Mosquito bites

Related Terms

Allergic, allergic reaction, allergic response, allergy, anaphylaxis, anaphylactic shock, Anopheles, anti-coagulating agents, antivenin, arachnid, bed bugs, bedbugs, biting insects, black widow spider, Borrelia burgdorferi, brown recluse spider, blood meal, cephalothora, chiggers, Culicidae, DEET, DDT, deer tick, Eastern equine encephalitis, EEE, eggs, eggshells, encephalitis, engorged, epinephrine, exterminate, extermination, exterminator, hard ticks, host, hypersensitive, hypersensitivity, Ig, IgE, immunoglobulin, immunoglobulin E, inflammation, insects, larva, larvae, Loxosceles, Lyme disease, malaria, molt, mosquitoes, nonvenomous, northern black widow, nymphs, parasite, serum, serum sickness, soft ticks, spiders, toxic reaction, southern black widow, sucking insects, ticks, typhus, venom, venomous, West Nile virus, WNV.

Background

In general, biting insects themselves are not dangerous because allergic reactions are rare. However, many insects (like mosquitoes and ticks) can transmit diseases like malaria, Lyme disease, and the West Nile virus to humans.
This is because many insects inject their saliva into the host when they bite. While insect's saliva may aid in digestion, inhibit clotting, increase blood flow to the area bitten or anesthetize (numb) the bite site, it may also contain disease-causing organisms.
The mouthparts of biting insects can be classified into three groups: piercing and/or sucking, sponging, and biting/chewing. Most insect bites cause minor puncture wounds to the skin.
Deaths associated with insect bites are typically a result of hypersensitivity, either anaphylactic (allergic) or anaphylactoid (non-allergic) or from complications resulting from infection. While the exact incidence rate remains unknown, researchers estimate that between 50 and 150 Americans die each year from insect-provoked anaphylaxis. Mosquito bites cause the greatest number of deaths worldwide because they transmit diseases like malaria and the West Nile virus. Malaria is prevalent in tropical and subtropical areas, such as Africa, Asia, the Middle East, South America, and Central America.
Most insect bites are treated with antihistamines or anti-inflammatories. In some cases, symptoms subside without any treatment. Some insects may transmit diseases that require antibiotic treatment.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

American Academy of Allergy Asthma & Immunology. .
Asthma and Allergy Foundation of America. .
Centers for Disease Control and Prevention. .
Environmental Protection Agency. .
Natural Standard: The Authority on Integrative Medicine. .

