Insect Bites Clinical Presentation

  • Author: Bo Burns, DO, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 14, 2011
 

History

Most patients are aware of insect bites when they occur or shortly thereafter, but because it is such a common occurrence, the exposure is typically dismissed unless a severe or systemic reaction occurs.

Reactions to bites may be delayed due to the host being asleep or because the saliva of some micropredators may contain an anesthetic secreted to allow uninterrupted blood-feeding.

Patients who present with a history of homelessness or of staying in homeless shelters may have an exposure to organisms such as bedbugs.[5, 6, 7] Alternatively, patients with impairment from mental illness may also be susceptible to infestation with insect parasites.

Exposure to feral animals or even to domesticated animals, such as livestock or house pets, may predispose patients to exposure to biting insects such as fleas, bedbugs,[8, 6, 7] or lice.

Types of reactions

In a local reaction, the patient may complain of discomfort, itching, moderate or severe pain, erythema, tenderness, warmth, and edema of tissues surrounding the site. Although it may involve neighboring joints, local reactions cause no systemic symptoms.

In a severe local reaction, complaints include generalized erythema, urticaria, and pruritic edema. Severe local reactions increase the likelihood of serious systemic reactions if the patient is exposed again at a later time.

In a systemic or anaphylactic reaction, the patient may complain of localized symptoms as well as symptoms not contiguous with the bite location. Symptoms can range from mild to fatal. Early complaints typically include generalized rash, urticaria, pruritus, and angioedema. These symptoms may progress, and the patient may develop anxiety, disorientation, weakness, gastrointestinal disturbances (eg, cramping, diarrhea, vomiting), uterine cramping in women, urinary or fecal incontinence, dizziness, syncope, hypotension, stridor, dyspnea, or cough. As the reaction progresses, patients may experience respiratory failure and cardiovascular collapse.

Delayed reactions may appear 10-14 days after a sting. Symptoms of delayed reactions resemble serum sickness and include fever, malaise, headache, urticaria, lymphadenopathy, and polyarthritis.

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Physical

Without a clear patient history, diagnosis of an insect bite can be difficult since the initial response may be limited to erythema, local pain, pruritus, or edema.

Wheals and urticaria are common initial signs and generally appear within a few minutes of the bite. Unfortunately, many dermatologic conditions also produce similar cutaneous signs and may confound the diagnosis.

Identification of the insect responsible for the bite may be possible by examining the location, number, pattern, and sequelae of the bite(s).

Physical examination elements indicating a systemic reaction include the following:

  • Cardiovascular - Hypotension, orthostasis
  • Cutaneous - Urticaria, wheals, angioedema, blood at bite site, pruritus
  • Respiratory - Tachypnea, stridor, wheezing, bronchospasm
  • Gastrointestinal - Hyperactive bowel sounds
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Contributor Information and Disclosures
Author

Bo Burns, DO, FACEP, FAAEM  Assistant Professor, Associate Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine

Bo Burns, DO, FACEP, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Kavon Charles Azadi, MD  Resident Physician, Oklahoma Institute for Disaster and Emergency Medicine, University of Oklahoma College of Community Medicine, Department of Emergency Medicine

Kavon Charles Azadi, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Oklahoma State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Miguel C Fernandez, MD, and Nicolas F Arredondo, MD, to the development and writing of this article.

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Insect Bites. Yellowjacket wasp. Image courtesy of CDC.
Insect Bites. Anopheles albimanus mosquito feeding on human host. Image courtesy of CDC.
Insect Bites. A bedbug, Cimex lectularius, feeding on human blood. The bedbug's name comes from its preferred habitat, including mattresses, sofas, and other furniture. Image courtesy of CDC.
Insect Bites. Louse, Pediculus humanus, dorsal view after feeding on blood. Most lice are scavengers, feeding on skin and other debris found on the host's body, but some species feed on sebaceous secretions and blood. Image courtesy of CDC.
 
 
 
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