​Kembara Xtra - Medicine - Bed Bug

​Kembara Xtra - Medicine - Bed Bug 
Introduction
​5 to 7 mm oval, reddish brown, flat, wingless shape Nocturnal obligatory blood parasites found in furniture and bedding A mature bed insect, Cimex lectularius, according to microscopic research, is about the size of an apple seed.

Statistics and Epidemiology 
Incidence
Bed bug infestations are becoming more common and challenging to treat.
 A resurgence brought about by modifications to pesticides, a rise in travel, the use of secondhand furniture, and high rates of hotel guests changing rooms. Prevalence
Over the past ten years, infestations in public areas (schools, hospitals, hotels/motels, and airplanes) have increased by 10% to 30% across the United States. Since the late 1990s, the number of bed bugs (C. lectularius and Cimex hemipterus, family Cimicidae) has significantly increased. This is probably brought on by a rise in international travel, trade, and insecticide-resistant bedbug populations. According to estimates, the number of bed bugs worldwide is growing by 100–500% every year. It will be fascinating to monitor how the COVID-19 travel limitations affect the prevalence of infection, if at all.
● The two genera and species implicated in human infestations are C. lectularius and C. hemipterus. C. lectularius occurs in urban surroundings, and C. hemipterus resides in tropical climes. There are about 75 species of Insecta: Hemiptera: Cimicidae ("bed bugs").

Pathophysiology and Etiology 

Three species of the insect family Cimicidae—C. lectularius, C. hemipterus, and Leptocimex boueti—bite people.
C. lectularius is the species that is most common. 
Occurring in temperate and tropical climates 
Hide in the cracks of headboards, baseboards, box springs, and mattresses. 
Hospitals, movie theaters, automobiles, airplanes, hotels/motels, and residences are all affected by infestations.
They are not linked to hygiene shortcomings like other infestations.
An absence or mild response to the normal pruritic, erythematous, maculopapular rash are the two extremes of reactions.
An anaphylactoid or urticarial reaction occurs less frequently.
Bugs are attracted to body heat and carbon dioxide exhaled from the body, and bites do not spread any other known pathogens. Skin reactions are caused by host immunologic response to parasite salivary proteins. Urticarial reactions are mediated via immunoglobulin (Ig) G antibody response to salivary proteins. Bullous reactions are caused by an IgE-mediated hypersensitivity to nitrophorin in bug saliva.


High hotel turnover, immune-compromised guests, and used furnishings in the residence are risk factors.

Prevention Techniques 
Traps usually employ heat and carbon dioxide to attract and catch bugs, but they can be very expensive.
Vector control measures include routine vacuuming, clearing clutter, caulking wall cracks, and inspecting clothing and luggage.
All clothing and bedding should be washed in water that is at least 130 degrees Fahrenheit (50 degrees Celsius) for two hours, or they should be stored in a 20 degree (-5 degrees Celsius) or colder climate for at least five days. Based on the bed insect pheromones, several pest treatment firms use canines to find live bed bugs and their eggs.

History; recent travel; bed bug observation; blood stains on linens; morning discovery of new skin lesions; intense itching, agony, or burning

clinical assessment 
Erythematous pruritic papules in an atypical linear pattern are characteristic lesions.
Patients are mostly asymptomatic but may present with papular urticaria, widespread urticaria, bullous lesions, and/or anaphylactoid symptoms. They are most commonly found on body parts exposed while sleeping, such as the face, neck, arms, legs, and shoulders.

Differential diagnosis: dermatitis herpetiformis, urticaria, bug or spider bites, and scabies 

examination of diagnostic procedures.
Initial Examinations (lab, imaging) Mineral oil pretreatment of the skin Skin biopsy 

Skin scraping is negative for mineral oil, excluding scabies from the test's interpretation.
An arthropod bite reaction is consistent with the non-specific perivascular eosinophilic infiltration seen in the skin sample.

Generally Measures 
Treatment should focus on three things: treating the skin, getting rid of the infestation, and checking for any possible mental health effects.
The majority of patients seek therapy for skin blemishes and discomfort.
Treat symptomatically; disease is self-limited and disappears in 1 to 2 weeks.

First Line of Medications
Topical antipruritics, such as pramoxine/calamine ointment or doxepin cream, as well as oral antihistamines (such as diphenhydramine and hydroxyzine). Hydrocortisone and triamcinolone are examples of topical low- to mid-potency corticosteroids that can be used for two weeks. Systemic corticosteroids can be used in extreme situations.

Further Treatments 
Use antibiotics against Staphylococcus and Streptococcus spp., such as topical mupirocin, cephalexin, tetracycline, doxycycline, and clindamycin, if you are secondary infected.
Epinephrine for an allergic reaction 
Extermination by experts might be required.
The CDC advises a thorough integrated pest management approach, including clearing debris, caulking cracks, applying heat, vacuuming, and using non-chemical pesticides.
There are new methods (further research is required), such as xenointoxication (using an arthropodicide that is toxic to bed bugs).

Continuous Treatment
​Not required because the illness is self-limiting May require specialized care in rare instances or in the event of anaphylactoid reactions Consider consulting a behavioral health professional depending on how severely the patient is emotionally reacting to the infestation.

Patient Advice 
Avoid scratching to prevent superinfection, and routinely check your bags, mattress, and furniture.
CDC website: http://parasites/bedbugs/
EPA website: www.epa.gov/bedbugs
Myth 1: Bed bugs cannot be seen. They are nocturnal and spend the daytime in hiding. Eggs are about the size of a pin head and adult bugs are about 1/4 inch long.
Myth 2: Bed bugs multiply quickly. They have a longer life cycle than house flies, lasting 4 to 5 weeks.
Myth 3: Bed bugs are able to survive without food. Bugs can go three to five months without eating blood.
Advice for preventing and eliminating bed bugs - Verify the presence of bed bugs and not fleas, other insects, or ticks.
– Wash and hot dry your bedding and clothing frequently, especially if it touches the floor.
EPA advice is available at https://www.epa.gov/bedbugs/top-ten-tipsprevent- or-control-bed-bugs.

Significant psychological suffering (insomnia, depression, anxiety, and delusional parasitosis) Secondary bacterial infections Transmission of blood-borne diseases (rare) Bed bug dermatitis, allergic reactions, asthma exacerbations, and anaphylaxis