Insect Bites Disease

BASICS

DESCRIPTION

Arthropods affect man by being pests, inoculating poison, invading tissue, or transmitting disease. Inoculation of poison may occur as either a bite or a sting. This discussion is limited to the irritative, poisonous, allergic effects of these pests.

Harmful arthropods of the U.S. include:
- Bees: Bumblebees, sweat bees, honeybees
- Wasps: Hornets, wasps
- Ants: Fire ants, harvester ants
- Brown recluse spider
- Black widow spider
- Hobo spiders
- Scorpions
- Mosquitoes
- Flies: Deer, horse, black, stable, and biting midges
- Lice: Body, head, pubic
- Bugs: Kissing, bed, wheel
- Fleas: Human, cat, dog
- Mites: Itch mite (scabies), red bugs (chiggers)
- Ticks
- Caterpillars: Puss, browntail, buck, moth saddleback
- Centipedes
Characteristic reactions include:
- Local tissue irritation, inflammation and destruction
- Systemic effects related to inoculated poisons
- Allergic reactions: Immediate or delayed
System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Widespread (seasonal and regional variance)
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Local reactions:
- Erythema
- Pain
- Heat
- Swelling
- Itching
- Blisters
- Secondary infection - cellulitis, abscess
- Necrosis
- Ulceration
- Drainage
Toxic reactions: Non-antigenic
- Nausea
- Vomiting
- Headache
- Fever
- Diarrhea
- Lightheadedness
- Syncope
- Drowsiness
- Muscle spasms
- Edema
- Convulsions
Systemic reactions: Allergic
- Itching eyes
- Facial flushing
- Generalized urticaria
- Dry cough
- Chest/throat constriction
- Wheezing
- Dyspnea
- Cyanosis
- Abdominal cramps
- Diarrhea
- Nausea
- Vomiting
- Vertigo
- Chills/fever
- Stridor
- Shock
- Loss of consciousness
- Involuntary bowel/bladder action
- Frothy sputum
- Respiratory failure
- Cardiovascular collapse
- Death
Delayed reaction:
- Serum-sickness-like reactions
- Fever
- Malaise
- Headache
- Urticaria
- Lymphadenopathy
- Polyarthritis
Unusual reactions:
- Encephalopathy
- Neuritis
- Vasculitis
- Nephrosis
- Extreme fear/anxiety

CAUSES

Local tissue inflammation and destruction from poison
Allergic reaction from previous sensitization
Toxic reaction from large inoculation of poison

RISK FACTORS

Living environment
Climate
Season
Clothing
Lack of protective measures
Perfumes, colognes
Previous sensitization
Young or elderly at more risk

DIAGNOSIS

LABORATORY

Leukocytosis, thrombocytopenia, hypofibrinogenemia, abnormal coagulation, DIC, proteinuria, hemoglobinemia, hemoglobinuria, myoglobinemia, myoglobinuria, and azotemia are uncommon but possible manifestations in severe reactions

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Inflammation, ulceration, vesiculation, pustulation, rupture, eschar, swelling

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient or inpatient, depending on individual response to injury
Hospitalize for severe systemic reactions with threatened airway obstruction, bronchospasm, hypotension, severe angiodermatitis or pain

GENERAL MEASURES

First aid measures, local treatment, activate emergency services in severe reactions. If history of allergy or large envenomations, don't wait to seek emergency care.
Use ANA kit and over-the-counter antihistamines, if available and required
Local (depending on severity):
- Remove stinger (scrape it out - don't squeeze with tweezer)
- Cleanse wound
- Ice packs to bite or sting site (alternate 10 minutes on/10 minutes off)
- Elevation of affected part
- Rest the affected area
- Debride ulcers
- Drain abscesses
Systemic (depending on severity, and type of reaction); home use - Epi-Pen:
- Adequate airway (intubation, tracheostomy) - if needed to bypass obstruction
- Oxygen (4-6 L/min) - if needed for respiratory distress
- Hospitalize and observe 24-48 hours

SURGICAL MEASURES

Optimal treatment of necrotic spider bites is not well defined. Surgical repair may be required of severe ulcerative lesions, but not until primary necrotizing process is complete.

ACTIVITY

Rest to limit spread of poison

DIET

No special diet; nothing by mouth if severe systemic reaction

PATIENT EDUCATION

Protective measures, ANA kit use, risks
Individuals with known sensitivity should wear medical identification (bracelet, tag) or carry a card

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid re-exposure in known hypersensitive individuals
Prescribe anaphylactic (ANA kit) or Epi-Pen, if indicated
Educate on risks of increasing anamnestic responses in future
Consider desensitization with immunotherapy in severe cases
DEET or other proven insect repellants
Permethrin applied to clothes is better against ticks than DEET

POSSIBLE COMPLICATIONS

Infection
- Bacterial
- Arthropod associated diseases with tick, fly, bug and mosquito bites, e.g., lyme borreliosis, rickettsial disease (Rocky Mountain spotted fever), arboviral encephalitis, malaria, leishmaniasis, trypanosomiasis, dengue
Scarring
Drug reactions
Multisystem failure
Death

EXPECTED COURSE AND PROGNOSIS

Minor reactions - excellent
Severe reactions - excellent with early, appropriate treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: More at risk
Geriatric: More at risk
Others: N/A

PREGNANCY

Not a contraindication to appropriate management

OTHER NOTES

Imported fire ants and Africanized bees in endemic areas of the Southern United States pose increased risks to persons living in these areas

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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