Insect Bite Reactions

Yuni Eka Anggraini

Etiology

Arthropods That Bite, Sting, or Infest

I. Arachnida (four pairs of legs): mites, ticks, spiders, scorpions

   A. Acarina
     1. Mites: follicle (Demodex), food, fowl, grain, harvest, murine, scabies (Sarcoptes)
     2. Ticks
   B. Araneae: spiders
   C. Scorpionida
II. Chilopoda and Diplopoda: centipedes, millipedes
III. Insecta (three pairs of legs)
   A. Anoplura: lice (Phthirius and Pediculus)
   B. Coleoptera: beetles
   C. Diptera: mosquitoes, black flies, midges (punkies, no seeums, sand flies),
Tabandae (horseflies, deerflies, clegs, breeze flies, greenheads, mango flies); botflies,
Callitroga americana, Dermatobia hominis, phlebotomid sand flies, tsetse flies
   D. Hemiptera: bedbugs, kissing bugs
   E. Hymenoptera: ants, bees, wasps, hornets
   F. Lepidoptera: caterpillars, butterflies, moths
   G. Siphonaptera: fleas, chigoe or sand flea
 Diptera
• Family culicidae : 2000 species of masquito, many of which
transmit disease
• including Anophles, Culex, and Aedes
- Maquito bites incite the formation of pruritic wheals and
papular lesions,
- Which form in response to irritating salivary secretions
- Masquito bites may have urticarial, vesicular, eczematous,
or granulomatous appearence.
- Bite reactions usually subside over several days-
- Short couse of topical steroids and systemic antihistamin
may be used to control pruritus
 Hemiptera
- Family cimicidae : Cimex lectularius (bedbugs)
- Bedbugs is a nocturnal feeder, sommon and distributed worldwide
- stay hidden during the day in cracks of headboards, picture frame, bed,
behind loose wallpaper
- Bedbugs are attracted to the warmtsh and carbon dioxide production of
the victim
- Survive for 1 year without feeding
- Seek bloodmeal every 5-10 days.
- Bedbugs bite usually painles
- Bites are multiple, and may grouped in a linear fashion
- Referred to as breakfast, lunch, and dinner
- Reaction to the bites : wheals and papules, often with a small
hemorrahgic puntum at the center
- Bullous reaction to bites are prossible in sensitized individual
- Treatment : Topical corticosteroid for pruritus, and topical antibiotic for
secondary infection.
- Exterminator is a must !!
 Hymenoptera

• Family : Apidae and Bombidae (bees), Vespidae (wasp)

and Formicidae (ants)
• Many members of this order have evolved poison
glands use for defense and/or hunting
• Aside from local cutaneous reactions, Hymenoptera
stings are and important problem due to fatal
anaphylaction reactions
• All stings are inflicted by female insects.
• The stings occure when the nest or individual
threatened.
 Cont’d
• Hymenoptera stings typically produce immediate burning and
pain, followed by the development of an intense, local,
erythematous reaction with swelling and urticaria.
• Immediate reactions are commonly related to histamine,
serotonin, formic acid or kinins.
• Subside within several hours
• More severe local reactions can occur including extensive swelling
and prolong induration lasting up to 1 week.
• Generalized systemic reactions to the sting occur approx 0,4-3%
patients.
• Treament : mild local skin reactions only require local cleansing,
appication of ice, possible injection of local anesthetic to control
pain
• Oral or parenteral dihenhydramine may hel urticara and pruritus
• Anahylaxis must be treated with subcutaneous epinephrine.
Differential Diagnosis
• Bite Site Reactions (Erythematous Papules,Blisters)
Allergic contact dermatitis, especially to plants such as poison ivy or
poison oak.
Prevention
• Wearing gloves while working in garage or basements
• Avoiding bright colors and artificial scent which are attractans for
masquitos and flying insects
• Infestations of living area by arthropod are difficult to eliminate and
may require the assistance of professional exterminator.
• Chemical repellent are useful in preventing bites includinf N,N-diethyl-
3-methylbenzamide (DEET), picaridin and eucalyptus oil.
Treatment
• Camphor and menthol lotions and gel formulations may be useful in
the control of pruritus.
• For persistent bite reactions topical corticosteroid
• Prevention of bites : the use of protective clothing and repellents.
DEET (N,N-diethyl-3-methylbenzamide,previously called N,N-diethyl-
m-toluamide)