MICROBIOLOGY II

(PPAS 240)

Mr. Kwabena Oppong

ENVENOMATION BY BITING AND STINGING ARTHROPODS
 INTRODUCTION
• Arthropod bites and stings are a significant cause of morbidity
worldwide.
• Although many arthropod attacks produce only mild, transient
cutaneous changes, more severe local and systemic sequelae can
occur, including potentially fatal toxic and anaphylactic reactions.
• Arthropods also serve as vectors for numerous systemic diseases.
• The medically significant classes of nonaquatic arthropods are
Arachnida (spiders), Chilopoda (Centipedes), Diplopoda
(Millipedes), and Insecta (Insects).
• Arthropods can infest human skin, especially scabies and head lice.
• They can inflict bites and stings.
• They can carry diseases such as malaria, yellow fever and filariasis.
• They can give rise to allergic conditions such as hay fever, asthma
and atopic eczema.
SCORPIONS
• Scorpions are terrestrial arachnids most commonly encountered in tropical or
arid regions.
• Scorpions are nocturnal creatures, which seek shelter under stones and other
coverings during the day. As with other arachnids, scorpions are generally shy
and sting humans only when provoked.
• Although capable of producing significant local wounds, the potential for
serious, even lethal, cardiovascular complications following a scorpion sting
remains of primary concern.

Clinical findings
• Scorpion stings usually produce an immediate, sharp, burning pain.
• This may be followed by numbness extending beyond the sting site.
• Regional lymph node swelling, and, less commonly, ecchymosis (discoloration
of the skin resulting from bleeding underneath) and lymphangitis
(inflammation of the lymphatic system), may develop.
• Venom of some species contains a powerful neurotoxin, capable of producing
muscle spasticity, nystagmus, blurred vision, slurred speech, excessive
salivation, respiratory distress, pulmonary edema, and myocarditis.
• Infants and young children are at the greatest risk for serious complications.
Management
• Mild scorpion envenomation may only require symptomatic treatment,
including analgesics and local ice compresses.
• Any child stung by a scorpion should be hospitalized for close monitoring of
respiratory, cardiac, and neurologic status.
• Critically ill patients with neurotoxic effects of scorpion envenomation can
benefit greatly and promptly with intravenous administration of scorpion-
specific F(ab′)(2) antivenom. Lack of it may have serious consequences.
• Although serum sickness is common after antivenom infusion, it is usually
self-limited and can be managed with antihistamines and corticosteroids.
CENTIPEDES

• Centipedes have one pair of legs per body

segment, and are nocturnal carnivores
that may produce extremely painful bites
with a pair of poisonous claws.
• In addition to severe pain and erythema
following a bite, localized sweating,
edema, secondary infection, and
ulceration may be seen. There are also
case reports of proteinuria, acute
coronary ischemia, and myocardial
infarction following centipede bite.
• Treatment consists of analgesia, including
injection of local anesthetics,
antihistamines, and tetanus prophylaxis.
Antibiotics may be required to treat
secondary infection.
MILLIPEDES

• Millipedes have two pairs of legs per body

segment, and usually feed on living and dead
plant matter.
• They lack poison claws and neither bite nor
sting. However, millipedes possess
repugnatorial glands on either side of each
segment and may emit a toxic substance if
threatened.
• The oily, viscous liquid can cause a brownish
discoloration of the skin that can persist for
months and may produce burning and
blistering.
• Severe reactions are mainly seen in tropical
species. Some species are capable of squirting
the toxin several inches. This can result in
various eye lesions including periorbital
edema, periorbital discoloration,
conjunctivitis, and keratitis.
• Although ophthalmologic evaluation should
be considered for eye exposures, thorough
immediate cleansing with soap and water is
Venomous and non-venomous bites and stings
• Insect bites and stings can be divided into two groups: venomous and non-
venomous.
• A small number of spiders are also venomous.

