WORDS Dr. Kendall Wagner, Chaffee Crossing Clinic
IMAGE MIA Studio/Shutterstock
It’s summertime! You are spending more time outdoors, so it is inevitable you will cross paths with bugs whose bites or stings may result in attention by a physician. The arthropod class of insects includes bees, wasps, fire ants, bedbugs, fleas, and lice. Let’s discuss!
BEES, WASPS, FIRE ANTS
Bees, wasps, and fire ants deliver a painful sting from a venom-injecting rear stinger. Local reactions such as pain, redness, and swelling are common. Serious reactions include severe itching, facial swelling, and hives and can progress to wheezing, difficulty breathing, low blood pressure, severe abdominal pain, temporary loss of consciousness, and rarely, cardiorespiratory failure. Severe reactions require the prompt use of an EpiPen at the time of exposure. Local reactions can be managed by removing the stinger, applying a cold compress, and taking Tylenol or Motrin for pain. At times, your physician may recommend a short course of oral antihistamine, such as Zyrtec or Benadryl, and/or treatment with an oral corticosteroid for severe infection.
Bedbugs are small, flat, ovoid-shaped, red brown in color, and can be found in crevices in walls, floors, mattresses, cushions, bed frames, and other structures. They must have a human host to survive. Bites usually occur at night and appear as small, red bumps or punctures in the skin with minimal surrounding reaction. Your physician may recommend topical steroid treatment and oral antihistamines to decrease itching. Occasionally, secondary bacterial infections may require prescription topical or oral antibiotics.
Fleas do not require a human host as they can also feed on pets and birds. Their bites appear as red bumps that are very itchy. Many patients have a reaction like hives or fluid-filled blisters around the bite site. Topical treatment is recommended. The main concern is fleas can transmit infections between animal and human hosts. Historically, fatal diseases such as tularemia, typhus, and even the plague have been linked to fleas. Regular veterinarian care and flea control are important to prevent these infections.
Lice only feed on humans and are tan to grayish white in color. Head lice are the most common. The three stages of lice growth are egg (nit), nymph, and adult. Symptoms are feeling something moving in the hair, itching, or visible nits, nymphs, or adults. Treatment focuses on egg removal with a fine-toothed comb combined with topical solution at the onset, repeated in one week to eliminate any lice that may have hatched following the initial treatment.
Ticks have eight legs, an ovoid body and feed by cutting a hole in the skin and injecting anticoagulants. While bites are initially painless, they often progress to red, itchy bumps with surrounding redness and swelling. After the initial reaction, rashes and other dermatologic symptoms may follow. Tick-borne illness includes Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, and southern tick-associated rash illness. It is imperative to quickly remove the tick to limit the transmission of tick-borne illness. Remove the tick with fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upward with steady, gentle pressure. Ticks should not be removed with fingernail polish, alcohol, or hot items as they may cause regurgitation of the tick, increasing the chances of disease transmission. Treatment of the bite area includes topical steroid ointments and antihistamines as directed by your physician. Secondary infections or tick-borne illness should be evaluated by a physician and treated appropriately.
Chiggers are tiny red mites found in tall grasses, weeds, and woodlands. Infestations occur when they reach areas of constricting clothing such as the ankles, thigh, or waist as they feed on human skin. While initially painless, an allergic reaction develops within a few hours, leading to extremely itchy red papules. Chiggers can be seen as tiny red dots on the skin and can be easily removed with soap and water. Topical steroid treatment and antihistamines are used to decrease the itchiness.
Scabies are very small mites which burrow into the superficial layer of the skin where it lays eggs. The initial infection is asymptomatic, but then the body develops an allergic reaction which results in an intensely itchy rash often in the webs of fingers and toes, folds of the wrists and elbows, and on the buttocks or genital area. Diagnosis is confirmed by microscopic evaluation of skin scrapings which reveal the mites, eggs, or fecal material excreted by the mite. Scabies is treated with permethrin 5% cream applied from the neck down at bedtime and washed off the following morning. Treatment should be repeated in one week to address any mites that might have hatched following initial treatment.
The United States has only one species of scorpion, the bark scorpion, that contains venom with potential to cause systemic toxicity. Most stings produce only localized pain, similar to a wasp or bee sting, and are managed by removing the stinger and cleansing the wound, followed by an ice compress. Topical steroid and oral Tylenol may also be used for pain.
In Arkansas, only two spiders have the potential to cause significant morbidity: the black widow and brown recluse. The brown recluse is yellow to brown and has a violin-shaped marking on its back. While not aggressive, they typically bite when disturbed or threatened. Bites are felt as a sharp, stinging sensation, but are often minor and painless. Some bites develop an area of loss of color or darkness of the skin. Hemorrhagic blisters may occur, and skin death can occur around the bite. Initial care consists of cleansing with soap and water, confirmation of tetanus vaccination status, and a cold compress to decrease activity of skin-damaging enzymes found in the spider venom. Physician evaluation is necessary if skin necrosis occurs. The black widow is dark brown to black with a rounded shiny abdomen with a red/orange hourglass shape. Often found in woodpiles, attics, and crawlspaces, bites occur when there is a perceived threat. The bite feels like a sharp pinprick-like sensation followed by a dull aching or numbness. Two red punctures and redness usually develop within sixty minutes of the bite. While many bites have minimal symptoms, serious reactions such as muscle spasms and pain of the chest, abdomen, and lower back can occur. These symptoms can be followed by elevation of blood pressure, sweating, shortness of breath, and nausea/vomiting. While local necrosis does not occur, cleansing the bite with soap and water followed by confirming tetanus vaccination is important. Tylenol may be given for pain. However, systemic symptoms may require management in the ER or an urgent care.
PREVENTION IS KEY
Wearing longer, lightweight clothing when outdoors, avoiding woodpiles, tall grasses and weeds, and removal of cardboard boxes from attics and crawlspaces go a long way in prevention. Showering with soap and water after outdoor activities and examination for visible organisms is also important. Bedbugs, scabies, and lice can be prevented with good hygienic practices of washing bedding, routine hair inspection, and quick elimination of the organisms when found.
Kendall Wagner, M.D. is a regular healthcare contributor to Do South® Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas