Part 2

2. Bumble Bees. The bumble bees are considered to be the most primitive of the social bees. Their colonies lack much of the structure and highly evolved behavior of the honey bees; however, like the honey bees, the bumble bees are diurnal plant feeders and important pollinators of crops. A typical colony consists of at least one queen, several males, and numerous workers. Only young fertilized queens survive the winter to establish new colonies the next spring. The nests are normally located deep in undisturbed ground, like fence rows, and are supplied with a mixture of pollen and honey. During late summer, a colony usually contains between 100 and 500 bees. Although bumble bees are 2 to 3 times larger than honey bees, they are neither as aggressive nor as abundant as the honey bees, and therefore not as dangerous.

Avoidance/Control. The best way to avoid Hymenoptera stings is to prevent human contact with these insects. This is especially important for persons hypersensitive to bee venom. Some preventive steps are:

1 Avoid outdoor activities in unfamiliar areas where stinging insects are known to occur.

2 When outdoors, don’t use floral-scented cosmetic products or leave sweet beverages or foods exposed in areas where they might attract bees.

3 Avoid garbage collection areas, which attract Hymenoptera.

4 When outdoors, always wear shoes and, if possible, a long-sleeved shirt, long pants, or other protective clothing. Don’t wear clothing with a bright floral print or loose-fitting clothing in which stinging insects may be trapped.

5 Don’t make rapid movements around stinging insects or intentionally disturb either the insects or their nests.

6 Eliminate all Hymenoptera nests around inhabited areas (wild honey bee colonies may be removed by a local beekeeper). When necessary, an insecticide such as 5% carbaryl dust may be applied in a nesting area within a building to eliminate the nuisance colony.

7 Educate young children on the hazards of venomous arthropods.

Envenomization Reaction/Treatment. (See appendix.)

3. SCORPIONS (Class: Arachnida; Order: Scorpionida)

Identification. Scorpions are crablike in appearance, with pincers attached to their two front appendages. They also possess a five-segmented “tail” terminating in a bulbous structure with a prominent stinger. The body size of mature scorpions varies from 2 to 10 cm (0.8-4 in) or more, depending upon the species.

Distribution. Scorpions are most prevalent in warmer climates. In the United States the two most dangerous scorpion species, _Centruroides sculpturatus_ and _C. gertschi_, have been found only in Arizona.

Biology/Behavior. During daylight hours scorpions hide under objects or debris on the ground. At night, they come out of hiding to search for food, which consists primarily of ground-inhabiting arthropods. The prey is grasped with the pincers and stung by rapidly bringing the stinger forward directly over the head. This quick stinging motion is also used for defense, as is usually the case with human envenomizations.

Avoidance/Control. To avoid stings in scorpion-infested areas: remove accumulations of boards, rocks, and other debris; wear leather gloves to remove any item from the ground; inspect and shake out clothing or shoes before donning them; and when moving about at night, turn on lights to avoid contacting these nocturnally active arthropods. Insecticides that are commonly used for household cockroach control are also useful for controlling scorpions. Special care should be taken to treat around all baseboards thoroughly.

Envenomization Reaction/Treatment. (See appendix.)

4. VELVET ANTS (Order: Hymenoptera; Family: Mutillidae)

Identification. Female velvet ants, wingless and antlike in appearance, are actually wasps that only resemble ants. The males are winged and usually larger than the females. Both male and female are covered with a velvety pubescence which is normally bright red, orange, or yellow. The female has a formidable stinger at the posterior end of her abdomen which she can use to inflict a painful envenomization. The length of a mature mutillid wasp varies from 1 to 2.5 cm (0.4-1 in). In some localities, mutillids are commonly referred to as cow killers, mule killers, or wooly ants.

Distribution. The Mutillidae is a large family with most species distributed in the southern and western parts of the United States.[2] However, one species, _Dasymutilla occidentalis_, is commonly found on the sandy beaches of Lake Erie and during the summer months causes barefoot bathers much distress.[5]

Biology/Behavior. Female velvet ants are solitary, diurnal, parasitic wasps. An efficient stinging apparatus and an extremely thick exoskeleton allow the female mutillid to conspicuously, yet safely, run about in the open searching for a suitable place to lay her eggs. Most cases of human envenomization occur when the female wasp is accidentally touched while roaming about on the ground or is trapped against the body in clothing or bedding.

