Insect Bites Treatment & Management

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

Prehospital Care

  • If the bee stinger is present in the wound, it should be removed. Although conventional teaching suggested scraping the stinger out to avoid squeezing remaining venom from the retained venom gland into the victim, involuntary muscle contraction of the gland continues after evisceration and the venom contents are quickly exhausted. Immediate removal is the important principle and the method of removal is irrelevant.
  • Most insect bites may be treated acutely with a compress after routine wound cleaning with soap and water to minimize the possibility of infection.
  • For a large local reaction, ice packs may minimize swelling. Apply ice for no more than 15 minutes at a time using a cloth barrier between ice and skin to prevent direct thermal injury to the skin.
  • Epinephrine is the mainstay of prehospital treatment of a systemic reaction; the route of administration (subcutaneous, intramuscular, intravenous [IV], endotracheal) depends on the patient's condition and the expertise of the prehospital provider. Systemic antihistamines and corticosteroids, if available, help manage systemic reactions. Many patients who are allergic to stings carry commercially available bee sting kits containing an autoinjector of epinephrine. Refer to Hymenoptera Stings.
  • Topical antihistamines should not be applied over large surface areas, and they should not be used concurrently with systemic H1 antihistamines. Systemic anticholinergic toxicity may result from misuse of these medications.
  • Use of H2-blocking drugs (usually used to reduce gastric acid secretion) may be used concurrently with H1-blocking antihistamines.
  • In many patients, transport to a hospital is not necessary. Those requiring transport include patients who develop signs or symptoms of a systemic response or individuals with a history of insect-related anaphylaxis. A phone call to the regional poison center may save a costly visit to the ED.
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Emergency Department Care

  • Endotracheal intubation and ventilatory support may be required for severe anaphylaxis or angioedema involving the airway.
  • Treat emergent anaphylaxis in an atopic individual with an initial intramuscular injection of 0.3-0.5 mL of 1:1000 epinephrine. This may be repeated every 10 minutes as needed.
  • A bolus of IV epinephrine (1:10,000) may be used cautiously in severe cases. Solution of 1:10,000 typically is found in 10-mL vials. Repeated 1-mL doses are a reasonable initial approach in a critically ill patient with anaphylaxis. Once a positive response is achieved, these boluses can be followed by a carefully monitored, continuous epinephrine infusion. Use extra care in monitoring formulation, concentration, and dose when administering IV epinephrine to avoid inadvertent overdose.
  • Severely hypotensive patients may require a large volume of IV fluids. Monitor for angioedema and pulmonary edema.
  • Antihistamines, both H1 and H2 blockers, are useful in treating systemic reactions. Corticosteroids also are indicated routinely in such patients.
  • Refer to Anaphylaxis and Serum Sickness for further guidance.
  • Ensure appropriate tetanus prophylaxis.
  • Undefined erythema and swelling seen may be difficult to distinguish from cellulitis. As a general rule, infection is present in a minority of cases and antibiotic prophylaxis is not recommended.
  • Related diagnostic and treatment guidelines are available on anaphylaxis, travel medicine, and referral guidelines (also see Further Reading).[9, 10, 11]
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Consultations

  • In cases in which determining the insect species is important, a health department, agriculture extension, or university entomologist may be useful.
  • In cases of potential vector-borne disease transmission, an infectious disease specialist may be of help.
  • If the potential infection is associated with travel to a tropical region, consider contacting a tropical medicine specialist or the Centers for Disease Control and Prevention (CDC) at 1-877-394-8747 (Traveler's Health Hotline).
  • A regional poison center may be of assistance in difficult or complicated cases or for general information.
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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.

References

  1. Ewan PW. ABC of allergies. BMJ. 1998;316:1442,.

  2. Diaz JH. Recognizing and reducing the risks of Chagas disease (American trypanosomiasis) in travelers. J Travel Med. May-Jun 2008;15(3):184-95. [Medline].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  4. Rodriguez M, Perez L, Caicedo JC, et al. Composition and biting activity of Anopheles (Diptera: Culicidae) in the Amazon region of Colombia. J Med Entomol. Mar 2009;46(2):307-15. [Medline].

  5. Anderson AL, Leffler K. Bedbug infestations in the news: a picture of an emerging public health problem in the United States. J Environ Health. May 2008;70(9):24-7, 52-3. [Medline].

  6. Stucki A, Ludwig R. Images in clinical medicine. Bedbug bites. N Engl J Med. Sep 4 2008;359(10):1047. [Medline].

  7. Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical consequences of their bites. JAMA. Apr 1 2009;301(13):1358-66. [Medline].