Integrative therapies

Good scientific evidence:
Calcium: Calcium supplementation is used in the treatment of black widow spider bites to relieve muscle cramping in combination with antiserum, analgesics (pain relievers), and muscle relaxants. Treatment of a black widow spider bite should only be done under the supervision of a qualified healthcare professional.
Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with hypercalcemia (high levels of calcium in the blood), hypercalciuria (high levels of calcium in urine), hyperparathyroidism (high levels of parathyroid hormone), bone tumors, digitalis toxicity, ventricular fibrillation (ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or arrhythmia (irregular heartbeat). Calcium appears to be safe in pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
Unclear or conflicting scientific evidence:
Andiroba: Andiroba (Carapa spp.) oils have been traditionally used to make insect repellant based soaps and candles. High quality clinical research is needed.
Use cautiously in patients with known allergies or known sensitivities to andiroba, Carapa spp., or its constituents. Avoid in patients with known dermatologic sensitivities, as well as in newborns and infants.
Catnip: Early studies have assessed the efficacy of catnip (Nepeta cataria) oil or its constituents as an insect repellent against mosquitoes. These studies have yielded promising results, however, further research is needed to obtain additional data on the level of effectiveness of catnip oil for this application.
Avoid if allergic or hypersensitive to catnip, its constituents, or members of the Lamiaceae family. Use cautiously with psychiatric disorders or if taking medications that affect the central nervous system. Avoid if pregnant or breastfeeding.
Celery: Preliminary research suggests that a celery (Apium graveolens) extract may be an effective mosquito repellent. Additional research is needed in this area.
Use with caution in patients with bleeding disorders or in those taking agents processed by the liver, agents that affect blood pressure, agents that may increase the risk of bleeding, or cholesterol- or triglyceride-lowering agents. Use cautiously in patients who will be exposed to ultraviolet radiation, those with bile secretion disorders, those with misaligned teeth, and those using anticonvulsants, photosensitizing agents, or sedatives (including pentobarbital). Avoid in patients eating large amounts of psoralen-containing foods or herbs. Avoid medicinal amounts during pregnancy. Avoid with known allergy or hypersensitivity to celery (Apium graveolens), its constituents, members of the Apiaceae or Umbelliferae family, or any birch pollen-related antigens. Other chemical compounds related to birch pollen allergens are those found in apple, cherry, hazelnut, carrot, and soybean. Specific reported cross-sensitivities include anise, apple, Artemisia vulgaris pollen, birch pollen, caraway, carrot, chamomile, Chinese bellflower root, coriander, corn, cucumber, cumin, fennel, garlic, grape, grass pollens, hazelnut, hops, latex, legumes, mango, mugwort pollen, nuts, olive pollen, onion, paprika, parsley, parsnip, peaches, peanut, pepper, pineapple, pistachio nuts, poppy, potato, ragweed, rice, spices, sunflower, tomato, watermelon, and zucchini. Symptoms of celery allergy include oral allergy syndrome, eczema (skin rashes), swelling under the skin, skin burn or inflammation when exposed to light, hives, dermatitis (skin inflammation), laryngeal swelling, celery-dependent exercise-induced anaphylaxis (life-threatening reaction), anaphylactic shock (life-threatening reaction), poisoning, and swelling.
Chocolate: Preliminary studies have suggested that cocoa (Theobroma cacao) oil may be an effective insect repellant. However, additional studies are needed in this area.
Chocolate contains relatively high levels of caffeine. Use with caution in patients with addictive tendencies, anemia, cardiovascular disease, endocrine disorders, gastrointestinal disorders, kidney stones, migraine headaches, nervous disorders, respiratory disorders, or skin disorders. Use with caution in those who are overweight or obese or who are pregnant, breastfeeding, or trying to become pregnant. Use with caution in patients using agents that affect blood pressure, agents that affect blood sugar, antimicrobials, birth control pills, blood thinners, ergot derivatives, painkillers, sedatives, and stimulants. Use with caution in children. Avoid with known allergy or sensitivity to chocolate, cocoa, any of its components (including caffeine), or members of the Sterculiaceae family.
Cinnamon: Preliminary evidence suggests that cassia oil (Cinnamomum cassia) may reduce dust mites. Based on human study, cinnamon may be useful as a mosquito repellant. However, well-designed trials are needed before a firm conclusion can be made.
High levels of cinnamon may contain coumarin. Use cautiously if prone to atopic reactions or if taking cytochrome P450 metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, medications that affect the immune system, medications that lower cholesterol, agents toxic to the liver, or cardiovascular agents. Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or Balsam of Peru. Avoid if pregnant or breastfeeding.
Clove: In laboratory and field tests, undiluted clove (Eugenia aromatica) oil repelled multiple species of mosquitoes for up to two hours. However, undiluted clove oil may also cause dermatitis. Further research is needed to better determine the effectiveness of clove as a mosquito repellant.
Avoid if allergic to Balsam of Peru, clove, eugenol, or some licorice and tobacco (clove cigarette) products. Avoid with bleeding disorders and in pediatric patients. Avoid use of undiluted clove oil on the skin. Use cautiously with seizure disorders and kidney or liver dysfunction. Use cautiously in patients with low blood pressure or in those taking drugs that lower blood pressure. Use cautiously in patients taking estrogen. Use cautiously in patients with autoimmune disorders or in those taking drugs that suppress the immune system. Avoid if pregnant or breastfeeding.
Eucalyptus oil: Preliminary research shows that Citriodiol? spray, which contains eucalyptus (Eucalyptus spp.), may reduce the number of tick bites and thereby tick-borne infections. Additional studies are warranted to better determine the effectiveness of eucalyptus oil as a tick repellant.
