Insect Bites & Stings, and Pediculosis Objectives  Identify signs and symptoms of insect bites and stings and pediculosis  Provide non pharmacologic treatment options for insect bites and stings and pediculosis  Recommend appropriate nonprescription therapy for insect bites and stings and pediculosis given patient specific presentation and history  Recognize when self case is not appropriate – (when to refer to primary care provider) Insect Bites  Nonvenemous Insects  Mosquitoes  Fleas  Bedbugs   Nonvenemous Arachnid  Ticks  Chiggers  Scabies 

Mosquitoes  Found worldwide  More abundant in warm, humid climates  Most prevalent in early morning and at dusk  Land on skin → inject anticoagulant saliva  Causes welt, itching (“mosquito bite”)  Complications  Mosquitoes transmit more diseases to humans than any other biting insect  Malaria  West Nile Virus  Dengue Fever  Yellow fever Fleas  Tiny bloodsucking insects, found worldwide  Breed best in humid climate  Bites in humans common when:  Moving into vacant flea-infested habitat  Living with infested pets  Bites usually multiple, grouped  Erythematous region, intense itching  Legs, ankles in humans  Complications  Transmission of disease  Bubonicplague  Endemictyphus Bedbugs  Hide during the day, bite victims at night  Hide in bedding, crevices of walls, floors, furniture, picture frames, folds of linens, corners of suitcases  Bite emits anesthetic and anticoagulant  Increased concern of bedbug infestation in the US with growing mobility of society  Places frequented by travelers (hotels)  Bites  Clusters of 2s and 3s, straight line  Exposed areas of skin: head, neck, arms  Reactions vary – depend on sensitivity of individual  Irritation at the site → small dermal hemorrhage  Currently no link to spread of diseases Ticks  Feed on human and animal blood  Mouthparts of tick are introduced into the skin during “feeding”  Able to hold firmly  Tick should be removed within 36 hours  Use fine tweezers, grasp near head and gently pull  If mouthparts are left behind when tick is removed → Intense itching, nodules  Do not use heating methods, do not paint anything onto tick  If not removed  Tick fully engorged with blood remains attached up to 10 days before dropping of  Local reaction: itching papules → disappear within 1 week Tick Complications (systemic)  Lyme Disease  Caused by bacteria found in Deer ticks  Transmitted after tick attached for 36 hours  Acute: flu-like symptoms, rash  Rash: papule → enlarged circle with clear center (“bull’s- eye”)  Tender lesions 3-22 days after bite  Disappear within 3-4 weeks  If untreated → neurologic symptoms, cardiac disturbances  Rocky Mountain Spotted Fever  Transmitted by Wood ticks or Dog ticks  Severe headache, rash, high fever, extreme exhaustion Chiggers 