Insect Stings and Bites

Question 1

What is the goal of therapy

Answer 1

Prevent bites and stings
Prevent diseases caused by bites or stings
Prevent local reactions/allergic reactions to bites or stings
Ensure patient receives appropriate care if needed
Provide symptomatic relief of localized reactions

Question 2

Describe the habitat of honeybees

Answer 2

Their nest varies and is found in trees, attics, chimneys (places with crevices)

Question 3

Describe the stinger of honeybees

Answer 3

The stinger has barbs that must be removed to prevent further release of venom. Gently scrape side to side with a fingernail or straight edge object

Question 4

Describe the reaction to a honeybee sting

Answer 4

Localized pain, redness and swelling, itching and irritation

Question 5

Describe the habitat of bumblebess

Answer 5

Bumblebees are generally found close to the ground (grass, under decks) or above ground (roof beams, attics)

Question 6

Describe the stinger of bumblebees

Answer 6

The stinger has no barbs and they are able to sting multiple times

Question 7

Describe the reaction to a bumblebee sting

Answer 7

Swelling and irritation, rarely causes venom allergies

Question 8

Describe the habitat of wasps

Answer 8

Commonly nest in eaves, rafters and in the ground (rodent burrows, rocks, tree stumps, under stairs)

Question 9

Describe the stinger of wasps

Answer 9

The stinger has no barbs (able to sting multiple times) and they only sting when provoked

Question 10

Describe the reaction to a wasp sting

Answer 10

Redness, some swelling, itching and minor pain at the site of the sting

Question 11

Describe the habitat of hornets

Answer 11

Commonly nest in trees or bushes. Yellow jackets are a common type of hornet that nests in the ground

Question 12

Describe the stinger of hornets

Answer 12

The stinger has no barbs (able to sting multiple times) and they only sting when provoked

Question 13

Describe the reaction to a hornet sting

Answer 13

Redness, some swelling, itching and minor pain at the site of the sting

Question 14

Describe the initial reaction to a sting

Answer 14

Within 4-48 hours

Localized pain, redness, swelling, itching at the site of the sting

Question 15

Describe the systemic reaction to a sting

Answer 15

Within 12-24 hours
Headache, fever, nausea and vomiting, anaphylactic reaction
More likely to occur with multiple stings or repeated stings

Question 16

Describe the anaphylactic reaction to a sting

Answer 16

Within minutes to 72 hours

Hives, throat tightness, difficulty breathing

Question 17

What is the best way to prevent bee, wasp and hornet stings?

Answer 17

Avoid wearing perfumes and scented soaps
Avoid leaving food outdoors (attracted to sweet foods or uncovered foods)
Avoid wearing bright coloured clothing and flowered prints which may attract bees
Avoid swatting at stinging insects as they will attack if they feel treatened
Avoid the outdoors at dawn and dusk
Cuff clothing around ankles, wrists and neck

Question 18

What is the best way to treat bee, wasp and hornet stings?

Answer 18

1. Remove the insect/stinger if applicable (never squeeze or rub the area as more venom will be released)
2. Apply ice (reduces swelling)
3. Clean area well (warm water to relieve pain and inflammation/cool water to relieve itching)
4. OTC treatment (relieves itching; non-prescription oral antihistamines, like diphenhydramine, and/or non-prescription topical steroid, like hydrocortisone 0.5%)

Question 19

Describe ants

Answer 19

In Canada, there are red ants, black carpenter ants and pavement ants.
Ants bite and sting; the bite anchors the ant
Canadian ants are not aggressive but they can bite

Question 20

Describe the reaction to an ant bite/sting

Answer 20

Itching and burning at the site of the bite which usually resolves in a few hours

Question 21

Describe fleas

Answer 21

They prefer to live on dogs and cats
They can live for months without feeding (only require blood to lay eggs)
They can remain in houses/apartments for long periods of time

Question 22

Describe the reaction to flea bites

Answer 22

Small red bumps in groups of three
Some itching with a red rash
Repeated bites may cause sensitization

Question 23

What is the best way to prevent fleas

Answer 23

Treat pets who carry or have become infested with fleas (dogs, cats)
Avoid sleeping with pets who have fleas (until treated completely)
Clean daily if fleas found in the home (vacuum rugs, beds, couches and discard vacuum bag after each use)
Avoid contact with stray animals who may carry fleas

Question 24

Describe spiders

Answer 24

Spiders help to control other pests in the home and garden

They rarely bite humans and only if they are trapped or protecting their eggs

Question 25

Describe the reaction to spider bites

Answer 25

Venom is not toxic to humans but can cause slight swelling, inflammation and itching

Question 26

What spiders pose a health risk?

