Download Bedbugs in the 21st Century

Overview
Bedbugs in the 21st Century: The Reemergence
of an Old Foe
Katelyn Williams, BS,1 Monte S. Willis, MD, PhD2*
ABSTRACT
Bedbugs are small parasites that feed exclusively on blood from
vertebrates, including humans. Attention to these parasites largely
disappeared until the past decade, when their incidence grew sharply
due to increased international travel, use of less-effective insecticides,
and growing insecticide resistance among bedbugs. Bedbugs can
be found virtually anywhere, including homes, offices, hotels, and
hospitals. They are a severe nuisance and have a real psychological
and financial impact on those infested; however, their medical
importance is limited. Although more than 40 infectious diseases
Insects of the Cimicidae family, more generally
known as bedbugs, are small parasites that feed
exclusively on blood from vertebrates.1 Attention
to these parasites largely disappeared until the past
decade, not only in the scientific literature but also in
the news media.2 Although more than 40 infectious
diseases have been suspected of being transmitted
by bedbugs, this transmission has not been proven,
to our knowledge. However, bedbugs can cause
great psychological stress because of their incorrect association with poor hygiene and poverty. In
this review, we discuss the biological characteristics
of Cimex lectularius and C. hemipterus, reasons for
their increasing prevalence during the past two decades, the public health risks they pose, and countermeasures available to identify and treat infestations.
The goal of this article is to put the news-media
accounts of bedbugs into the proper context of our
current scientific understanding of this notorious pest.
DOI: 10.1309/LM1TBJG6S7USSKEN
Abbreviations
DDT, dichlorodiphenyltrichloroethane; HBV, hepatitis B virus; HIV,
human immunodeficiency virus; HCV, hepatitis C virus; PCR, polymerase
chain reaction
Department of Biological Sciences, Hampton University, Hampton,
Virginia,
2
McAllister Heart Institute, Department of Pathology and Laboratory
Medicine, University of North Carolina, Chapel Hill, North Carolina
1
*To whom correspondence should be addressed.
E-mail: [email protected]
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may be transmitted by bedbugs, actual transmission of any of those
diseases has not been proven to date. This review presents the
biological characteristics of Cimex lectularius and C. hemipterus, the
public health risks of those parasites, and countermeasures to identify
and treat infestations. The goal is to put news-media accounts of
bedbugs into the proper context of our current scientific understanding
of their characteristics.
Keywords: clinical pathology, microbiology, virology, AP infectious
disease
Background and Appearance
Bedbugs are “true bugs” of the order Hemiptera.
Insects in this order mostly have wings that are half
sclerotic and half membranous (“kissing bugs” of
the same order transmit Trypanosoma cruzi [Chagas
disease]). Bedbugs are part of the family Cimicidae
and are commonly referred to as cimicids. Cimicids
can infest not only human households but also the
environment of birds (including chickens), bats, and
certain domestic animals.3 Cimicids are parasites
unique among obligate blood feeders because they
do not remain on the host to complete their life
cycle. After feeding, they move to local areas and
hide in places where their host is resting, such as
a bed or a couch.
The two species of bedbugs that most commonly
affect humans are C. lectularius and C. hemipterus.
Their identification is possible only by specialists;
both sexes are hematophagous and can live for 12
months without feeding (as long as 1.5-2.0 years in
colder environments).4 C. lectularius is found in temperate climates including parts of the United States,
whereas C. hemipterus is found mainly in tropical
climates. However, both can be found in every type
of climate due to their easy portability by travelers.
Differentiating these species is not simple; further,
more than one species may be found in an infestation. C. lectularius ranges in size from 5 to 7 mm;
although C. hemipterus is longer, these species can
interbreed5 and their sizes may overlap. Before feeding,
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Overview
Image 1
Adult bedbug feeding on a human
host. Their flat, oval-shaped bodies
are reddish brown until they feed,
at which point they become reddish and round. Courtesy of http://
www.wikimediacommons.org.
bedbugs have flat, reddish brown, oval-shaped bodies; their size is comparable to that of a dog tick. After
feeding, the bedbug’s flat body becomes elongated
and appears more reddish than brownish (Image 1).
