The diagnosis of a bedbug infestation should be based on the clinical history and appearance of bites. A thorough inspection of sleeping quarters by the patient, a family member, or a pest control expert may demonstrate the telltale signs of an infestation15 (i.e., specks of blood-tinged insect feces and exoskeleton casts [Figure 5]). With the aid of a magnifying glass, special attention should be given to cracks and crevices of furniture, baseboards, electrical boxes, curtains, carpet, luggage, bed frames and headboards, picture frames, wall hangings, mattress and box spring seams, peeling wall paper, clothes, and linens.37 Live bedbugs can sometimes be caught by turning on a flashlight just before dawn, when bedbugs are most active, larger in appearance, and slower to scatter because of recent feeding.40
The best way to confirm that the bites are from bed bugs is to find other evidence of a bed bug infestation. Common telltale signs can be found on or near your mattress: pull up your sheets and check the seams and folds for thin black fecal streaks or small red blood spots. You might also find bed bugs, living or dead, and their discarded shells in various hiding places, such as the joints of your bed frame.

General housecleaning measures, (e.g. vacuuming floors and surfaces), seldom reach where bed bugs hide. For this reason, repetitive vacuuming by occupants may not be worth the effort, especially compared to other important preparatory activities. Targeted vacuuming of bed bugs and infested harborages, however, can help remove some of the bugs before other treatment measures are undertaken. Bed bugs and especially the eggs can be difficult to dislodge. Optimum results will be achieved by moving and scraping the end of the suction wand along infested areas such as seams and fabric folds of beds and sofas, and the perimeter edge of wall-to-wall carpet. Bed bugs can survive the high speed trip down a vacuum, so it’s important to carefully dispose of the vacuum contents in a sealed trash bag afterwards. 
One bed bug will usually take more than one bite. Once a bed bug inserts its mouthparts and finds a suitable blood vessel, it will begin feeding. However, finding the right blood vessel may take more than one injection into the skin. In addition, bed bugs are very sensitive to movement by the host they are feeding on. Therefore, if a sleeping person moves, a feeding bed bug will probably withdraw its mouthparts and begin its search for a blood meal on another part of the body. It’s important to remember that the number of bites a person receives is not indicative of the number of bed bugs that feed on that person.
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