Insect Bites Follow-up

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

Further Inpatient Care

  • Patients with true anaphylaxis, particularly if associated with hypotension, often are admitted for monitoring or observation in the ED upon recovery. Accepted definition of "true" anaphylaxis requires the involvement of at least 2 of the following 4 systems: cardiovascular, gastrointestinal, skin, or respiratory. Literature provides no clear direction on who needs admission. Certain patients with a disease transmission (eg, malaria) may require admission.
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Further Outpatient Care

  • Follow-up monitoring for infection is advised for individuals bitten by an insect known to transmit a secondary disease, if exposed to the vector in an endemic area (eg, Chagas disease in the case of kissing bugs [Reduviidae]).
  • Individuals who recover from a systemic reaction should consult with an allergist regarding desensitization and prevention measures.
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Inpatient & Outpatient Medications

  • Prescribe a bee sting kit with a device for self-administration of epinephrine prior to discharge if the patient had a systemic response to an envenomation (see Hymenoptera Stings).
  • Corticosteroids and antihistamines usually are continued for a few (3-4) days after a systemic response. Serum sickness reactions may require longer therapy (see Serum Sickness).
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Deterrence/Prevention

  • Patients may be educated about avoidance measures. Refer to Patient Education.
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Complications

  • Secondary infection may result from an insect bite.
  • Symptoms of disease transmitted by insect bites may not be evident for days, weeks, or even longer.
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Prognosis

  • Prognosis generally is good except in patients with severe untreated anaphylaxis or in those with chronic or invasive infections.
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Patient Education

  • Biting insects are ubiquitous in nearly all parts of the world, yet certain measures can be taken to minimize risk of exposure. Periodic pest control may eliminate nests and minimize reproduction of biting insects.
  • Wear protective clothing (ie, long pants, long sleeves), especially when outdoors. Many insects are incapable of biting through clothing. Additionally, light-colored clothing appears to be less attractive to many biting insects, including mosquitos.[12] Avoid dark colors or brightly colored floral patterns. Wear protective footwear. Wear gloves when working with soil or in areas of heavy infestation.
  • Avoid use of heavy perfumes, scented soaps, sprays, or lotions that may attract insects. Be aware of surroundings; for example, avoid dense vegetation or animals suspected of carrying fleas, chiggers, or ticks. Prudent use of insect repellent can help minimize exposure to insect bites and stings (See Insect Repellents).[13] Be aware of the potential for bees or other foraging insects to enter opened soft drink containers that are left idle.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education articles Insect Bites, Allergy: Insect Sting, Severe Allergic Reaction (Anaphylactic Shock), Black Widow Spider Bite, Brown Recluse Spider Bite, and Ticks.
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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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