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.
Media Gallery
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Yellow jacket wasp. Image courtesy of US Centers for Disease Control and Prevention.
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Anopheles albimanus mosquito feeding on human host. Image courtesy of US Centers for Disease Control and Prevention.
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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 US Centers for Disease Control and Prevention.
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Insect Bites. World Allergy Organization anaphylaxis pocket card. Reprinted from The Journal of Allergy and Clinical Immunology, Vol 127, Issue 3, Simons FER et al, World Allergy Organization anaphylaxis guidelines; Summary, Pgs 587-93, March 2011, with permission from Elsevier. Available at http://www.jacionline.org/article/S0091-6749(11)00128-X/fulltext.
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Fire ant (Solenopsis invicta). Image courtesy of Wikimedia Commons.
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Fecal staining from bed bugs in the crevice of a mattress. © 2014 Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners (RACGP), published in Doggett SL, Russell R. Bed bugs - What the GP needs to know. Aust Fam Physician. Nov 2009;38(11):880-4.
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Various stages of the bed bug life cycle. © 2014 Australian Family Physician. Reproduced with permission from The Royal Australian College of General Practitioners (RACGP), published in Doggett SL, Russell R. Bed bugs - What the GP needs to know. Aust Fam Physician. Nov 2009;38(11):880-4.
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Kissing bug (Triatoma sanguisuga) can be a vector for Chagas disease. Image courtesy of US Centers for Disease Control and Prevention.
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The Oriental rat flea (Xenopsylla cheopis). Image courtesy of US Centers for Disease Control and Prevention.
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Typical bed bug rash. Image courtesy of Wikimedia Commons.
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