Juvenile bedbugs (eg, nymphs) can be as small as 1.5
mm and are yellow to translucent in color before feeding; immediately after feeding, they are bright red.
Life Cycle
Infestations of bedbugs occur throughout the world.
They have long been associated with economically
poorer regions; however, they are frequently found in
areas to which people travel or in places frequented
by many individuals (eg, hotel rooms).6 Institutional
facilities and multi-dwelling homes are susceptible
because bedbugs may move from one local area to
another, affecting many people. Bedbugs do not inhabit the visible surfaces of beds, couches, or chairs.
Rather, they move to crevices and cracks, such as the
seams of chairs, mattresses, in wallpaper, between
couch cushions, and into the folds of curtains. They
come out of their hiding places every 5 to 10 days to
feed.7 In developing countries, they are commonly
found not only in the crevices of mud houses but also
in thatched roofs. Infestations are common in refugee
camps; for example, 98% of rooms investigated in a
refugee camp in Sierra Leone had bedbugs, with 86%
of the residents having evidence of bedbug bites.8
Bedbugs can sense and locate warmth and carbon
dioxide production, 9,3,10 allowing them to easily
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Lab Medicine Summer 2012 | Volume 43, Number 5
migrate toward humans.7 They walk at approximately the same rate as ladybugs. Their appearance
within a home owes solely to human dispersal.
Humans constantly move throughout their homes;
therefore, bedbugs can also be found inside personal items, and suitcases.11 Bedbugs feed for approximately 5 minutes per night. Bite marks are
typically found on the neck, face, hands, and arms
of the host, depending on what parts are exposed
during his or her resting period. Bite marks can be
found on various parts of the body because some
individuals may toss and turn in their sleep, which,
in turn, exposes more skin the bedbugs can bite.
Most people do not feel the bite marks until several
days later; in some cases, an urticarial reaction to
the bite can occur.7 When bedbugs feed, they deliver anticoagulant factors, vasodilatory compounds
(including the nitric oxide-carrying protein nitrophorin)12 and proteolytic enzymes via their saliva,
promoting local hypersensitivity (ie, urticarial) reactions.3 Bedbugs use 2 separate elongated stylets
during feeding: one withdraws the blood without
clotting and the other injects the saliva that makes
their feeding pain-free to the host.13
Male bedbugs direct their sexual activity toward females that have recently fed; each female undergoes
approximately 5 traumatic inseminations after each
feeding.1 Sperm is deposited by the male’s intromittent organ, bypassing the female genital tract,
piercing the cuticle.4 Sperm is injected into the mesospermagele, a female organ that directs the migration of sperm. Female mortality is common during
copulation; however, on average, each fertilized adult
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Overview
Life Cycle:
The Bedbug Life Cycle
1 Egg
5 Nymph stages (N1-N2-N3-N4-N5)
1 Adult (male or female)
Haematophagy for each nymph stages (N1-N5) and male and female adults
Adult male
Time of a blood meal
Time between two blood meals
Adult female
Traumatic
insemination
Adult life span
Duartion of life cycle (egg to egg):
Egg
Mating frequency
After mating, females stop laying fertilized eggs after
Males impose a mating rate on females
N1
N5
N2
N4
N3
Time to egg laying after mating
Female egg laying rate, always in excess
Hatching time
Time between two nymph stages (blood meal obligatory)
Lifetime total number eggs laid by a female
30-45 days after contamination by a few bedbugs, their number is exponentially multiplied
Figure 1
The life cycle of C. lectularius or C. hemipterus. The life cycle of cimicids includes the egg stage, 5 nymph stages (N1, N2, N3, N4,
and N5), and the adult stage. From Delaunay P et al., 2011.4 Used with permission ©2011.
