Bug Bites: Serious or Just a Nuisance?
Our patients are exposed to flying insects,
such as mosquitoes, wasps, and bees, as well as crawling bugs,
such as mites, ticks, and spiders. Each bug has its own special
bite, some just causing itchiness for a few hours, but many causing
serious problems, some even life-threatening.
As healthcare professionals, we usually see a bug bite after it has caused extensive tissue damage, infection, and sometimes systemic involvement. A major puzzle for us is trying to determine which bug caused the bite, thereby allowing us to better treat the injury.
Spider bites are usually harmless in the U.S., but the brown recluse spider bite can be more serious. Its name tells its habits: it usually seeks out secluded places that are not disturbed. Fortunately it is not aggressive, so bites are rare. The venom of the brown recluse spider contains an enzyme that destroys soft tissue, resulting in a blister, open wound, and/or a blackened area. Advise patients to seek medical attention immediately if it sounds like they have been bitten by a brown recluse spider. A lot of photos of brown recluse spiders are available by searching for online images. Information about the brown recluse spider can be found on the National Library of Medicine website at www.nlm.nih.gov, and also on the websites www.medlineplus.com and www.emedicinehealth.com, by entering “brown recluse spider” into the search box.
Mosquitoes are certainly a nuisance and their bites itch, but rarely do they cause major problems. They can transmit diseases, though, such as West Nile Virus (WNV). Many people with WNV have no symptoms, some people develop mild symptoms such as nausea and muscle aches for a few days with a mild fever, and a few people develop serious symptoms including high fever, headache, disorientation, stiff neck, loss of vision, numbness, muscle weakness, and paralysis. The symptoms can last for several weeks and have permanent neurological effects. The CDC site for WNV information is www.cdc.gov/westnile/. Prevention focuses on getting rid of mosquito breeding areas like standing water and on preventing mosquito bites.
The website www.wikipedia.org defines ticks as small external parasites that live on the blood of mammals, birds, and other animals. These small bugs like to hitch rides on animals that walk among wooded foliage. Ticks bite by burrowing their heads into the skin and should be carefully removed without squeezing the body. Tick bites, like mosquitoes bites, are usually harmless except that ticks can secrete toxins and transmit other diseases such as Rocky Mountain spotted fever (mostly east of the Rocky Mountains), Lyme disease, and tick paralysis. There are at least 11 recognized tick-transmitted diseases in the U.S., with Lyme disease at the top of the list with almost 25,000 reported cases in 2002.
Rocky Mountain spotted fever (called the black measles in the late 1800s) usually presents with persistent fever lasting 2–3 weeks, nausea and vomiting, lethargy, muscle pain, chills, and anorexia. Sometimes diarrhea, abdominal pain, and joint pain can develop. A red rash appears a few days later, developing into black areas of tissue death. Treatment is with antibiotics.
Lyme disease usually (80% of the time) starts with a large circular rash that appears anywhere from days to weeks after the bite and is accompanied by fever, chills, fatigue, painful joints and muscles, and swollen lymph glands. Looking at those symptoms, and the lag time, it is easy to see why Lyme disease is often confused with the flu and other viral diseases. In the next few months it develops into multiple rashes, arthritic-like symptoms, heart palpitations, extreme fatigue and weakness, and nervous system disorders. If left untreated, these symptoms develop into chronic arthritis and neurological problems, especially dangerous during pregnancy, lasting months or years. If treated early with several weeks of antibiotics, all these complications can be avoided.
Caution patients to remove ticks by firmly grasping the body with tweezers and pulling steadily straight out, not twisting. Evidently using nail polish, oil, or burning them does not stop them from delivering pathogens. Ticks may be saved in a plastic container and sent for testing. There is a fee attached. Contact your local health department for testing resources. If the tick’s head is left in the human body during removal, an irritation can occur at the site, but this does not increase the likelihood of contracting a disease. The longer the tick is attached, the more likely it is that a disease will be transmitted. The following link is to a brochure about Lyme disease: http://www.cdc.gov/ncidod/dvbid/lyme/resources/handbook.pdf. Another website, www.nlm.nih.gov/medlineplus/tickbites/html, also has a lot of information about ticks.
Younger patients will enjoy reading the CDC’s online brochure about insects, diseases, and health and safety found at www.bam.gov.
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