A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use. Use cautiously if driving or operating machinery. Avoid if allergic to eucalyptus oil or if a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Avoid with history of acute intermittent porphyria (group of genetic disorders in which substances called porphyrins build up in the blood). Avoid if pregnant or breastfeeding due to insufficient evidence of safety.
Garlic: There is currently not enough evidence to suggest that garlic (Allium sativum) is an effective mosquito repellent. According to preliminary research, self-reports of tick bites were significantly less in people who received garlic over placebo (sugar) pills. Further well-designed research is needed to better determine the effectiveness of garlic as a tick repellant.
Use cautiously with history of peptic ulcer disease. Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (like hyacinth, tulip, onion, leek, chive). Avoid with history of bleeding problems, asthma, diabetes, low blood pressure or thyroid disorders. Stop using supplemental garlic two weeks before dental/surgical/diagnostic procedures and avoid using immediately after such procedures to avoid bleeding problems. Avoid in supplemental doses if pregnant or breastfeeding.
Geranium: Geranium (Geranium spp.) is commonly used as a mosquito repellent. Some studies looked at the effects of geranium essential oil when applied to the skin. However, the results were unclear, and further research is required.
Geranium is thought to be safe when applied to the skin to keep insects away or taken by mouth to treat diarrhea. Safety data and reports of side effects are lacking. Use cautiously when drinking tea made from geranium for more than 2-3 weeks. Use cautiously in people who take agents that block nerve impulses and laxatives. Use cautiously in people who have constipation. Avoid in people who are allergic or sensitive to Geranium species or members of the Geraniaceae family. Geranium thunbergii, Geranium nepalense, Geranium wallichianum, and Geranium maculatum are in the U.S. Food and Drug Administration (FDA) poisonous plant database.
Homeopathy: Early studies have produced mixed results on the effect of homeopathy in treating mosquito bites. More studies are needed before a conclusion can be made.
Homeopathy is generally considered safe. In some cases homeopathic practitioners describe side effects as a "healing crisis." Because homeopathic remedies are often specific to the person and condition being treated, it is difficult to make general statements about safety. Some homeopathic preparations may contain arsenic. Reports of serious side effects are lacking. Drowsiness or sedation may occur. Use cautiously if driving or operating heavy machinery. Use all homeopathic medicines cautiously, particularly in women who are pregnant or breastfeeding. Avoid using homeopathy to treat severe or life-threatening conditions. Avoid using homeopathic preparations for which appropriate homeopathic dilution processes are lacking. Avoid using in people who are allergic to ingredients contained in the homeopathic preparation.
Jojoba: There is currently not enough available evidence to make a conclusion on the effectiveness of jojoba (Simmondsia chinensis) oil as a mosquito repellent. In a study investigating the mosquito repellant effects of a combination product containing jojoba oil, the combination product was able to offer complete protection up to three to four hours post-application. As jojoba oil was only one ingredient in this product, the effect of jojoba oil alone cannot be determined.
Avoid if allergic or hypersensitive to jojoba, its constituents or members of the Simmondsiaceae family. Avoid oral consumption of jojoba products. Avoid if pregnant or breastfeeding.
Neem: Neem (Azadirachta indica) oil and neem cream exhibited protective effects against mosquito bites from various species in non-randomized, controlled studies. However, the studies are limited by small sample size and lack of randomization and blinding. Further research is necessary before a conclusion can be reached on the use of neem as a mosquito repellant.
Use cautiously with liver disease. Avoid if allergic or hypersensitive to neem. Avoid in children and infants. Avoid if pregnant or breastfeeding.
Stinging nettle: Limited available clinical study has examined the effectiveness of a topical combination product containing stinging nettle (Urtica dioica) for insect bites. Results did not show a significant reduction in erythema or itching with the nettle-containing cream. Further well-designed clinical trials are required before a firm conclusion can be made.
Use cautiously with diuretics and anti-inflammatory drugs. Use cautiously in the elderly. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Avoid if allergic or hypersensitive to nettle, the Urticaceae family or any ingredient of nettle products. Avoid if pregnant or breastfeeding.
Witch hazel: A homeopathic formulation containing an extract of witch hazel (Hamamelis virginiana) and tinctures of other botanicals was studied for its effects in relieving redness and itching associated with mosquito bites. According to study results, the formulation did not provide effective relief from mosquito bite symptoms. However, because information about the strength or concentration of the witch hazel extract used was not available, and witch hazel was not evaluated alone, conclusions about the effects of witch hazel on symptoms of insect bites cannot be made. Additional research is needed in this area.
Avoid if allergic or sensitive to witch hazel. Avoid if pregnant or breastfeeding. Use cautiously in people with liver or kidney disorders, diabetes, and in children.
Fair negative scientific evidence:
Papain: Limited research investigating the treatment of fire ant bites with papain found a lack of benefit. Additional research is needed in this area.
Use cautiously in people being treated for prostatitis (prostate inflammation) or in those undergoing radiation therapy. Avoid the combination product Wobenzym?, which contains papain, in people with bleeding disorders, or those taking anticoagulants, antiplatelet agents, or other drugs, herbs, or supplements that may increase the risk of bleeding. Symptoms of Coumadin? overdose (increased bleeding) have been reported in a person taking Coumadin? and Wobenzym? that was possibly contaminated with Coumadin?. Avoid in people with gastroesophageal reflux disease, gastrointestinal ulcers, or those using therapy that suppresses the immune system. Avoid in people sensitive to papain or with known allergy or hypersensitivity to papain, papaya (Carica papaya), or other plants or foods that may contain papain.

