Bites and Stings
Most bites and stings are easily treatable and non-threatening. However, some insects, snakes, jellyfish - and even humans - can bite or break the skin and potentially introduce disease into your body.
Animal bites can be frightening, and in some cases, are medical emergencies. The most common animal bites in the United States are from household pets, with dogs and cats causing the most injury. Cat bites and scratches are especially prone to infection. Human or animal bites can become infected or transmit illnesses such as rabies. A tetanus shot may be required if you have not had one within 10 years; if you are not sure when you had your last tetanus shot, and you've been bitten, you should get one within 72 hours after your injury.
If bitten, but the bleeding is minor, cleanse and treat the wound as you would a minor wound. Wash the area thoroughly with soap and water, apply an antibiotic ointment (unless the person has allergies or sensitivities to antibiotics) and cover with a clean bandage.
If the bite creates a deep puncture or the skin is badly torn and bleeding, apply direct pressure to stop the bleeding and get medical attention right away. If you develop a fever or other signs of infection - swelling, redness, pain, a bad smell or fluid draining from the area - see a physician immediately.
If an animal acts strangely and bites you, go to an emergency department or see your doctor immediately, because the animal may have rabies. This is especially true for bats, skunks, raccoons and foxes. If possible, capture the animal, if it is safe to do so, so it can be checked for rabies, which is fatal in humans if left untreated. If the animal is dead, wear gloves or use a shovel to move it into a plastic bag. Do not damage the animal's head, since rabies testing is done on the brain, and do not freeze the animal. Clean the area and any tools used to remove the animal with a bleach solution. Some people avoid seeking treatment, because they fear it will involve a series of painful shots to the abdomen. This used to be true, but a simpler, less painful treatment is now involved.
Strange animal behavior may be a sign of rabies and typically includes an unprovoked attack. For example, if normally shy nocturnal (night) animals bite during the day, they may be infected. Rabies is rare in dogs, cats, rodents and plant-eating animals. Other signs of rabies in animals include drooling, running in circles, appearing paralyzed or exhibiting unusual or aggressive behaviors.
To prevent children from getting animal bites, including from those that may have rabies:
- Teach children to avoid unfamiliar animals, particularly wild animals, and to understand that any animal may bite when it is frightened, ill or injured. Even pets that are normally friendly may bite when startled by sudden noises or motions, or disturbed when sleeping or eating.
- Never leave young children unattended with animals.
- Make sure your child has had a tetanus shot.
Most people have mild reactions to insect bites, but some have severe allergic reasons that require emergency treatment. In addition, some insects carry disease, such as West Nile Virus or encephalitis, although this is rare.
Insect bites or stings that cause severe pain and swelling at the site of the bite, a generalized rash or any swelling of the face or difficulty breathing, require immediate medical evaluation.
If you are stung by an insect, such as a bee, treat the area by:
- Removing the stinger. Scrape or flick it out with something stiff like a credit card, or even grasp it with tweezers and pull it straight out, to avoid squeezing more venom into the wound.
- Washing the wound with soap and water.
- Using cold compresses or ice to help reduce any swelling and relieve pain.
- Monitoring for signs of severe allergic reaction.
If a bite or sting wound remains or worsens over several days, seek medical treatment for possible infection. Get immediate medical attention if you have been bitten or stung and you exhibit signs of an extreme allergic reaction or anaphylaxis.
Symptoms of an allergic reaction include:
- Hives, itching or rash at the site or even away from the bite area
- Swollen lips or eyelids
- Swelling of the throat
- Difficult or noisy breathing (wheezing)
- Loss of consciousness
While it's nearly impossible to prevent all insect bites and stings, these are steps you can take to minimize the risks:
- Use insect repellent. Repellents with DEET are effective in preventing bites by mosquitoes, ticks, fleas, chiggers, and biting flies. Repellents for children should contain no more than 10 percent DEET. Do not use DEET on babies. " Don't use scented soaps, perfumes, hair sprays, or sunscreens, which can attract bugs.
- Avoid going outdoors during peak hours when insects are out - dusk and dawn.
- Avoid areas where insects nest or gather, such as stagnant pools of water, garbage cans, and orchards and gardens where flowers are in bloom.
- Don't leave food, drinks, or garbage out and uncovered.
- When outdoors in wooded, floral or grassy areas, or in areas infested with ticks or mosquitoes, wear long-sleeved shirts and pants and protective shoes. Dress in light colors, if possible (so insects will be easier to detect) and void dressing in bright colors or flowery prints, which attract some insects. Don't wear baggy clothing, which can trap bugs.
- Check yourself and your children for ticks after leaving infested areas. If you find one, and you know how to remove it, do so. If not, see "How to Remove a Tick."
- If you have removed a tick, keep an eye on the area and check for signs of Lyme disease or Rocky Mountain Spotted Fever, and call your physician if symptoms are present.
- Children and adults who are highly allergic should wear medical identification bracelets, and adrenaline auto-injectors (epi pens) should be available at all times.