female yields 200 to 500 eggs in her lifetime. Eggs
hatch in 4 to 10 days on average, leading to nymphs
1 to 3 mm long. There are 5 nymph stages (Figure
1), each requiring a blood meal lasting 10 to 20 minutes. These stages are passed every 3 to 7 days until
adulthood is reached; this explains how a previously
noninfested home may, in a single month, undergo
an exponential multiplication of bedbugs. Bedbugs
are generally active in the dark and emit a strong, distinct odor resulting from the oils (containing 4-oxoaldehydes, among other chemicals) secreted by their
dorsal abdominal glands.14
Clinical Manifestations
When a cimicid feeds with its proboscis, it pierces
the skin (this behavior is often incorrectly called
biting), which may cause skin reactions in individuals responding to cimicid saliva. 3 Because
the urticarial reaction is allergic in nature, not all
individuals experience it; some individuals do not
respond at all. Often, reactions to a bite are minor:
the typical skin lesion is a pruritic, erythematous,
firm papule (ie, an itchy, red, edematous reaction)
5 to 20 mm in diameter with a central vesicle or
hemorrhagic crust at the point where the proboscis had entered.4 These skin reactions may
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be mistaken for spider bites or mosquito bites,
particularly in developed countries in which bedbugs are not common. Many victims of bedbug
bites are misdiagnosed by their doctors with hives
or scabies.15 Bedbug bites can be identified by
their distribution to the uncovered areas of the
skin, sometimes appearing in a row (whimsically
referred to as “breakfast, lunch, and dinner”).16
Situational cues that support the correct diagnosis
include the patient awakening with new lesions
and the presence of bedbug fecal smears or blood
flecks on bed linen and on the patient’s skin. These
clues may prompt an inspection of crevices, the
mattress lining, and the box springs to reveal any
additional bedbugs. Finally, the pungent odor of
the oils released by bedbugs may be identified
locally or throughout the residence.
The microscopic anatomy of a bedbug bite resembles those of various insect and arthropod hypersensitivity reactions. It involves a perivascular
infiltrate within the upper dermis that includes histiocytes, mast cells, eosinophils, and lymphocytes.17
Mast cells release histamine and other substances
during an allergic reaction: histamine causes the
itchy sensation humans feel after being bitten by
a bedbug or a mosquito. Every individual bitten by
a bedbug does not have an allergic reaction to the
saliva of the bug; however, when a reaction occurs,
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Overview
further treatment is needed. For those that have an
allergic reaction, itchy, red wheals appear and can
become infected through scratching. In most cases,
bites will heal after 1 week. If the reaction to the bite
is deemed to be severe, antihistamines or a corticosteroid (eg, hydrocortisone) is given to suppress
itching; an antibiotic is prescribed only if a secondary infection develops due to excessive scratching.16
Antihistamines are highly effective for reducing itching; however, there is a risk that they will reduce the
patient’s ability to detect an ongoing infection.
Prevention of Further Bites
To prevent bedbugs from taking further blood
meals, patients can cover exposed skin, which will
prevent bites. Nighttime sleepwear covering as
much skin as possible can block the relatively weak
skin-piercing apparatus of the bedbug, which cannot penetrate even the thinnest layers of fabric or
paper.17 Tape or other tightly woven material placed
over crevices known to harbor bedbugs can effectively prevent their mobility.17 Bedbugs are not able
to move on surfaces with low-friction covering, so
covering bedposts with petroleum jelly or paraffin
oil has been suggested.18,19
Treating Infestations
Infestations can be identified by small specks of
bedbug remnants, including their feces and blood
from their hosts and cast skins left behind on bed
linens when the bedbugs molt. 20 However, bedbugs
are often difficult to locate. Trained detector dogs
have been used to identify them based on smell.
The services of these dogs are available commercially; the dogs’ detection abilities have a remarkable 97.5% positive indication rate and 0% false
positives). 21 Once bedbugs are identified, patients
should launder all their bed linens and vacuum
their furniture to reduce the number of bedbugs
within the household. 22 Professional exterminators
should be consulted, as should management personnel in shared housing, with the understanding
that the entire dwelling (and adjacent structures),
not just the bed, must be treated. Chemical and
nonchemical approaches can then be implemented
to rid the area of these insects. The chemical approach
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is a challenge because bedbugs are increasingly
resistant to pesticides in current use 4 and there
are no effective repellents for these insects, to our
knowledge.
