What Bit You?

”What bit my daughter, doctor?”, a father asks, showing a red bump on his daughter’s forehead.

”Where was she at the time of the bite?”, the doctor inquires, as he gears up to make the diagnosis: local skin reaction due to a bug bite.

The father scratches his head, trying to remember where his daughter was, but comes up with nothing. Finally he says, “I don’t know.”

This kind of dialogue is what often goes on between clinicians, parents and caregivers as they try to solve the puzzle of insect bites.

Sting or bite – what’s the difference?

When they are in pain, victims of bug bites do not care whether they suffered a sting or a bite. However, technically speaking, when a bug stings it injects toxins into its victim’s skin and blood system. This venom can trigger a local and extended skin reaction or a general body reaction. Bugs that have the tendency to sting include bees, wasps, yellow jackets, hornets, and fire ants.

In contrast to stinging, which is passing poison into the victim, an insect bite is for the purpose of feeding, of taking a meal from the victim. To help them feed while biting, insects inject saliva onto the victim’s skin and tissues. The insect’s saliva is foreign to the victim, making them itch and scratch, and leads to local or extended swelling.

Signs and symptoms of a bug bite

A skin bump from a bug bite refers to the local area of swelling that we feel when we slide our palm over the skin.An itch, a bump in the skin or redness of the skin is one of the early sign that suggests a bug has bitten someone.

Other symptoms and signs of a bug bite include pain, itching, swelling and redness at the site and the area surrounding the bite. There can be more associated complaints and symptoms, such as a child who refuses to put his right foot down on the floor because of the pain associated with a bug bite on that leg.

Skin bumps due to bug bites can be single or multiple and their sizes vary. They can be anywhere on the body. They can appear immediately or a few days after the bite, by which time the answers to the ”where” and ”why” questions are buried under a heap of similar lost memories.

Though insects transmit diseases, they do not always do so when they bite. This article therefore will not address potentially fatal insect-borne diseases, like Malaria and West Nile fever which are caused by mosquitoes, or trypanosomiasis, which is caused by tsetse flies.

The article is narrowly limited to local reactions or skin swelling due to insect or ant bites.

How to treat a local skin bump caused by an insect bite

Since some readers may be eager to find out how to treat local reactions to insect bites, I will reveal the protocol right away.

Minor bug bites do not need medical treatment. They will heal by themselves.

Bug bites that are bothersome require some form of medical intervention: Benadryl is given by mouth to inhibit itching: hydrocortisone cream, preferably 2.5%, is to be rubbed over the swollen area and is used to tame the redness, which is also called inflammation. Analgesics such as Tylenol or ibuprofen are given by mouth to control pain.

Note that Benadryl, or any other antihistamine, can cause drowsiness. Do not give Benadryl if itching is absent.

A milder strength of steroid cream (hydrocortisone 1%) can be tried by caregivers. Like Benadryl and analgesics, hydrocortisone cream can be purchased in medicine stores without prescription.

From experience gained in private practice, I can assure you that except in very severe cases the local allergic reaction caused by bug bites gets better in a couple of days. So discontinue medications when the child feels well.

There is no indication for the use of antibiotics for skin swelling caused by bug bites, except for the rare instance when a bacterial super-infection occurs. This is usually caused by children picking and scratching the bite areas.

Consult a clinician if the swelling caused by a bug bite is not going down, if there is fluid of any color coming out of the bump, if there is an accompanied fever, and of course for any other specific concerns for the child.

Mosquitoes in Nigeria

Dividing bugs into those that bite outside the house and those that bite inside the house is an essential way of looking at them.

Bed bugs are a good example of bugs that bite a victim indoors, and mosquitoes are a good example of insects that bite outside.

There are plenty of bugs out there and many are natives in the community where they reside. Quite a few can deliver a stinging bite.

There is, however, a substantial overlap between indoor and outdoor bugs, depending on where in the world you are.

For example, Nigerian mosquitoes are everywhere; under the bed sheets, perching on the window panes, resting in the cabinet drawers and on pots of soup, enjoying eguisi [melon] soups—–seriously, no exaggeration.

How to find out what bit you

Clinicians can only give an informed opinion on the specific cause of a bite, unless, of course, one was able to capture and bring the insect for identification, at which point a more confident recognition can be made.

Knowing what bugs are dominant in a location aids clinicians in determining the perpetrator.

For instance, if somebody in Onitsha, an urban ghetto, develops an itchy local swelling on their forearm or leg after staying out on their porch, you can be sure that angry blood-sucking mosquitoes have attacked them.

In the same manner, a six-year-old boy in Akokwa, a rural village in Nigeria, who got a fiery bite on the buttock as he sat down on a cement or sand floor to listen to Grandpa’s fairytale, will almost certainly be a victim of a home-grown mean black ant, called agbusi.

Going west, a child who sustained red bumps on the arms, legs, or face after playing in a community park in Connecticut has probably received bites from gnats, also called black flies, yellow flies, or mosquitoes.

A bug can attack anywhere on the body, but mostly on the exposed parts, with the legs and the arms being the most vulnerable places, especially for those who wear short sleeves.

A person’s whereabouts at the time of the bite is helpful when figuring out what bit them.

As the ice thaws and spring arrives, the weather is good for outdoor activities. Children are eager to play in the backyard or at the park. Unfortunately, the bugs are waiting to bite; to lay their suckers on the exposed skins of helpless kids.

It is a bug’s world, keep moving

Bugs are opportunistic and target people who are stationary, who stop momentarily to put on socks or shoes, for example. They deliberately target kids who are transient, in between activities; stationery, seated or resting.

If two kids go out to a park, one can sustain a bug attack while the other is spared. Why does this happen? Well, the child who is stationary is like a sitting duck waiting for bugs to attack. A child who is constantly busy is too fast a target for a bug attack. Another explanation is that some people have an intense reaction to an insect bite, while others are not affected as much.

Frequently, the exact time of the bite is forgotten. Swelling at the site of the bite can be immediate, or it can take a day or two to show, by which time most people have forgotten about their exposure.

Insects that fly, ants that crawl, and scorpions and spiders that creep are all related. They have all descended from a common ancestor, named Arthropod; an animal that has stiff-jointed arms and legs but no backbone.

Although this article is about local skin swelling following insect bites as mentioned earlier, the upcoming paragraph deserves attention.

The need to carry an EpiPen for people who suffer a severe reaction

A potentially deadly phenomenon known as anaphylaxis can occur in individuals who are allergic to certain insects’ poisonous stings. Persons suffering from an anaphylactic reaction can experience difficulty in breathing, facial swelling, and circulatory collapse. These individuals must carry the medication epinephrine, in a ready to use form-for example, EpiPen Auto-Injection, for an intramuscular shot.

Hornets, wasps, and yellow jackets are examples of insects equipped to deliver a sting that could reverberate around the entire body, resulting in difficulty in breathing, swelling around the face, fainting spells, wheezing, breakdown of muscles, seizures, and potentially death.

Preventing insect bites

Preventing bug bites isn’t too hard. Wear long sleeves, trousers, and socks when anticipating any exposure to biting insects. Spray repellents or Bug Off around where there are infestations, and spray repellants on the margins of clothes, caps, and shoes while on a trail laden with insects. Removing stagnant water, the breeding place of many insects, is also essential in controlling the menace of bugs.

Disclaimer: This article is not meant to diagnose or treat any individual bite or sting. Every bite or sting is different. Whenever there is doubt about a specific bite, a clinician’s direct assessment is indispensable.

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