Most spiders are not dangerous. For most bites, wash the wound with soap and water and apply an antibiotic ointment. The bite may cause some irritation or itching, but should heal in five to seven days. Some bites can lead to local skin infections, which are easily treated with antibiotics.
Two of the most poisonous spiders in the United States (more common in southern states) are the black widow (which is shiny with a red hourglass marking on belly) and the brown recluse (has a violin-shaped marking on top, and is about one-inch long). Always seek emergency care if you are bitten by one of these types of spiders.
Black widows release a toxin when they bite that can damage the human nervous system. Reactions to a black widow bite can include pain at the bite site, nausea, severe abdominal pain or muscle cramping.
Venom from a brown recluse can cause tissue damage. Reactions from its bite may include fever, nausea, headache, burning, pain or itching, or a deep blue or purple area around the bite, surrounded by a whitish ring and then a red ring (similar to a bull's eye)
If you are bitten by either one of these poisonous spiders:
- Call-911 and explain what has happened.
- Wash the area with soap and water and cover with gauze and a cold pack.
Scorpions in the United States typically are found in Arizona, New Mexico and in California. Scorpion stings are most dangerous to the very young and the very old. If you are stung by a scorpion, you will feel immediate pain or burning.
Scorpion stings usually occur at night. Stings may cause bite marks, swelling and pain, which can be treated with medication. You also might apply ice to help with pain. Seek immediate medical care for more serious symptoms, such as nausea, vomiting, rise in blood pressure, diarrhea, or allergic reactions.
Most jellyfish stings are harmless and occur by accident when people come in contact with the tentacles. Some varieties of jellyfish are more poisonous than others, such as the box jellyfish from Australia. Most stingray injuries require emergency care. To prevent injury, avoid swimming in areas where there are sightings of jellyfish or stingrays.
The tentacles of a jellyfish release a poison that results in a skin eruption, in the form of a painful red rash that itches. The sting usually causes a sting mark, pain and swelling, which may last several days to several weeks. Both jellyfish and stingray stings also can cause life-threatening shock and allergic reactions.
The sting of a stingray causes a bleeding wound that may become swollen and turn blue or red. It causes excruciating pain and can result in death. Severe symptoms may include nausea, fever, muscle cramps, paralysis, elevated heart rate and seizures.
If stung by a jellyfish or stingray:
- Carefully remove any tentacles or stingers still on the body. Make sure to cover your hand - do not directly touch the tentacles or you will be injured.
- Soak jellyfish stings in salt water or vinegar (fresh water will increase pain and may release more of the toxin).
- Soak stingray stings in hot (but not scalding) water until the pain diminishes.
- Wash and bandage.
- For stingray stings, apply pressure to stop the bleeding. If necessary, and you are trained to do so, perform CPR
- If an allergic or life-threatening reaction is observed, call 911 or your local emergency number immediately.
Snake bites can be life-threatening if the snake is poisonous. Poisonous snakes found in the United States include rattlesnakes, copperheads, cottonmouth water moccasins and coral snakes. If you see a snake, do not touch it, but instead, back away from it slowly.
If you are bitten, remember the color and shape of the snake. This information will help medical providers treat you. If you are walking in high water, and you are not sure you have been bitten by a snake, look for a pair of puncture marks at the wound and for redness and swelling, as well as severe pain.
If bitten by a pit viper (rattlesnake, copperhead, cottonmouth):
- Call 911 or your local emergency number immediately.
- Cleanse the wound, but do not try to cut around the fang marks and suck out the venom. People who do this often do more damage than good.
- Immobilize the bitten area and keep it at the same level as the heart. Do not try to apply a tourniquet.
- It's important for the victim to remain calm and move as little as possible. That will help prevent the spread of the poison through the body.
- Do not apply ice or flush the wound with water.
If bitten by an elapid snake (coral snake):
- Take an additional step of wrapping the area in an elastic roller bandage so that it is snug but not tight; the point farthest from the heart should be wrapped first.
- Check the area for sensation, increased skin temperature and redness before and after bandaging.
- Minor swelling and itching can be treated with cool compresses, over-the-counter oral antihistamines or hydrocortisone creams. Use only as directed.
Tick bites can cause Lyme disease or Rocky Mountain spotted fever, which must be treated by a physician. Ticks cause 20,000 new cases of Lyme disease in the United States each year, especially in the northeast, mid-Atlantic and north-central states. Visit the Centers for Disease Control and Prevention website and check their Lyme Disease map to see how prevalent it is in your area: http://www.cdc.gov/ncidod/dvbid/lyme/ld_statistics.htm. Several hundred to more than one thousand new cases of Rocky Mountain spotted fever are reported each year, although it is likely that many cases go unreported.
Lyme Disease.-Lyme disease is usually treated easily when caught early enough. Early symptoms of Lyme disease usually appear within a few weeks of infection and include:
- A bull's-eye-shaped rash - white in the center and bright red on the outside; but this is not true in all cases.
