites.

What are bed bugs?

The two main species of bed bugs are Cimex lectularius and Cimex hemipterus, which are found in tropical zones and temperate areas, respectively. They are brown, wingless, flat, 2-5 mm …

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