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Trauma & Injuries

Insect Bites & Stings Management

Management of bites or stings from various insects like bees, wasps, ants, spiders, and scorpions. Most cause mild local reactions, but some individuals may develop severe allergic reactions (anaphylaxis), or rarely, systemic toxicity from venom (esp. certain scorpions/spiders).

Also known as: Bee Sting, Wasp Sting, Ant Bite, Scorpion Sting, Spider Bite

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Referral and warning signs

When to refer

Refer URGENTLY to HC3/HC4/Hospital if: Signs of anaphylaxis develop. Signs of systemic envenomation (severe pain, muscle cramps, neurological symptoms, cardiovascular instability - esp. scorpion/spider). Bite/sting involves mouth, throat, or eye area (risk of airway compromise). Very large local reaction. Signs of secondary infection.

Red flags

  • Difficulty breathing, wheezing, stridor
  • Swelling of lips, tongue, throat
  • Generalized hives (urticaria)
  • Dizziness, confusion, loss of consciousness
  • Severe pain, muscle cramping, fasciculations
  • Rapid heart rate, hypotension

Signs and symptoms

  • Local Reaction (Common): Pain, burning sensation, itching, redness, swelling, discoloration at the site. Visible sting may be present (esp. bees).
  • Large Local Reaction: Excessive swelling extending beyond the immediate site.
  • Systemic Allergic Reaction (Anaphylaxis - see EM001): Urticaria (hives), angioedema (swelling of lips, face, throat), difficulty breathing (wheezing, stridor), dizziness, hypotension, collapse.
  • Systemic Toxic Reaction (Rare, e.g., certain scorpions/spiders): Muscle cramps, sweating, salivation, nausea/vomiting, hypertension, tachycardia, neurological symptoms (agitation, seizures), cardiovascular collapse.

Risk factors

  • Outdoor activities (gardening, hiking, farming).
  • Living in areas with high insect populations.
  • Disturbing insect nests (bees, wasps, ants).
  • Previous history of allergic reaction to stings increases risk of anaphylaxis.

Diagnosis

Clinical assessment

Based on history of bite or sting, identification of insect if possible, and clinical signs (local reaction vs. systemic allergic reaction vs. systemic toxic reaction).

Investigations

  • Wound inspection (remove stinger if present).
  • Assessment for signs of anaphylaxis (airway, breathing, circulation, skin).
  • Allergy testing may be considered later for those with systemic reactions.

Diagnostic criteria

History of insect bite/sting with resulting local or systemic symptoms.

Management

Non-pharmacological management

  • Remove Stinger (if present, esp. bees): Gently scrape away horizontally with a firm edge (e.g., credit card, knife blade, fingernail). Avoid squeezing the venom sac with forceps/fingers.
  • Clean the area with soap and water.
  • Apply cold compress or ice pack wrapped in cloth to reduce pain and swelling.
  • Elevate the affected limb if swelling is significant.

Pharmacological treatment

  • Local Reactions:
  • - Analgesics: Paracetamol or NSAIDs for pain.
  • - Antihistamines (Oral): For itching and swelling (e.g., Chlorpheniramine 4mg q6h - Adult; Child doses: 6-12y 2mg q6h, 2-5y 1mg q6h, 1-2y 1mg q12h).
  • - Topical preparations: Calamine lotion for itching. Topical corticosteroids may help severe local reactions.
  • Severe Local Reactions (Large): Consider short course of oral corticosteroids (e.g., Prednisolone) in addition to antihistamines.
  • Painful Scorpion Sting: Local infiltration with Lignocaine 2% (2 ml) around the bite area.
  • Anaphylaxis: IMMEDIATE management required (See EM001 - Anaphylactic Shock). Adrenaline (Epinephrine) IM is first-line treatment.
  • Systemic Envenomation (e.g., severe scorpion sting): Requires supportive care (manage pain, respiratory/cardiovascular support) and potentially specific antivenom if available and indicated. Refer urgently.

Monitoring

Monitor for worsening local reaction or development of systemic symptoms (allergy or toxicity). Patients with anaphylaxis require prolonged observation.

Complications

  • Anaphylaxis
  • Secondary bacterial infection of the bite/sting site (cellulitis)
  • Severe systemic toxicity (rare, depends on species)
  • Persistent swelling or discomfort

Prevention

  • Avoid disturbing insect nests.
  • Wear protective clothing (long sleeves, pants, shoes) when outdoors in endemic areas.
  • Use insect repellents.
  • Avoid strong perfumes or brightly colored clothing that may attract insects.
  • Check shoes and clothing before putting on in areas with scorpions/spiders.
  • Keep surroundings clear of overgrown vegetation/bushes.
  • Use pest control methods.
  • Individuals with known severe allergy should carry an epinephrine auto-injector and wear medical alert identification.

Patient education

  • Explain how to remove stinger correctly.
  • Advise on local care measures (cold compress, cleaning).
  • Educate on signs of allergic reaction and need for immediate action (seeking help, using epinephrine auto-injector if prescribed).
  • Discuss prevention strategies.
  • Advise seeking medical attention if reaction worsens or infection suspected.

Uganda-specific notes

Anaphylaxis from bee/wasp stings is a potential emergency. Scorpion stings can occur, severity varies by species. Awareness of local dangerous species is helpful. Ensure adrenaline is available for anaphylaxis.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 1, Section 1.2.1.2

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 1, Section 1.1.1 (Anaphylactic Shock)

For learning and professional reference. Use current local guidance and clinical judgement.

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