Avoidance/Control. The solitary and roaming nature of velvet ants makes it very difficult to predict or designate ways to avoid contacting them. In areas like the beaches of Lake Erie where mutillids are known to frequent, however, potential victims should be made aware of the velvet ant hazard and how to avoid accidental envenomization. Since mutillids are not gregarious and do not congregate in accessible places, chemical control is not feasible.

Envenomization Reaction/Treatment. (See appendix.)

5. WASPS (Order: Hymenoptera; Family: Vespidae)

Identification. This information applies to all dangerous wasps found in the United States except the mutillids (previously discussed). Wasps are elongate insects with three distinct body parts and four wings. As with all winged forms of Hymenoptera, the front pair of wings is larger than the hind pair. Only the female wasps are equipped with a stinger at the posterior end of the abdomen. To distinguish wasps from similar-appearing bees, the specimen’s thoracic hairs should be examined microscopically to determine if they are smooth (a wasp) or feathered (a bee). In the United States, members of the paper-wasp family (Vespidae) are generally considered to be the most dangerous because of their social nesting habits, aggressive behavior, and abundance. Two representative members of the Vespidae family found in North America are the bald-faced hornet, _Vespula maculata_, and a common yellow jacket, _V. pennsylvanica_. Although it takes an expert to identify most wasps according to species, the paperlike nests of the vespids make their identification easy. Another important group of dangerous wasps easily distinguished by their nests are the mud daubers. These wasps usually build their mud nests in the corners of man-made structures. Besides their distinctive nests, mud daubers are identified by their dark shiny color and long narrow waist.

Distribution. Dangerous species of wasps can be found throughout the United States.

Biology/Behavior. Most vespids are social insects that feed primarily on other arthropods. These wasps build paperlike nests by masticating wood fiber into pulp. In addition to the social wasps, many types of solitary wasps are capable of envenomization; but these wasps are easy to avoid since they are neither abundant nor aggressive. Female members of the dangerous wasp species will readily attack and inject their venom if someone disturbs or annoys them. Wasp stingers do not become detached, and a single wasp can sting a victim several times before retreating. Social wasps are particularly dangerous because a disturbance of their nest may result in attack by numerous wasps.

Avoidance/Control. Avoid garbage accumulation sites, which attract wasps. To avoid wasp stings, recognizing the nests of the dangerous species in the local area, is important. If possible, remove and destroy all nests found around inhabited areas. Wasps can be controlled by treating their nests with insecticide—preferably at night, when the wasps are least active. Treat nests found above the ground with a commercial wasp spray or other insecticide recommended by an entomologist. To treat wasp nests in the ground or in houses, a 5% carbaryl dust may be used.[38]

Envenomization Reaction/Treatment. (See appendix.)

URTICATING/VESICATING ARTHROPODS

1. BLISTER BEETLES (Order: Coleoptera; Family: Meloidae)

Identification. The Meloidae are narrow elongate beetles characterized by a “neck” (pronotum) which is distinctly narrower than its head or wings. Adult beetles range in body length from 1 to 2 cm (0.4-0.8 in) and vary considerably in their coloration.

Distribution. In general, blister beetles are found in greater numbers in the western half of the United States.[5]

Biology/Behavior. The immature stages of the blister beetle are usually predacious on other insects and are not harmful to man. Adult blister beetles release a clear amber fluid by rupture of thin membranes in the leg joints or other segmented areas of the body. The release of this fluid, which contains a vesicating agent called cantharidin, is triggered by pressure against the body of the beetle. Light pressure exerted by clothing or by brushing off a beetle is usually sufficient to cause the release of its vesicating fluid. The adult blister beetles are readily attracted to bright white light, and many cases of human exposure occur at night around such lights. Since the adults are plant feeders, some cases of human vesication occur as persons move through vegetation infested with blister beetles.

Avoidance/Control. In areas with an abundance of blister beetles, use yellow light bulbs for outdoor lighting. If a meloid beetle lands on the skin, blow it off, do not crush it. Since cantharidin is distributed throughout the beetle’s body, crushing the beetle against exposed skin would result in maximum cantharidin exposure. Dermatoses resulting from blister beetle contact are seasonal, with the greatest number of vesicating incidents in the United States occurring in July, August, and September. Chemical control usually is not recommended because of the mobility and wide distribution of blister beetles.

Envenomization Reaction/Treatment. This information is not included in the appendix because the envenomization reaction generally consists of a superficial linear bulla which does not require emergency treatment.

