Laboratory of dermatovenerology

Medical faculty of Pattimura University

INSECT BITE
REACTION
Wahyu syafiah
SUPERVISOR :
Dr. Hanny Tanasal, Sp.KK
 INTRODUCTION

 Cutaneous reactions to arthropod bites are inflammatory and/or

allergic reactions.
 Insect hipersensitivity is caused by bites, stings and contact with
insect body.
 The vast majority of reactions to arthropod bites or stings
depend upon the presence in the host.

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  Systemic allergic reactions to insect stings affect up to 5% of the
population during their lifetime, with only 2% who might develop
cardiorespiratory arrests.
 Common occur during summer
 These rates vary between countries

EPIDEMIOLOGY 214 cases in 40 deaths

indonesia are reported
diagnosed as annually in
insect bites the US

16 to 18 in France

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 1. Arachnida

Acarina (mites and ticks) Sarcoptes scabiei (scabies). Demodex folliculorum and
D. Brevis (demodicidosis)

ETIOLOGY
Aranea (spider): loxosceles reclusa or brown recluse spider. Latrodetus or
 5 of 9 classes of widow spiders.
arthropods cause
local and systemic
reactions associated
with their bites : Scorpionida

Figure 1. Lone star tick6 Figure 2. a). Brown recluse spider, b). Black widow6 Figure 3. Centruroides scorpion6

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 2. chilopoda • centipede

• Milipede
3. diplopoda
• caterpillar

Etiology

figure 5. a). Seedleback Catepillar, b). Milipede6

figure 4. Centipede6

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 4.INSECT Anoplura : Phthirius pubis

Cleoptera : bedbugs

Diptera : musquito

Etiology Hemiptera : kutu busuk

Hymeniotera : ant, bee

Figure 6. Differences between arachnida and insect7

Lipidoptera : butterfly

Siphonatera : kutu, tuma

atau kutu tanah

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 1. Direct contact
 Example : cattepillar
Pathogenesis  Irritation is produced by contact of the hairs with the skin.
 Toxins in the hairs can produce severe pain, local pruritic
erythematous macules, and wheals, depending on the species.
Arthropods produce their
effects on the skin by a
variety of mechanisms
The venoms
contain histamine, has direct effect
urticating
histamine on mast cells,
properties of these
liberators, leading to
caterpillars
serotonin and degranulation
proteases

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 2. sting
 Bee and scorpion can inject the venom contains anaphilactogenic,
Brown recluse hemolitic, antigenic, sitolitic dan neurotoxic that can cause
spider oedem, necrosis or urticaria of the skin and anaphylaxis reaction.
 Bee venom contains histamine, mellitin, hyaluronidase, a high
molecular weight substance with acid phosphatase activity, and
The venom contains a phospholipase A.
phospholipas enzyme,
sphingomyelinase D,
which is the major
toxin.
3. Bites
 Example : spider
the major cause of
necrotic arachnidism
in the US.
 Many spider venoms are not well characterized

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 Clinical manifestation
Insect bite reaction is
characterized by an intensely
pruritic eruption at the bite
sites immediately to minutes
to hours to days after the bite, In some cases, systemic
persisting for days to weeks, symptoms may occur,
ranging from mild to
manifested by solitary or severe, with death
grouped: occurring
from anaphylactic shock.
- Urticarial papules
- Papulovesicles Figure 10. bullous lession in insect bites8

- Bullae

Figure 9. a). and b). papular urtikaria

In insect bites2
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 Acarina (mites and ticks)
1. scabies
 Sarcoptes scabiei (scabies)
causing scabies in humans
 Itching is usually the most
obvious manifestation of
scabies.
Clinical  It is generally worst at night
and when the patient is warm.
manifestation  The onset occurs 3–4 weeks Figure 11. Scabies predilection site2
after the infection is acquired,
and coincides with a
widespread eruption of
inflamatory papules.
 A vesicle or pustule containing
the mite may be noted at the
end of the burrow

Figure 12. Scabies in the hand2

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 The brown recluse spider (Loxosceles
reclusa

In the localized type of reaction, known as necrotic

cutaneous loxoscelism, extensive local necrosis develops

A painful severe edematous reaction occurs within the first

8h
Figure 12. Brown Recluse Spider Bite6

development of a bulla with surrounding zones of

erythema and ischemia.

Accociation with maculopapular exantem, fever, headache,

malaise, arthralgia and nausea/vomiting manifestation.

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  Widow spiders inject neurotoxin (α-latrotoxin) that can cause lokal
reaction and/or mild to severe sistemik reaction

Black widow  Often the bite is barely noticed and only tiny dots mark the site.
 Within few minutes, however, the patient experiences intense pain,
spider associated with cramping, muscular rigidity and variety of other
symptoms including diaphoresis, nausea, vomiting, resiratory
difficulty or evem respiratory arrest.

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 The venom causes pain, paresthesia, and variable swelling at the site of the
sting.

SCORPION
The neurotoxic
venom may produce numbness at the sting site, laryngeal
edema, profuse sweating and salivation, cyanosis, nausea, and
paresthesia of the tongue.

