Insect bites and stings

WikiDoc Resources for Insect bites and stings

Articles

Most recent articles on Insect bites and stings

Most cited articles on Insect bites and stings

Review articles on Insect bites and stings

Articles on Insect bites and stings in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Insect bites and stings

Images of Insect bites and stings

Photos of Insect bites and stings

Podcasts & MP3s on Insect bites and stings

Videos on Insect bites and stings

Evidence Based Medicine

Cochrane Collaboration on Insect bites and stings

Bandolier on Insect bites and stings

TRIP on Insect bites and stings

Clinical Trials

Ongoing Trials on Insect bites and stings at Clinical Trials.gov

Trial results on Insect bites and stings

Clinical Trials on Insect bites and stings at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Insect bites and stings

NICE Guidance on Insect bites and stings

NHS PRODIGY Guidance

FDA on Insect bites and stings

CDC on Insect bites and stings

Books

Books on Insect bites and stings

News

Insect bites and stings in the news

Be alerted to news on Insect bites and stings

News trends on Insect bites and stings

Commentary

Blogs on Insect bites and stings

Definitions

Definitions of Insect bites and stings

Patient Resources / Community

Patient resources on Insect bites and stings

Discussion groups on Insect bites and stings

Patient Handouts on Insect bites and stings

Directions to Hospitals Treating Insect bites and stings

Risk calculators and risk factors for Insect bites and stings

Healthcare Provider Resources

Symptoms of Insect bites and stings

Causes & Risk Factors for Insect bites and stings

Diagnostic studies for Insect bites and stings

Treatment of Insect bites and stings

Continuing Medical Education (CME)

CME Programs on Insect bites and stings

International

Insect bites and stings en Espanol

Insect bites and stings en Francais

Business

Insect bites and stings in the Marketplace

Patents on Insect bites and stings

Experimental / Informatics

List of terms related to Insect bites and stings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

[edit | edit source]

Insect bites and stings occur when an insect is agitated and seeks to defend itself through its natural defense mechanisms, or when an insect seeks to feed off the bitten person.

## Pathophysiology

[edit | edit source]

Insects inject formic acid, which can cause an immediate skin reaction often resulting in redness and swelling in the injured area.

## Diagnosis

[edit | edit source]

### History and Symptoms

[edit | edit source]

The sting from fire ants, bees, wasps and hornets are usually painful, and may stimulate a dangerous allergic reaction called anaphylaxis for at risk patients. Wasps can bite and sting at the same time.

## Differentiating insect bites from other diseases

[edit | edit source]

Different rash-like conditions can be confused with insect bites and are thus included in its differential diagnosis. The various conditions that should be differentiated from insect bites include:[1][2][3][4][5][6][7]

Disease | Features

|

Impetigo |

* It commonly presents with pimple-like lesions surrounded by erythematous skin. Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of trauma to the skin.

Insect bites |

* The insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles.

Kawasaki disease |

* Commonly presents with high and persistent fever, red mucous membranes in mouth, "strawberry tongue", swollen lymph nodes and skin rash in early disease, with peeling off of the skin of the hands, feet and genital area.

Measles |

* Commonly presents with high fever, coryza and conjunctivitis, with observation of oral mucosal lesions (Koplik's spots), followed by widespread skin rash.

Monkeypox |

* The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.

Rubella |

* Commonly presents with a facial rash which then spreads to the trunk and limbs, fading after 3 days, low grade fever, swollen glands, joint pains, headache and conjunctivitis. The rash disappears after a few days with no staining or peeling of the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate.

Atypical measles |

* The symptoms commonly begin about 7-14 days after infection and present as fever, cough, coryza and conjunctivitis. Observation of Koplik's spots is also a characteristic finding in measles.

Coxsackievirus |

* The most commonly caused disease is the Coxsackie A disease, presenting as hand, foot and mouth disease. It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.

