Skip to Main Content

Clinical Summary

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.

FIGURE 16.81

Paper Wasp. Paper wasps are found throughout the world and often establish nests close to or within human dwellings. (Photo contributor: R. Jason Thurman, MD.)

FIGURE 16.82

Paper Wasp Nest. A typical paper wasp nest in a roof corner. Disturbance of a nest may result in swarming attacks. (Photo contributor: Clay B. Smith, MD.)

FIGURE 16.83

Fire Ant Mound. This typical fire ant mound is a raised area of dirt in an urban yard. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 16.84

Fire Ant Bites. These fire ant bites on the anterior knee occurred after this patient knelt on a mound. These bites are 3 days old; the initial sterile pustules have begun to crust over. (Photo contributor: Alan B. Storrow, MD.)

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.

Management and Disposition

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.

FIGURE 16.85

Honeybee Envenomation. Many honeybee stingers (barbs and venom sacs) are seen on this patient’s cheek and ear and along the hairline. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 16.86

Honeybee Stingers. The barbs and attached venom sacs (stinger apparatus) after removal from the patient. (Photo contributor: Alan B. Storrow, MD.)


  1. 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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.