How To Diagnose And Treat Insect Bites And Stings

By Gary Dockery, DPM, and Stephen Schroeder, DPM

There are abundant crawling and flying insects that infest, bite and sting humans, particularly on the foot and ankle regions. At this time of the year, people may be particularly susceptible to bites from ants, fleas, ticks and spiders. Other possible problems may include infestations with scabies and stinging insects.
There are various types of ants that can inflict different levels of bites and stings. The three main stinging and biting ants are fire, harvester and pharaoh ants.
The fire ant is common in the southeastern United States and Caribbean islands. Its sting causes immediate pain that quickly resolves and leaves a cluster of cutaneous lesions. Small red wheals form and convert to vesicles within three to four hours. After 24 hours, the lesions typically are pustules with a red rim and will resolve in about 10 days. Multiple ant stings may cause a more serious systemic allergic reaction. Treatment includes cool compresses, antipruritic lotions, oral antihistamines and scrupulous cleansing of the area to prevent secondary bacterial infection.

Harvester ants are found in the southern portion of the U.S. They are large (up to 1 cm long), red-brown and sometimes winged ants. Like fire ants, they are ferocious stingers that swarm in large numbers. The stings can be nasty. They usually sting multiple times and the stings tend to form a linear pattern. Unlike the lesions left by fire ants, the lesions of the harvester ant do not form pustules and they usually clear within a few days. Treatment is symptomatic only.
The pharaoh ant is found in the warm southern states. This small brown ant may inflict a small but painful sting that is considered milder than that of other ants. The area typically stays red for several days before resolving and often resolves with no treatment.

How To Remedy Flea Bites
The flea is a blood-sucking parasite from the order Siphonaptera, which contains two important groups or families: Pulicidae (human, dog, cat and bird fleas) and Tungidae (true sand fleas). Fleas found on beaches on the East Coast of the U.S., in Mexico and in the Caribbean islands are frequently called “sand fleas” but they are almost always of the Pulicidae family rather than the Tungidae family. The Tungidea fleas are more common in South America, Africa and the West Indies.
The human, dog, cat and bird fleas will all feed on humans. Fleas are small, reddish-brown to black, hard-bodied, flat-sided, wingless insects that have the ability to jump about two feet. The adult flea can survive for several months without eating. They live in rugs, furniture, sand, grass and pet sleeping areas.
Human attacks from pet fleas are more often acquired from the furniture or carpet region than from the pet itself. Most pet fleas prefer their host animal but will bite humans in the same house. An increase in flea bites is sometimes noticed when the pet is lost or gone from the living area. Flea bites frequently occur on the lower extremities in irregular clusters because the flea likes to sample several adjacent areas while feeding. Individuals at the beach often get multiple flea bites about the feet and ankles while sitting in the sand.
Fleas also feed in a characteristic linear pattern of three to four bites in a row. These papules may have a hemorrhagic center and be intensely pruritic.

Treatment begins with topical corticosteroids for the pruritus and oral antihistamines for the sensitized individual. In order to eliminate the fleas and larvae from the living environment, one must utilize insecticide sprays and powders for all suspected flea breeding and living grounds.

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