In this review, bedbug encompasses both species.[8] Adult bedbugs are flattened, oval-shaped, wingless insects 4 to 7 mm long, usually brown to beige in color (Figure 1A), with a characteristic thickening of the thorax (pronotum) (Figure 1B) and distinct mouthparts for blood feeding Selleckchem AZD6244 (Figure 1C).[9] Both sexes are hematophagous but, under favorable environmental conditions (ie, cool temperature,

humidity, shelter), bedbugs can survive over a year without a blood meal.[10] Eggs are whitish and measure 1 to 2 mm (Figure 1D). They are often laid in small masses and a female can reportedly lay 50 to 500 eggs during her lifetime but, in the wild, C lectularius lay 100 to 150 eggs and C hemipterus lay 50 eggs.[11] The immature insects MLN0128 in vivo go through five successive developmental stages as nymphs, with each successive progression to the next stage requiring a blood meal, before becoming adults (Figure 1E). The nymphal

stages (2–4 mm long), often translucent and light in color, can be difficult to see.[8, 10] Adults and nymphs are generally only active at night and flee daylight or artificial light (bedside lamp or flashlight), which does not facilitate their detection. Their resting places, egg-laying sites, and breeding areas are generally difficult to access because they are usually unnoticeable, hidden in cracks, and creases, eg, grouped in the folds between the mattress and bed frames, bedside furniture and belongings (eg, clock radio, books), picture frames, curtain rods, peeling wallpaper, baseboards, and the carpet–wall junction. Big and elongated blood spots on the sheets are suggestive of bedbugs crushed by the victim. If a single impregnated female bedbug is brought to a new site, it takes several weeks for the life Carnitine palmitoyltransferase II cycle to start again (Figure 2) and numerous offspring to become detectable.[8, 10] During this latency period, those living on the site are usually not yet bothered

by their presence. No evidence supports bedbug involvement in the transmission of any disease-causing pathogens,[12] but, what is more-and-more frequently reported and related daily by experts or pest-management technicians is psychological disorders or various phobias.[13] Knowing or imagining that you can be blood-sucked by an undetectable insect only when you are asleep is nerve-racking for some people. For physicians, experts, and technicians, empathy, listening, and patience are essential. Even anemia in the case of severe infestation[14, 15] has been reported, but their most common impact remains nuisance biting, and associated dermatological and allergic consequences, ranging from simple bites to systemic manifestations.[16-18] The bite itself is generally not painful but the resulting reaction (Figure 3) can cause serious irritation. Sites of predilection are arms, legs, and neck, ie, parts of the body often exposed during the night.