Got the Travel Bug? A Review of Common Infections, Infestations, Bites, and Stings Among Returning Travelers

Matthew P. Vasievich; Jose Dario Martinez Villarreal; Kenneth J. Tomecki


Am J Clin Dermatol. 2016;17(5):451-462. 

In This Article

Insect Bites

Insect bites are a common complaint in returning travelers. Bites typically result from an insect trying to obtain a blood meal from a host. Clinically, they appear as erythematous edematous papules that can be distributed singly, grouped, or generalized, depending on the amount of accessible skin and the number and type of insects biting. A robust host response to the bite can produce a bulla. Pruritus often results either as a direct result of the bite or as a host response to proteins injected into the skin by the insect.

One of the most common biting insects encountered by travelers is the bedbug. Bedbugs (genus Cimex) are sub-centimeter reddish-brown flat arthropods found throughout the world. They live within the cracks, crevices, and seams of mattresses and chairs and generally only come out onto the resting surface to obtain a blood meal from a host. Bedbugs are more common in poor areas, but can potentially be found anywhere humans sit, rest, or sleep, including hotels, theaters, airplanes, workplaces, and schools. They feed when the host is sleeping or otherwise distracted and still. The bite is painless and occurs on exposed skin—primarily the face, neck, hands, and arms. The papules of bedbug bites are often in a linear pattern as a bug probes multiple sites looking for a suitable blood vessel on which to feed (Fig. 1). Other signs of bedbug infestation include specks of feces on bedsheets, wallpaper, or box springs. Specks of blood on sheets are also suggestive. Bedbugs can reside in luggage, which can result in infestation of a traveler's home on their return. Thus, suitcases should be kept off the floor and closed when not in use. Once a building is infested with bedbugs, eradication is difficult. Measures to remove bedbugs include heat treatments, as bedbugs cannot tolerate temperatures above 50 °C, and insecticides, though resistance to some compounds has been reported.[4]

Figure 1.

Bedbug bites

Describing the biting patterns of other specific insect species encountered in rural or wilderness areas is not possible within the confines of this review. However, if travelers do plan on spending significant amounts of time in these areas, they should be familiar with the most likely species to be encountered and bring appropriate protective clothing and insect repellant. The papules and pruritus from the bites themselves are generally self-limited, and treatment is aimed at symptom control. Usually mid-potency topical steroid creams or ointments are appropriate, with oral antihistamines as needed. For severe or generalized bites, a short course of oral corticosteroids or an intramuscular corticosteroid injection could be used.