Dichlorodiphenyltrichloroethane (DDT) was used
against bedbugs in the 1970s as less toxic alternatives used at that time were not as effective in
eliminating those insects. Mosquito repellent and
eucalyptus oils have been suggested; however, their
use against bedbugs has not been effective.11 Fumigants do not penetrate deeply enough into the hiding places of bedbugs; further, their use can harm
humans. Typical bug sprays that kill cockroaches
immediately also kill bedbugs; it is recommended
that these chemicals be sprayed directly on infected
areas for instant results.4 In spite of these measures, bedbug infestations can continue.
Nonchemical solutions such as vacuuming, heat
treatments, freezing, and laundering infested articles23 have yielded the best bedbug-eradication
results. Vacuuming the infected area with a device
that contains a high-efficiency air filter removes
bedbug debris and allergens; however, bedbug
eggs almost always remain because they are affixed tightly onto surfaces by means of a glue-like
substance produced by the mother’s body.17 Heat
treatments are used as alternatives to insecticides
and should be applied by a professional exterminator. With the proper equipment, it is possible to
heat rooms to temperatures lethal to bedbugs: this
insect, at all stages of its growth, dies when exposed to temperatures equal to or exceeding 50°C
(122°F) for at least 90 minutes. Laundering the affected clothing or linens should be performed on
the hottest possible washer and dryer settings and
at the highest possible temperature the particular
fabrics can withstand. This procedure can easily
kill the bedbugs, making it unnecessary to discard
clothing and linens; however, it does not prevent
further infestations. Freezing the affected items is
only effective in cases of limited infestation; items
must be frozen for 4 days.17,23 Heating and freezing
kits are used by professional exterminators; however, many individuals cannot afford the $500 to
$1500 cost to hire such professionals.24 If chemical
or nonchemical methods do not work, furniture,
clothing, and linen from the affected area must be
removed and replaced. For many, this is a last resort due to cost, although it ensures that bedbug
clusters are eliminated from the home.
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Overview
Psychological Effects
Bedbugs cause more than physical harm to their
human victims, who may develop psychological
complications from bedbug infestations. These
infestations can lead to psychosocial stress affecting daily life and can lead to constant worrying,
self-isolation, and management tactics that interrupt daily life.25 Physical marks left by bedbugs can
cause individuals to feel insecure and can lower
their self-esteem, especially when the bites are located on the face or neck. Because exposed bites
are plainly visible, employment performance can
also be affected.25 Some individuals may worry
constantly about bedbugs even when the insects
have been successfully eradicated from the home;
some individuals develop delusions that they feel
bedbugs crawling on their skin.40 Self-isolation is
very common because those with bedbug bites
avoid other people and, in turn, they are avoided
by the members of their community.25 Harboring
a bedbug infestation is seen as a sign of poor hygiene; this stigma is the primary reason for avoidance.25 Also, individuals experience mental trauma
from the expense of bedbug eradication: having to
pay hundreds, even thousands, of dollars to properly eliminate those insects can be difficult to accept.25 As a result, individuals may experience mild
to severe levels of stress, depression, and anxiety,
all of which may require treatment.25,26
Bedbugs as Vectors for
Infectious Disease: An Unproven
(But Warranted) Hypothesis
Bedbugs feeding on human blood are exposed to
all the pathogens found therein. Arthropod-borne
viruses (ie, arboviruses), Lyme disease, and West
Nile virus are the most recent examples of diseases
that are transmitted by insects between individuals
in the United States. However, throughout history,
humankind has been plagued by diseases spread
by insect vectors, such as malaria (Plasmodium
species [spp]), leishmaniasis (Leishmania spp), and
Chagas disease (Trypanosoma cruzi). As a result,
there has been concern that bedbugs can and do
harbor some of the most burdensome infectious
diseases known in the developed world.
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More than 40 pathogens have been suspected of
being transmitted via C. lectularius or C. hemipterus.4 However, no reported cases, to our knowledge, display evidence that any of these infectious
diseases have been passed to humans.25 The evidence that these pathogens found in the Cimex
spp. is incomplete; the causal relationship between
vector and disease has not been proven. To prove
that an insect transmits disease (ie, that it acts as
a vector), it must first be shown that the arthropod
can harbor the disease and pass it to another host.