Prevention

Individuals with a history of anaphylaxis should carry an autoinjectable epinephrine device (known as an EpiPen?) with them at all times.
Learn what biting insects look like and where they live to avoid exposure and limit the risk of getting bitten.
Wear protective clothing that covers the skin when outdoors.
Avoid use of heavy perfumes, sprays, scented soaps, shampoos, lotions, or creams that may attract insects.
Insect repellants can effectively keep away most biting insects.
Citronella, linalool, and geraniol candles have been shown to trap or reduce the number of mosquitoes and may be useful when outdoors.
Mosquitoes are most active at dawn and dusk. Limit time outdoors during these peak times to reduce the risk of being bitten.
Since mosquitoes lay their eggs on the surface of water, remove items around the home (such as buckets and empty flower pots) that collect water.
Ensure that all the screens in the home are installed correctly and repair any holes or tears to prevent biting insects from entering the home.
Individuals should thoroughly check their bodies after being outdoors for possible insect bites.
Individuals who plan to travel to areas where malaria is prevalent, like Africa, Asia, the Middle East, South America, and Central America, should consult their healthcare providers about receiving a malaria vaccine.

Complications

Anaphylaxis:
Some patients who are severely allergic to insect venom may experience a life-threatening allergic reaction called anaphylaxis after being bitten by an insect. Anaphylaxis develops rapidly and affects multiple parts of the body.
The time lapse between the insect bite and anaphylactic symptoms varies among individuals. Symptoms may appear immediately or can be delayed from 30 minutes to one hour after exposure. Symptoms may also disappear and then recur hours later. Once symptoms arise, they progress quickly.
Symptoms of anaphylaxis can vary from mild to severe, and they are potentially deadly. The most dangerous symptoms are low blood pressure, breathing difficulties, shock, and loss of consciousness, all of which can be fatal.
Symptoms of anaphylaxis may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, diarrhea, stomach cramps, chest pain or tightness, cardiac arrest, faint pulse, flushing, angioedema (swelling beneath the skin), trouble swallowing, respiratory arrest, rash, itchy mouth/throat, anxiety, hay fever-like symptoms, red/itchy/watery eyes, headache, nausea, or diarrhea. The body releases histamine during an anaphylactic reaction, which can cause the arteries and air tubes in the lungs to narrow. In severe cases, a rapid drop in blood pressure may cause shock and loss of consciousness.
Anaphylaxis is a medical emergency and treatment must be administered as soon as possible. Epinephrine is a medication used to treat anaphylaxis. Administering epinephrine as soon as possible improves the chances of survival and a quick recovery. Epinephrine opens the airways and raises the patient's blood pressure. Patients may also be admitted to the hospital to have their blood pressure monitored and to possibly receive breathing support.
Other emergency interventions may also include endotracheal intubation (placing a tube through the nose or mouth into the airway) or emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).
Low blood pressure is usually treated with intravenous fluids and sometimes with vasoconstrictive medications, also called "pressors."
Bronchodilator drugs like Albuterol? are used to treat bronchospasms (narrowing of the airways).
After epinephrine and other lifesaving measures are taken, antihistamines (like diphenhydramine) and corticosteroids (like prednisone) may be given to further reduce symptoms.
Individuals with a history of anaphylaxis should carry an autoinjectable epinephrine device (known as an EpiPen?) with them at all times.
Toxic reaction:
A toxic reaction occurs when the insect venom acts like a poison in the body. The reaction may occur after one bite from a highly toxic insect or spider, or after several bites from multiple insects or spiders. Symptoms of a toxic reaction are similar to an allergic reaction and may include nausea, fever, swelling at the bite site, fainting, seizures, diarrhea, weakness, lightheadedness, muscle spasm, headache, vomiting, shock, and even death.
In most cases, symptoms resolve on their own within 48 hours. Toxic reactions are rarely serious, but they occasionally sensitize children. Individuals who become sensitized will experience allergic reactions to the insects or spiders in the future.
It is possible to have both a toxic reaction and an allergic reaction at the same time.
Serum sickness:
Serum sickness is a rare reaction to antivenin, which may be used to treat certain spider bites. The body's immune system mistakes a protein in the antivenin as a potentially harmful substance (antigen). The body then develops an immune response against the antivenin. Patients may experience fever, joint pain, hives and flu-like symptoms hours or days after treatment. Patients who experience symptoms of serum sickness should consult their qualified healthcare providers. Patients who have serum sickness usually recover completely with treatment within seven to 28 days.
Antihistamines like diphenhydramine HCL (Benadryl?) may be used to relieve itching that is associated with serum sickness. Corticosteroids like prednisone (Deltasone?, Orasone? or Sterapred?) have been used to reduce inflammation associated with serum sickness. Treatment usually lasts about two weeks. Doses should gradually decrease as symptoms clear up. Symptoms may reappear in severe cases if steroids are stopped too soon. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin? or Advil?) have been used to decrease inflammation and reduce fever.

