Experimental Acquisition, Maintenance, and Transmission of Methicillin-Resistant Staphylococcus aureus by the Common Bed Bug, Cimex lectularius.

Here, we fed bed bugs through a membrane contaminated with methicillin-resistant Staphylococcus aureus (MRSA) at a concentration naturally present on human skin. We then determined the amount of viable MRSA present on their surface and internally over a period of 7 days. We also determined whether bed bugs that fed through the contaminated membrane could transmit MRSA to an uncontaminated membrane when taking a second blood meal 7 days later. Bed bugs acquired MRSA both externally on the cuticle surface as well as internally when feeding. MRSA was found to persist for 7 days both externally and internally in some bed bugs. Furthermore, MRSA replicated internally but not externally. Most importantly, bed bugs were able to transmit MRSA to an uncontaminated membrane feeder in 2 of 3 trials. These findings provide the first experimental support for the hypothesis that bed bugs may contribute to the transmission of MRSA in some settings.

Sexual conflict and sexual networks in bed bugs: the fitness cost of traumatic insemination, female avoidance and male mate choice.

Sexual conflict is prevalent among animals and is primarily caused by the fact that the optimal mating rates are often higher in males than in females. While there is a growing appreciation that females can also gain from multiple matings, we still know relatively little about which sex controls the observed mating rates and how close it is to the optimal female mating rates. To address this issue, we tracked female bed bugs (Cimex lectularius) inseminated daily versus weekly and found that weekly inseminated females lived longer and produced over 50% more offspring. In a follow-up experiment employing a social network framework, we placed 24 bed bugs into a semi-naturalistic arena and recorded all sexual interactions. While recently inseminated females did not avoid males more often, they were more frequently rejected by males. Finally, we tracked avoidance behaviour in a single cohort of female bed bugs as they received six successive daily inseminations. Avoidance rates increased and insemination durations decreased with increasing number of prior inseminations. Overall, our results indicate high costs of polyandry. Although females possess some plastic avoidance strategies, the observed rates of insemination fall closer to the male rather than female optimum.

Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities.

Arthropod vectored diseases have been a major impediment to societal advancements globally. Strategies to mitigate transmission of these diseases include preventative care (e.g. vaccination), primary treatment and most notably, the suppression of vectors in both indoor and outdoor spaces. The outcomes of indoor vector control (IVC) strategies, such as long-lasting insecticide-treated nets (LLINs) and indoor residual sprays (IRSs), are heavily influenced by individual and community-level perceptions and acceptance. These perceptions, and therefore product acceptance, are largely influenced by the successful suppression of non-target nuisance pests such as bed bugs and cockroaches. Adoption and consistent use of LLINs and IRS is responsible for immense reductions in the prevalence and incidence of malaria. However, recent observations suggest that failed control of indoor pests, leading to product distrust and abandonment, may threaten vector control programme success and further derail already slowed progress towards malaria elimination. We review the evidence of the relationship between IVC and nuisance pests and discuss the dearth of research on this relationship. We make the case that the ancillary control of indoor nuisance and public health pests needs to be considered in the development and implementation of new technologies for malaria elimination.

Under the radar: Transcriptomic responses of bed bugs to an entomopathogen, environmental bacteria, and a human pathogen.

