Insect Bites and Diseases Quiz
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Questions and Answers

What percentage of individuals infected with West Nile virus experience flu-like symptoms?

  • 30%
  • 10%
  • 20% (correct)
  • 40%

    • Which of the following is NOT a characteristic of flea bites?

  • Grouped bites on the legs
  • Blisters on exposed skin (correct)
  • Found in humid climates
  • Intense itching

    • What is a common misconception regarding the incidence of bedbug bites?

  • They are attracted to pets.
  • They bite at night and deposit eggs during the day.
  • Bites often appear in clusters or straight lines.
  • Bites can appear immediately on the skin. (correct)

    • Which of the following statements about tick bites is true?

    <p>Tick mouthparts can remain in the skin, causing intense itching.</p> Signup and view all the answers

    Which insect is primarily associated with the transmission of the bubonic plague?

    <p>Flea</p> Signup and view all the answers

    What is the most common age group affected by pediculosis in the United States?

    <p>3-12 years</p> Signup and view all the answers

    What type of reaction do mosquitoes typically induce in their victims?

    <p>Localized swelling and itching</p> Signup and view all the answers

    Which factor contributes to increased encounters with biting and stinging insects?

    <p>Outdoor exposure</p> Signup and view all the answers

    Which group of individuals is particularly at risk for severe allergic reactions to insect stings?

    <p>Children less than 2 years of age</p> Signup and view all the answers

    What is the first step in the non-pharmacologic treatment of insect stings?

    <p>Remove stinger and venom sac</p> Signup and view all the answers

    Which treatment is recommended for monitoring allergic reactions to insect stings?

    <p>Follow up on the same day if possible</p> Signup and view all the answers

    What is a potential sign indicating a severe allergic reaction that requires immediate medical attention?

    <p>Difficulty breathing and weakness</p> Signup and view all the answers

    What is an important preventative measure to avoid insect stings?

    <p>Avoid brightly colored clothes and fragrances</p> Signup and view all the answers

    Which medication is commonly used for treating mild allergic reactions to insect stings?

    <p>Oral diphenhydramine</p> Signup and view all the answers

    What should be the follow-up for non-allergic reactions to insect stings?

    <p>Follow up within 7 days</p> Signup and view all the answers

    Which symptom indicates a need for immediate medical attention during treatment?

    <p>Developing secondary infection</p> Signup and view all the answers

    What is the most effective method of preventing tickborne diseases?

    <p>Cover skin with clothing</p> Signup and view all the answers

    Which repellent ingredient is considered the most efficacious?

    <p>N, N-diethyl-m-toluamide (DEET)</p> Signup and view all the answers

    What type of sting is associated with repeated stinging due to a non-barbed stinger?

    <p>Yellow jacket stings</p> Signup and view all the answers

    Which symptom is NOT associated with fire ant bites?

    <p>Localized numbness</p> Signup and view all the answers

    What is a potential severe reaction to bee or wasp stings?

    <p>Anaphylaxis</p> Signup and view all the answers

    After how much time can delayed local inflammation occur following a sting?

    <p>1-2 weeks</p> Signup and view all the answers

    What is a common misconception about insect repellents?

    <p>Higher concentration ensures complete protection</p> Signup and view all the answers

    What is a key step to minimize mosquito exposure during specific times of day?

    <p>Limiting time outside at dawn and dusk</p> Signup and view all the answers

    Which option is NOT a recommendation for preventing insect bites?

    <p>Washing shoes frequently</p> Signup and view all the answers

    What is a common symptom associated with Lyme disease?

    <p>Bull’s eye skin rash</p> Signup and view all the answers

    Which condition is NOT a reason for medical referral after a spider or tick bite?

    <p>Age over 2 years old</p> Signup and view all the answers

    Which of the following is true about chigger bites?

    <p>Chigger larvae cause cellular disintegration</p> Signup and view all the answers

    What treatment goal is essential for insect bites?

    <p>Relieve swelling and itching</p> Signup and view all the answers

    What should be avoided when removing a tick?

    <p>Applying a hot nail or match</p> Signup and view all the answers

    Which symptom is associated with a black widow spider bite?

    <p>Severe muscle spasms</p> Signup and view all the answers

    What is the recommended duration for using an ice pack on a bug bite?

    <p>10 minutes on, 10 minutes off</p> Signup and view all the answers

    Which of the following is a common effect of spider bites?

    <p>Erythematous lesion</p> Signup and view all the answers

    Which insect is known for its myth of burrowing into the skin?

