Bed Bugs and Infectious Disease: A Case for the Arboviruses

Bed bug infestations (Cimicidae; Cimex lectularius) have been increasing worldwide over the last few decades [1,2]. Several factors have been posited to explain this resurgence, including widespread insecticide resistance, human population growth, and increased international travel [1]. Clinically, reactions to bed bug bites vary from unapparent, to small (,5 mm) maculopapular lesions, to large wheals (2–6 cm); other reactions include bullous rashes, dermatitis, and asthma [1,3]. However, in the developed world the psychological, social, and economic impacts of bed bugs may be the most troubling aspects of the resurgence [2]. While the bed bug invasion cuts across economic lines, those with sufficient resources are able to clear the infestations, while those without may have to live with their bed bugs into the foreseeable future [2,4]. Bloodfeeding arthropods such as mosquitoes, ticks, fleas, kissing bugs, biting flies, and lice serve as biological vectors for human pathogens. Thus, it seems natural that bed bugs would also transmit infectious agents. However, more than 100 years of searching has produced little evidence to support this assumption. Comprehensive reviews examining bed bugs’ ability to vector a wide range of high-profile human pathogens, such as HIV, MRSA, and hepatitis B, C, and E viruses, among others, have recently been published [1,3]. Such experiments have so far failed to provide any convincing evidence of bed bugs in the transmission of these agents and thus will not be discussed here. Surprisingly, previous attempts to link bed bugs with disease transmission have largely omitted those viral pathogens known to have transmission cycles involving insect vectors. Thus, the purpose of this review is to refocus the attention of the research community on those pathogens most likely to be vectored by bed bug species given the appropriate ecological circumstances, and away from human pathogens with no previous history of transmission by insect vectors.