Bed Bug Bites: Effects on Sleep, Mental Health, and Disease Transmission

This brochure provides information on the effects of bed bug bites on sleep, mental health, and disease transmission. It includes five articles that discuss the correlation between Cimex infestation and sleep disturbance, the potential of Cimex to transmit Chagas disease, the cold tolerance and resistance to insecticides of bed bugs, and the adverse physiological and mental reactions caused by bed bug bites. The brochure emphasizes the need for health organizations to find ways to control the widespread growth of these blood-sucking parasites before it becomes a major worldwide threat.

Running head: BED BUG BITES
Bed Bug Bites
Name of Student
Name of University
Author Note

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Introduction:
Bed bugs or Cimex lectularius is a type of parasitic insect that feeds on blood of other
animals, and is commonly found in third world countries where there is unsanitary hygiene
conditions and congested population. Contradictorily, after the latter half of the twentieth
century, spread of bed bugs was observed even in developed countries like Europe, United States
and Canada. The aim of this brochure is to provide a brief idea regarding the Cimex bug which
would help research scholars develop ways to control its spread and for health organizations to
make the general population aware of the bed bug infection and its harmful effects. The brochure
is important to draw attention about bed bugs, because according to an article provided by
Centers for Disease Control and Prevention, bed bugs can occur anywhere regardless of
cleanliness and every clinical symptom is different for each affected person (CDC - Bed Bugs -
Frequently Asked Questions (FAQs), 2018), which makes it difficult to treat.
Article 1 by Susser (2013)
According to a journal article published in International Journal of Molecular Sciences, it
was addressed that sleep deprivation over a prolonged period of time may lead to different health
problems, physical as well as mental. Any hindrances or nocturnal pruritus can lead to
malfunction in the restorative process of sleep (Lavery, Stull, Kinney & Yosipovitch, 2016). The
constant irritant stimulus and compulsion to perform nocturnal pruritus can lead to both infection
and mental health declination. The research paper is dedicated to correlate the occurrence of
Cimex infestation and its impact on the sleep disturbance which leads to anxiety and depression.
There are no epidemiological study data that would support the hypothesis of the paper, but it is
most likely to be observed that recurrent infestations of Cimex will eventually hamper sleep of

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the person affected and thereby will most likely to become irritable, anxious and will eventually
suffer from temporary mental illness. The scientists performed a secondary research based on a
survey conducted by Montreal Public Health department in 2010. A total of 91 participants who
lived in unhealthy living conditions were questioned and was noted that half of the sample
participants suffered from sleep deprivation and most of those people suffered depression and
preferred isolation. The patients’ physical as well as mental health should be clinically diagnosed
by doctors to ensure an all rounded therapy. The doctors are also advised to make the patient and
their family aware to be careful regarding the infection.
Article 2 by Salazar et al. (2015)
The parasite Trypanosoma cruzi, causing a disease known as Chagas disease is rampant
in the Latin America, where low sanitation is seen. According to an estimate provided by CDC
shows that, nearly eight million people are affected by Chagas dieases in Latin American
populated areas (Chagas disease, 2018). The problem with this disease is that it can remain
undetected for years and prolonged exposure leads to enlargement of heart ventricles, esophagus
and colon. Recent research has shown that Cimex has similar features like the Triatomine class of
insects like that of T. cruzi (Benoit et al., 2016) Scientists are trying to find out the relation
between these similar features and whether or not Cimex can serve as a vector for Chagas
disease. In their experiment they infected a group of healthy mice with T. cruzi and those mice
were exposed to Cimex. The results showed that the Cimex that fed on the infected mice acquired
the Chagas disease effectively. The Cimex were then observed to transmit the T.cruzi into normal
mice when they were subjected to cohabitation with normal mice. Another method of disease
transmission was through contact with T. cruzi contaminated fecal matter in healthy mice. Data
analysis has shown that the more probable cause of Chagas disease transmission was due

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exposure to fecal matter of the infected mice into the normal mice via Cimex. This can pose a
threat to entomologists in considering Cimex as a potential vector to T.cruzi and awareness
should be created in areas where Chagas disease is potent.
Article 3 by Olson et al. (2013)
Olson et al. (2013) worked on cold tolerance of bed bugs. It is a known fact that the
performance of animals as well as insects is controlled by the temperature of the surrounding
environment, geographical locations where temperate and polar conditions prevail; the majority
of the insect population faces a set back and is challenged to survive in under low nutritious
conditions. This is nature’s own pest controlling method to inhibit excessive spreading of insects
directly or indirectly by impacting physiological responses, biological function and reproductive
ability (Sinclair, Alvarado & Ferguson, 2015). An article of Journal of Economic Entomology,
states that Cimex has high tolerance to even cold temperatures and can feed in those extreme
freezing conditions. This suggests that Cimex infestation can also occur in cold climatic
conditions in which generally all other insects are unable to thrive. The scientists exposed the
Cimex to extreme freezing temperatures with variable time of exposure and determined the bug’s
tolerance towards cold and how the mortality is affected by harsh temperatures. They studied the
different life cycle stages of the Cimex and determined the optimum tolerance to manage pest
control. The mean temperature ranged from -21.3°C to -30.3°C, with the egg phase having the
lowest tolerance. Only when the bugs were exposed to a lethal freezing temperature of about -
31.2°C, all the bugs were reported to be dead, meaning these bugs could not survive a
temperature lower than body freezing. Health organizations should create awareness in colder
countries and observe the low hygienic areas to find the presence Cimex bugs and way to control
them.

