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Causes and Effective Management of Insect Bites in the UK

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Causes and Effective Management of Insect Bites in the UK KNOWLEDGE WOUND CARE SUPPLEMENT Marion Richardson, BD, CertEd, RGN, RNT, DipN, is senior lecturer Causes and effective management and programme leader, emergency of insect bites in the UK nursing, University of Hertfordshire Insects play an important role in maintaining the site of bites and, worldwide, mosquitoes transmit Marion Richardson describes world’s ecosystem (Zhu and Stiller, 2002) but many diseases from one bitten host to the next. These include the causes of insect bites of them feed on other animals. Humans are relatively malaria, yellow fever, dengue fever (acute arbovirus and the management of this hairless and provide an easy target, especially when infection), lymphatic filariasis (caused by the lymphatic uncomfortable problem partly clothed (Cohn, 2003). Biting insects common filarial parasites), and encephalitis (Zhu and Stiller, 2002). to the UK include midges, gnats, mosquitoes, flies, West Nile virus is the most likely mosquito-borne fleas, lice, mites, ticks, and bedbugs (Fig 1). disease in the UK. It is uncommon because the KEY WORDS population density of mosquitoes is relatively low Insects Although their bites rarely cause serious problems, the (Prodigy, 2003). In most people the infection is Bites salivary gland excretions they deposit contain various asymptomatic or causes a mild influenza-like illness. It Inflammation antigenic substances that may provoke a reaction in may cause encephalitis or aseptic meningitis, especially susceptible people (Prodigy, 2003). in people aged over 50 (Prodigy, 2003; Crook et al, 2002). Insect habits and habitats Midges Only female midges attack, often in swarms at Bedbugs These are nocturnal blood-sucking parasites sunrise or sunset and with a higher frequency in that feed at night. During the day they hide in seasons with increased humidity (Cohn, 2003). Midges mattresses and bed covers, and in cracks in walls, are rarely vectors of disease. floors and furniture, where they can survive for more than a year without a suitable food source (Fletcher et Scabies These mites are found either on animals or in al, 2002; Zhu and Stiller, 2002). Bedbug bites do not stored goods. They mate on the skin and the female usually cause reactions. burrows into the epidermis, usually on the hands, wrists or elbows, leaving a small opening and a linear burrow. Fleas These live on small rodents, bats, birds and pets, Scabies causes severe itching, especially at night, not and move from them to feed on humans. Most flea bites only at the burrowing sites but also over much of the are not associated with disease transmission though rat body. Secondary bacterial infection is a complication fleas can transmit plague (Zhu and Stiller, 2002). (Zhu and Stiller, 2002). Body lice These live on clothing and move to nearby Ticks These are blood-sucking parasites that may body areas to feed. Pubic or crab lice live in the pubic embed in the human skin (Storer et al, 2003). They are or perianal areas – both are blood-feeding parasites. found in woodland areas with plentiful wildlife (Cutler, Body lice bites can cause allergic hypersensitivity, 1997) and are especially prevalent in spring and early erythematous papules (small elevated palpable lesions), summer. Ticks often attach in obscure areas such as pruritus (itching), swelling, excoriation, behind the ear (Storer et al, 2003) and once attached, lymphadenopathy and conjunctivitis. Crab lice rarely may feed for many weeks in preparation for egg-laying cause these conditions (Zhu and Stiller, 2002). (Howell, 2001). Tick bites often cause local allergic reactions such as Mosquitoes There are many species of mosquito. The eczematous changes, urticaria, blistering, and temporary females need a blood meal to produce eggs but males alopecia (hair loss). Susceptible people may have a feed on plant nectar. Skin reactions are common at the delayed hypersensitivity reaction including symptoms of REFERENCES BOX 1. BITES AND SUGGESTED CAUSES (ADAPTED FROM PRODIGY GUIDELINES, 2003) ATTRACT (2003) Question: I have a patient with possible tick bites. LOCATION SUGGESTED CAUSE Wales: NHS Wales. www.attract. wales.nhs.uk Abdomen and thighs – from animal sitting on lap Cheyletiella mite Burns, D.A. (1998) Diseases Below knees and most profuse around ankles. Cat or dog fleas caused by arthropods and other noxious animals. In: Champion, Clusters of a bite found elsewhere on the body if the person has been R.H. et al (eds) Textbook of lying on an infested rug or sofa Dermatology. Oxford: Blackwell Scattered all over the body Bird fleas, bird mites or bedbugs (Burns, 1998) Science. Cohn, B.A. (2003) Biting midges – Patterned areas around the elastic of clothing Lice or fleas those marauding ‘no-see-ums’. International Journal of Primarily on exposed areas Mosquito and fly bites Dermatology; 42: 6, 459–460. NT 1 June 2004 Vol 100 No 22 www.nursingtimes.net 63 KNOWLEDGE WOUND CARE SUPPLEMENT FIG 1. DIFFERENT TYPES OF BITING INSECTS THAT ARE COMMON IN THE UK Coloured scanning electron Coloured scanning electron Macrophotograph of Coloured scanning electron micrograph of pubic lice, micrograph of a mosquito micrograph of a cat flea’s head bedbugs on human skin also known as crab lice, hanging from human hair SPL fever, pruritus, and urticaria (Storer et al, 2003). occur if there are numerous bites or the local reaction is REFERENCES Lyme disease is transmitted by one species of tick severe (Prodigy, 2003). Anaphylactic reactions to insect Crook, P.D. et al (2002) West Nile virus and the threat to the UK. (Ixodes ricinus) and, though uncommon in the UK, its bites are uncommon. Typical reactions are listed in Box Communicable Disease and Public incidence is rising – currently there are approximately 2. Health; 5: 2, 138–143. 