Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Pediatr Rev. 2024;20(2):137-149. doi: 10.2174/1573396320666230406084801.
In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations. Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions. Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.
在过去的十年中，臭虫的滋生在全球范围内再次出现，尤其是在发达国家。正确认识和识别臭虫滋生对于指导治疗和根除至关重要。本文旨在使医生熟悉臭虫叮咬，以便他们能够有效诊断、治疗和解答有关臭虫叮咬和滋生的问题。臭虫叮咬通常是无痛的。典型的反应包括瘙痒、红斑性丘疹，成群出现或呈线性或曲线状分布于身体暴露部位。在叮咬痕迹的中心可能会看到一个小红点。如果在连续三个部位出现皮疹，以及上眼睑出现红斑伴水肿，则高度提示为臭虫叮咬。在先前致敏的个体中，可能会出现过度的局部反应，如水疱、荨麻疹性风团、荨麻疹性皮损周围斑块、弥漫性荨麻疹、大疱和结节。臭虫叮咬的反应是自限性的。因此，治疗主要是对症治疗。局部应用普莫卡因和口服抗组胺药可缓解瘙痒。对于明显的皮疹，可以使用局部皮质类固醇来控制炎症和瘙痒，并加速皮损的消退。虫害综合管理是一种根除臭虫的方法，包括监测设备（主动监测包括使用热或二氧化碳引诱剂，被动监测包括使用粘性垫来捕捉）以及明智地使用已知有效的非化学和化学处理方法。非化学干预措施包括保持受影响区域清洁无杂物、吸尘、用热水洗涤床上用品、堵塞墙壁上的洞和裂缝（臭虫可以藏身其中）、妥善处理高度感染的物品以及在床和家具底部放置臭虫诱捕器/拦截器。化学干预包括使用杀虫剂，如合成拟除虫菊酯、硅酸盐、昆虫生长调节剂、氨基甲酸酯、有机磷酸酯、新烟碱类、二乙基间甲苯酰胺、氯虫腈、氟虫腈和植物精油。使用杀虫剂时应谨慎，以防过度暴露和中毒（特别是，如果周围有年幼的孩子）。值得注意的是，存在多种杀虫剂耐药机制，因此，只有了解耐药性当前文献的经过培训的专业人员才能进行化学处理。为了达到最佳效果，应将非化学和化学技术结合使用。臭虫滋生可能会引起不同的皮肤反应、污名化、自尊心差、情绪压力、焦虑、对生活质量产生重大不利影响以及给社会带来巨大的社会经济负担。因此，迅速发现和根除臭虫至关重要。建议咨询专业的灭虫人员，以彻底根除滋生。