Bed bugs (Hemiptera: Cimicidae) are widely distributed, obligately blood-feeding insects, but they have never been linked to pathogen transmission in humans. Most other hematophagous insects that frequently bite humans transmit pathogens, and it is unclear why bed bugs do not. One hypothesis is that bed bugs have evolved a highly robust immune system because their mating system, traumatic insemination, exposes females to consistent wounding and bacterial infections. Although this has been proposed, very little is known about the bed bug immune system and how bed bugs respond to microbial challenges introduced by wounding. Similarly, there is little known about how the bed bug immune system responds to human pathogens. Understanding the bed bug immune system could give insight to why bed bugs appear not to transmit disease and under what circumstances they could, while also facilitating biological control efforts involving microbes. To investigate the transcriptomic response of bed bugs to immune challenges, we exposed female bed bugs to three bacterial challenges. 1.) Pseudomonas fluorescens, an entomopathogen known to have harmful effects to bed bugs, 2.) bacteria cultured from a bed bug enclosure (99.9 % Bacillus spp.), likely encountered during traumatic insemination, and 3.) Borrelia duttoni, a human vector-borne pathogen that causes relapsing fever. We compared the transcriptomes of infected bed bugs with uninfected matched controls in a pairwise fashion, focusing on immune-related genes. We found many known antimicrobial effector genes upregulated in response to P. fluorescens and traumatic insemination-associated bacteria, but interestingly, not in response to B. duttoni. In the differentially expressed genes that were shared between experiments, we found significant overlap in the P. fluorescens treatment and the traumatic insemination bacteria treatment, and between the P. fluorescens and B. duttoni treatments, but not between the traumatic insemination bacteria treatment and the B. duttoni treatment. Finally, we identify previously overlooked candidates for future studies of immune function in bed bugs, including a peroxidase-like gene, many putative cuticle-associated genes, a laccase-like gene, and a mucin-like gene. By taking a comprehensive transcriptomic approach, our study is an important step in understanding how bed bugs respond to diverse immune challenges.

Irrigation, migration and infestation: a case study of Chagas disease vectors and bed bugs in El Pedregal, Peru.

BACKGROUND: The city of El Pedregal grew out of a desert, following an agricultural irrigation project in southern Peru. OBJECTIVES: To describe infestation patterns by triatomines and bed bugs and their relationship to migration and urbanization. METHODS: We conducted door-to-door entomological surveys for triatomines and bed bugs. We assessed spatial clustering of infestations and compared the year of construction of infested to un-infested households. To gain a better understanding of the context surrounding triatomine infestations, we conducted in-depth interviews with residents to explore their migration histories, including previous experiences with infestation. FINDINGS: We inspected 5,164 households for Triatoma infestans (known locally as the Chirimacha); 21 (0.41%) were infested. These were extremely spatially clustered (Ripley's K p-value < 0.001 at various spatial scales). Infested houses were older than controls (Wilcoxon rank-sum: W = 33; p = 0.02). We conducted bed bug specific inspections in 34 households; 23 of these were infested. These were spatially dispersed across El Pedregal, and no difference was observed in construction age between bed bug infested houses and control houses (W = 6.5, p = 0.07). MAIN CONCLUSIONS: The establishment of agribusiness companies in a desert area demanded a permanent work force, leading to the emergence of a new city. Migrant farmers, seeking work opportunities or escaping from adverse climatic events, arrived with few resources, and constructed their houses with precarious materials. T. infestans, a Chagas disease vector, was introduced to the city and colonized houses, but its dispersal was constrained by presence of vacant houses. We discuss how changes in the socioeconomic and agricultural landscape can increase vulnerability to vector-borne illnesses.

Bat ectoparasites: chigger mites (Trombiculidae), ticks (Ixodidae and Argasidae), and bugs (Cimicidae) in the Eastern Palaearctic.

Nine species-level taxa of bat ectoparasites, three chigger mites (Trombiculidae), three hard (Ixodidae), and one soft tick (Argasidae) species, as well as two bug (Cimicidae) species from nine bat species hosts were detected in the Eastern Palaearctic. Trombiculid larvae of Leptotrombidium schlugerae, Leptotrombidium album, and Ascoschoengastia latyshevi were first recorded on bats in the temperate zone of eastern Russia. L. schlugerae was more abundant than A. latyshevi in the same study sites in Eastern Siberia, and the main hosts of both chigger species were Plecotus ognevi and Eptesicus nilssonii. Ixodid ticks Dermacentor marginatus, Ixodes simplex, and Ixodes sp. were sampled from bats in Kazakhstan, the Far East, and Eastern Siberia, respectively. Phylogenetic analysis based on Cox1, 16S rDNA, and ITS2 sequences of I. simplex showed that the specimens from the Far East grouped into a clade distributed in the Eastern Palaearctic and India. In turn, the specimen of Ixodes sp. from Eastern Siberia was most closely related to Ixodes soricis and Ixodes angustus with p-distance of 9.8-10.7% (Cox1), suggesting that this tick probably belongs to a new species. Argas vespertilionis larvae were collected from three widespread bat species in Kazakhstan. Two bug species, Cimex pipistrelli and Cimex aff. lectularius, were recorded in the Far East and Eastern Siberia, respectively. Specimens from Transbaikalia were morphologically identified as Cimex lectularius. However, they differed from the latter by 12.5-12.9% of Cox1 sequences, indicating that C. aff. lectularius may be a new species.

