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Nonvenomous arthropods 

Nonvenomous arthropods

Chapter:
Nonvenomous arthropods
Author(s):

J. Paul

DOI:
10.1093/med/9780199204854.003.712_update_001

May 30, 2013: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Bedbug (Cimex lectularius)—genetic basis for pyrethroid resistance.

Jigger flea (Tunga penetrans)—a cause of serious morbidity in tropical endemic areas.

Myiasis—expanded discussion of ophthalmomyiasis and nosocomial myiasis.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 29 April 2017

Most medically important arthropods are insects (including mosquitoes, midges, other flies, bedbugs and other true bugs, lice, fleas, and cockroaches) or arachnids (spiders, ticks, mites, scorpions).

Clinical features

Arthropod-related problems include the following: (1) injuries from direct contact (bites, stings, and other penetrating or crushing injuries from spines, bristles, or pincers) and the consequences of such contact (envenoming, allergic reactions, secondary infection of wounds, and transmission of infectious agents); (2) infestation of the patient’s body, skin, hair, clothes, or immediate environment (myiasis, canthariasis, tungosis, pediculosis etc.); (3) inhalant allergy; (4) hygiene and aesthetic issues; and (5) the psychological phenomena of delusion and phobia.

Treatment and prevention—general aspects

Broad principles of management include: (1) Identification of the problem and the kind of arthropod involved. (2) The immediate treatment—if necessary—of allergic reactions or secondary infection. (3) Appreciation of consequences of exposure, such as transmission of infectious agents; many species of dipterans (flies)—including mosquitoes, blackflies, sand flies, tsetse flies, and horse flies—bite humans, and in some regions some of these are important vectors. (4) Use of antimalarials or vaccines and the development of strategies to avoid further contact, including eradication of infestations, changes in behavior, use of repellents and clothing that covers the skin, and bed nets. Travellers and their clinicians should be aware of the risks posed by arthropod-borne infections and ways to prevent them in particular geographical areas.

Particular conditions

True bugs (Hemiptera)—bedbugs infest dwellings and bite at night: patients may complain of mysterious skin lesions and sleeplessness, and a special search may be necessary to find the bugs. In South America, triatomine bugs bite at night and are vectors of trypanosomiasis.

Ticks (Ixodoidea)—these attach themselves while feeding and are noticed by the patient. They are important vectors of many infections, which are often specific to particular genera or species of tick and confined to particular geographical areas. In Europe, tick-related infections include Lyme borreliosis and tick-borne encephalitis.

Infestations—clinically important infestations include the following. (1) Scabies (infestation of the skin by scabies mites) and pediculosis (infestation of the hair or clothing by head or body lice)—these are cosmopolitan in distribution and usually managed by use of topical acaricides or insecticides, although resistance is a growing problem. (2) Fleas—the human flea is now rare in the developed world, but infestation of dwellings with cat fleas is commonly reported. Tungosis is a condition of tropical areas where jigger fleas (not to be confused with similarly named trombiculid mites) burrow into the feet or under the toenails of those who walk about barefoot. (3) Fly and beetle larvae—myiasis, which is the infestation of the body by the larvae (maggots) of dipteran flies, is classified as (a) benign when self-limiting or malign when there is destructive tissue invasion, (b) according to anatomical site (dermal, wound, orbital, ophthalmic, urogenital, intestinal), and (c) according to the species involved. Canthariasis—infestation of the body by beetles or beetle larvae—is clinically similar to myiasis and is rarely reported.

Other aspects—some synanthropic insects, especially certain species of fly, cockroach, and pharaoh’s ants, have been implicated in the passive transmission of infections, e.g. shigellosis and hepatitis A. It is generally considered to be in the interests of good hygiene to control these insects in health care settings or where food is prepared.

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