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The order Hymenoptera includes wasps, hornets, yellow jackets, bees, and ants. Envenomation usually results in local pain, mild erythema, swelling, and pruritus. Severe systemic or toxic reactions may occur from one or multiple stings, manifesting as gastrointestinal symptoms, headache, pyrexia, muscle spasms, or seizures. Anaphylaxis may occur within minutes from a single sting and may cause death from airway obstruction and/or cardiovascular collapse. A serum sickness–type reaction may occur 7 to 14 days after envenomation.
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Solenopsis invicta was imported from South America and is the most prominent fire ant in the United States. These ants are primarily found in the South and build mound nests in open grass settings, commonly in urban yards. Disturbing the nests may result in severe swarming attacks, a common occurrence in the unsuspecting barefoot victim. Bites are painful and produce sterile pustules that crust over in a few days.
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Management and Disposition
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Anaphylaxis is treated with conventional therapy with careful attention to airway management. Local reactions may be treated with ice packs, steroid cream, and oral antihistamines. Opiates may be needed for severe pain.
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Honeybee stings are usually apparent since the stinger apparatus, including barb and venom sac, is often detached and present on the patient’s skin. These should be removed by scraping them off, as grasping with tweezers may result ...