  8. Lane RP, Crosskey RW. Medical Insects and Arachnids. 1993. Chapman & Hall.

  9. [Guideline] Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. Mar 2005;115(3 Suppl 2):S483-523. [Medline].

  10. [Guideline] Hill DR, Ericsson CD, Pearson RD, Keystone JS, Freedman DO, Kozarsky PE, et al. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Dec 15 2006;43(12):1499-539. [Medline].

  11. [Guideline] American Academy of Allergy, Asthma & Immunology. Consultation and referral guidelines citing the evidence: how the allergist-immunologist can help. J Allergy Clin Immunol. Feb 2006;117(2 Suppl Consultation):S495-523. [Medline].

  12. Voigt TF. [Mosquitoes. As carriers of infectious diseases they are increasingly important]. Med Monatsschr Pharm. Aug 2008;31(8):280-9. [Medline].

  13. Karunamoorthi K, Sabesan S. Field trials on the efficacy of DEET-impregnated anklets, wristbands, shoulder, and pocket strips against mosquito vectors of disease. Parasitol Res. Sep 2009;105(3):641-5. [Medline].

  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].

  15. Auerbach PS, ed. Wilderness Medicine. 4th ed. 2001.

  16. Blum J, Beck BR, Brun R, Hatz Ch. Clinical and serologic responses to human 'apathogenic' trypanosomes. Trans R Soc Trop Med Hyg. Oct 2005;99(10):795-7. [Medline].

  17. Busvine JR. Disease Transmission by Insects: Its Discovery and 90 Years of Effort to Prevent it. Springer Verlag; 1993:11-74.

  18. Clark RF, Schneir AB. Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed.

  19. Davis CL. Insects, allergy and disease. In: Allergic and Toxic Responses to Arthropods. 1979:300-9.

  20. Edwards L, Lynch PJ. Anaphylactic reaction to kissing bug bites. Ariz Med. Mar 1984;41(3):159-61. [Medline].

  21. Erbilen E, Gulcan E, Albayrak S, Ozveren O. Acute myocardial infarction due to a bee sting manifested with ST wave elevation after hospital admission. South Med J. Apr 2008;101(4):448. [Medline].

  22. Garcia LS, Bruckner DA. Diagnostic Medical Parasitology. 3rd ed. Amer Society for Microbiology; 1997.

  23. Goddard J. Physician's Guide to Arthropods of Medical Importance. CRC Press; 1996.

  24. Hoffman DR. Allergic reactions to biting insects. In: Levine MI, Lockey RF, eds. Monograph on Insect Allergy. 1981:69-74.

  25. Khamaysi Z, Dodiuk-Gad RP, Weltfriend S, et al. Insect bite-like reaction associated with mantle cell lymphoma: clinicopathological, immunopathological, and molecular studies. Am J Dermatopathol. Aug 2005;27(4):290-5. [Medline].

  26. Krause RS. Immune system disorders, hypersensitivity. In: Aghababian R, ed. Emergency Medicine: The Core Curriculum. Lippincott Williams & Wilkins Publishers; 1998:417-22.

  27. Lynch PJ, Pinnas JL. "Kissing bug" bites. Triatoma species as an important cause of insect bites in the southwest. Cutis. Nov 1978;22(5):585-91. [Medline].

  28. Mieller UR. Insect Sting Allergy: Clinical Picture, Diagnosis, and Treatment. Gustav Fischer; 1990:144-7.

  29. Moffitt JE, Yates AB, Stafford CT. Allergy to insect stings. A need for improved preventive management. Postgrad Med. Jun 1993;93(8):197-9, 203-4, 207-8. [Medline].

  30. Nhachi CF, Kasilo OM. Poisoning due to insect and scorpion stings/bites. Hum Exp Toxicol. Mar 1993;12(2):123-5. [Medline].

  31. Shai A, Halevy S. Direct triggers for ulceration in patients with venous insufficiency. Int J Dermatol. Dec 2005;44(12):1006-9. [Medline].

  32. Soylu A, Kavukcu S, Erdur B, Demir K, Turkmen MA. Multisystemic leukocytoclastic vasculitis affecting the central nervous system. Pediatr Neurol. Oct 2005;33(4):289-91. [Medline].

  33. Ter Poorten MC, Prose NS. The return of the common bedbug. Pediatr Dermatol. 2005;22(3):183-7.

  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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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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