    <p>Chiggers</p> Signup and view all the answers

    What may result from scratching an insect bite?

    <p>Secondary bacterial infection</p> Signup and view all the answers

    What is one of the contraindications for using phenol as a local anesthetic?

    <p>It should not be applied extensively or under compresses.</p> Signup and view all the answers

    How often should topical antihistamines be applied for effective pain relief from insect bites?

    <p>3-4 times per day.</p> Signup and view all the answers

    What is a potential risk when using hydrocortisone 1% for insect bites?

    <p>It should not be used by pregnant women without supervision.</p> Signup and view all the answers

    What effect does camphor have when applied topically?

    <p>It depresses cutaneous receptors causing an anesthetic effect.</p> Signup and view all the answers

    Which of the following statements about topical antihistamines is incorrect?

    <p>Skin absorption can cause significant systemic side effects.</p> Signup and view all the answers

    What type of product is zinc oxide classified as?

    <p>A skin protectant.</p> Signup and view all the answers

    Which statement regarding the application of corticosteroids is true?

    <p>Hydrocortisone 1% should be used for minor insect bites.</p> Signup and view all the answers

    Which application guidance is relevant for counterirritants like menthol?

    <p>Apply multiple times up to 7 days.</p> Signup and view all the answers

    What is an important follow-up recommendation after self-treatment?

    <p>Seek medical advice after 7 days if no improvement occurs.</p> Signup and view all the answers

    What instructions should be given regarding the storage of ticks after removal?

    <p>Save them in a sealed bag for future identification.</p> Signup and view all the answers

    Study Notes

    Bites, Stings, and Pediculosis

    • Objectives
      • Identify exclusions for self-care treatment
      • Compare and contrast clinical presentations and treatments of bites, stings, and pediculosis
      • Describe strategies to prevent bites, stings, and pediculosis
      • Apply disease state and therapeutic knowledge to patient case(s)

    Epidemiology

    • Very common in outdoor exposure
    • Local reactions
    • 0.5-3% experience systemic allergic reactions
    • In the US, more people die from insect stings than bites from venomous animals combined
    • Biting and stinging insect encounters are typically brief
    • Pediculosis and scabies remain infesting the host until eradicated
    • 10-12 million people in the US are affected by pediculosis annually
    • Most common in children aged 3-12 years

    Insect Bites

    • Flea Bites
      • Blood-sucking insects
      • Breed well in humid climates
      • Flea-infested habitats or pets
      • Many bites grouped together, often on legs or ankles
      • Intense itching
      • Transmit diseases such as bubonic plague and endemic typhus
    • Bedbug Bites
      • Deposit eggs during the day and bite at night
      • Crevices of walls, floors, furniture, bedding
      • Increased incidence in travelers/hotels
      • Resistance to common pesticides
      • Bites appear in clusters, sometimes in a straight line
      • Often on head, neck, and arms
      • Mild skin irritation to small dermal hemorrhages and intense itching
    • Mosquito Bites
      • Abundantly found worldwide, especially in humid and warm climates
      • Vectors for spreading infections (West Nile virus, Zika viruses, Chikungunya)
      • 20% of West Nile-infected patients experience flu-like symptoms
      • Inject anticoagulant saliva into victims
      • Characteristic welt/itching
      • May progress to a larger blister or urticarial reaction with systemic symptoms
      • Anaphylaxis is rare
    • Tick Bites
      • Feed on the blood of humans and animals
      • Mouthparts introduced into the skin enabling a firm hold
      • Left attached for up to 10 days before detaching
      • Intense itching and nodules requiring surgical excision can occur if mouthparts remain in place
      • Local reaction: itching papules that disappear within one week
      • Transmission of systemic diseases (rocky mountain spotted fever, Lyme disease)
    • Chigger Bites
      • Known as "Red Bugs"
      • Live in shrubs, trees, and grass
      • Attach to skin around edges of tight-fitting clothes
      • Larvae inject digestive fluid causing cellular disintegration, clusters of red papules, and intense itching
      • Fluid hardens to form a tube where chigger stays to feed, then drops off into an adult
    • Spider Bites
      • All are venomous, but most cannot penetrate the skin
      • Exceptions are black widows, brown recluses, and hobo spiders
      • Death is rare, but symptoms can be serious
      • Erythematous lesion, itching, slow healing wound, delayed intense pain
      • Severe symptoms: muscle spasms, abdominal disturbances, fever, chills, dyspnea, necrotic ulceration