To date, no evidence has been reported that any of
these 40 or more potential pathogens are passed
to humans by bedbugs. The most studied and/or
strongest candidates for transmission by bedbugs
have recently been reviewed;4 they include Coxiella
burnetii (ie, Q fever), Wolbachia spp. (ie, Anaplasmataceae bacteria-obligate bacterial species), Aspergillus spp. (ie, mold) and bacteria (ie, Staphylococcus
spp. and Enterobacter spp.),4 Trypanosoma cruzi (ie,
Chagas disease), hepatitis B virus (HBV), and human
immunodeficiency virus (HIV). C. burnetii has been
reported to persist in bedbugs for as long as 250
days without loss of pathogenic potential it is excreted in bedbug feces.27,28 The potential to transmit
these pathogens to humans requires further investigation. Wolbachia spp. have been detected in most
C. lectularius; transovarial transmission to future
generations has been established4 but its ability to
spread to humans is unknown. Like most insects,
bedbugs can passively transmit mold, such as the
Aspergillus spp.; also, 9 bacterial and fungal spp.
have been found in the male intromittent organs.1
However, an epidemiologic role in transmission has
not been established. When bedbugs were allowed
to feed on blood from infected patients with high
titers of HBV and hepatitis C virus (HCV), HBV DNA
was found in those bedbugs as long as 6 weeks after
their feedings. However, HCV RNA was not present in the feces of those bedbugs at any time after
feeding, as assayed by polymerase chain reaction
(PCR)29; this suggests that HBV has the potential to
be passed to humans. Although the HBV pathogen
is found in bedbug feces, additional studies must
be performed to demonstrate that the bedbug can
successfully transmit this virus to its host (ie, to
prove its vector competence).11 In a separate study5
conducted in Gambia, spraying insecticide in children’s bedrooms reduced the presence of bedbugs
but it had no effect on HBV infection rates, which
suggests no correlation between bedbugs and HBV
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A B C
Image 2
Locations where bedbugs hide. Being small but visible, bedbugs often hide in furniture (A, B) and luggage (C). From Bedbugs Detroit
Extermination and Pest Control Web page. http://www.bedbugsdetroit.com/bed-bugs-news. Accessed June 28, 2011.
infections in children. Lastly, HIV has not been identified in bedbugs, although experimental feeding
with HIV-tainted blood identified that the virus could
survive for 8 days in bodies of these insects.11 Replication and transmission of HIV to laboratory animals
has not been possible, despite using high titers of
the virus.11 Therefore, HIV is not likely a candidate
pathogen for bedbug transmission. So far, bedbugs
have not been shown to transmit any of the diseases
mentioned in this paragraph to human hosts, despite
evidence for their presence in bedbug feces.
The Return of Bedbugs
to the Developed World
In industrialized countries, bedbug infestation decreased
throughout the end of the 20th century due to improvements in insecticide effectiveness and in household and
personal hygiene.30-33 However, infestations began to
reappear in the late 1990s (ie, approximately 1996)
due to the use of less-effective insecticides and increased international travel.31,33-35
Organophosphates, including DDT, were banned in
the late 1970s and were followed by the introduction
of less-toxic alternatives.36 The limited effectiveness
of these insecticides was due to the fact that they did
not persist to the degree necessary to kill the insects,
especially in the crevices and cracks where bedbugs
were most likely to hide.31 Also, bedbugs have been
reported to be resistant to new insecticides such as
pyrethroids (eg, λ-cyhalothrin and deltamethrin) and
chlorfenapyr.35 In Denmark, for example, bedbugs
have widespread resistance to permethrin and deltamethrin (ie, pyrethroids) and a reduced sensitivity to
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Lab Medicine Summer 2012 | Volume 43, Number 5
chlorpyrifos,2 which limits the arsenal against these
insects. Resistance to pyrethroids may occur due to
mutations in voltage-gated sodium channels, which
have been reported in multiple insect species.37,38
Despite the decline in bedbug infestations in the developed world during most of the latter 20th century,
bedbug prevalence did not decline in less-developed
countries; in fact, bedbug incidence thrived.33 Because bedbugs are particularly adept at hitching
rides on humans via luggage or clothing, increased
travel has brought bedbugs back to the more inviting environment in developed countries in the 21st
century.30-33 It is possible that much of the increase in
bedbug infestation we now observe results from the
reintroduction of those insects into certain environments and is not necessarily a sign of the fitness of
bedbugs over time.
