eMedicine Specialties > Emergency Medicine > Environmental

Bites, Insects: Differential Diagnoses & Workup

Author: Bo Burns, DO, FACEP, FAAEM, Assistant Professor, Assistant Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine, St Francis Hospital Trauma Emergency Center
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
Contributor Information and Disclosures

Updated: Oct 13, 2009

Differential Diagnoses

Acute Coronary Syndrome
Mycosis Fungoides
Anaphylaxis
Pediatrics, Anaphylaxis
Arthritis, Rheumatoid
Pediculosis
Bites, Animal
Pityriasis Rosea
Burkitt Lymphoma and Burkittlike Lymphoma
Plant Poisoning, Resins
Caterpillar Envenomations
Scabies
Catscratch Disease
Scorpion Envenomations
Centipede Envenomations
Serum Sickness
Delusions of Parasitosis
Snake Envenomation, Mohave Rattle
Dermatitis, Atopic
Snake Envenomations, Cobra
Dermatitis, Contact
Snake Envenomations, Coral
Disseminated Intravascular Coagulation
Snake Envenomations, Moccasins
Erysipelas
Snake Envenomations, Rattle
HIV Infection and AIDS
Spider Envenomations, Funnel Web
Impetigo
Spider Envenomations, Tarantula
Lice
Spider Envenomations, Widow
Lymphoma, Cutaneous T-Cell
Lymphoma, Mantle Cell
Millipede Envenomations

Workup

Laboratory Studies

  • Laboratory studies are seldom necessary. Appropriate laboratory studies should be ordered if the patient is compromised severely and requires hospital admission or end-organ failure is suspected, or for evaluation of secondary complications such as cellulitis.
  • Biopsy of lesions generally is nondeterminant and is impractical in the ED.
  • Microscopic examination of skin scrapings can be useful in the diagnosis of scabies or mite infestations but are not useful for most insect bites.
  • Serology studies may be useful in determining infection due to an insect vector, but these are not available in the ED and may take weeks to obtain a result.

More on Bites, Insects

Overview: Bites, Insects
Differential Diagnoses & Workup: Bites, Insects
Treatment & Medication: Bites, Insects
Follow-up: Bites, Insects
Multimedia: Bites, Insects
References
Further Reading
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References

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  14. Asada H, Miyagawa S, Sumikawa Y, et al. CD4+ T-lymphocyte-induced Epstein-Barr virus reactivation in a patient with severe hypersensitivity to mosquito bites and Epstein-Barr virus-infected NK cell lymphocytosis. Arch Dermatol. Dec 2003;139(12):1601-7. [Medline].

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  34. Tokura Y, Ishihara S, Tagawa S, Seo N, Ohshima K, Takigawa M. Hypersensitivity to mosquito bites as the primary clinical manifestation of a juvenile type of Epstein-Barr virus-associated natural killer cell leukemia/lymphoma. J Am Acad Dermatol. Oct 2001;45(4):569-78. [Medline].

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Further Reading

Clinical guidelines

 The diagnosis and management of anaphylaxis: an updated practice parameter.
American Academy of Allergy, Asthma and Immunology - Medical Specialty Society
American College of Allergy, Asthma and Immunology - Medical Specialty Society
Joint Council of Allergy, Asthma and Immunology - Medical Specialty Society. 1998 Jun (revised 2005 Mar). 41 pages. NGC:004211

Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help.
American Academy of Allergy, Asthma and Immunology - Medical Specialty Society. 2006 Feb. 29 pages. NGC:005003

The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Infectious Diseases Society of America - Medical Specialty Society. 2006. 96 pages. NGC:005086

Clinical trials

 Cause of Unexplained Anaphylaxis

Population Pharmacokinetics of Benznidazole in Children With Chagas Disease

Immunogenicity, Safety and Interchangeability of Two Tbe Vaccines Administered According to a Conventional Schedule in Children

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Keywords

insect bite, bug bites, Insecta, Hymenoptera, Arachnida, anaphylactic shock, Lyme disease, Chagas disease, trypanosomiasis, tick-borne encephalitides, blackflies, Simuliidae, onchocerciasis, river blindness, dermatitis, cellulitis, urticaria, myiasis, fly larvae, human botflies, NewWorld screwworms, Old World screwworms, Wohlfahrtia flies, Tumbu flies, fly maggots, delusional parasitosis, plant-eating phytophagous insects, cockroach bite, earwigs, reduviid bug, horsefly bites, mosquito, malaria, angioedema

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Contributor Information and Disclosures

Author

Bo Burns, DO, FACEP, FAAEM, Assistant Professor, Assistant Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine, St Francis Hospital Trauma Emergency Center
Bo Burns, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care 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.

Medical Editor

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.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

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

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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