Answer 26

The brown recluse spider and the black widow spider (common in the southern US)

Question 27

What is the best way to prevent spider bites

Answer 27

Avoid areas where spiders live (wood piles, rock piles, webs in garages)
Clear away old furniture, tires, junk, newspapers, old clothes where they may choose to live
Remove access to the home (openings, crevices, drains)
Move the bed away from the wall and shake out bedding if spiders are seen near the bed

Question 28

Describe bed bugs

Answer 28

Generally active about 1 hour before dawn
Typically seek blood every 5 to 10 days but can live longer without blood
Located in cracks and crevices of walls, wood furniture, wood paneling, under carpeting, bed mattresses (seams of mattress, bed frames, head board)

Question 29

Describe the reaction to bed bug bites

Answer 29

Itchy, hard, swollen, welts that can last days or weeks - usually found on arms, legs, shoulders and neck

Question 30

What is the best way to prevent bed bugs?

Answer 30

Avoid bringing infested items into your home (inspect luggage when returning from areas of infestation, inspect second hand furniture)
Wash bedding frequently using hot water
Vacuum frequently, reduce clutter where bed bugs may hide
Repair screens, cracks and crevices that may allow them to enter the home
Inspect mattresses regularly for signs of bugs

Question 31

What is the best way to treat bed bugs?

Answer 31

Physical symptoms resolve within 1 to 2 weeks (once bugs are eradicated)
OTC treatment (relieves itching)
-non-prescription oral antihistamines (diphenhydramine)
-non-prescription topical steroid (hydrocortisone 0.5%)
-topical antihistamines are NOT recommended (benadryl cream)
Refer if signs of infection or severe reaction

Question 32

Describe mosquitoes

Answer 32

Only the female mosquito bites and only to obtain blood to incubate their eggs
They are attracted to carbon dioxide, strong scents or the chemicals in sweat

Question 33

Describe the reaction to mosquito bites

Answer 33

Occurs about 10-15 minutes after initial bite

Itchy, red bump (or several) with some swelling

Question 34

What is the best way to prevent mosquito bites?

Answer 34

Avoid or limit time in areas where mosquitoes are commonly found
Remove standing water (ponds, bird baths) from yard
Wear light coloured clothing that covers arms and legs (attracted to dark clothing)
Avoid scented products (perfumes, hair products)
Wear insect repellants

Question 35

What is the best way to treat mosquito bites?

Answer 35

Avoid scratching (can break the skin and lead to bacterial infection)
A cold pack or crushed ice to reduce swelling if necessary
OTC treatment (relieves itching)
-non-prescription oral antihistamines (diphenhydramine)
-non-prescription topical steroid (hydrocortisone 0.5%)
Monitor each day for sings of infection, spreading to other areas of the body and allergic reaction

Question 36

What are symptoms of West Nile, in mild cases?

Answer 36

Symptoms appear within 2 to 15 days
Flu-like symptoms, including fever, headache and body aches
Some may have mild rash, or swollen lymph glands

Question 37

What are symptoms of West Nile, in severe cases?

Answer 37

Rapid onset of severe headache, high fever, stiff neck, nausea, difficulty swallowing, vomiting, drowsiness, confusion, lack of coordination, muscle weakness

Question 38

What are the long term effects of West Nile?

Answer 38

Physical effects (long-term muscle weakness and paralysis, fatigue and headache)
Cognitive effects (confusion, depression, problems with concentration and memory loss)
Functional effects (difficulty with preparing meals)

Question 39

Describe ticks

Answer 39

Ticks bite by cutting the skin and inserting their feeding tube into the bite area
Reaction: usually painless but may have some itching, burning and redness
Increased risk of disease transmission (higher if tick remains attached for more than 24 hours)
Infected ticks can spread Lyme disease

Question 40

What is the best way to prevent ticks?