Types of insect bites

Bed bugs:
Overview: Bedbugs are small, brown, flattened insects that feed on the blood of animals and humans. The Cimex lectularius species is most likely to affect humans.
Adult bedbugs are about 1/4 inch long and reddish brown, with flat oval bodies. The nymphs (immature bedbugs) look similar to the adults, but they are smaller and lighter in color. While bedbugs cannot fly, they can crawl quickly.
Female bedbugs lay up to five eggs a day in secluded areas. These whitish-colored eggs are difficult to see without magnification. Bedbugs molt (shed their skin) five times before reaching adulthood. Before each molt, the bugs eat a blood meal.
Bedbugs are able to withstand harsh living conditions. Nymphs can survive months without food, while adults can survive for more than a year without eating. If a home becomes infested with these insects, extermination by a professional is almost always necessary.
The feces of bedbugs will appear as dark spotting and staining. Bloodstains may also appear on bed linens after they feed on the host.
Since bedbugs are active during the night, most bedbug bites occur while people are sleeping. Once the bugs pierce the skin, they become engorged (full) in about 3-10 minutes. Bites are typically painless, and most hosts do not even realize they are being bitten.
Symptoms vary among individuals. Many people develop an itchy red welt or localized swelling, which may develop a day or two after the bite. Others have little or no reaction. Bedbugs feed on any bare skin that is exposed while sleeping. Bedbugs are generally unlikely to transmit diseases to humans, and they are not considered a serious health threat.
Bedbug infestations were common in the United States before World War II. Improvement in hygiene and widespread use of DDT (Dichloro-Diphenyl-Trichloroethane, an insecticide that is no longer available in the United States) during the 1940s and 1950s led to a drastic decline of infestations. However, bed bugs are starting to become more prevalent the United States, especially in apartments, homes, hotels, motels, dormitories, and shelters. The bugs are commonly found in other parts of the world including Africa, Asia, Central and South America, and Europe.
Symptoms: Bedbugs feed on any bare skin that is exposed, including the face, neck, shoulders, feet, arms, and hands. Many people develop an itchy red welt or localized swelling, which may appear a day or two after the bite. Others experience little or no reaction.
Diagnosis: A healthcare provider can diagnose bedbug bites after a physical examination and confirmation of the bugs' presence. Patients should look for specks of blood on bed linens and behind wallpaper. Fecal stains may also be visible. Areas of high infestation may also have an intense sweet odor that is caused by bedbugs' oil secretions.
Treatment: Treatment focuses on alleviating symptoms. Bedbugs will need to be exterminated in order to prevent symptoms from recurring. A professional exterminator should be consulted when there is a bedbug infestation. Bed linens should be washed in hot water to kill the insects. Oral antihistamines like diphenhydramine (Benadryl?) have been used to relieve the itching associated with bedbug bites. Hydrocortisone cream or ointment may also be applied to the skin to relieve itching and irritation.
Black widow spider:
Overview: Out of the approximately 20,000 species of spiders found in North, South and Central America, only 60 can bite humans. Black widow spiders are about a half-inch long. The two species that commonly inhabit the United States are the southern black widow and northern black widow. The southern black widow has a shiny, black abdomen with a red hourglass shape on the underside. The northern black widow has red, yellow, or white spots on the upper and underside surface of its abdomen. Some spiders also have red legs.
Black widow spiders are nocturnal (active at night) and they are typically found in dark areas. Only female black widows can bite humans; they only bite when they feel threatened, disturbed, or provoked, according to researchers.
The black widow spider venom affects the victim's nervous system. Some people experience mild symptoms while others may have a severe reaction.
Symptoms: A black widow spider bite is painful. The severity of symptoms after the bite depends on the age and overall health of the victim. Children and elderly individuals are more likely to experience more serious symptoms than healthy adults. Individuals may experience pain at the bite site, which is often followed by severe muscle cramps, weakness, abdominal pain, and tremors. Severe reactions may cause lightheadedness, dizziness, chest pain, difficulty breathing, increased heart rate, increased blood pressure, nausea, and vomiting. Patients who experience severe symptoms should seek medical attention immediately.
Diagnosis: A diagnosis can only be confirmed after a physical examination and medical history. The healthcare provider will also consider the likelihood of a bite, which depends on whether the spider lives in the area of the country where the patient was bitten.
Treatment: Treatment is not generally needed because symptoms will resolve on their own. Severe cases may be treated with narcotics and antivenin (antitoxin to counteract the effects of the spider venom).
The antivenin used to treat black widow spider bites is made from horse serum (clear fluid portion of blood). The antivenin is produced from a horse that has developed antibodies and is immune to the spider's venom.Some experts suggest that antivenin be used in any severe bite because one dose of the antivenin quickly relieves symptoms. However, others only suggest antivenin in children, the elderly, and in those with severe underlying medical conditions.
Patients who receive antivenin may experience allergic reactions to the horse serum. Therefore, patients should be skin-tested for a possible allergy prior to treatment.
Since antivenin may not be readily available at most hospitals, there may be some delay in obtaining it.
Brown recluse spider:
Overview: Brown recluse spiders are found in the Midwestern and Southeastern United States.
Brown recluse spiders have a violin pattern on the back of their cephalothoras (body part to which the legs attach). These spiders may range in color from yellowish-tan to dark brown. The name of the genus, Loxosceles, means six eyes. Unlike most other spiders, which have eight eyes, the brown recluse has six.
The spiders live in large numbers, and they are commonly found in dark, warm, dry environments, such as attics, closets, and basements. These spiders only bite humans when they feel threatened, disturbed, or provoked. Bites are most likely to occur during the summer.
The brown recluse venom is more potent than rattlesnake venom. However, the spider's venom causes less severe reactions than a rattlesnake because much smaller quantities are injected into its victims.
The venom is made of enzymes that destroy the tissues of its victims. This allows the spider to suck up and ingest the body parts of the insects it preys on. When the spider bites a human, the venom causes tissue death in the areas immediately surrounding the bite site.
