Makindo Medical Notes

Introduction

• 🩺 Bites and stings are a common reason for presentation to primary care, urgent care, and emergency departments in the UK.
• While many are self-limiting, some carry risks of serious infection, anaphylaxis, or zoonotic disease.
• ⚖️ NICE CKS guidance provides a framework for safe, evidence-based management in both adults and children.

💡 Key principle: Always assess for systemic involvement (airway compromise, widespread allergic reaction, sepsis) and local complications (infection, deep tissue injury, tissue necrosis).

🧪 General Approach

• 🔎 History: Type of bite/sting, time of onset, environment (UK vs abroad), systemic symptoms (fever, rash, SOB, collapse).
• 👀 Examination: Local wound (size, depth, discharge, foreign body), lymphadenopathy, systemic features.
• 🧾 Investigations (if severe/systemic): FBC, CRP, blood cultures, wound swab, U&E/LFTs if septic, Lyme serology (if tick + systemic).
• 💉 Immediate priorities: ABCDE approach, airway protection in suspected anaphylaxis, haemostasis, pain relief.
• 💊 Prophylaxis checks: Tetanus, rabies (if from endemic regions), hepatitis B (human bites).

🦟 Bites and Stings – Clinical Presentation & Management

• 🐝 Insect Bites/Stings (bees, wasps, mosquitoes)
  • Clinical: Local itching, erythema, swelling; may cause anaphylaxis 🚨.
  • Management:
    • Mild ➝ ❄️ cold compress, non-sedating antihistamines, topical steroids
    • Secondary infection ➝ oral antibiotics (flucloxacillin/clarithromycin)
    • Anaphylaxis ➝ 🚑 IM adrenaline 500 mcg (adult) / 150–300 mcg (child) + O2, IV fluids, antihistamines, steroids
    • Prevention ➝ repellents, protective clothing, avoidance advice
• 🕷️ Tick Bites
  • Clinical: Local redness; risk of Lyme disease ➝ erythema migrans (target rash), flu-like illness, neurological/arthritic features later.
  • Management:
    • Careful removal with fine tweezers (close to skin, steady pull)
    • Do not burn/suffocate the tick ❌
    • If erythema migrans ➝ treat empirically (doxycycline 100 mg BD 21 days; amoxicillin in pregnancy/children)
• 🧑 Human Bites
  • Clinical: Puncture/tearing wounds; high risk of infection (Eikenella, anaerobes).
  • Management:
    • Immediate irrigation, wound exploration, remove debris
    • Prophylactic antibiotics ➝ co-amoxiclav 7 days
    • Consider HIV/hepatitis B exposure prophylaxis if high-risk
    • Tetanus vaccination if needed
    • Escalate to IV antibiotics if cellulitis/sepsis
• 🐶 Animal Bites (dog, cat)
  • Clinical: Dogs cause crush injuries; cats cause deep puncture wounds (→ Pasteurella multocida risk).
  • Management:
    • Thorough cleaning ± surgical debridement
    • Antibiotics ➝ co-amoxiclav 7 days
    • Tetanus update
    • Rabies prophylaxis if animal from high-risk area 🌍
• 🕸️ Spider Bites
  • Clinical: Local pain, erythema, swelling. Rare systemic ➝ cramps, abdominal pain.
  • Management:
    • Mild ➝ cold compress, analgesia
    • Severe/systemic ➝ admit, supportive care ± antivenom
• 🌊 Jellyfish Stings
  • Clinical: Burning pain, linear welts. Rare systemic ➝ arrhythmias, respiratory compromise.
  • Management:
    • Rinse with seawater (❌ not fresh water)
    • Hot water immersion (40–45°C, 20–30 mins) to inactivate venom
    • Systemic involvement ➝ emergency care

Special Considerations

• 👶 Children: More prone to systemic reactions and severe swelling. Always use weight-based dosing for antihistamines/antibiotics.
• 🤰 Pregnancy: Avoid doxycycline (tick bites) – use amoxicillin. Always consider maternal-fetal safety.
• 🧓 Immunocompromised: Higher risk of infection and poor healing ➝ lower threshold for IV antibiotics & admission.
• 🌍 Travel-related: Consider exotic infections (rabies, leishmaniasis, malaria, dengue). Always take a travel history.

Red Flags 🚩

• Rapidly spreading erythema, cellulitis, systemic upset → sepsis pathway.
• Signs of anaphylaxis (airway obstruction, wheeze, hypotension, collapse).
• Bites near critical structures (face, hands, genitals, joints) → higher complication risk.
• Deep puncture wounds (cats, humans) → very high infection risk.

Summary

🌟 Clinical takeaway: Most insect bites are benign, but human and cat bites, tick bites, and systemic allergic reactions require urgent recognition and early treatment. Always check tetanus & rabies status, and never miss anaphylaxis 🚨.

References

• NICE CKS: Insect bites & stings
• NICE CKS: Human bites
• NICE CKS: Animal bites
• UKHSA: Lyme disease guidance