Population genetic structure of tropical bed bug (Hemiptera: Cimicidae) populations and their breeding pattern in Iraq.

A study was conducted to investigate the population genetic structure and breeding pattern of 140 tropical bed bugs, Cimex hemipterus (F.) (Hemiptera: Cimicidae), collected from 14 infested sites in major cities in Iraq. The samples were genotyped using a set of 7 polymorphic microsatellite markers. High genetic variety was seen among populations, with an average of 2-9 alleles per locus. The number of alleles across 7 microsatellite loci was between 6 and 18. There was a notable disparity in the alleles per loci when comparing the overall population to those within it. The overall population exhibited an average observed heterozygosity of 0.175 and an average expected heterozygosity of 0.730. Among the population, the average observed heterozygosity was 0.173, while the average expected heterozygosity was 0.673. Analysis of molecular variance (AMOVA) revealed that 93% of the genetic variability was within the populations, and 7% was among them. The genetic differentiation coefficient (FST = 0.045), indicates a low degree of genetic differentiation and a high degree of inbreeding (FIS = 0.761), as indicated by notably significant positive inbreeding coefficients. Admixed individuals were revealed using STRUCTURE and neighbor-joining phylogenetic trees, demonstrating moderate gene flow between populations and a lack of genetic structure in the regional groups. Thus, both active dispersion and human-mediated dispersion possess the potential to influence the low population genetic structure of tropical bed bug C. hemipterus populations in Iraq, which can have implications toward tropical bed bug and management strategies.

Effectiveness of heat treatment in rapid control of bed bugs in environmental conditions resembling their natural habitats.

We evaluated lethal temperatures and times for killing bed bugs in diverse covered and uncovered conditions simulating their natural habitats. A total of 5400 adult bed bugs were collected alive from 17 infested locations in Paris. They were morphologically identified in laboratory as Cimex lectularius. They were then distributed in multiple sets of 30 specimens to examine in covered (tissue, furniture, mattress or blanket) and uncovered (direct exposure) conditions and in diverse step-function temperatures (50, 55 and 60°C) and times (15, 30, 60 and 120 minutes), replicated three times. Effective mortality was observed in 1080 specimens exposed directly to 50°C for 60 minutes. In specimens covered by tissue (1080 specimens), furniture (1080) or mattress (1080), all were dead at 60°C within 60 minutes. The specimens covered by blanket (1080) at the same temperature were dead after 120 minutes. A 60-minutes delay in reaching to lethal temperature within blanket compared to uncovered thermometer was observed.

Historical and Contemporary Control Options Against Bed Bugs, Cimex spp.

Bed bugs (Hemiptera: Cimicidae) are an important group of obligate hematophagous urban insect pests. The global resurgence of bed bugs, involving the common bed bug, Cimex lectularius L., and the tropical bed bug, Cimex hemipterus (F.), over the past two decades is believed to be primarily due to the development of insecticide resistance, along with global travel and poor pest management, which have contributed to their spread. This review examines and synthesizes the literature on bed bug origins and their global spread and the literature on historical and contemporary control options. This includes bed bug prevention, detection and monitoring, nonchemical and chemical control methodologies (and their limitations), and potential future control options. Future research needs are highlighted, especially the factors behind the modern resurgence, the necessity of identifying differences between the two bed bug species relevant to control, and the need to improve insecticide test protocols and management strategies.

Bedbugs: how to diagnose and manage cases of infestations.

