Part 9

SYSTEMIC:

1. Systemic corticosteroids is the treatment of choice and must be administered immediately—methylprednisolone (Depo-Medrol) 80 mg IM, followed by prednisone 60 mg a day for 3 days and gradually tapered over a 10-14-day course of therapy 2. Heparin therapy may reduce the disseminated intravascular coagulation phenomenon 3. Analgesics for pain

CENTIPEDES

REACTIONS

IMMEDIATE: Pain, often intense

LOCAL: 1-4 hours—A two-puncture wound at the site with redness, swelling, and a burning aching pain that subsides in 4-5 hours

REGIONAL: Rare—Purpura of an entire limb

ANAPHYLAXIS AND DEATH: None reported in the United States

TREATMENT

LOCAL FIRST AID:

1. Wash with soap and water 2. Apply ammonia in 10% solution 3. Apply cool wet dressings of a saturated magnesium sulfate solution

SYSTEMIC: Analgesics for pain

TRUE BUGS (KISSING BUGS)

REACTIONS

IMMEDIATE: Usually no sensation, occasionally mild pain

LOCAL: (Four distinct reactions depending on degree of sensitivity):

1. Papule with a central punctum 2. Small vesicles grouped around bite site with swelling and little redness 3. Giant urticarial lesion with central punctum and surrounding brawny edema 4. Hemorrhagic nodular-to-bullous lesions on hands and feet—the characteristic “kissing bug bites”

ANAPHYLACTIC SHOCK: Rare, but reported

DEATHS: None reported

TREATMENT

LOCAL FIRST AID: Wash with soap and water

SYSTEMIC: Oral antihistamines (Chart 1)

ANTS

REACTIONS

IMMEDIATE: Fierce burning pain lasting minutes

LOCAL: (Fire Ants)

Minutes—Wheal formation 2-4 Hours—Clear fluid-filled vesicles 8-10 Hours—Cloudy fluid-filled vesicles 12-24 Hours—Umbilicated pustules on a red base, with pain and tenderness 3-8 Days—Lesions resolve; may leave scars

SYSTEMIC: Due to allergic sensitization; severity and speed of onset related to degree of sensitivity. May see wheezing, urticaria, abdominal cramps, generalized edema, nausea, vomiting, dizziness, confusion, shock