ContextBed bug    (Cimex lectularius) infestations are rapidly    increasing worldwide. Health consequences include nuisance    biting and cutaneous and systemic reactions. The potential for    bed bugs to serve as disease vectors and optimal methods for    bed bug pest control and eradication are unclear.  
    ObjectivesTo present    current knowledge of the health and medical effects of bed bugs    and to explore key issues in pest control and eradication    efforts.  
    Data SourcesA search    of MEDLINE and EMBASE databases (1960-October 2008) for    articles using the keywords bed bugs, Cimex    lectularius, humans, parasitology,    pathogenicity, and drug effects. For pest    control, PubMed and Toxline searches (1960-October 2008) were    performed using the keywords bed bugs, Cimex,    control, prevention, and    eradication. Manual searches of older journals,    textbooks, pest control trade journals, and newspapers    (1892-October 2008) were also performed.  
    Study    SelectionOriginal accounts or investigations of    bed bugs, clinical responses with sufficient detail of cause    and effect between the bed bug bite and clinical response, and    convincing evidence of substantiated presence of bed bug    exposure. For pest control, documentation that an eradication    measure quantitatively decreased bed bugs.  
    Data ExtractionA    trained medical reference librarian assisted with the    literature search. Two authors with expertise in the diagnosis,    treatment, and eradication of bed bugs reviewed the clinical    articles. One author evaluated the pest control    articles.  
    Data    SynthesisFifty-three articles met inclusion    criteria and were summarized. Only 2 clinical trials concerning    bed bugs were identified and tested the ability of pest control    interventions to eradicate bed bugs. Although transmission of    more than 40 human diseases has been attributed to bed bugs,    there is little evidence that they are vectors of communicable    disease. A variety of clinical reactions to bed bugs have been    reported, including cutaneous and rarely systemic reactions. A    wide range of empirical treatments, including antibiotics,    antihistamines, topical and oral corticosteroids, and    epinephrine, have been used for bite reactions with varying    results. No evidence-based interventions to eradicate bed bugs    or prevent bites were identified.  
    ConclusionsTreatment    options for cutaneous and systemic reactions from bed bug bites    have not been evaluated in clinical trials and there is no    evidence that outcomes differ significantly from those    receiving no treatment. Evidence for disease transmission by    bed bugs is lacking. Pest control and eradication is    challenging due to insecticide resistance, lack of effective    products, and health concerns about spraying mattresses with    pesticides.  
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