Bedbugs are on the rise in urban populations across the world, perhaps reflecting the ban on the use of organophosphates in many countries worldwide. They are flat obligate haematophagous insects, preferring humans, and as a consequence the bedbug bites lack toxins and can often go unnoticed for some time. Bites can, however, cause weals, purpura, petechiae, vesicles, pustules, papular urticaria, localized infection and rarely anaphylaxis. Infestations have to be confirmed by finding the bugs, usually around the bed of the person being bitten. Eradication usually requires a combination of physical (for example high temperature, mattresses protectors, traps, cold) and chemical methods (for example chrysanthemic acid derivatives plus potentiators such as geraniol and piperonyl butoxide or acetylcholine esterase inhibitors).

The common bed bug Cimex lectularius synthesizes hemozoin as an essential defense against the toxic effects of heme.

The common bed bug Cimex lectularius (Linnaeus 1758) is an ectoparasite that feeds preferably on human blood, being considered an important public health issue. Blood-feeding is a challenging process for hematophagous organisms, and one of the inherent risks with this kind of diet is the liberation of high doses of free heme after the digestion of hemoglobin. In order to deal with this potent cytotoxic agent, such organisms have acquired different defense mechanisms. Here, we use UV-visible spectrophotometry and infrared spectroscopy to show that C. lectularius crystalizes free heme to form the much less dangerous compound, hemozoin. According to our results, the peak of formation of hemozoin in the intestinal contents occurred 4-5 days after the blood meal, primarily in the posterior midgut. The quantification of the rate of conversion of heme to hemozoin revealed that at the end of digestion all the heme was in the form of hemozoin. Inhibition of the synthesis of hemozoin using the anti-malarial drug quinine led to an increase in both catalase activity in the intestinal epithelium and the mortality of the bed bugs, indicating that the insects were unable to cope with the oxidative stress generated by the overload of free heme. The data presented here show for the first time how C. lectularius deals with free heme, and how the process of formation of hemozoin is essential for the survival of these insects. Since resistance to insecticides is a common feature among field populations of bed bugs, there is an urgent need to develop alternative control methods. Thus, targeting the synthesis of hemozoin emerges as a possible novel strategy to fight bed bugs.

A metatranscriptomic evaluation of viruses in field-collected bed bugs.

Cimex lectularius, known as the common bed bug, is a widespread hematophagous human ectoparasite and urban pest that is not known to be a vector of any human infectious disease agents. However, few studies in the era of molecular biology have profiled the microorganisms harbored by field populations of bed bugs. The objective of this study was to examine the viruses present in a large sampling of common bed bugs and related bat bugs (Cimex pipistrelle). RNA sequencing was undertaken on an international sampling of > 500 field-collected bugs, and multiple workflows were used to assemble contigs and query these against reference nucleotide databases to identify viral genomes. Shuangao bed bug virus 2, an uncharacterized rhabdovirus previously discovered in Cimex hemipterus from China, was found in several bed bug pools from the USA and Europe, as well as in C. pipistrelle, suggesting that this virus is common among bed bug populations. In addition, Shuangao bed bug virus 1 was detected in a bed bug pool from China, and sequences matching Enterobacteria phage P7 were found in all bed bug pools, indicating the ubiquitous presence of phage-derived elements in the genome of the bed bug or its enterobacterial symbiont. However, viral diversity was low in bed bugs in our study, as no other viral genomes were detected with significant coverage. These results provide evidence against frequent virus infection in bed bugs. Nonetheless, our investigation had several important limitations, and additional studies should be conducted to better understand the prevalence and composition of viruses in bed bugs. Most notably, our study largely focused on insects from urban areas in industrialized nations, thus likely missing infrequent virus infections and those that could occur in rural or tropical environments or developing nations.

A Comparative Study of Body Lice and Bed Bugs Reveals Factors Potentially Involved in Differential Vector Competence for the Relapsing Fever Spirochete Borrelia recurrentis.