The venom also causes an immune response in humans. The immune system releases inflammatory chemicals such as cytokines, histamines, and interleukins. These chemicals signal white blood cells to flood to the bite site. However, in rare but severe cases, the inflammatory chemicals may cause serious adverse reactions in the human, including the destruction of red blood cells and platelets, blood clots in capillaries, kidney failure, coma, and death. Death has only been reported in children younger than seven years old.
Symptoms: Initially, the bite site becomes red and fang marks might be visible. The bite mark typically has a "bull's-eye" appearance (red ring around the site, which often becomes blistered). Symptoms usually develop two to eight hours after the bite. Some patients may experience a minor burning sensation at the bite site. Patients may experience severe pain at bite site, as well as severe itching, fever, muscle pain, nausea and vomiting. After about 12-48 hours, the blistered bite mark may turn bluish and then black in color, as the skin tissue dies.
Diagnosis: Reliable clinical tests to diagnose a brown recluse spider bite are lacking. A diagnosis can only be confirmed after a physical examination and medical history. The healthcare provider will also consider the likelihood of a bite, which depends on whether the spider lives in the area of the country where the patient was bitten.
Treatment: There is no antivenin available in the United States to treat brown recluse spider bides. Controversial therapies include steroids and the antibiotic dapsone (Avlosulfon?). These therapies are controversial because they have little proven benefit. These are typically reserved for patients with severe systemic diseases (such as certain types of anemia, blood clotting problems, and kidney failure). Most wounds, especially necrotic lesions (dead tissue), will need to be monitored by a healthcare provider every day for at least three to four days. The doctor may remove dead tissue to reduce the likelihood of secondary bacterial infections.
Oral antihistamines like diphenhydramine (Benadryl?) may be used to decrease the histamine reaction. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin? or Advil?), may be used to decrease the pain and inflammation at the bite site.
Chiggers:
Overview: Chiggers are the parasitic larvae of the harvest mite. While the adults are harmless to humans, the larvae are parasites to many animals, including birds, livestock, reptiles, and humans. Chigger bites only occur during the late summer and early autumn because this is when the larvae are active.
Chiggers are found in many parts of the world, including the southern United States. Chiggers typically live in brush and grassy areas. Females lay up to 400 eggs in damp areas on the ground.
Once the eggs have developed into larvae (chiggers), they move to the tips of grasses. When a potential host, such as a rodent or human passes by, the chigger latches on. The chiggers then move to protected areas on the host, such as under socks or under belts.
Chiggers pierce the skin, especially near hair follicles. When they pierce the skin, they secrete digestive enzymes from their saliva and then they suck up and ingest the liquefied host tissues. The rash and intense itching that develops after a chigger bite is an allergic reaction to their salivary secretions. Once the larva is fully fed, it drops off the host.
These insects generally do not transmit diseases, but they are known to carry "scrub typhus" in certain parts of Asia.
Symptoms: After a chigger is fully fed, it will drop off the individual. Three to six hours after a bite, patients develop a red, itchy welt that has a white center. The welt may develop into dermatitis (dry, itchy, flaky skin). Some patients may also experience fever and swelling. Depending on the sensitivity of the patient, symptoms may last for weeks. Patients should not scratch the bite mark because it may break the skin and potentially lead to secondary infections.
Diagnosis: A qualified healthcare provider can diagnose chigger bites after examining the patient's rash. Chiggers cause a distinctive red welt, with a hard central area on the skin that itches.
Treatment: Hydrocortisone cream has been applied to the affected area to temporarily relieve itching. Hydrocortisone 1% cream, which is available over-the-counter, has anti-inflammatory effects, and relieves swelling and redness in addition to itching. Antipruritic agents like calamine lotion (Calamox?) have been applied to the skin to relieve itching.
Mosquitoes:
Overview: Mosquitoes have long, slender bodies, and long, thin legs. The males, and occasionally, the females, eat nectar and other plant juices. However, the females of most mosquito species need to have a blood meal to mature their eggs, which are laid on the surface of water.
The female mosquito inserts a thin proboscis (tubular, feeding, and sucking organ) into the victim's skin. The mosquito injects saliva into the host. This prevents the victim's blood from clotting as it is sucked into the insect's abdomen. Mosquitoes feed until they are full or brushed away by the victim.
The mosquito's saliva causes an allergic reaction in humans that causes the bite site to itch and swell.
Mosquitoes are potentially dangerous because they can carry diseases such as malaria and the West Nile Virus (WNV). The Anopheles mosquito can transmit malaria. Malaria is an infectious disease of the red blood cells. The disease is most common in tropical and subtropical areas, such as Africa, Asia, the Middle East, South America, and Central America.
The WNV causes a viral infection of the brain called encephalitis. The infection is considered a seasonal epidemic in Northern America. Outbreaks typically occur during the summer and fall months.
Eastern equine encephalitis (EEE) is a virus found in freshwater swamp birds and mosquitoes. It is occasionally transmitted to horses, and very rarely, to people. EEE affects the brain and central nervous system. The risk of contracting EEE is highest in mid to late summer.
Symptoms: Mosquito bites usually cause swelling, itching, and burning at the bite site. A bite may take several days to heal and stop itching.
Symptoms of malaria include cycles of chills, fever, and sweating every one, two, or three days if the infection is not treated. Some individuals may also experience diarrhea, jaundice (yellowing of the skin and eyes), coughing, nausea, and vomiting.
According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 80% of patients who are infected with WNV experience no symptoms. If symptoms do develop, they typically occur three to 14 days after being bitten by an infected mosquito. Mild symptoms may include fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach, and/or back. Mild symptoms can last anywhere from a few days to several weeks. Severe symptoms may include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. Severe symptoms may last several weeks and neurological effects may be permanent.
Symptoms of EEE include fever, stiff neck, and headache starting between two and 10 days after infection. Encephalitis followed by coma is possible. Patients who survive suffer mild to severe neurological complications.