Answer 40

Avoid swampy areas, dense woods or brush
Walk on pathways or trails instead of through wooded areas or tall grass
Tuck pants into socks
Use an insect repellant (DEET products preferred)
Check clothing and skin before going indoors and remove any ticks present
Check pets before going indoors

Question 41

What is the best way to treat ticks?

Answer 41

Removal must be done as soon as possible. Grasp head of tick with tweezers (close to the skin), pull with steady pressure (do not twist or turn the tick as part of it may break off and remain in the skin, increasing the risk of infection). Clean the area with soap and water. Monitor the area for a few days for signs of infection or Lyme disease
Do not use a match, nail polish or gasoline as it increase the risk to the host and may cause the tick to inject saliva

Question 42

Describe Lympe disease

Answer 42

Causes by a bite from the black legged tick (deer tick)
Symptoms: non-specific flu symptoms, rash (like a bulls eye), malaise, fatigue, headache, fever, chills, stiff neck, joint pain, muscle pain, anorexia, sore throat
Refer to physician if suspected

Question 43

When should a patient be referred for bites and stings?

Answer 43

Anaphylactic reaction within 30 minutes
Late systemic reaction (2 to 4 hours)
Significant allergic response away from the site of sting
History of previous stings
Stings in the tongue or in the mouth
Under 2 years of age
Unresolved symptoms after 7 days of treatment
Area worsens or spreads within 24 hours (increased pain, increased swelling of site, signs of infection, such as pus, redness or high fever)

Question 44

Describe DEET?

Answer 44

Products containing DEET are the most effect and the most widely used
The higher the concentration, the longer it repels mosquitos
Repels against mosquitos, ticks, fleas, some flies
Toxic effects may occur with ingestion or long term or excessive use particularly in children

Question 45

When should you use DEET?

Answer 45

Do not apply to hands or face
Children over 12 years and adults can use up to 30% DEET up to TID
Children 2 to 12 years can use up to 10% DEET up to TID
Children 6 months to 2 years can use up to 10% DEET once daily
Children under 6 months should not use DEET

Question 46

What are some products with DEET?

Answer 46

OFF
-Deep Woods Aerosol, Pump Spray (25-30%)
-Active Lotion, Aerosol, Pump Spray (7.5%, 15%, 25%)
-Family Care Spray, Towelettes, Smooth and Dry (5%, 7%a and 15%) - used to be called Skintastic
Family Care Eucalyptus Lotion (10% PMD)
Muskol
Muskol Aerosol, Lotion (23.5-30%)

Question 47

Describe Icardin

Answer 47

Approved in Canada for protection against mosquitoes, black flies and ticks
Adults and children 6 months and over
-20% Icardin is approved
-Is first choice for children (over DEET) as higher strength can be used
Not approved for children younger than 6 months

Question 48

What are some products with Icardin?

Answer 48

OFF! Deep Woods Pump Spray Insect Repellent Clean Feel (Icardin 20%)
OFF! Active Insect Repellent Clean Feel (Icardin 20%)
OFF! Family Care Clean Feel Insect Repellent Towelettes (Icardin 20%)
Avon Skin-So-Soft Bug Guard Plus Icardin (Icardin 10%)
All Family Insect Repellent

Question 49

How should insect repellent be applied?

Answer 49

Apply repellent lightly and only to exposed skin or directly onto clothing
-do not apply to open wounds or irritated skin
-wash hands after application and was area covered once repellent is no longer required
-use in a well ventilated area
Apply sunscreen first and allow it to penetrate for 20 minutes and then apply insect repellent

Question 50

What are some natural insect repellents available?

Answer 50

Soybeen oil (2%), which protects 1 to 4 hours against mosquitoes and protects up to 8 hours against black flies (Bite Blocker - US only at this time)
Citronella protects 30 minutes to 2 hours against mosquitoes (Natrapel Lotion/Pump Spray, Druide Citronella Spray which if found at MEC)
P-menthane 3,8-diol (lemon-eucalyptus oil) protects for up to 2 hours against mosquitoes and 5 hours against black flies (OFF faimly care botanicals repel lemon eucalyptus - US only at this time)
100% garlic juice - spray on plants and standing water (do not apply directly to skin) - acts as mosquito barrier