Preventing Future Bedbug
Infestations
With mounting evidence that travel is one of the
primary ways in which humans are exposed to bedbugs, some suggestions to help individuals avoid
being unintended vehicles for these insects are warranted. Bedbugs attach themselves to clothing during travel and can be found in hotel rooms, among
other public areas, allowing them to make their way
back to the homes of their hosts (Image 2). It is suggested that when traveling, individuals should inspect their hotel rooms before unpacking and should
put their luggage in the bathroom because bedbugs
do not frequent that room. An inspection of the mattress and the headboard may help determine the
presence of bedbugs. Also, sheets should be turned
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Overview
down to check for bedbug remnants such as blood
and feces. Closets and dressers should be inspected
thoroughly with a flashlight before storing any clothing within. Luggage should never be placed on the
floor of the hotel room; instead, travelers should use
the luggage racks provided or use tabletops located
away from the walls. On leaving the hotel room, all
clothing that requires laundering should be placed
in a tightly closed plastic bag, so that any possible
bedbugs are contained within. Once travelers return
home, they should wash their clothing and thoroughly examine their suitcases. If bedbugs are found
on or in suitcases, those items must be scrubbed
with boiling hot water.39 Signs of bedbugs, especially
fecal stains, can be seen in buses, cars, and taxis.
Bags should be kept on one’s lap if possible, avoiding the trunk or storage compartments. Bedbugproof luggage liners and laundry bags may be used
by those who travel frequently; it is always a good
idea to check one’s clothing and skin for bedbugs
and their by-products after exiting a vehicle.
bedbugs are here to stay, and the problems they cause
will likely get worse. However their threats to people’s health is limited to their ability to be a nuisance
not a disease vector. LM
Additional Resources
1. Bedbugs. National Geographic Channel. Available at: www.youtube.
com/watch?v=WfKCcSPCOQo.
2. Centers for Disease Control. Bedbug resource page. Available at:
www.cdc.gov/nceh/ehs/topics/bedbugs.htm.
To read this article online, scan
the QR code.
References
1. Reinhardt K, Siva-Jothy MT. Biology of the bed bugs (Cimicidae).
Annu Rev Entomol. 2007;52:351-374.
QR code generated on http://qrcode.littleidiot.be
Summary
Bedbug infestations of human habitats in the United
States have become increasingly common during
the past decade. The saliva components of these
nocturnal blood feeders produce variable skin reaction responses in humans, in much the same manner as the saliva components of mosquitoes. These
reactions may manifest as erythematous rashes,
urticarial eruptions, or wheals, all accompanied by
pruritus (ie, itching). As many as 45 infectious diseases have been suspected of being transmitted by
bedbugs (many of which had been found living in
those insects for some time); these diseases can be
passed via bedbug feces. However, to date, actual
transmission of any infection has not been proven.
Treatment to counteract bedbug infestation involves
symptomatic therapy and elimination of the infestation, the latter of which can be challenging. Because
bedbugs can be found almost anywhere humans
dwell, including homes, offices, hotels, and hospitals, specific precautions can be taken when traveling to prevent bedbug infestations, including early
identification of such infestations and protection of
clothing and luggage from potential contact with
bedbugs and their by-products. Given increased international travel, the use of inferior pesticides, and the
growing resistance of bedbugs to available pesticides,
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2. Kilpinen O, Jensen KM, Kristensen M. In: Robinson WH, ed.
Proceedings of the Sixth International Conference on Urban Pests.
Budapest, Hungary: OOK Press; 2008:395-399.
3. Huntley AC. Cimex lectularius. What is this insect and how does it
affect man? Dermatol Online J. 1999;5:6.
4. Delaunay P, Blanc V, Del Giudice P, et al. Bedbugs and infectious
diseases. Clin Infect Dis. 2011;52:200-210.
5. Walpole DE, Newberry K. A field study of mating between two
species of bedbug in northern KwaZulu, South Africa. Med Vet
Entomol. 1988;2:293-296.
6. Kells SA. Bed bugs: A systemic pest within society. Am Entomol.
2006;52:107-108.