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Article 4 by Zhu et al. (2013)
Zhu et al. (2013) worked on resistance to pyrethroid insecticides. Chemical insecticides
are mostly used to control disease causing vectors that affect the human population and spread
diseases and rampant infection. The first choice of insecticide is the pyrethoid class of chemicals
which is highly efficient to destroy most of the vectors (Nkya, Akhouayri, Kisinza & David,
2013). The recent advancement in the genomic mapping of Cimex, have been able to analyze of
the whole genome of the species. The analysis has showed that, as of late, the species has
developed a resistance towards pyrethroid group of insecticides. Fourteen molecular markers
have been identified to be associated with the insecticide resistance by transcriptome analysis.
The article shows that the genes responsible for the insecticide resistance have different
mechanism to inhibit the pesticide action by slowing down the toxin effect before it is targeted to
the nervous tissues. The variety in the different strategies is dependent on the physiological,
morphological and metabolic construct of the Cimex, which is only unique to this insect.
Scientists should try to find chemicals that would directly destroy the genetic structure of the
bugs that are structurally dissimilar to pyrethriods.
Article 5 by Rahim et al. (2016)
The dependence of the Cimex on humans for its blood meal leads to the direct exposure
of human contact with the bug. Due to this reason, many adverse physiological and mental
reactions are observed in patients who undergo Cimex infestation. The discomfort caused to the
patient are mainly, irritability, nocturnal pruritus which may lead to the development of chronic
inflammation, transmission to other domestic mammals and people, adverse allergic reactions
and skin rashes (Minocha et al., 2017) The common clinical symptoms from Cimex bite include

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inflammation, swelling, redness, bullous eruptions, itchiness and development of rash and
lesions. Affected individual develop compulsive pruritis (adverse itching sensation) and lesions
after they have been bitten by Cimex. The severity of the skin reactions manifested from the bed
bug bites varies between individuals and the bite from female Cimex were observed to take
longer time to heal than male bug bites. Health practitioners are requested to clinically treat their
mental health if necessary along with physical treatment and advise the affected people not
enhance their infection by mistreatment and scratching.
Conclusion:
The sudden uprise of the Cimex or bed bugs is a growing concern and is clinically
neglected in most developed countries. The United States are recorded to have the highest
number of Cimex infested population in the world. The past decade, Canada has been
susceptible to spread of bed bugs and mainly the homeless population seems to suffer from the
recurrent manifestations of the bug. The clinical manifestations of the bug bite are not only
restricted to physical infections but also impact the overall mental health of the individual. The
more alarming issue that needs to be addresses is that the Cimex has developed resistance against
the widely used insecticide, pyrethroids. Health organizations should be focusing to find out
ways to control the widespread growth of these blood sucking parasites before it becomes a
major worldwide threat.

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References:
Benoit, J. B., Adelman, Z. N., Reinhardt, K., Dolan, A., Poelchau, M., Jennings, E. C., ... & Zhu,
F. (2016). Unique features of a global human ectoparasite identified through sequencing
of the bed bug genome. Nature communications, 7, ncomms10165.
Chagas disease. (2018). World Health Organization. Retrieved 26 February 2018, from
http://www.who.int/mediacentre/factsheets/fs340/en/
Lavery, M., Stull, C., Kinney, M., & Yosipovitch, G. (2016). Nocturnal Pruritus: The Battle for a
Peaceful Night’s Sleep. International Journal Of Molecular Sciences, 17(12), 425.
http://dx.doi.org/10.3390/ijms17030425.
Minocha, R., Wang, C., Dang, K., Webb, C. E., Fernández‐Peñas, P., & Doggett, S. L. (2017).
Systemic and erythrodermic reactions following repeated exposure to bites from the
Common bed bug Cimex lectularius (Hemiptera: Cimicidae). Austral Entomology, 56(3),
345-347.
Nkya, T. E., Akhouayri, I., Kisinza, W., & David, J. P. (2013). Impact of environment on
mosquito response to pyrethroid insecticides: facts, evidences and prospects. Insect
biochemistry and molecular biology, 43(4), 407-416.
Olson, J., Eaton, M., Kells, S., Morin, V., & Wang, C. (2013). Cold Tolerance of Bed Bugs and
Practical Recommendations for Control. Journal Of Economic Entomology, 106(6),
2433-2441. http://dx.doi.org/10.1603/ec13032.
Quarles, W. (2015). New IPM methods for bed bugs. IPM Pract, 34(7/8), 1-9.

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Rahim, A. H. A., Zahran, Z., & Ab Majid, A. H. (2016). Human skin reactions towards bites of
tropical bed bug, Cimex hemipterus F.(Hemiptera: Cimicidae): A preliminary case
study. Asian Pacific Journal of Tropical Disease, 6(5), 366-371.
Salazar, R., Borrini-Mayorí, K., Tustin, A., Levy, M., Náquira, C., & Castillo-Neyra, R. (2015).
Bed Bugs (Cimex lectularius) as Vectors of Trypanosoma cruzi. The American Journal
Of Tropical Medicine And Hygiene, 92(2), 331-335. http://dx.doi.org/10.4269/ajtmh.14-
0483.
Sinclair, B. J., Alvarado, L. E. C., & Ferguson, L. V. (2015). An invitation to measure insect cold
tolerance: methods, approaches, and workflow. Journal of thermal biology, 53, 180-197.
Susser, S. R. (2013). «Good night, sleep tight, don’t let the bed bugs bite»: exploring the mental
health fallout of urban bed bug infestation in Montréal, Québec.
Zhu, F., Gujar, H., Gordon, J. R., Haynes, K. F., Potter, M. F., & Palli, S. R. (2013). Bed bugs
evolved unique adaptive strategy to resist pyrethroid insecticides. Scientific reports, 3,
1456.