Borrelia recurrentis is the causative agent of louse-borne relapsing fever and the only Borrelia species transmitted by an insect rather than a tick vector. While bed bugs (Cimex lectularius L.) are not established vectors of any human pathogens, a recent study reported that they may be competent vectors of B. recurrentis. However, many aspects of infection and transmission remain unclear in this possible secondary vector. Here, we carried out several quantitative laboratory studies to gain a better understanding of the host suitability of bed bugs relative to the established body louse vector as well as the factors that may affect the ability of bed bugs to transmit the pathogen. We fed bed bugs B. recurrentis and estimated the level and duration of infection in the hemolymph using live imaging. We performed quantitative PCR (qPCR) to examine whole-body spirochete levels and the occurrence of vertical transmission to progeny. We also developed an assay to compare the amounts of force required to release infectious hemolymph from recently engorged bed bugs and body lice. Finally, we analyzed humoral antibacterial activity in the hemolymph, hemolymph pH, and hemocyte activity in both insect species. Our results confirm that within 24 h of ingestion, B. recurrentis can penetrate the midgut epithelium of bed bugs and enter the hemolymph, overcoming a major host barrier, as in body lice. Once in the hemolymph, spirochetes remain visible for at least 4 days. Moreover, we show that bed bugs are more physically susceptible to crushing than body lice, suggesting that crushing is a feasible route for the natural dissemination of B. recurrentis from the hemolymph of bed bugs, as for body lice. Nonetheless, our data also indicate that bed bugs are suboptimal hosts for B. recurrentis, as the bacterium does not appear to proliferate to high levels or stably colonize the hemolymph and exhibits pleomorphism in this environment. In particular, our data suggest that hemolymph pH and unique cellular immune responses, rather than humoral effectors, may be involved in limiting spirochete survival in bed bugs. Notably, we document the formation of extracellular DNA traps by bed bug hemocytes for the first time. For these reasons, while bed bugs may be capable of limited transmission given their ecology, vector competence is probably minimal relative to body lice. Additional mechanistic studies of human pathogen infection of bed bugs may provide much-needed insight into the biological factors that restrict their ability to act as vectors and may reveal novel mechanisms of immunity.

Female bed bugs (Cimex lectularius L) anticipate the immunological consequences of traumatic insemination via feeding cues.

Not all encounters with pathogens are stochastic and insects can adjust their immune management in relation to cues associated with the likelihood of infection within a life cycle as well as across generations. In this study we show that female insects (bed bugs) up-regulate immune function in their copulatory organ in anticipation of mating by using feeding cues. Male bed bugs only mate with recently fed females and do so by traumatic insemination (TI). Consequently, there is a tight temporal correlation between female feeding and the likelihood of her being infected via TI. Females that received predictable access to food (and therefore predictable insemination and infection cycles) up-regulated induced immunity (generic antibacterial activity) in anticipation of feeding and mating. Females that received unpredictable (but the same mean periodicity) access to food did not. Females that anticipated mating-associated immune insult received measurable fitness benefits (survival and lifetime reproductive success) despite laying eggs at the same rate as females that were not able to predict these cycles. Given that mating is a time of increased likelihood of infection in many organisms, and is often associated with temporal cues such as courtship and/or feeding, we propose that anticipation of mating-associated infection in females may be more widespread than is currently evidenced.

Dynamics of bed bug infestations and control under disclosure policies.

Bed bugs have reemerged in the United States and worldwide over recent decades, presenting a major challenge to both public health practitioners and housing authorities. A number of municipalities have proposed or initiated policies to stem the bed bug epidemic, but little guidance is available to evaluate them. One contentious policy is disclosure, whereby landlords are obligated to notify potential tenants of current or prior bed bug infestations. Aimed to protect tenants from leasing an infested rental unit, disclosure also creates a kind of quarantine, partially and temporarily removing infested units from the market. Here, we develop a mathematical model for the spread of bed bugs in a generalized rental market, calibrate it to parameters of bed bug dispersion and housing turnover, and use it to evaluate the costs and benefits of disclosure policies to landlords. We find disclosure to be an effective control policy to curb infestation prevalence. Over the short term (within 5 years), disclosure policies result in modest increases in cost to landlords, while over the long term, reductions of infestation prevalence lead, on average, to savings. These results are insensitive to different assumptions regarding the prevalence of infestation, rate of introduction of bed bugs from other municipalities, and the strength of the quarantine effect created by disclosure. Beyond its application to bed bugs, our model offers a framework to evaluate policies to curtail the spread of household pests and is appropriate for systems in which spillover effects result in highly nonlinear cost-benefit relationships.