Death may occur from cardiac or respiratory

failure, especially in children.

Figure 13. centruroides scorpion6

Renal and hepatic toxicity

may also occur.

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 Musquito Midges Bedbugs
INSECT • Bites usually • Bites produce • They commonly
present as papular immediate pain occur on the face
urticaria on with erythema at and neck, hands
exposed sites; bite site with 2- to and arms, but may
• Reactions can be: 3-mm occasionally be
urticarial papulovesicles, generalized
followed by • In the individual
eczematous
indurated nodules not sensitized by
granulomatous (up to 1 cm) previous exposure,
Figure 14. Bedbug bite persisting for there may be no
many months. symptoms at any
stage, and only a
purpuric macule
indicates the site
of the bite.

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 House Fly
Larvae deposited into any exposed
skin site (ear, nose, paranasal
sinuses, mouth, eye, anus, and
grow into maggots, which can be
vagina) or at any wound site (leg
seen on surface of wound
ulcers, ulcerated squamous and
basal cell carcinomas, hematomas,
umbilical stump)

Figure 15. Wound myasis, magot of the housefly2

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 BEE, HORNET OR WASP
 Female bee, hornet, or wasp sting producing immediate
burning/pain, followed by intense, local, erythematous reaction
with swelling and urticaria.
 Severe systemic reactions occur in individuals who are sensitized,
with angioedema/generalized urticaria and/ or respiratory
insufficiency from laryngeal edema or bronchospasm and/or
shock.

Fire and harvester ants

 produce local skin necrosis and systemic reactions to sting;
 Bite reaction begins as an intense local inflammatory reaction that
evolves to a sterile pustule.

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 Caterpillar/moth
 Caterpillar / moth contact can produce
burning/itching sensation, papular
urticaria, irritation due to histamine
release, allergic contact dermatitis,
and/or systemic reactions.
 Wind-borne hairs can cause
keratoconjunctivitis. Figure 16. Caterpillar site7

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 medicamentosa preventif

 Insect bite can be treated based on

the clinical manifestation. Steroid
topical, analgetic and anti-
histamin may be used.  Avoid contact with arthropods.

 Potent topical glucocorticoids  Apply insect repellent

TREATMENT given for a short time are helpful
for intensely pruritic lesions. In
 Use passive measures such as
screens, nets, clothing.
some cases, a short tapered
course of oral glucocorticoids can  Treat flea-infested cats and dogs;
be given for extensive cutaneus spray household with insecticides
reaction that are persistent. (with special attention to
baseboards, rugs, floors,
 Secondary Infection : Antibiotic upholstered furniture, bed frames,
treatment with topical agents such mattresses, and cellar).
antistaphylococcal/
antistreptococcal agents if
secondary infection is present.

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 SCABIES
 Benzyl benzoate.
 10% sulphur
The treatment of
 Malathion 0.5%
choice for anaphylaxis  Permethrin 5%
is intramuscular  Ivermectin
epinephrine
(adrenaline) (in adults,
a dose of 0.5 ml 1 :
ANT
1000 solution should
be administered  ice pack, oral antihistamine and
topical antipruritics or
corticosteroids may help.
 Secondary infection is so common
that oral antibiotics are sometimes
prescribed.
 If multiple bites are present, the
patient should be monitored for
more serious problem
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BEE
 The management of bee or
wasp sting is depent on the
presence or absence of
sensitization.
 Normal host  th stinger
should be removed if still
present.
 First aid meassure, such as
applying ice to reduce the
spread of toxin + topical
antipruritic agent or
corticosteroid suffice.
 More severe reaction 
pastient must be handled just
as in any other anaphylactic
reaction.
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 Brown recluse spider
 For mild reaction, systemic
antihistamines and antibiotics
along with tetanus prophylaxis
are sufficient.
Spider bite  Recommendations ncluse
surgical exicion, systemic
corticosteroids and dapsone,
but none of these boardly
accepted.
 If the disease advances,
standard supportive care for
the hematologic problems is
needed; an unfortunate few
require renal dialysis.
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Black widow spider
 Cooling the bite site with an ice
cube, attemting to remove
venom with suction, and
applying a tourniquet are all
appropiate first-aid measures
 Children, the elderly and
patient with cardiovascular
problems should be
hospitalized
 Serum antivenom is available
 10% calcium gluconate
solution (10 ml intravenously)
appears to be the best
approach for cramping ;
muscle relacants may also
help.
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 milipede

 Skin lesions should be

washed with copious
Scorpion amounts of water to remove
Treatment of any remaining secretions,
 Ice packs should be applied
scorpion sting  The area cleaned with alcohol
 the injection of local (a solvent of benzoquinones)
and milipede anaesthetic around the sting if available.
site will help to reduce the
pain.  Blisters should be treated
with a topical antiseptic.
 Specific antivenoms are
available.  If the ocular injuries present
 should be dealt with by an
ophthalmologist.

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 THANK YOU

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