Stings

As discussed in the first chapter, stings by venomous arthropods can produce direct effects in humans by the toxic action of the venom alone or indirect effects due to allergic reactions (Table 3.1). Direct toxic effects are very rare but may include cerebral infarction, neuropathies (even optic), and seizures.1-3 In addition, secondary infection may arise from stings, especially if the lesion is scratched (Figure 3.1). The direct effects of a sting can be mild such as pain, itching, wheal, flare, etc., or can be serious when numerous stings are received and the large amount of venom injected produces toxic effects. Small children are at a higher risk for developing severe toxicity because of their smaller body weight. One account of a toxic reaction in a child from massive hornet stings described clinical features such as coma, respiratory failure, coagulopathy, renal failure, and liver dysfunction.1 But, for most individuals, the risk of a severe reaction resulting from either a toxic or allergic mechanism is quite low. Lightning claims more lives annually in the United States than stinging arthropods,2 and adverse reactions to penicillin kill seven times as many.3