Geographical patterns and mechanisms of Cimex lectularius Linnaeus, 1758, and Cimex hemipterus Fabricius, 1803 (Hemiptera: Cimicidae) resistance to insecticides: a systematic review and meta-analysis.

This study aimed to review published scientific literature on bed bugs in countries where insecticide resistance has been reported worldwide from 2000 to 2021. Electronic databases, including Scopus, PubMed, and WOS, were searched. Out of 606 articles found in the initial search, we selected 57 articles, of which 40 articles had reported on Cimex lectularius (C. lectularius), and 22 papers had reported on Cimex hemipterus (C. hemipterus). Most studies on insecticide resistance were carried out on C. lectularius in North America (14, 35%) and C. hemipterus in Asia (16, 72.7%). The most common method used to detect bed bug resistance to insecticides was toxicological bioassay with an overall random pooled effect size of 0.38 (95% CI: 0.23-0.53) in C. lectularius and 0.46 (95% CI: 0.27-0.65) in C. hemipterus. Resistance to pyrethroids was reported against C. lectularius with an overall pooled effect size of 0.75 (95% CI: 0.56-0.94) and C. hemipterus with an overall pooled effect size of 0.81 (95% CI: 0.57-0.93) in 33.40 (82.5%) and 19.22 (86.3%) published articles, respectively. A very high resistance level to pyrethroids in both studied species was observed, and resistance ratios at the highest level were 76389.3 and 315.5 in C. lectularius and C. hemipterus, respectively. Resistance mechanisms against pyrethroids were reported from most locations except Iran and Thailand, but these mechanisms were not studied in other insecticide groups. These reports indicate that chemical control options for bed bugs are limited. Therefore, a combination of chemical and non-chemical strategies is recommended for bed bug control.

Pilot study: specific immunotherapy in patients with Papular urticaria by Cimex lectularius.

Summary: Background. Papular urticaria is a chronic allergic reaction induced by insect bites. In México the most common causative arthropods reported are bed bugs, fleas and mosquitoes. Approximately 70% of people who are bitten by Cimex lectularius experience hypersensitive reactions, papular urticaria, extensive erythema, urticaria, and even anaphylaxis has been reported, pruritus is the major complaint, impairing quality of life and sleep. Immunotherapy has been used in mosquito bite papular urticaria resulting in improvement of skin lesions and possibly protecting against reactions to subsequent exposures to mosquitoes. Methods. Children, 4-10 years of age, with recurrent papular urticaria due to bedbugs not responsive to multiple treatments were included. An initial allergy assessment included clinical history, skin prick test (SPT), and specific IgE sensitisation was performed to confirmed bedbug sensitization. Twenty children were randomized to receive subcutaneous specific immunotherapy (SSI) with whole body bed bug extract or conventional treatment. The treatment was carried out over twelve months and the response was assessed using the Dermatology Quality of Life Index (DLQ), the immunotherapy satisfaction questionnaire (ESPIA questionnaire) and the 12-Item Pruritus Severity Scale (12-IPSS). The results from both the treated and control groups were compared. Results. The twenty patients were randomized, 12 to receive immunotherapy and 8 to receive conventional treatment for 12 months. Quality of life improved with a reduction in the DLQI score of 19.83 in the immunotherapy group versus 9 in the conventional treatment group (p = 0.03). Itch improved with a reduction in the 12-IPSS of 16.5 in the immunotherapy group versus 9.63 in the conventional treatment group (p = 0.02). After twelve months of treatment, all 12 patients who received immunotherapy, reported a decrease of persistent cutaneous lesions but the 8 on conventional treatment did not. A mean score of 95.75 (SD 3.3) was recorded for satisfaction with immunotherapy. Conclusions. Patients with papular urticaria by Cimex lectularius receiving allergen immunotherapy for 1 year showed a significant improvement compared with baseline and patients receiving conventional treatment regarding skin lesions, quality of life impairment, intensity of pruritus and satisfaction with immunotherapy.