2. URTICATING CATERPILLARS

a. IO MOTH CATERPILLAR (_Automeris io_)

Identification. The _Automeris io_ caterpillar is the larva of the Io moth, which belongs to the moth family Saturniidae. A full-grown caterpillar is about 5 to 8 cm (2-3 in) long, pale green, with lateral strips of red or maroon over white running the length of the body. Near the center of each body segment is a partial row of tubercles armed with radiating green and black spines. Many of these spines are venomous, and their tips are connected to rather large individualized poison glands.

Distribution. In the United States, the Io moth is found in the states east of the Rocky Mountains.[68]

Biology/Behavior. Io moth larvae feed on the leaves of a variety of plants, including corn and willow.[17] In most areas they produce only one annual generation, emerging as a moth in the spring or summer and overwintering as a pupa. In south Texas, however, two generations occur, with one developing in May-July and the second in October-December. Therefore, the urticating larval stages can be found anytime from early spring to late fall, depending upon the area of the country and climatic conditions. As with most urticating caterpillars, _A. io_ envenomizations normally occur when the victim inadvertently contacts caterpillar-infested vegetation. At the instant the victim’s skin touches this caterpillar, the spine tips break off in the skin, thus allowing toxin to flow out of the hollow spines and onto the skin.

Avoidance/Control. Wear gloves, a long-sleeved shirt, and long pants when working in an infested area. Children should be warned not to handle caterpillars. If necessary, infested vegetation may be treated with an appropriate insecticide.

Envenomization Reaction/Treatment. (See appendix.)

b. PUSS CATERPILLAR (Megalopyge opercularis)

Identification. The puss caterpillar is the larva of a lepidopterous group commonly referred to as “flannel moths.” In some parts of the United States the larva is incorrectly referred to as an “asp.” When fully mature, the larvae are near white to dark gray in color, 2 to 3 cm (0.8-1.2 in) long, and completely covered dorsolaterally with hairs that cause them to resemble elongate tufts of cotton. Some of the hairs are venomous, and when they penetrate the skin a “toxin” passes from an underlying gland through the hairs at the points of contact. The color variation of the larvae in this species is dependent upon larval age, locality, and time of year. In Texas, where this species is most abundant, the spring/summer generation of caterpillars is usually lighter in color than the fall generation.

Distribution. This species has been recorded primarily from the Southeastern States, including Alabama, Arkansas, Florida, Georgia, Louisiana, Maryland, Mississippi, Missouri, North Carolina, South Carolina, Texas, and Virginia.

Biology/Behavior. In most of the southern area of its range, the puss caterpillar is thought to have two generations per year. The first generation develops in the spring and early summer, while the second generation develops in the fall. After emerging from a cocoon and mating, the female moth lays her eggs on a suitable host plant. In a few days the eggs hatch into larvae, which develop by feeding on the leaves of a wide range of trees and shrubs. The natural enemies of the puss caterpillar usually keep its numbers under control; however, every 4 or 5 years the caterpillars become more numerous, and the number of envenomizations associated with them increases.[66]

Avoidance/Control. Always wear protective clothing such as gloves and a long-sleeved shirt when working in areas heavily infested with puss caterpillars. During periods of _M. opercularis_ abundance, children should be instructed to stay away from infested trees and shrubs and not to handle caterpillars. If necessary, heavy puss caterpillar infestations may be treated with an appropriate insecticide.

Envenomization Reaction/Treatment. (See appendix.)

c. SADDLEBACK CATERPILLAR (_Sibine stimulea_)

Identification. The saddleback caterpillar is easy to recognize since its brown sluglike body is covered mid-dorsally with markings that resemble a brown or purplish saddle sitting on a green and white saddle blanket. Upon close examination, stout spines can be observed along the caterpillar’s lateral body margin and on its four tubercles. Many of these spines are hairs that are connected at their bases with individual poison glands. Just prior to pupation and subsequent development into a moth, the caterpillar is 2-3 cm (0.8-1.2 in) long.

Distribution. In general, the saddleback caterpillar in the United States is distributed southeast of a diagonal line drawn from Massachusetts through the middle of Texas.[68]

Biology/Behavior. From May to November, _Sibine stimulea_ caterpillars may be found feeding on the leaves of a large variety of trees, shrubs, and other plants. Envenomization usually occurs when the victim accidentally contacts vegetation infested with these caterpillars. At the instant the victim’s skin contacts the caterpillar, the spine tips break off, thus allowing toxin to flow out of the hollow spines and into or onto the skin.

Avoidance/Control. When working in infested areas, wear gloves, a long-sleeved shirt, and long pants to prevent accidental envenomization. During periods of local heavy infestations, children should be instructed to avoid trees, shrubs, and other vegetation commonly infested with these caterpillars. Local entomologists may be contacted to obtain information on the most effective insecticide for saddleback caterpillar control in a given area.

Envenomization Reaction/Treatment. (See appendix.)

BIBLIOGRAPHY

General

1. Barnard, J.H. Cutaneous responses to insects. JAMA 196:3 (1966).

2. Borror, D.J., and D.M. DeLong. An introduction to the study of insects, 2d ed. New York: Holt, Rinehart and Winston, 1964.

3. Dodge, N.N. Poisonous dwellers of the desert. Popular Series No. 3, Southwestern Monuments Assoc., Box 1562, Globe, Ariz., 1955.

4. Frazier, C.A. Diagnosis and treatment of insect bites. Clin Symp 20:75-100 (1968).

5. Frazier, C.A. Insect allergy: Allergic reactions to bites of insects and other arthropods. St. Louis: Warren H. Green, Inc., 1969.

6. Frazier, C.A. Treatment guide: Common biting and stinging insects and other arthropods. West Point, Pa.: Merck Sharp & Dohme, 1972.

7. Frazier, C.A. Cutaneous manifestations of insect allergy. Cutis 13:1038-1047 (1974).

8. Horen, W.P. Insect and scorpion sting. JAMA 221:894-898 (1972)

9. Infections and bites: Parasites, arthropods and animals, Section 18. _In_ D.J. Demis et al. (eds.). Clinical dermatology, vol. 4. Hagerstown, Md.: Harper & Row, 1974.

10. James, M.T., and R.F. Harwood. Herm’s medical entomology, 6th ed. London: Collier-MacMillan, 1970.

11. Lyon, J.B. Insect bites and stings. Practitioner 200: 670-677 (1968).

12. Micks, D.W. Insects and other arthropods of medical importance in Texas. Tex Rep Biol Med 18:624-635 (1960)

13. Millikan, L.E., and R.S. Berger. Clinical and laboratory diagnosis of arthropod bites. CRC Crit Rev Clin Lab Sci 5:201-225 (1974).

14. Parrish, H.M. Deaths from bites and stings of venomous animals and insects in the United States. Arch Intern Med 104:198-207 (1959).

15. Parrish, H.M. Analysis of 460 fatalities from venomous animals in the United States. Am J Med Sci 245:129-141 (1963).

16. Perlman, F. Insects as allergen injectants: Severe reactions to bites and stings of arthropods. Calif Med 96:1-10 (1962).

17. Riley, W.A., and O.A. Johannsen. Medical entomology, 2d ed. New York: McGraw-Hill, 1938.

18. Russell, F.E. Injuries by venomous animals. Am J Nurs 66:1322-1326 (1966).

19. Scott, H.G. Envenomization. DHEW CDC Publ No. (HSM) 72-8121, 1972.

Blister Beetles

20. Lehmann, C.F., et al. Blister beetle dermatosis. Arch Dermatol 71:36-38 (1955).

21. Rosin, R.D. Cantharides intoxication. Br Med J 4:33 (1967)

Centipedes

22. Cloudsley-Thompson, J.L. Spiders, scorpions, centipedes and mites. New York: Pergamon, 1958.

23. Pineda, E.V. A fatal case of centipede bite. J Philipp Med Assoc 3:59-61 (1923).

24. Remington, C.L. The bite and habits of a giant centipede (_Scolopendra subspinipes_) in the Philippine Islands. Am J Trop Med 30:453-455 (1950).

Hemiptera

25. Hall, M.C. Lesions due to the bite of the wheel-bug, _Arilus cristatus_ (Hemiptera, Reduviidae). Arch Intern Med 33:513-515 (1924).

26. Marks, M.B. Stinging insects: Allergy implications. Pediatr Clin North Am 16:177-191 (1969).

27. Nichols, N., and T.W. Green. Allergic reactions to “kissing bug” bites. Calif Med 98:267-268 (1963).

28. Parsons, D.J. Bedbug bite anaphylaxis misinterpreted as coronary occlusion. Ohio Med J 51:669 (1955).

29. Readio, P.A. Studies on the biology of the Reduviidae of America north of Mexico. Univ Kans Sci Bull 17:5 (1927).

30. Shields, T.L., and E.N. Walsh. “Kissing bug” bite. Arch Dermatol 74:14-21 (1956).

31. Smith, F.D., et al. Insect bite by _Arilus cristatus_, a North American Reduviid. Arch Dermatol 77:324-330 (1958).

32. Wray, D.L. Two cases of Hemiptera biting humans (Hemiptera, Reduviidae). Entomol News 82:228 (1971).

Hymenoptera

33. Barnard, J.H. Studies of 400 hymenoptera sting deaths in the United States. J Allergy Clin Dermatol 52:259-264 (1973).

