Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV.
Am Fam Physician. 2022 Aug;106(2):137-147.
Arthropods, including insects and arachnids, significantly affect humans as vectors for infectious diseases. Arthropod bites and stings commonly cause minor, usually self-limited reactions; however, some species are associated with more severe complications. Spider bites are rarely life-threatening. There are two medically relevant spiders in the United States. Widow spider (Latrodectus) envenomation can cause muscle spasm and severe pain that should be treated with analgesics and benzodiazepines. Antivenom is not widely available in the United States but may be considered for severe, refractory cases. Recluse spider (Loxosceles) bites are often overdiagnosed, should be treated supportively, and only rarely cause skin necrosis. Centruroides scorpions are the only medically relevant genus in the United States. Envenomation causes neuromuscular and autonomic dysfunction, which should be treated with analgesics, benzodiazepines, supportive care, and, in severe cases, antivenom. Hymenoptera, specifically bees, wasps, hornets, and fire ants, account for the most arthropod-related deaths in humans, most commonly by severe allergic reactions to envenomation. In severe cases, patients are treated with analgesia, local wound care, and systemic glucocorticoids. Diptera include flies and mosquitoes. The direct effects of their bites are usually minor and treated symptomatically; however, they are vectors for numerous infectious diseases. Arthropod bite and sting prevention strategies include avoiding high-risk areas, covering exposed skin, and wearing permethrin-impregnated clothing. N,N-diethyl- m-toluamide (DEET) 20% to 50% is the most studied and widely recommended insect repellant.
节肢动物，包括昆虫和蛛形纲动物，作为传染病的载体，对人类有重大影响。节肢动物咬伤和螫伤通常会引起轻微的、通常是自限性的反应；然而，有些物种与更严重的并发症有关。蜘蛛咬伤很少危及生命。在美国有两种与医学相关的蜘蛛。黑寡妇蜘蛛（Latrodectus）的毒液会引起肌肉痉挛和剧烈疼痛，应使用镇痛药和苯二氮䓬类药物治疗。抗蛇毒血清在美国并不广泛供应，但在严重、难治性病例中可能会被考虑使用。隐士蜘蛛（Loxosceles）咬伤通常被过度诊断，应给予支持性治疗，只有极少数情况下会导致皮肤坏死。Centruroides 蝎子是美国唯一与医学相关的属。螫伤会引起神经肌肉和自主功能障碍，应使用镇痛药、苯二氮䓬类药物、支持性护理，在严重情况下使用抗蛇毒血清治疗。膜翅目昆虫，特别是蜜蜂、黄蜂、胡蜂和火蚁，是导致人类因节肢动物而死亡的主要原因，最常见的原因是对毒液的严重过敏反应。在严重情况下，患者接受镇痛、局部伤口护理和全身糖皮质激素治疗。双翅目昆虫包括苍蝇和蚊子。它们的叮咬通常直接影响较小，症状治疗即可；然而，它们是许多传染病的传播媒介。节肢动物咬伤和螫伤的预防策略包括避免高风险地区、覆盖暴露的皮肤和穿氯菊酯浸渍的衣服。N,N-二乙基间甲苯酰胺（DEET）20%至 50%是研究最多和广泛推荐的昆虫驱避剂。