Characterization of New Defensin Antimicrobial Peptides and Their Expression in Bed Bugs in Response to Bacterial Ingestion and Injection.

Common bed bugs, Cimex lectularius, can carry, but do not transmit, pathogens to the vertebrate hosts on which they feed. Some components of the innate immune system of bed bugs, such as antimicrobial peptides (AMPs), eliminate the pathogens. Here, we determined the molecular characteristics, structural properties, and phylogenetic relatedness of two new defensins (CL-defensin1 (XP_024085718.1), CL-defensin2 (XP_014240919.1)), and two new defensin isoforms (CL-defensin3a (XP_014240918.1), CL-defensin3b (XP_024083729.1)). The complete amino acid sequences of CL-defensin1, CL-defensin2, CL-defensin3a, and CL-defensin3b are strongly conserved, with only minor differences in their signal and pro-peptide regions. We used a combination of comparative transcriptomics and real-time quantitative PCR to evaluate the expression of these defensins in the midguts and the rest of the body of insects that had been injected with bacteria or had ingested blood containing the Gram-positive (Gr+) bacterium Bacillus subtilis and the Gram-negative (Gr-) bacterium Escherichia coli. We demonstrate, for the first time, sex-specific and immunization mode-specific upregulation of bed bug defensins in response to injection or ingestion of Gr+ or Gr- bacteria. Understanding the components, such as these defensins, of the bed bugs' innate immune systems in response to pathogens may help unravel why bed bugs do not transmit pathogens to vertebrates.

Pesticides Misused for Bed Bug Control: Comparing Professional and Nonprofessional Applications Reported to the National Pesticide Information Center, 2013-2017.

Objectives. To compare outcomes when pesticides are used to control bed bugs by professionals and nonprofessionals. Methods. All US National Pesticide Information Center inquiries from 2013 to 2017 were assessed to identify scenarios involving bed bugs and pesticide applications. Cases were evaluated with respect to types of applicators, misapplications, and human pesticide exposures. Results. Misapplications were more than twice as likely to be reported in cases involving nonprofessional applications (14%) as in cases involving professional applications (5%). Human exposures to pesticides were reported more often when pesticides were misapplied (70%) than when there were no apparent misapplications (31%). Conclusions. Both professionals and nonprofessionals may misuse pesticides to control bed bugs, which may increase the risks of exposure and adverse outcomes. Policy interventions may reduce pesticide incidents related to bed bug control by promoting professional involvement and adherence to product label instructions.

Association between bed bugs and allergic reactions.

AIMS: To evaluate whether bed bugs are associated with allergic reactions in patients seen in the emergency department (ED). METHODS AND RESULTS: This retrospective study included data from 9 EDs in Ohio between February 2011 and February 2017. The study comprised 332 patients with bed bug infestation matched 1:15 with 4952 control patients without bed bugs on the basis of age, sex and the presenting ED. Compared with uninfested patients, patients infested with bed bugs were more likely to have an ED or inpatient diagnosis of pruritus, hives or urticaria (odds ratio [OR], 9.12 [95% CI, 3.41-24.42]) and to be treated in the ED with an antihistamine (OR, 3.20 [95% CI, 1.87-5.50]) or albuterol (OR, 1.59 [95% CI, 1.07-2.36]) (P ≤ .02 for all). There were no significant differences in the rates of anaphylaxis and angioedema diagnosed in patients with and without bed bugs, which occurred in <1% in both groups. CONCLUSION: Bed bug-infested patients are more likely to be diagnosed and treated for itchy cutaneous rashes, but are not clearly associated with more severe allergic reactions.