Diagnosis: Mosquito bites are harmless, unless the insect transmitted a disease such as malaria or WNV.
Patients who have traveled to areas of the world where malaria is common and who experience symptoms of malaria should consult their qualified healthcare providers. A diagnosis of malaria can be confirmed after a blood test. Since malaria is a cyclic virus, two samples taken at six- and 12-hour intervals can confirm the presence of malaria.
A diagnosis of WNV or EEE can be made after the virus is identified. A sample of blood and spinal fluid is analyzed for the viral DNA.
Treatment: Antipruritic agents like calamine lotion (Calamox?) have been used to relieve itching. Oral antihistamines like diphenhydramine (Benadryl?) are also commonly used to relieve the itching associated with mosquito bites.
Malaria is treated with one or more antimalarials including: chloroquine (Aralen?), quinine (Quinamm? or Quiphile?), hydroxychloroquine (Plaquenil?), Mefloquine (Lariam?), doxycycline (Doryx?, Vibramycin?), a combination of sulfadoxine and pyrimethamine (Fansidar?), or a combination of atovaquone and proguanil (Malarone?).
There is currently no cure for WNV. However, since most patients experience no symptoms, treatment is not usually necessary. Patients who experience severe symptoms may need to be hospitalized and receive intravenous (IV) fluids. Some patients may also need to have breathing tubes inserted into their airways to help them breathe.
There is currently no cure for the EEE virus in humans. Medical treatment focuses on treating symptoms of the infection. Treatment options may include antibiotics to treat secondary infections, anticonvulsants to treat seizures, a respirator for assisted breathing, and corticosteroids to reduce swelling in the brain.
Ticks:
Overview: Ticks are external parasites that feed on the blood of animals and humans. These arachnids (invertebrates that have four pairs of legs and simple eyes) are usually found in tall grasses or bushes. There are two main types of ticks: hard ticks and soft ticks. Hard ticks, such as the common dog tick and the deer tick, have a hard shell just behind the mouthparts, while soft ticks do not. Soft ticks rarely affect humans because they prefer to feed on birds or bats.
Once the tick has reached its host, it will attach firmly and draw blood until full (engorged), and then it will drop off.
In general, ticks do not cause serious health problems, unless they carry a disease. However, in rare cases, the tick itself can cause temporary paralysis in some patients. Symptoms include numbness, tingling, weakness, lack of coordination, and spreading paralysis. Once the tick is removed, symptoms will disappear.
Internationally, there are more 30 major tick-borne diseases. The most common disease transmitted by ticks is Lyme disease, which is a bacterial infection that that may lead to arthritis, as well as neurological and heart-related problems.
Symptoms: Some people may have a mild allergic reaction and experience symptoms such as swelling, itching, and reddening at the bite site. In rare cases, a severe and potentially life threatening allergic reaction called anaphylaxis may occur. Another rare symptom is temporary paralysis, which may occur in sensitive patients. Symptoms of tick-induced paralysis include numbness, tingling, weakness, lack of coordination, and spreading paralysis. Once the tick is removed, symptoms will subside and the patient will fully recover.
In the United States, Lyme disease is caused by the bacteria called Borrelia burgdorferi,which is carried by deer ticks. These ticks are brown and usually about the size of the head of a pin. Patients who have Lyme disease typically develop a rash with a bull's eye appearance at the bite site (red ring around the bite mark). Symptoms may also include flu-like symptoms, joint pain and swelling, inflammation of the meninges surrounding the brain, Bell's palsy (temporary paralysis on one side of the face), numbness or weakness in the limbs, poor muscle movement, and memory loss. Some patients may develop heart-related problems, such as irregular heartbeat, several weeks after infection. These symptoms typically only last a few days or weeks. Other less common symptoms include eye inflammation, severe fatigue, and hepatitis (inflamed liver).
Diagnosis: If Lyme disease is suspected, a qualified healthcare provider may conduct an enzyme-linked immunosorbent assay (ELISA) and a Western blot test to determine whether the patient has the disease. An ELISA test is used to determine whether the patient has developed antibodies to B. burgdorferi. During the procedure, a sample of the patient's blood is sent to a laboratory for testing. If antibodies to the B. burgdorferi are present in the patient's blood sample, the test solution will have an intense color reaction generated by the attached enzyme. If results are positive, a Western blot test is performed to confirm a diagnosis because ELISA may produce false-positive results.
Treatment: Patients should remove ticks promptly with tweezers after they are discovered. If the tick is difficult to remove, rub a petroleum jelly (Vaseline?) or paint nail polish over the tick. These products will kill the tick. Patients should consult their healthcare providers if they are unable to remove the tick. Once the tick is removed, patients should thoroughly wash the bite site and their hands with soap and water. Patients should observe the bite site for the next several days. If a bull's eye rash develops around the bite site, a qualified healthcare provider should be consulted immediately.
Oral antihistamines like diphenhydramine (Benadryl?) are usually taken to decrease the histamine reaction in the body.
Patients who have Lyme disease usually receive oral antibiotic treatment with doxycycline (Vibramycin?) for adults and children who are at least eight years old. Younger children typically receive treatment with amoxicillin (Amoxil?, Prevpac?, Trimox?) or cefuroxime axetil (Ceftin?). Treatment generally lasts 14-21 days.
Patients who have late-stage Lyme disease typically receive intravenous antibiotics like ceftriaxone (Rocephin?) for 14 to 28 days. Symptoms of late-stage Lyme disease include chronic joint inflammation, Bell's palsy, memory loss, and irregular heartbeat. Side effects of treatment may include low white blood cell count, gallstones, and mild to severe diarrhea.
According to the U.S. Food and Drug Administration (FDA), bismacine, also known as chromacine, should not be used to treat Lyme disease. Alternative medicine practitioners sometimes prescribe bismacine for the treatment of Lyme disease. Bismacine contains high amounts of bismuth, a heavy metal that is used in some medications taken by mouth to treat Helicobacter pylori (a bacteria that can cause stomach ulcers). Although bismuth is considered safe when used in some oral medications to treat stomach ulcers, it is not approved as an intravenous medication or to treat Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure. In March 2005, one patient was hospitalized after receiving a bismacine treatment and in 2006, one person died after treatment, according to the FDA.