    Assessment

    • Spider or tick bites: need medical referral
    • Seriousness of reaction should be evaluated before non-prescription or non-pharmacological measures are recommended
    • Exclusions for self-treatment include hypersensitivity to insect bites, systemic symptoms, age less than two years, history of tick bite and systemic effects indicating infection, suspected spider bite, signs of secondary infection in the bite area
    • Treatment Goals:
    • Relieve swelling, pain, and itching
    • Prevent scratching that may lead to secondary infection (e.g., impetigo)
    • Monitor for infections transmitted by ticks
    • Prevent future insect bites

    Non-Pharmacological Treatment

    • Avoid insect bites
    • Apply ice pack wrapped in a washcloth (10 minutes on, 10 minutes off)
    • Avoid rough clothing over bite areas
    • Removing ticks (within 36 hours of attachment): use fine tweezers, avoid heating methods or ointments.
    • After removal: clean with rubbing alcohol or soap and water; save the tick in a sealed bag.

    Pharmacological Treatments

    • Local Anesthetics
      • Reversible blockade of nerve impulses at the application site
      • Options include benzocaine, pramoxine, benzyl alcohol, lidocaine, dibucaine, phenol
      • Apply 3-4 times daily up to 7 days; avoid extensive use, topical compresses or bandages
      • Relatively nontoxic when applied as directed; may cause allergic contact dermatitis
    • Topical Antihistamines
      • Exert anesthetic effect by depressing cutaneous receptors
      • Provide temporary pain and itching relief
      • Applied 3-4 times daily up to 7 days
      • Diphenhydramine is frequently used but absorption is limited to only providing local, not systemic effects
      • Cautions for use with extensive areas and young children include photosensitivity and hypersensitivity
    • Counterirritants
      • Applied 3-4 times daily up to 7 days
      • Camphor (0.1-3%) and menthol (<1%) decrease cutaneous sensory/pain receptors thus causing local anesthetic effect
      • Relieves itching and irritation
      • DO NOT INGEST
    • Corticosteroids
      • Hydrocortisone 1% used for temporary relief of minor insect bites
      • Apply 3-4 times daily for up to 7 days
      • Caution for use in patients with scabies, infections, and fungal infections
    • Skin Protectants
      • Reduce inflammation and irritation (zinc oxide, calamine)
      • Apply as needed up to four times per day; safe and effective in 1-25% formulations
      • Recommended for adults, children, and infants

    Dosage Forms

    • Patient's preference should guide recommendations; various topical medications are available

    Evaluating Patient Outcomes

    • Follow up after 7 days of self-treatment
    • Seek medical attention if:
      • Redness, itching, or localized swelling worsens during treatment.
      • Secondary infections, fever, joint pain, or lymph node enlargement.
      • Symptoms persist beyond 7 days

    Prevention

    • Cover as much skin as possible with clothing and avoid densely wooded areas and swamps
    • Keep pets free of pests; remove standing water from homes and yard
    • Limit outdoor time in the early morning and evening
    • Shower 2 hours after coming indoors
    • Apply insect repellent (Permethrin 0.5% treat clothing and gear)
    • Avoid wearing perfume or scented lotions, brightly colored clothing and control odors in garbage and picnic areas; wear shoes when outdoors, destroy nests of stinging insects near home

    Insect Repellents

    • Insect repellents prevent biting insects, but not stinging insects.
    • Repellent selection is based on ingredients (concentration, formulation, type, and length of exposure, patient considerations)
    • Common types include N, N-diethyl-m-toluamide (DEET) (5-100% concentrations), 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl esters (IR3535) and picaridin.
    • Plant-based repellents such as lemon eucalyptus oil (OLE), catnip oil, and 2-unecanone also exist