7. Bryks S. The bed bug dilemma [letter to the editor]. J Environ Health.
2010;73:48.
8. Gbakima AA, Terry BC, Kanja F, et al. High prevalence of bedbugs
Cimex hemipterus and Cimex lectularis in camps for internally
displaced persons in Freetown, Sierra Leone: A pilot humanitarian
investigation. West Afr J Med. 2002;21:268-271.
9. Ter Poorten MC, Prose NS. The return of the common bedbug.
Pediatr Dermatol. 2005;22:183-187.
10.Montes C, Cuadrillero C, Vilella D. Maintenance of a laboratory colony
of Cimex lectularius (Hemiptera: Cimicidae) using an artificial feeding
technique. J Med Entomol. 2002;39:675-679.
11. Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical
consequences of their bites. JAMA. 2009;301:1358-1366.
12. Valenzuela JG, Walker FA, Ribeiro JMC. A salivary nitrophorin (nitricoxide-carrying hemoprotein) in the bedbug Cimex lectularius. J Exp
Biol. 1995;198(Pt 7):1519-1526.
13.Wilson KM. They only come out at night: Bed bugs and their alarming
resurgence. Nursing. 2011;41:54-58.
14. Feldlaufer MF, Domingue MJ, Chauhan KR, et al. 4-Oxo-aldehydes
from the dorsal abdominal glands of the bed bug (Hemiptera:
Cimicidae). J Med Entomol. 2010;47:140-143.
15.Benac N. Bedbug bites becoming bigger battle. CMAJ.
2010;182:1606.
16.Easing bedbug anxiety. What you need to know about the recent
bedbug resurgence. Harv Womens Health Watch. 2011;18:7.
17. Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther.
2009;22:347-352.
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18.Thomas I, Kihiczak GG, Schwartz RA. Bedbug bites: A review. Int J
Dermatol. 2004;43:430-433.
30.Paul J, Bates J. Is infestation with the common bedbug increasing?
BMJ. 2000;320:1141.
19.Crissey JT. Bedbugs: An old problem with a new dimension. Int J
Dermatol. 1981;20:411-414.
31. Anderson AL, Leffler K. Bedbug infestations in the news: A picture
of an emerging public health problem in the United States. J Environ
Health. 2008;70:24-27, 52-23.
20.Cleary CJ, Buchanan D. Diagnosis and management of bedbugs: An
emerging U.S. Infestation. Nurse Pract. 2004;29:46-48.
32.Masetti M, Bruschi F. Bedbug infestations recorded in Central Italy.
Parasitol Int. 2007;56:81-83.
21. Pfiester M, Koehler PG, Pereira RM. Ability of bed bug-detecting
canines to locate live bed bugs and viable bed bug eggs. J Econ
Entomol. 2008;101:1389-1396.
33.Boase C. Bed bugs: Back from the brink. Pestic Outlook.
2001;12:159-162.
22.Leininger-Hogan S. Bedbugs in the intensive care unit. A risk you
cannot afford. Crit Care Nurs Q. 2011;34:150-153.
34.Romero A, Potter MF, Potter DA, et al. Insecticide resistance in the
bed bug: A factor in the pest’s sudden resurgence? J Med Entomol.
2007;44:175-178.
23.Elston DM, Kells S. Bedbugs. UpToDate 2011 Web site. Available at
http://www.uptodate.com/contents/bedbugs. Accessed May 27, 2011.
35.Moore DJ, Miller DM. Laboratory evaluations of insecticide
product efficacy for control of Cimex lectularius. J Econ Entomol.
2006;99:2080-2086.
24.Manuel J. Invasion of the bedbugs. Environ Health Perspect.
2010;118:A429.
25.Doggett SL, Russell R. Bed bugs: What the GP needs to know. Aust
Fam Physician. 2009;38:880-884.
36.Gubler DJ. Vector-borne diseases. Rev Sci Tech. 2009;28:583-588.
26.Jacobs A. Just try to sleep tight: the bedbugs are back. The New
York Times. November 27, 2005:A1.
37. Burton MJ, Mellor IR, Duce IR, et al. Differential resistance of insect
sodium channels with kdr mutations to deltamethrin, permethrin and
DDT. Insect Biochem Mol Biol. 2011;41:723-732.
