Recognizing And Treating Insect Bites And Stings In Athletes

By Mark A. Caselli, DPM

What You Should Know
About Fire Ant Stings
In the southern United States, particularly the Gulf region, the imported fire ants, Solenopsis richteri and S. invicta, account for many thousands of stings each year. As much as 40 percent of the population in infested urban areas may be stung each year and at least 30 deaths have been attributed to these insects.
The fire ant grasps the skin with its jaws while it pivots and stings repeatedly with its abdominal stinger in a circular fashion. You may see two red puncta at the center of the stings. Immediate pain results but it quickly resolves. Small red wheals form and convert to vesicles within three to four hours. After 24 hours, the lesions typically become pustules with an erythematous rim. These pustules resolve in about 10 days. Multiple ant stings may cause a more serious systemic allergic reaction similar to those caused by other Hymenoptera species. These ants commonly bite the feet and lower legs.
One should treat the bite area with cool compresses, antipruritic lotions and oral antihistamines, and scrupulously clean the area to prevent secondary bacterial infection.

Recognizing The Symptoms Of Tick Bites
Ticks are blood-sucking ectoparasites that typically live in grass, brush and wooded areas. Athletes are usually infested on the legs and feet while hiking or jogging through heavy grass or in the woods. The tick bite is usually inconsequential by itself, but the tick may act as a carrier of several organisms that may cause rickettsial, spirochetal, bacterial and parasitic infections. The tick bite itself is usually painless and may go unnoticed until the patient discovers a lump or notices a local reaction of an urticarial wheal or the formation of a pruritic area around an embedded tick.
Some of the more important conditions that might affect the outdoor athlete include Rocky Mountain spotted fever and Lyme disease.
Rocky Mountain spotted fever occurs in many parts of the United States but is prevalent in Oklahoma, Texas and the South Atlantic states. This condition is caused by Rickettsia rickettsii transmitted in the tick bite. The infection is seasonal. Most cases are reported between April 1 and Sept. 30, which corresponds to the increased activity of ticks. The principal vector in the western states is the wood tick Dermacentor andersoni. In the eastern states, it is the dog tick Dermacentor variabilis. In the south central states, it is the Lone Star tick Amblyomma americanum.

The tick will transmit the disease after it has been attached for at least six hours. The incubation period ranges from three to 12 days. The onset of early symptoms is abrupt with fever, chills, headache, myalgia, arthralgia and generalized rash. The rash usually appears first on the wrists and ankles. The forearms, palms and soles become involved within hours at which time the symptoms become generalized.

A Guide To Treating Tick Bites
Treatment involves immediately removing the tick once it has been identified. Tick removal requires care and should not be performed with the fingers because of the danger of contracting a rickettsial infection. The proper technique for tick removal is to use forceps, tweezers or a thread attached as close as possible and pull upward with steady even pressure for several minutes until the tick is removed. Take care not to squeeze the tick’s body, which will cause infectious fluids to enter the skin. Do not rotate or twist the tweezers during the removal process because this may allow the forepart of the tick to break off within the skin.
If the mouth parts do not come away or portions are left in the skin, remove them with a small punch biopsy. Do not apply hot water or heat packs since heat tends to induce the tick to regurgitate infected fluids into the skin. If the mouth parts are left below the skin surface, they may produce a nodule known as a tick bite granuloma. Once the tick has been removed, cleanse the area well with warm water and soap and disinfect it with isopropyl alcohol. Additional treatment should include doxicycline (except for pregnant women) or chloramphenicol for pregnant women. Continue therapy for at least three days after fever subsides.

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