Arthropod Bites and Stings



  • Arthropods are the largest division of the animal kingdom. Two classes, insects and arachnids, have the greatest impact on human health.
  • Arthropods affect humans by inoculating poison, microorganisms, or irritative substances through a bite or sting; by invading tissue; or by contact allergy to their skin, hairs, or secretions.
  • Transmission of infectious microorganisms during feeding is of the greatest concern.
  • Sequelae of bites, stings, or contact include
    • Local redness with itch, pain, and swelling: common, usually immediate and transient
    • Large local reactions that increase over 24 to 48 hours
    • Systemic reactions with anaphylaxis, neurotoxicity, organ damage, or other systemic toxin effects
    • Tissue necrosis or secondary infection
    • Infectious disease transmission: Presentation may be delayed weeks to years.



  • 33,671 cases of arthropod exposures were reported in 2016. This is a small fraction of arthropod encounters.
  • Systemic reactions to Hymenoptera venom occur in 0.5–3.3% of population and most fatalities involve those with no prior allergic reaction.

Widespread, with regional and seasonal variations

Etiology and Pathophysiology

  • Arthropods: four medically important classes
    • Insects: Hymenoptera (bees, wasps, hornets, fire ants), mosquitoes, bed bugs, flies, lice, fleas, beetles, caterpillars, and moths
    • Arachnids: spiders, scorpions, mites, and ticks
    • Chilopods: centipedes
    • Diplopods: millipedes
  • Four general categories of pathophysiologic effects: toxic, allergic, infectious, and traumatic
    • Toxic effects of venom: local (tissue inflammation or destruction) versus systemic (neurotoxic or organ damage)
    • Allergic: Antigens in saliva or venom may cause local inflammation. Exaggerated immune responses may result in anaphylaxis or serum sickness.
    • Trauma: Mechanical injury from biting or stinging causes pain, swelling, and portal of entry for bacteria and secondary infection. Retention of arthropod parts can cause a granulomatous reaction.
    • Infection: Arthropods may transmit bacterial, viral, and protozoal diseases.

Family history of atopy may be a factor in the development of more severe allergic reactions.

Risk Factors

  • Previous sensitization
  • Certain outdoor activities, occupations, and travel exposures increase risk.
  • Greater risk for adverse outcome in young, elderly, immunocompromised, and those with chronic or poorly controlled cardiac or respiratory disease
  • Increased risk of anaphylaxis in patients with mastocytosis

General Prevention

  • Avoid common arthropod habitats.
  • Insect repellents (not effective for bees, spiders, scorpions, caterpillars, bed bugs, fleas, ants)
    • N,N-diethyl-meta-toluamide (DEET)
      • Most effective broad-spectrum repellent against biting arthropods (1),(2)[A]
      • Formulations with higher concentrations (20–50%) are first-line choice in areas of endemic arthropod-borne diseases (2)[A].
      • Concentrations >30% have longer duration of action. No significant protection benefits with DEET concentrations >50%.
      • Safe for children >6 months of age; pregnant and lactating women (2)[B]
    • Picaridin (icaridin)
      • 20% spray comparable to 20% DEET for mosquito protection (2)[A]
    • P-menthane-3,8-diol (PMD; lemon eucalyptus extract)
      • 30% concentrations give 4 to 5 hours of protection against mosquitoes and ticks (1)[A].
      • Not recommended for children <3 years old
    • IR3535: less effective in most studies; not appropriate for malaria-endemic regions (1)[B]
  • Barrier methods: clothing, bed nets
    • Wear long pants, long-sleeved shirts, and hats.
    • Permethrin: synthetic insecticide derived from chrysanthemum plant. Do not apply directly to skin. Permethrin-impregnated clothing provides good protection against arthropods and is safe for children of all ages and for pregnant women.
    • Mosquito nets: advised for all travelers to disease-endemic areas at risk from biting arthropods. Permethrin-treated nets may offer additional protection (2)[B].
  • Desensitization 75–95% effective for Hymenoptera-specific venom
    • Skin tests to determine sensitivity
    • Refer to allergist/immunologist.
  • Fire ant control (but not elimination) possible
    • Baits; sprays, dusts, aerosols; biologic agents
  • Risk of tick-borne diseases may be decreased by prompt removal of ticks within 24 hours of attachment.

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