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Chapter07:BitesandStings
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BitesandStings
Arthropodbitesandstingsarecommonandoftenselflimited.Bothmosquitoesandtickscanbe
potentialvectorsforsystemicillnesses.PreventionusinginsectrepellentsthatcontainDEET,
picaridin,orpermethrinimpregnatedclothesandwearinglongsleevedclothingis
recommended.

SpiderBites
Mostspiderbitesareunnoticedormayappearaspruriticredpapules(Figure50).Diagnosisis
madeuponclinicalpresentation,andtreatmentissymptomaticinmostpatients.
Figure50.OpeninNewWindow

Spiderbitespresentingasred,pruritic,urticarialpapulesthatarepruritic.

Severespiderbitesthatcausesystemicsymptomsarerare.Thebrownreclusespider,Loxosceles
recluse,isfoundinsouthernandcentralUnitedStates(Figure51)andcancausesevereskin
necrosiswithsignificantpainandsystemicsymptoms,includingnausea,vomiting,fever,
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muscleandjointpain,hemolysis,andacutekidneyinjury(Figure52andFigure53).
Figure51.OpeninNewWindow

Brownreclusespidersarequiteshy,andtheirbitesareoftenmisidentifiedandoverdiagnosed.

Figure52.OpeninNewWindow

Abrownreclusespiderbite(early).

Figure53.OpeninNewWindow

Ulcerationfromabrownreclusespiderbite(late).
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Brownreclusespiderbitesareuncommonbecausethespidersaretimidinsectsandoftenare
hiding.Mostsuspectedspiderbitesactuallyaremisdiagnosedandarecausedbyotherinsect
bitesorinfections,includingbacterialabscesses.Althoughdiagnosisisusuallymadeclinically,
serumenzymelinkedimmunoabsorbentassaysorbiopsycanbeperformedtoconfirmabite.
Treatmentincludesanalgesicagents,woundcare,anddebridementinsomecases.

Hymenoptera
Waspandbeestingsarepainfulbutoftenselflimited.Stingersshouldberemovedrapidly,as
venomcancontinuetobereleased.Localizedreactionsincludepain,redness,andswelling.
Systemicreactionsincludinghivesandanaphylaxiscanoccurinsomepersons,andsuch
personsshouldcarryaninjectableepinephrinepen.Becausemassivewaspandbeestingscan
resultinmultiorganfailure,desensitizationusingallergytherapycanbeperformedinpersons
whohavehadsystemicreactions.
Fireants,foundinthesouthernUnitedStates,canbothbiteandsting,causingasignificant
response.Thesebitescauseaninitialburninganditchysensationfollowedbyseveralpustules.
Thepustulescanmimicotherdermatologicdiseasesincludinginfections.Topical
glucocorticoidsmayberequiredforsymptomaticrelief.Personswithseverebitesmayrequire
oralglucocorticoids.

Worms
RelatedQuestion
Question53
Cutaneouslarvamigransisanintenselypruriticskineruptioncausedbyhookwormsasaresult
ofwalkingbarefootinareaswhereanimalfecesmaybepresent(suchasonbeaches).Wearing
footwearisthereforerecommended.Theeruptionislinearorserpiginous,andoftenoccurson
theextremities(Figure54).Oralantiparasiticagents(ivermectinasthepreferredagentor
albendazoleasanalternative)canhelpresolvetheeruption.Antihistaminesorglucocorticoids
canbeusedtorelievesymptoms.
Figure54.OpeninNewWindow

Serpiginous,linearredtrackmarksthatarepathognomonicforcutaneouslarvamigrans.

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Bibliography
HaddadVJr,CardosoJL,LupiO,TyringSK.Tropicaldermatology:venomous
arthropodsandhumanskin:partI.Insecta.JAmAcadDermatol.2012Sep67(3):331.e1
14.PMID:22890734
HaddadVJr,CardosoJL,LupiO,TyringSK.Tropicaldermatology:venomous
arthropodsandhumanskin:partII.Diplopoda,Chilopoda,andArachnida.JAmAcad
Dermatol.2012Sep67(3):347.e19.PMID:22890735
MillerMJ,GomezHF,SniderRG.StephensEL,CzopRM,WarrenJS.Detectionof
Loxosclesvenominlesionalhairshaftsandskin:applicationofaspecificimmunoassay
toidentifydermonecroticarachnidism.AmJEmergMed.2000Sep18(5):6268.PMID:
10999583
ThiscontentwaslastupdatedinAugust2015.

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