27. Daiter AB. Experimental infection of arthropods with human Q fever
[in Russian]. Tr Leningr Inst Epidemiol Mikrobiol. 1963;25:92-100.
38.Soderlund DM. Pyrethroids, knockdown resistance and sodium
channels. Pest Manag Sci. 2008;64:610-616.
28.Daiter AB. The bedbug as a possible reservoir of Rickettsia bumetii
(experimental and epidemiological data) [in Russian]. Vopr Virusol.
1960;6:591-598.
39.Chalupka S. Preventing bedbug infestation. AAOHN J. 2010;58:500.
40.Vandam J. Sleep tight, and don’t let...Oh, just forget about it. New
York Times. 2003. Available at: www.nytimes.com/2003/11/02/
nyregion/neighborhood-report-greenpoint-sleep-tight-and-don-t-letoh-just-forget-about-it.html.
29.Silverman AL, Qu LH, Blow J, et al. Assessment of hepatitis B virus
DNA and hepatitis C virus RNA in the common bedbug (Cimex
lectularius L.) and kissing bug (Rodnius prolixus). Am J Gastroenterol.
2001;96:2194-2198.
CELEBRATING OUR DIAMOND ANNIVERSARY
Earn up to 52
CME/CMLE/SAM credits
REGISTER EARLY
AND SAVE
NOVEMBER 2-6, 2012 ◆ BALLY’S LAS VEGAS
Plus, ASC members
save up to 60% more!
cytopathologymeeting.org
American Society of Cytopathology
100 West 10th Street, Suite 605 ■ Wilmington, DE 19801
Phone: (302) 543-6583 ■ Fax: (302) 543-6597
Email: [email protected]
Experience everything this meeting has to offer.
Education. Credits. Perspective. Interaction. Fun.
With a combination of returning favorites and new additions, this will be
the best meeting experience to date — you don’t want to miss it!
New this year…
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Hot Topic: ASC Workload
Recommendations
Half-day Thyroid Ultrasound
Guided FNA
Career Planning and Growth
Cytohistology Workshops
60th Anniversary Celebration
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Plus more events…
Scientific Sessions include…
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Platform and Poster Presentations
State of the Society Address
Papanicolaou Address
Current Issues in Cytology
Guest Lecture
State of the Art Symposium
Innovation & Trends in Medicine
Leopold Koss Lectureship
Diagnostic Cytology Seminar
Gathering for 1st Time Attendees
ASC President’s Welcome
Reception
Lab Medicine Summer 2012 | Volume 43, Number 5
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Strategies in Cytology Education
Lunch with the Presidents
Challenges in Diagnostic
Cytomorphology
Video Microscopy Tutorials
Workshops
Panel Luncheon Seminars
Roundtable Discussions
Presidents’ Rounds
Award Presentations
Scientific and Technical Exhibits
Continuing Medical Education (CME): The American Society
of Cytopathology is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing
medical education for physicians.
AMA Physician’s Recognition Award: The American Society
of Cytopathology designates this educational activity for a
maximum of 52 AMA PRA Category 1 credits.™ Physicians
should only claim credit commensurate with the extent of their
participation in the activity.
Continuing Medical Laboratory Education (CMLE): The ASC
designates these activities for a maximum of 52 Continuing
Medical Laboratory Education (CMLE) credit hours. The CMLE
credit hours meet the continuing education requirements for
the ASCP Board of Registry Certification Maintenance Program.
This program is also approved for continuing education credits
in the State of Florida and the State of California.
American Board of Pathology Maintenance of Certification
(MOC): The 60th Annual Scientific Meeting will have up to
90 courses available to help fulfill the CME requirements
mandated by the American Board of Pathology Maintenance of
Certification (MOC) process.
Self-Assessment Modules (SAMs): The 60th Annual Scientific
Meeting will offer 52 additional sessions (maximum of 36.75
credits) requiring completion of (SAM) to test knowledge. The
two “Challenges in Diagnostic Cytomorphology” sessions,
all Video Microscopy Tutorials, Workshops, Panel Luncheon
Seminars and select Scientific Sessions qualify for SAMs.
12-0691
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