Abstract
Bed bugs are common urban pests. Unlike many other blood-feeding human ectoparasites, bed bugs are not known to be vectors of human infectious diseases, but clinical and epidemiological studies to directly interrogate this link have been limited. Here, we aimed to determine whether bed bugs were associated with infectious diseases in a set of infested patients presenting to emergency departments (ED) in the greater Cleveland, OH area. We performed a retrospective case-control study involving 332 ED patients with bed bugs and 4,952 control patients, seen from February 1, 2011, through February 1, 2017. Cases and controls were matched by age, sex, and the presenting ED. Additionally, data were adjusted for ≥20 sociodemographic variables, triage data, and comorbidities in multivariable regression analyses. Seventeen laboratory values, ten different ED and inpatient diagnoses, chest radiographs, infectious disease consults, and blood cultures were examined. The odds of bed bug infestation were significantly higher for patients that had positive blood cultures, had blood cultures growing coagulase-negative Staphylococcus, were diagnosed with pneumonia, were diagnosed with cellulitis, received an infectious disease consult, received a chest radiograph, and had higher percentages of eosinophils in the blood (P < .05 for all). Additional investigations are needed to determine whether bed bugs directly contribute to disease by transmitting causative agents, whether bed bug exposure contributes secondarily contributes to infections, or whether these associations are better explained by other environmental and social determinants of health.
Highlights
The common bed bug, Cimex lectularius L., is an obligate bloodfeeding ectoparasite that preferentially feeds on humans [1]
There is no International Classification of Diseases code specific for bed bugs
Potential bed bug cases were identified by searching patient records for the keywords “bedbug,” “bed bug,” “Cimex,” or “lectularius.” A study investigator reviewed the clinical encounters and identified 332 patients with bed bugs based on previously described criteria [23, 24, 25]
Summary
The common bed bug, Cimex lectularius L., is an obligate bloodfeeding ectoparasite that preferentially feeds on humans [1]. These insects have a cosmopolitan distribution, and infestations increasingly affect individuals of all socioeconomic backgrounds across urban environments [2, 3]. The ability of bed bugs to directly transmit human pathogenic microbes has been the subject of contentious debate, but the insects have not been shown to be vectors of infectious agents despite a lack of welldesigned clinical investigations [7, 8, 9, 10, 11, 12]. The transmission of infectious agents from bed bugs to humans has never been demonstrated
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