34. Barr, S.E. Allergy to hymenoptera stings. JAMA 228:718-720 (1974).

35. Busse, W., et al. Protection following honeybee venom immunotherapy in a case of beesting anaphylaxis. (Abstract) J Allergy Clin Immunol 53:104 (1974).

36. Busse, W.S., et al. Immunotherapy in bee-sting anaphylaxis: Use of honeybee venom. JAMA 231:1154-1156 (1975).

37. Charavejasarn, C.C., et al. Stinging insect hypersensitivity. II. Studies of bee venom antigenicity. (Abstract) J Allergy Clin Immunol 53:104 (1974).

38. Controlling wasps. U.S. Department of Agriculture, Home and Garden Bull No. 122, 1972.

39. Favorite, F.G. The imported fire ant. Public Health Rep 73:445-448 (1958).

40. Insect-sting allergy: Questionnaire study of 2,606 cases. JAMA 193:109-114 (1965).

41. Lichtenstein, L.M., et al. Treatment of honeybee anaphylactic sensitivity with honeybee venom: A case report. (Abstract) J Allergy Clin Immunol 53:104-105 (1974).

42. Majeski, J.A., et al. Acute systemic anaphylaxis associated with an ant sting. South Med J 67:365-366 (1974).

43. McCormick, W.F. Fatal anaphylactic reactions to wasp stings. Am J Clin Pathol 39:485-491 (1963).

44. McLean, J.A. Management of insect sting reactions. Mod Treat 5:814-824 (1968).

45. Morse, R.A., et al. Protective measures against stinging insects. NY State J Med 59:1546-1548 (1959).

46. Reisman, R.E. Stinging insect allergy—treatment failures. J Allergy Clin Immunol 52:257-258 (1973).

47. Spencer, J.T. Treatment of yellow jacket stings. JAMA 206:649 (1968).

48. Torsney, P.J. Treatment failure: Insect desensitization. J Allergy Clin Dermatol 52:303-306 (1973).

49. Valentine, M.D., et al. Blocking antibody to bee venom: Induction by venom and not by whole body extracts. (Abstract) J Allergy Clin Immunol 53:105 (1974).

Scorpions

50. Masco, H.L. Scorpion bite treatment with chlorpromazine. JAMA 212:2122 (1970).

51. Stahnke, H.L. Scorpions. Tempe, Ariz.: Arizona State College Bookstore, 1949.

52. Vachon, M. The biology of scorpions. Endeavor April:80-89 (1953).

Spiders

53. Anderson, P.C. What’s new in loxoscelism? Mo Med 70:711, 712, 718 (1973).

54. Atkins, J.A., et al. Probable cause of necrotic spider bite in the Midwest. Science 126:73 (1957).

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56. Cheng, A.K. USAF School of Aerospace Medicine, San Antonio, Tex. Personal communication, 1974.

57. Gladney, W.J. Controlling the brown recluse spider. U.S. Department of Agriculture Leaflet No. 556, 1972.

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59. Hershey, R.B., and C.E. Aulenbacher. Surgical treatment of brown spider bites. Ann Surg 170:300-308 (1969)

60. Horen, W.P. Arachnidism. Clin Med (Aug):41-43 (1966)

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62. Taylor, E.H., and W.F. Denney. Hemolysis, renal failure and sudden death, presumed secondary to bite of brown recluse spider. South Med J 59:1209-1211 (1966).

63. The brown recluse. Public Health Service Publ No. 2062, 1970.

Urticating Caterpillars

64. Daly, J.A., and B.L. Derrick. Puss caterpillar sting in Arkansas. South Med J 68:893-894 (1975).

65. Kendall, R.O. San Antonio, Tex. Personal communication, 1975.

66. McGovern, J.P., et al. _Megalopyge opercularis_: Observations of its life history, natural history of its sting in man, and report of an epidemic. JAMA 175: 121-124 (1961).

67. Micks, D.S. Clinical effects of the sting of the “puss caterpillar” (_Megalopyge opercularis_ S. & A.) on man. Tex Rep Biol Med 10:399-405 (1952).

68. Mitchell, R.T., and H.S. Zim. Butterflies and moths. New York: Golden Press, 1964.

APPENDIX: ARTHROPOD ENVENOMIZATION REACTIONS AND TREATMENT