Intensive Care of Acute Poisoning - A. V. Hovenko 2010

Main types of acute poisoning and their treatment
Poisoning by animal toxins
Insect stings

An insect bite is a Skin injury caused by a puncture that creates a wound and introduces salivary gland secretions into it.

The antigenic composition of insect salivary gland secretions is quite reactogenic (allergenic) and can cause both local and systemic effects. The type of local reaction depends mainly on whether the person has been bitten previously by the same or a related insect.

In Europe, the main biting insects are blackflies, mosquitoes, sandflies, flies, fleas, and bedbugs. In recent years, tick bites have also become quite common.

Local signs of an insect bite:

- Irritation is the most frequent symptom. Scratching generally exacerbates the inflammatory signs caused by the irritating effect of the bite itself.

- Papular urticaria most commonly occurs in children aged 2–7 years and in patients with a history of atopic dermatitis. This is due to sensitization resulting from bites by fleas, lice, bedbugs, mosquitoes, ticks, and other insects. Skin lesions are typically observed at the bite site, but may also spread to distant PARTS OF THE body. The lesions appear as clustered pinprick skin damages or intensely itchy lines. New eruptions may continue to appear for up to 2 weeks. Scratching can lead to excoriations, erosions, and ulcers. Secondary pustular eruptions or Pyoderma are typical.

- Bullous reactions can occur when the bite is located below the lower leg, but may also appear on other parts of the body, especially in children.

- Fever and general weakness are observed in cases of multiple bites or pronounced local reactions.

The characteristics of symptoms arising from various insect bites are presented in Table 5.2.

Class="center">Table 5.2 Characteristics of symptoms caused by various insect bites

Insects

Symptoms

1

2

Blackflies, sandflies, mosquitoes

Small papules usually appear at the bite site. In sensitized individuals, blisters and bullae (large blisters) may develop.

Fleas

Bites are often grouped in lines or distinct clusters. Sensitive individuals may develop hives and even bullous eruptions. Fleas living on pets typically bite humans on the legs below the knee or on the forearms.

Horseflies

Bites can be quite painful. Typical manifestations include hives, dizziness, and weakness, accompanied by bronchospasm or angioedema. A fairly common complication is a secondary infection at the bite site.

Bedbugs

Bites are painful. In the absence of sensitization, the bite site may show no reaction at all. In sensitive individuals, a pronounced inflammatory reaction can occur at the bite site along with hemorrhagic papules. Bites are typically localized on the face, neck, arms, and feet.

Ticks

Bites are usually painless. Red papules form at the bite site, which may be accompanied by local edema and erythema. In some cases, the skin develops intensely itchy blisters followed by The formation of erosions.

Systemic reactions. Systemic allergic reactions to insect bites are characterized by four degrees of severity.

Grade I - mild course: generalized pruritus, urticaria, general weakness, anxiety, apprehension.

Grade II - moderate course: the clinical picture is complemented by angioedema, nausea, vomiting, diarrhea, confusion, abdominal pain, cardialgia.

Grade III - severe course: In addition to the aforementioned symptoms, dyspnea, hoarseness, followed by stridulous breathing, swallowing disorders, and arrhythmia are observed.

Grade IV - anaphylactic Shock: cyanosis, arterial hypotension, collapse, loss of consciousness.

First aid for insect bites. The sting must be quickly removed (in case of a bee sting) by scraping it off with the edge of a fingernail or a knife blade. Do not attempt to pull out the sting with the venom sac attached by pinching it with fingers or tweezers, as this can inject an additional amount of venom under the skin.

An attached tick must be removed promptly. This can be done independently if the insect's HEAD has not penetrated too deeply into the Tissues. If it has, medical assistance should be sought.

It is advisable to wash the bite site with soap and Water.

If possible, apply ice to reduce Swelling.

Do not rub or scratch the bite site, as this frequently increases swelling and itching, and also raises the risk of infection.

If there are signs of a systemic allergic reaction (anaphylactic shock), immediate hospitalization of the victim is required.

A systemic reaction can develop within a few minutes after an insect bite (typically a bee or wasp) and requires emergency care. A cold compress or ice pack should be applied to the bite site. The bite area can be infiltrated with 0.1–1 mL of epinephrine solution diluted in 4.5 mL of isotonic sodium chloride solution. Administer norepinephrine intravenously, along with 12–16 mg of dexamethasone (or 60–120 mg of prednisolone). The frequency and dosage of medications depend on the severity of the condition. In cases of bronchoconstriction, a 2.4% aminophylline solution in an age-appropriate dose diluted in isotonic sodium chloride solution should be administered intravenously as well.



Last update: 08/08/2026

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