    Insect Stings

    • Which Insect Stung Me?
      • Honeybees: Sting when threatened, leave behind stinger
      • Wasps: Legs dangle when flying, don't leave stinger,
      • Yellow Jackets: Nest on the ground, don't leave stinger, can cause skin infections
      • Fire Ants: Sting multiple times quickly
      • Hornets: Yellow and white-faced, nests resemble paper mache
    • Bee, Wasp, Hornet, and Yellow Jacket Stings
      • Venom has histamine release (more so than wild honeybees)
      • Stings are repeated from wasps, hornets, and yellow jacket because they are not barbed.
    • Fire Ant Bites/Stings
      • Introduced from South America, live underground, colonies are prevalent in southeastern part of US.
      • Symptoms include sharp stinging, redness, mild swelling, and can be lead to vesiculation, tissue necrosis, and anaphylaxis
      • Further symptoms include pain, burning, redness, swelling, itching, and small bump/blister
    • Clinical Presentation
      • Occurs 10-15 minutes after the sting (no longer than 6 hrs) and involves pain, itching, and irritation
      • Allergy can present with hives, itching, swelling, burning sensations
      • Anaphylaxis (rare- 3% adults and 1% children): Hypotension, light headedness, chest tightness, difficulty breathing, loss of consciousness
      • Toxic reaction
      • Delayed local inflammation (1-2 weeks after sting)
    • Assessment
      • Exclusions for self-treatment: Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing, previous severe reaction to insect bites. Significant allergic response away from the site, previous sting by honeybee, wasp or hornet, Personal or family history of allergic reactions, children less than 2 years
    • Treatment Goals
      • Relieve swelling, pain, and itching of insect stings
      • Monitor for any reaction to the sting
      • Prevent future insect stings

    Non-Pharmacological Therapy

    • Remove stinger and venom sac (scrape away with fingernail or credit card blade, minimizes venom flow)
    • Apply antiseptic after stinger removal(alcohol or hydrogen peroxide)
    • Apply ice packs in 10-minute intervals
    • Avoid scratching the affected area

    Pharmacologic Treatment

    • Same topical options as bites
    • Oral diphenhydramine (25-50 mg per dose for adults)
    • Mild analgesics

    Severe Allergic Reactions

    • Avoid future insect stings
    • Wear a medical bracelet or carry a card
    • Carry injectable epinephrine
    • Intramuscular epinephrine
    • Corticosteroids and antihistamines for treatment
    • Discharge and follow-up with allergist if necessary

    Evaluation of Outcomes

    • Follow up within 10 days for non-allergic reactions
    • Seek medical attention for significant skin irritation or excessive exposure to eyes or mucous membranes
    • Symptoms of lice infestation after secondary treatment and resistance to pyrethrins or permethrin

    Prevention of Ectoparasites (e.g. Lice)

    • Head Lice:
      • Avoid direct head-to-head contact
      • Avoid sharing personal items (combs, hats, scarves, etc.)
      • Visual inspection to confirm before treatments
      • Resistant to treatments, refer to healthcare provider to obtain prescription
    • Body Lice:
      • Live and hide in clothes and seams; transmit infectious diseases, such as typhus and trench fever
    • Pubic Lice:
      • Transmitted high-risk sexual contact
      • Found in the pubic area of the body

    Non-pharmacological treatments for Ectoparasites

    • Wash clothing and bedding in hot water (130F or higher) and dried in clothes dryer; for 2 week period if garments cannot be laundered, seal the clothing and bedding in a plastic bag
    • Wash combs, hairbrushes, and toys at least 10 minutes in hot water.
    • Vacuum carpets, rugs and upholstered furniture regularly; avoid using insecticidal sprays
    • Complete head shaving
    • Body lice controlled through appropriate hygiene, and frequent changing and laundering of clothing and bed linens; ensure that clothing washed or dried using high heat.

    Pharmacological treatments for Ectoparasites

    • Synergized Pyrethrins (applied as shampoos, foams, solutions or gels)
      • Can be used with head and pubic lice
      • Avoid eye and mucous membrane contact for 10 minutes and Rinse or shampoo as recommended, follow with lice comb, repeat in 7-10 days, do not apply more than twice in 24 hours
    • Permethrin (synthetic pyrethroid, 1% cream rinse/lotion)
      • Use for head lice only, disrupts sodium channel, delays repolarization and causes paralysis of lice
      • Cover or saturate washed hair and scalp with quantities; leave in for 10 minutes before rinsing, comb with lice comb, retreatment in 7-10 days (not required unless active lice detected)
      • Avoid contact with eyes and mucous membranes, contraindicated in infants younger than 2 months

    Summary

    • The majority of treatment for bites, stings, and pediculosis is non-pharmacological.
    • It is vital to recognize patients who need to be seen by a medical provider.

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    Bites, Stings, and Pediculosis - 2023 PDF

    Description

    Test your knowledge on the various factors associated with insect bites and the diseases they can transmit. This quiz covers topics such as the West Nile virus, flea bites, bedbugs, and pediculosis. Enhance your understanding of insect-related health issues.

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