Venomous insects
• A sting is usually an attack by a venomous insect that injects toxic and painful
venom through its stinger as a defence mechanism. Venomous insects
include:
• Bee
• Wasp
• Hornet
• Yellow jacket
• Fire ant
Venomous spiders

• Venomous spider bites are rare but

have potentially
• serious systemic neurotoxicity
(eg. Lactrodectus species),
• or usually local, cytotoxic effects
(eg. Loxosceles species).
• The majority of household spiders
are harmless. However,
identification of the offending
spider is essential to determine
management.
 Non-venomous insect bites
• Non-venomous insects pierce the skin to feed on blood. This usually results in
intense itching. Non-venomous insects that bite include:
• Mosquito
• Flea
• Tick
• Bed bug
• Louse
• Scabies
Caterpillars and moths
• Some caterpillars and moths have irritating hairs and sharp spines, causing
stinging, short-lasting papular urticaria, dermatitis and allergic reactions.
 CLINICAL FEATURES OF ARTHROPOD BITES AND STINGS
• The reaction to encounter with an arthropod depends on the species involved,
whether it carries disease, and individual factors such as host immunity.
• A venomous sting from a bee or wasp usually causes a stinging sensation or
pain with redness and swelling of the area. Sensitization to the venom affects
response.
• A large localized reaction causes swelling to spread more widely over several
hours.
• severe and rapidly developing systemic hypersensitivity reaction that is
associated with the skin rash (Anaphylaxis ) results in immediate abrupt and
short-lived swelling of the skin and mucous membranes (angioedema),
urticaria and bronchospasm, which can be life-threatening.
• An insect bite presents as one or more intensely itchy papules on a body site
exposed to the insect.
• The papule usually subsides within a few hours.
• It may have a central clear or haemorrhagic blisters and persist for several days.
• Scratching results in an open sore.
 Complications of arthropod bites include:

• Secondary infection with staphylococci and/or streptococci (impetigo,

cellulitis)
• Papular urticaria: Papular urticaria is a hypersensitivity reaction, most often
in a young child due to fleabites and/or mosquito bites. New bites are
accompanied by reactivation of old ones and present as symmetrical crops of
itchy urticated papules. Papular urticaria resolves with the development of
immunological tolerance.
• Persistent insect bite reaction: Solitary persistent insect bite reactions can
be urticarial, bullous, vasculitic or granulomatous.
• Arthropod-borne infections
• Diseases in which specific arthropods are the vector occur worldwide but are
particularly prevalent in tropical and developing regions.
• They include:
• Parasites: malaria, leishmaniasis, trypanosomiasis
• Bacteria: Lyme disease, plague, bacillary angiomatosis, relapsing fever,
tularaemia, typhus, babesiosis.
• Viral disease: dengue fever, chikungunya fever, zika fever
Diagnosis of Arthropod Bites and Stings
• Generally people are aware of bites, especially if they have observed the
arthropod, but occasionally they are not. The clinical appearance is usually
typical.
• Skin biopsy can be suggestive if it shows central punctum, eosinophilic
spongiosis, and a wedge-shaped mixed dermal infiltrate distributed around
the sweat ducts/glands.
 Treatment - Stings
• If the reaction is mild, insect stings should be treated by first removing the
stinger. This is necessary as the stinger continues to pump venom from its sack
until it is empty or removed.
• Place a firm edge against the skin next to the embedded stinger.
• Apply constant firm pressure and scrape across the skin surface to remove the
stinger. This is preferred to using tweezers or fingers, which can accidentally
squeeze more venom into the patient.
• Clean the site with disinfectant.
• Apply ice or cold pack to reduce pain and swelling. Topical steroid cream or
calamine lotion may be applied several times a day until symptoms subside. If
necessary, oral antihistamines can also be taken.
• If an insect sting causes a severe reaction or anaphylaxis, urgent medical
attention should be sought. If a patient is known to have an allergy to insect
stings they may carry with them an allergy kit containing adrenaline
(epinephrine).
Treatment - Bites

• The main treatment aim of insect bites is to prevent itching.

• Cool the affected area.
• Apply topical calamine lotion or local anaesthetic agent.
• Oral antihistamine reduces itch and weals.
• Use moderate potency topical steroids for papular urticaria or persistent
reactions.
• Bites from insects carrying disease may require specific antimicrobial
therapy to treat the disease.
 Prevention of arthropod bites and stings
• Wear fully covering clothing.
• Keep windows and doors closed at night.
• Avoid perfume and bright-coloured clothing to reduce the risk of bee stings.
• Control odours at picnics and garbage areas that can attract insects.
• Destroy or relocate hives or nests close to the home.
• Drain pools of stagnating water that attract mosquitoes.
• Use electrical insect repelling devices and lit coils.
• De-flea cats, dogs and other household pets regularly.
• Apply insect repellents containing DEET (diethyltoluamide) to exposed skin.
• Apply permethrin to clothing for 2-week protection, through two wash-cycles.
It can also be applied directly to exposed skin keeping the insects away for a
few days.