Hymenoptera Stings

Hymenoptera includes bees, wasps, hornets, and fire ants. When provoked, these insects inject their stinger into the victim. Bees can only sting once, but yellow jackets, other wasps, and hornets can sting repeatedly. The sting is initially very painful. Local erythema and swelling occur. Local and systemic hypersensitivity reactions can also occur. Local hypersensitivity reactions result in exaggerated swelling. If the sting occurs around the mouth or neck, airway compromise may result. Systemic hypersensitivity is an anaphylactic response, and its recognition and treatment are discussed elsewhere in this textbook.

Fire ants are seen in the southern United States but continue to migrate northward. They dwell in mounds on the ground. When the mound is disturbed, numerous fire ants rapidly run out of the mound. As a result, the victim is usually stung by many fire ants simultaneously. Each ant can sting repeatedly. Anaphylaxis has been reported following fire ant bites. Their sting is very painful and results in a pustule with an erythematous base ( Fig 242-6).

FIG. 242-6. Fire ant bites. This individual unknowingly disturbed a fire ant mound. She received numerous painful stings that developed into pustules with an erythematous base.

Initial treatment of hymenoptera stings includes removing the stinger as quickly as possible, since the stinger continues to release venom. A lateral motion with a knife, fingernail, or credit card is preferred over trying to pull the stinger straight out. Elevation and ice compresses can prevent further swelling.

BIBLIOGRAPHY

Goddard J: Physicians Guide to Arthropods of Medical Importance, 2d ed. Boca Raton, FL, CRC Press, 1996.

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