How to treat common bites and stings

South Africa is home to a rich variety of insects and arachnids, and many are found in our homes and gardens.

Bees, wasps, scorpions, hornets and spiders can pose a risk, particularly to young children. Here’s what you need to know about common bites and stings: 

Bees, wasps and hornets 

Generally, a sting from a bee or hornet will only result in a localised reaction, although it may result in life threatening symptoms in people who are highly allergic to bee venom. Local reactions include: 

Burning: lasting between one and two hours then followed by itching. 

Swelling: which can continue for 24 hours and only subside after seven days. 

Redness: This can last up to three days and is usually not caused by infection. 

Treatment for mild reactions to stings

Only bees leave a stinger behind. Some say not to squeeze the stinger when you remove the sting; but rather use tweezers or a clean credit card and ensure you remove it completely.

If it is below the skin’s surface, leave it there to fall out naturally. For pain and itching, apply ice or a cool compress for 20 minutes to bring relief, and some doctors may recommend over-the-counter pain medication such as ibuprofen, or an antihistamine. 

Severe allergic reactions

The biggest risk associated with bee stings is that the small amount of venom they release may trigger an allergic reaction and lead to anaphylaxis, a severe life threatening allergic reaction. Anaphylaxis occurs when your body develops a severe allergic reaction to something, such as food, medication or stings. Symptoms include:

• Swelling of the tongue, throat, body
• Suddenly developing a hoarse voice
• Rash, often itchy hives and/or redness
• Feeling lightheaded or fainting episodes
• Tight chest, wheezing or difficulty breathing
• Abnormally fast heartbeat
• Clammy skin
• Confusion
• Vomiting or stomach pain
• Sense of impending doom

Treatment for severe allergic reactions to stings

If someone in your family experiences any of the above symptoms after a sting:

• Administer auto-injectable epinephrine (adrenaline) if it has previously been prescribed and is on hand. (In some people who are high risk or suffered previous life threatening allergic events doctors will likely have given them adrenalin to keep on hand in case of emergency in the form of an EpiPen, as early intervention is imperative), and
• Lie the person down with their feet elevated, and,
• Call an ambulance urgently.

In severe allergic reactions, a person will likely be monitored in hospital (at times ICU or high care) until their symptoms have resolved. After recovery, the person who had the reaction would need to see a GP or a doctor specialising in allergies to formulate a treatment and prevention plan for future exposures to the insect. 

Spiders and scorpions

If you are bitten by a spider or scorpion it helps to carefully catch the spider or scorpion and bring it along to the hospital so that doctors know exactly how to treat the bite or sting. 

Spider bites

Fatalities from spider bites in South Africa are extremely rare. The most dangerous spiders in South Africa include black and brown button or widow spiders (Latrodectus species), sac spiders and the violin spiders. The button spiders are neurotoxic spiders as their venom causes widespread effects on the nerves and muscles.

The latter two are known as cytotoxic spiders because their venom can destroy cells. While larger spiders such as baboon and rain spiders can attack and bite if threatened, they are not poisonous. If children are bitten by larger spiders, they will require a lot of reassurance and some wound care.

It is always good to check the status of your tetanus immunisation after any spider bite, as the spores of the tetanus bacteria may be found in the mouth parts of spiders. If you have not had a booster in the past 5 years this is a good time to have one. 

Black button spider bites

Black and brown widow button spiders are fairly common in homes and particularly in gardens across South Africa. 

Symptoms: Immediate, burning pain that spreads to the lymph notes within 15 minutes. Generalised and often intense muscular pain and cramps develop within an hour. Anxiety, sweating and a general feeling of weakness also follow. Other symptoms may include rigid muscles, a racing pulse, involuntary movement of the limbs and a flushed face. In one in three cases there is no detectable bite. 

Treatment: It is important to take the victim to their GP or the emergency room if they have any systemic symptoms. Antivenom to these spider bites is available at hopsitals and depending on the severity of symptoms may be administered in the Emergency Unit in hospital. Other treatments and procedures also include intravenous fluid, performing and ECG and if antivenom is given, being monitored for allergic reactions or side effects to the antivenom itself. The elderly and small children are most at risk of complications. Fortunately, there have been no reported deaths from black button bites in South Africa since the 1960s. 

Brown button spider bites Symptoms: The reaction to a brown button/widow spider bite is usually milder than the reaction to a black button/widow spider bite. For adults, this includes a burning sensation at the site of the bite and pain in the regional lymph nodes. The surrounding muscles may feel stiff while the skin presents with a tingling sensation. Some patients experience muscular pain and weakness in the legs and a low-grade fever. Children may present with restlessness and hyperactivity. 

Treatment: A bite is detectable but does not normally require treatment. The reaction, while unpleasant, should clear up within three days. However, small children and the elderly should receive medical observation as a precaution because they may experience more severe symptoms. 

Cytotoxic spiders

Cytotoxic spiders such as sac and violin spiders are widely distributed in South Africa. Sac spiders are often found in the home and are known to be aggressive while violin spiders are rarely found in urban areas and will tend to hide in crevices. 

Symptoms: Most often the patient is unaware of being bitten although fang marks are often present and a red mark usually appears. The bite becomes painful between 12 and 24 hours and may develop blisters. Usually, these spider bites heal spontaneously. In rare cases, however, the bite results in systemic illness including fever and malaise between 3 and 5 days after the bite. The tissue around the bite may die off and leave a slow-healing ulcer that can take weeks to heal. 

Treatment: Patients should seek medical attention if they suspect that a cytotoxic spider has bitten them. Treatment is usually symptomatic and focused on preventing and treating secondary infections and complications. However, patients will often recover without medical intervention. 

Scorpions

Most scorpions are harmless but a few species can cause life-threatening systemic envenoming (poisoning in the body). One useful rule of thumb is that scorpions with thick tails and slender pincers are more venomous than those with slender tails and large pincers, as scorpions that use big, strong pincers to catch their prey, seldom have a very venomous sting at the end of their tail!

A second important feature is the size of the scorpion. A scorpion smaller than 4 cm in length (when uncurled) is very unlikely to cause serious envenomation. The two most dangerous scorpions are the amber-coloured Parabuthus granulatus and the black-coloured Parabuthus transvaalicus. Most deaths are attributed to the Parabuthus granulatus.

Small children are especially at risk from scorpion stings, as they can develop respiratory failure and may die. It is essential to seek urgent medical attention if a scorpion sting occurs, especially in children. Symptoms are similar to those associated with a button spider bite although the burning pain is more severe, there is often associated pins-and-needles, sweating, agitation, and generalized muscle pain. Difficulty breathing and visual disturbance can also occur. Children most often develop marked restlessness and irritability.

Antivenom to these scorpions is available at hospitals and may be administered, if required, in the Emergency Unit or High Care ward. If you’re unsure of what to do about a bite or sting, the best option is to call the Poison Information Helpline (0861 555 777) or visit your closest emergency room or GP, especially if the patient is a small child. Home remedies are best avoided unless recommended by your doctor. 

Reviewed by Dr Cindy Stephen, Director at the Poison Information Centre. 

http://www.seattlechildrens.org/medical-conditions/symptom-index/bee-stings/

http://www.webmd.com/allergies/guide/anaphylaxis#2

http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis

http://www.cmej.org.za/index.php/cmej/article/view/2547/2582 

http://www.cmej.org.za/index.php/cmej/article/view/2545/2580