Insect repellants

General: Many types of insect repellents are available in the United States. The U.S. Centers for Disease Control and Prevention (CDC) recommends the use of products containing active ingredients like DEET (N, N-diethyl-meta-toluamide), picaridin, permethrin, and oil of lemon eucalyptus that have been registered with the U.S. Environmental Protection Agency (EPA) for use as repellents applied to skin and clothing.
DEET: DEET (N, N-diethyl-meta-toluamide) is the active ingredient in many insect repellent products. According to the EPA, insect repellents containing DEET are not a health concern, as long as consumers follow the label directions and take necessary precautions.
DEET is used to repel biting insects like mosquitoes and ticks. On average, about one-third of Americans use DEET each year, according to the EPA. Products containing DEET are currently available to the public in many different types of liquids, lotions, sprays, and impregnated materials (such as wrist bands). DEET-containing products that are applied to the skin are made with 4-30% DEET. If used as directed (as a personal insect repellant), DEET is not likely to adversely affect aquatic or terrestrial wildlife, according to the EPA.
Picaridin: Picaridin, which is nearly odorless, offers protection against insect bites equal to DEET at similar concentrations. In addition, picaridin prevents mosquitoes from locating individuals who have applied the repellant.
Permethrin: Permethrin is primarily used to treat lice and permethrin-containing products are highly effective as insecticides and repellents, according to the EPA. Insect repellants that contain permethrin (like Permanone?) may be applied to clothing, shoes, and camping equipment to help reduce the risk of insect bites. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other arthropods (like spiders). Permethrin treated clothing is still effective after repeated washings.
Oil of lemon eucalyptus: Oil of lemon eucalyptus is a plant-based chemical. This ingredient, according to the EPA, may offer protection that is comparable to low concentrations of DEET.
Others: Shorter-acting repellents, such as the oil of geranium, lemon grass, cedar, soy, or citronella, may offer limited protection against insect bites.
EPA safety recommendations: Repellents should only be applied to exposed skin and/or clothing. These products should not be used under clothing. Do not apply to eyes or mouth, or to cuts, open wounds, or irritated skin. Apply sparingly around ears. Do not spray repellents directly onto the face. Instead, spray the repellant onto the hands and gently rub onto the face. Heavy application is not needed for effectiveness. After returning indoors, wash treated skin with soap and water. Patients who experience side effects or allergic reactions after exposure should wash the repellent off with mild soap and water and call a local poison control center and physician's office for further instructions. Keep repellants out of reach of children.