Bed bugs are tiny, flat, wingless insects that range in color from nearly white to deep brown/reddish. The parasitic pests get their name from their hiding spot of choice – they prefer burrowing into bed frames and mattresses during the day, then become active at night when they feed on people and pets. Bed bugs are resilient pests that can hitch a ride on luggage, furniture, storage boxes, backpacks and clothing (but rarely humans), very quickly causing an infestation.
Look for bedbug bites. You most likely know a bedbug infestation by a rash that resembles a mosquito bite. Most often these come at night but in an serious infestation they can occur during the day. A bedbug bite unlike a mosquito bite swells and spreads out. Also, the bites can come in lines and also burn unlike a mosquito bite. A mosquito bite stays round and neat looking.[2]
Bed bugs occur around the world.[36] Before the 1950s about 30% of houses in the United States had bedbugs.[2] Rates of infestations in developed countries, while decreasing from the 1930s to the 1980s, have increased dramatically since the 1980s.[3][4][36] Before the 1980s they were common in the developing world but rare in the developed world.[4] The increase in the developed world may have been caused by increased international travel, resistance to insecticides, and the use of new pest-control methods that do not affect bed bugs.[37]
Waking up with bites might be the first indicator that you have a bed bug problem. Their bites are often arranged in lines or clusters on the face, neck, arms or hands. Where there are bed bugs in large numbers, you might smell a sweet, musty odor (from the bugs’ scent glands) or see rust-colored spots on your bedding or mattress caused by bed bug blood or excrement. If you look closely, you might see adult bed bugs themselves, usually in mattress folds or seams or on the wall behind the headboard. Bed bugs prefer to stay close to their food source and are typically found hiding out within 1 to 5 ft of infested beds or furniture.

The size of bed bug bites varies with a number of different factors. Bed bugs inject an anti-coagulant along with their saliva when they pierce the skin to take a blood meal. This anti-coagulant is mostly responsible for how a person reacts to the bite and determines the size of the bug’s bite. Since people will have various sensitivities to the bed bug’s bite, the size of the bite will vary, as well. Another factor that influences the size of a bed bug reaction is the number of times a person is bitten. Bite reactions of people bitten many times are also variable, and their response may be either more or less intense as the number of bites increases.
One method of applying freezing temperatures to bed bugs entails the use of carbon dioxide (CO2) applied as “snow” with a portable application device, i.e., Cryonite™. When applied directly onto bed bugs, the frozen CO2 will kill them. However, this method is similar to using contact pesticides, that is, there is no residual activity. It can kill only as many bed bugs as the applicator can find. The advantage of using this type of freezing device is that bed bugs may be killed quickly and without the use of more hazardous pesticides. Again, this is not a stand-alone treatment, and it is recommended that it be used as a supplemental to the application of residual pesticides and/or other means of control.
Bedbugs lurk in cracks and crevices and they've been living on human blood for centuries. Though they aren't known to transmit disease or pose any serious medical risk, the stubborn parasites can leave itchy and unsightly bites. However, bedbugs don't always leave marks. The best way to tell if you have a bedbug infestation is to see the live, apple-seed-size critters for yourself. Unfortunately, once bedbugs take up residence in homes and businesses, they can be difficult to exterminate without professional help.
To prevent bringing bed bugs to one's own home, travelers are advised to take precautions after visiting an infested site: generally, these include checking shoes on leaving the site, changing clothes in a garage before returning to their home, and putting the used clothes in a clothes dryer outside the house. When visiting a new lodging, it is advised to check the bed before taking suitcases into the sleeping area and putting the suitcase on a raised stand to make bedbugs less able to crawl in. "An extreme measure would be putting the suitcase in the tub." Clothes should be hung up or left in the suitcase, and never left on the floor.[29] The founder of a company dedicated to bedbug extermination said that 5% of hotel rooms he books into were infested. He advised people never to sit down on public transport; check office chairs, plane seats and hotel mattresses, and monitor and vacuum home beds once a month.[30]
It is hard to tell if you’ve been bitten by a bed bug unless you find bed bugs or signs of infestation. When bed bugs bite, they inject an anesthetic and an anticoagulant that prevents a person from realizing they are being bitten. Most people do not realize they have been bitten until bite marks appear anywhere from one to several days after the initial bite. The bite marks are similar to that of a mosquito or a flea — a slightly swollen and red area that may itch and be irritating. The bite marks may be random or appear in a straight line. Other symptoms of bed bug bites include insomnia, anxiety, and skin problems that arise from profuse scratching of the bites. 

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Bedbug bites may go unnoticed or be mistaken for flea or mosquito bites or other types of rash or skin conditions, since the signs of bedbug bites are difficult to distinguish from other bites or skin conditions. Bedbugs also have glands whose secretions may leave musty odors, and they also may leave dark fecal spots on bed sheets and around places where they hide (in crevices or protected areas around the bed or anywhere in the room).
After treating a mattress or box spring for bed bugs, we recommend encasing each in a bed bug proof cover. This will prevent re-infestation and will make future inspections and treatments easier. Be sure any product that has been sprayed or applied to your mattress is dry before you cover the mattress with a bed bug proof cover. You can make the bed with your freshly laundered linens over a bed bug proof mattress cover.
Once the mattress and box spring are dry, encase them in sealed bed bug encasements. Encasements are crucial, as they prevent bed bugs from entering or escaping the mattress and box spring, cutting off key hiding places. Remember to leave the encasements on for at least 18 months to ensure that any bed bugs already inside have starved to death. Once the encasements have been applied, you can put your mattress and box springs back on your treated bed frame, and put your laundered bedding back on your bed.
Turns out, C. lectularius is also forming a resistance to other insecticides, according to a study published online April 10, 2017, in the Journal of Economic Entomology. The researchers, from Purdue University, found that three out of 10 bedbug populations collected in the field showed much less susceptibility to chlorfenapyr, and five of the 10 populations showed reduced susceptibility to bifenthrin, according to a post on Entomology Today. The scientists defined "reduced susceptibility" as a population in which more than 25 percent of the begbugs survived after seven days of exposure to the particular insecticide.
Reactions to bed bug bites vary among individuals. Many persons show no signs of bites. Others don’t realize they’ve been bitten until redness and swelling appear around the bite, sometimes with intense itching. Some exhibit inflamed swollen spots that may occur in linear series or have a rash-like appearance. Such bite marks, when they appear, may not show for several days after the person is bitten.
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