- Flu-like symptoms, such as a feeling of weakness or discomfort, sore throat, dry cough, stiff neck, headache swollen glands and fatigue.
- Photosensitivity (light sensitivity to the eyes or skin).
Left untreated, Lyme disease may spread to the heart, brain and nervous system. Later-stage symptoms of Lyme disease are more serious and can include:
- Arthritis, particularly in the knees, which can become chronic if the infection goes untreated
- Severe headaches
- Abnormal heartbeats
- Bell's palsy (a condition that causes facial muscles to weaken or become paralyzed)
- Cognitive difficulties
- Memory loss
- Numbness and tingling or coordination problems
- Extreme fatigue
- Chronic or extreme muscle pain
Rocky Mountain Spotted Fever.- Rocky Mountain spotted fever is the most severe of the tick-borne illnesses. After an incubation period of about 5 to 10 days, people with Rocky Mountain spotted fever have signs and symptoms that include:
- Sudden onset of fever
- Muscle pain
- Rash on hands and feet
The disease can be difficult to diagnose in the early stages, and without prompt and appropriate treatment it can be fatal. Antibiotic treatment is effective if it begins early enough.
Preventing Tick Bites.-To avoid exposure to disease-carrying ticks, ACEP recommends taking the following preventative measures:
- Cover up when you are outside, especially near wooded areas or grasslands; wear a hat and long-sleeved, light-colored clothing; and tuck pants into socks so that ticks will be easier to spot.
- Avoid wooded areas, piles of leaves and tall grasses, and, if hiking, stay on wide, clear trails.
- Use insect repellents, such as those containing DEET (no more than a 10 percent formula for children), on clothing and skin.
- Check yourself regularly for ticks, and shower or bathe after potential exposure.
- Use tick repellents on your pets, and check their fur, ears and paws for ticks, which can drop off once inside and lurk in carpeting and upholstery.
- If bitten, remove the tick by pulling it straight up with a tweezers (or between your fingertips if tweezers are not available). Avoid twisting the tick, which may cause its body parts to remain embedded underneath the skin, often causing infection.
- Get tested for Lyme disease if a tick bite is detected, or if Lyme disease symptoms develop.
How To Remove a Tick. - Adult deer ticks are approximately the size of a sesame seed, but nymph ticks are much smaller - about the size of a speck of dirt - and more difficult to detect. Avoid removing a tick with your bare hands, and do not crush the tick because it may contain fluids infected with disease. To remove a tick:
- Use tweezers to grasp it as close to the skin as possible.
- Pull outward with steady pressure.
- Do not twist, which can cause parts of it to remain in the skin.
- After removal, disinfect the area and wash your hands with soap and water.
- Save the tick for identification in case you become ill - put in a sealable plastic bag in your freezer.
First reported in the United States in 1999, West Nile Virus has since spread rapidly. It typically appears in the summer until fall.
For 20 percent of those who become infected, the virus causes a mild, flu-like illness. It is considered a public health concern because there is a risk of contracting a potentially fatal brain infection in about one percent of cases. The severity of the virus is greater for persons over age 50 and for persons whose immune systems are compromised.
West Nile Virus is transmitted by mosquitoes, which means the best way to reduce your chance of becoming infected is to avoid getting bitten. Here's how:
- When you are outside, use insect repellent such as DEET (no more than 10 percent formula for children; not intended for use on infants under two months old) or natural oil of lemon eucalyptus (not intended for use on children under age three) on clothing and skin. For details on insect repellents and usage guidelines see www.cdc.gov/ncidod/dvbid/westnile/qa/insect_repellent.htm.
- Eliminate mosquito breeding sites by draining sources of standing water, inserting mosquito larvae pellets in drains, maintaining clean gutters and keeping fountain waters flowing.
- Cover up as much as possible when you are outdoors; wear long-sleeve shirts and pants.
- Stay inside between sunset and sunrise, when mosquitoes are more active.
- Install or repair screens on doors and windows to keep mosquitoes out.
- Never handle dead birds with your bare hands (precautionary measure to prevent disease).
- Investigate and support your community's mosquito-control program. Many communities practice integrated pest management. For details, see www.beyondpesticides.org.
Identifying Mild and Severe Symptoms
- About one in five persons who become infected show any signs of illness, and usually these symptoms are mild. Most infected people will experience fever, headache, fatigue, aches and pains and, in some cases, swollen lymph nodes and a skin rash on the trunk of the body.
- These symptoms generally last for a few days, but in some cases can linger for a few weeks.
- Symptoms of serious infection include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis.
- Symptoms of the most severe infections include West Nile encephalitis (inflammation of the brain), meningitis (inflammation of the tissue surrounding the brain and spinal cord) and West Nile poliomyelitis (inflammation of the spinal cord that causes sudden weakness and/or paralysis in the limbs and/or breathing muscles).
Because specific treatments are not available for West Nile Virus, prevention of mosquito bites is critical.