Acne |

* It is typical of teenagers, usually appears on the face and upper neck, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. The typical acne lesions are comedones and inflammatory papules, pustules, and nodules. Some of the large nodules were previously called "cysts"

Syphilis | It commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic It is classically described as:

* Non-pruritic bilateral symmetrical mucocutaneous rash
* Non-tender regional lymphadenopathy
* Condylomata lata and
* Patchy alopecia.

Molluscum contagiosum |

* The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections.

Mononucleosis |

* Common symptoms include low-grade fever without chills, sore throat, white patches on tonsils and back of the throat, muscle weakness and sometime extreme fatigue, tender lymphadenopathy, petechial hemorrhage and skin rash.

Toxic erythema |

* It is a common rash in infants, with clustered and vesicular appearance.

Rat-bite fever |

* It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.

Parvovirus B19 |

* The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth.

Cytomegalovirus |

* The common symptoms include sore throat, swollen lymph nodes, fever, headache, fatigue, weakness, muscle pain and loss of appetite.

Scarlet fever |

* It commonly includes fever, punctate red macules on the hard and soft palate and uvula (Forchheimer's spots), bright red tongue with a "strawberry" appearance, sore throat and headache and lymphadenopathy.

Rocky Mountain spotted fever |

* The symptoms may include maculopapular rash, petechial rash, abdominal pain and joint pain.

Stevens-Johnson syndrome |

* The symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes occurs in about 30% of children. A rash of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.

Varicella-zoster virus |

* It commonly starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.

Chickenpox |

* It commonly starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a chickenpox blister can also spread the disease.

Meningococcemia |

* It commonly presents with rash, petechiae, headache, confusion, and stiff neck, high fever, mental status changes, nausea and vomiting.

Rickettsial pox |

* The first symptom is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the symptoms are flu-like including fever, chills, weakness and muscle pain but the most distinctive symptom is the rash that breaks out, spanning the person's entire body.

Meningitis |

* It commonly presents with headache, nuchal rigidity, fever, petechiae and altered mental status.

## Treatment

[edit | edit source]

### Medical Therapy

[edit | edit source]

Stingers in the skin should be removed by scraping it away with a fingernail or credit card edge. Baking soda paste should then be applied for 20 minutes to neutralize the formic acid. Bites from mosquitoes, fleas and mites are more likely to cause itching than pain.

## Related Chapters

[edit | edit source]

* Bee sting
* Schmidt Sting Pain Index

## References

[edit | edit source]

1. ↑ Hartman-Adams H, Banvard C, Juckett G (2014). "Impetigo: diagnosis and treatment". Am Fam Physician. 90 (4): 229–35. PMID 25250996.CS1 maint: Multiple names: authors list (link)
2. ↑ Mehta N, Chen KK, Kroumpouzos G (2016). "Skin disease in pregnancy: The approach of the obstetric medicine physician". Clin Dermatol. 34 (3): 320–6. doi:10.1016/j.clindermatol.2016.02.003. PMID 27265069.CS1 maint: Multiple names: authors list (link)
3. ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
4. ↑ Ibrahim F, Khan T, Pujalte GG (2015). "Bacterial Skin Infections". Prim Care. 42 (4): 485–99. doi:10.1016/j.pop.2015.08.001. PMID 26612370.CS1 maint: Multiple names: authors list (link)
5. ↑ Ramoni S, Boneschi V, Cusini M (2016). "Syphilis as "the great imitator": a case of impetiginoid syphiloderm". Int J Dermatol. 55 (3): e162–3. doi:10.1111/ijd.13072. PMID 26566601.CS1 maint: Multiple names: authors list (link)
6. ↑ Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y (2015). "Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan". Med Mycol J. 56 (1): E1–5. doi:10.3314/mmj.56.E1. PMID 25855021.CS1 maint: Multiple names: authors list (link)
7. ↑ CEDEF (2012). "[Item 87--Mucocutaneous bacterial infections]". Ann Dermatol Venereol. 139 (11 Suppl): A32–9. doi:10.1016/j.annder.2012.01.002. PMID 23176858.

Template:WH Template:WS nl:Insectenbeet de:Insektenstich