200 cases a year (Prodigy, 2003; McGarry et al, 2001). Bite reactions can persist for months – for example, Cutler, C. (1997) Lyme borreliosis: Lyme disease that is caused by a spirochaete can tick bites may result in persistent nodules or papules an update. Practice Nursing; 8: 8, result in arthritis, meningitis, neuropathies, carditis, caused by retained mouthparts. However, most tick bites 33–35. Driver, C. (1999) Happy holiday? and encephalopathy. heal within three weeks (Wilson and King, 2003). Primary Health Care; 9: 5, 14–19. Drug and Therapeutics Bulletin Distribution and appearance of bites Typical Management of bites Prodigy (2003) notes that (2002) Oral antihistamines for distribution of insect bites and their possible causes are there is a lack of good quality evidence regarding the allergic disorders. Drug and Therapeutics Bulletin; 40: 8, 59–62. listed in Box 1. Reactions to bites are varied. The first management of insect bites. Fletcher, C.L. et al (2002) time a person is bitten there is usually no reaction Widespread bullous eruptions due unless the saliva contains a substance that is likely to Midges, gnats, mosquitoes, flies, and ticks Bites to multiple bed bug bites. Clinical cause direct injury, for example, parasites and bacteria. from these are generally ‘one-off’ incidents and and Experimental Dermatology; After repeated bites, sensitivity occurs (Prodigy, 2003); treatment of symptoms is usually sufficient. Creams or 27: 1, 74. Fradin, M.S., Day, J.F. (2002) an itchy papule develops about 24 hours after each bite lotions with soothing qualities are prescribed and may Comparative efficacy of insect and lasts for several days. relieve itching. repellents against mosquito bites. After further bites, an extremely itchy rash develops Antihistamines are of little help in treating pruritus but New England Journal of Medicine; immediately and is followed by a firm, pruritic papule. a short course of sedative oral antihistamine at night 347: 1, 13–18. Howell, K. (2001) Tick-borne Following continued and repeated exposure, no reaction may allow sleep and break the itch-scratch cycle encephalitis. Practice Nursing; 12: occurs (Prodigy, 2003). (Prodigy, 2003). If local inflammation is present, a 6, 240–243. topical corticosteroid may help to relieve itching. McGarry, J.W. et al (2001) Symptoms Burns (1998) notes that irritation is an For urticarial reactions, a short course of oral Arthropod dermatoses acquired in almost constant symptom. Rubbing and scratching may antihistamine may be appropriate to help control the UK and overseas. The Lancet; 357: 9274, 2105–2106. increase the inflammatory changes. itching, the appearance of wheals, and sleeplessness Prodigy (2003) Prodigy Guidance Papular urticaria is common in young children and (Drug and Therapeutics Bulletin, 2002). People who – Insect Bites and Stings. London: those with a history of atopic dermatitis. It is caused by suffer severe anaphylactic reactions to these insect bites Prodigy. a sensitivity to the bites and consists of groups or lines need to carry adrenaline (Stringer et al, 2002). www.prodigy.nhs.uk/guidance. asp?gt=Insect%20bites%20and of very itchy, indurated papules that persist for up to two Ticks must be removed as soon as possible after the %20stings weeks (Prodigy, 2003; Stibich et al, 2001). bite to minimise complications. The literature has many Bullous reactions (fluid-filled blisters larger than 5mm suggestions as to how tick removal is best performed to in diameter) are common in the lower legs and may achieve the optimum outcome. occur at other sites, especially in children (Burns, 1998). The Prodigy guidelines (2003) suggest using fine- Chronic cases in adults can appear as lichen simplex point tweezers to grasp the tick as close to the skin as – rough thickened epidermis (Prodigy, 2003). possible and then pulling gently. It is important to avoid Bacterial infection may be introduced at the time of squeezing the body of the tick. The site of the bite the bite or may occur as a result of scratching. should be cleaned with disinfectant. Systemic urticarial reactions occur in some people Routine use of antimicrobial prophylaxis or serological several hours after the bite, and fever and malaise can tests for Lyme disease following a tick bite is not NT 1 June 2004 Vol 100 No 22 www.nursingtimes.net 65 KNOWLEDGE WOUND CARE SUPPLEMENT REFERENCES BOX 2.
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