Mostly out-of-focus photo of an arm that has a somewhat reddish swollen part in the middle of the frame. Within the center there is some very mild tearing of the skin from scratching.
#EntomologyConsult: a patient has an enlarging, progressively itchy, edematous area on her forearm with similar lesions on skin not typically covered by clothes. Bedbug inspection found no insects. This is atypical of her mosquito bite reactions. What could have caused this?
A dead insect curled up. It is red with black markings, slightly out of focus. You can make out the long thin stinger protruding from the tip of the abdomen.
#EntomologyConsult: a child was stung on the hand by an ant, but with pain beyond what is expected for a typical fire ant sting. Is this species more dangerous? My answer ⬇️
An occasional #EntomologyConsult I get is to identify the cause of a “sting” that results in bleeding. That is blood with anticoagulant from horse fly or deer fly saliva! The bites really hurt (and feel like a sting). When you don’t have the insect, bleeding is a clue for identifying the culprit
Looking down into a half full glass of red wine and mostly empty glass of beer you can make out four to five black insects with yellow stripes
#EntomologyConsult: we are at a picnic and are being swarmed by stinging insects! What are these things! My answer ⬇️
#EntomologyConsult: solitary female wasps have ovipositors to lay eggs in various substances. Those laying eggs in wood have long sharp ovipositors that can be used in self defense. The pain is from mechanical injury from piercing. Fortunately there’s no venom. It’s like getting poked with a needle!
On a clear plastic plate sit three lumps of crawfish that have already been peeled. Each piece is a semicircle that is white with reddish segments on the sides.
#EntomologyConsult: a patient has profuse vomiting and then diarrhea hours after eating mudbugs on three occasions. No one else eating them gets sick. Is this an allergy? [mudbug = crawfish = crayfish] My response ⬇️
A black fly with areas of gray is being held by out-of-focus fingers that seem to have some sand on them. The fly is seen in profile. There is a kidney shaped brown eye peering towards the viewer. At the bottom of the head is a strange mouth that first tapers straight down but then makes a 90 turn in from if the head, projecting forward for a distance the length of the whole head.
#EntomologyConsult: a patient on vacation at the beach is getting painful bites from flies. The bite reactions are getting larger. Is this dangerous? Photo of specimen provided. My answer ⬇️
A brown leaf-footed but is resting on white carpet, facing away from the camera. The hind legs are large with spikes pointing backwards on the femur, and there is a dilated midsection of the tibia.
#EntomologyConsult: a huge bug landed on my head. When I smacked it, the bug bit me. Is it dangerous?
#EntomologyConsult: how can I treat itchy mosquito bites? It depends on the type of itch! Histamine causes itch right after bites, usually gone in 30 mins. It takes >30 mins for antihistamines to work. You can take an antihistamine before the bite if it’s anticipated but after is usually too late 😢
The calloused texture of a palm with about 14 red dots of various size/depth/color.
#EntomologyConsult: a woman was weeding in the garden when she felt a sharp pain on her hand. Can you tell what stung her?
Two Yellowjackets are on a floor. One is upside down looking dead while the other is upright and appears alive. The alive one has more beautiful yellow and black markings that include spots of black within the yellow stripes
#EntomologyConsult: a child with #anaphylaxis after #yellowjacket stings (definitively identified) has negative serum testing. If we use skin testing, what concentration should be used?
Looking down on a flat, round insect with the circular abdomen containing slight ridges dividing it into 8 segments, with the top segment actually being part of the thorax. Above this is another smaller circle consisting of the rest of the thorax and head. The head itself is slightly out of focus, bending towards the white background of the photo. Two antennae and Toledo legs are sticking out in front of the insect.
#EntomologyConsult: insect was found on a plane after biting a passenger. What is it?
A black mosquito with bright white stripes is standing on skin, head bent into the skin. The abdomen is distended, with the side view showing a transparent budge of deep red.
#EntomologyConsult: can patients with #mosquito-induced #anaphylaxis be desensitized?
The forearm of a pale person. In the center is a white raised circle with irregular boarders, in the center of which is a hole with a little blood in it. Outside the white raised circle is splotchy redness that fades into the pale pink skin.
#EntomologyConsult: A patient is stung on the arm by an insect that she didn’t see, but did take a photo of the wound. She then developed hives and vomiting. Allergy testing identifies sIgE to yellow jacket, yellow hornet, bald faced hornet, and fire ants. What extracts should be used in treatment?
A photo of flour, mostly white but lots of dark shadows due to the uneven clumping of the flour. There is nothing visibly unusual about the flour. The normalness makes you wonder what horrors might be seen under magnification
An #EntomologyConsult to distract us all. A child had #anaphylaxis after eating pancakes made from scratch at home, but tests negative for wheat, egg, and milk allergy. Anaphylaxis recurs with home pancakes but not pancakes elsewhere. What is the trigger?
#EntomologyConsult: I just got a reviewer comment back and we’re not sure if we should make the change in our paper. Is “antivenom” or “antivenin” the preferred term?
A microscopic view of a long skinny mite. It tapers to a blunt end pointing to the bottom left and has a bit of a segmented bulbous region to the top right. There are four nubs of legs poking out to each side, with one nub per section.
#EntomologyConsult: a skin biopsy of an unusual rash was prepared. The slide contains an arthropod (nearly identical in appearance to mite depicted here). Is it clinically relevant?
A chunky fluffy bee is seen in profile. The yellow fluff of the thorax and upper abdomen look particularly soft. The black fluff of the posterior two thirds of the abdomen also look pretty soft. The head is black but small with a shiny black eye that is in contrast to the fluffiness. The bee is sitting in the center of a flower the center is about as long as the bee and consists of hundreds of dark red florets. The petals on the periphery are a light purple.
#EntomologyConsult: for people with venom allergy, is #bumblebee venom cross-reactive with honeybee venom?
Looking at the profile of a dead flea. It has very long back legs that are segmented poking out the back of the insect. Smaller middle and front legs are partly obscured by being folded up underneath the insect. The thorax and abdomen are segmented, although it’s harder to make out the segmentation because this area of the flea is much darker than the light brown on the legs. the elongated half circle of the head is visible above the front legs, but this isn’t a great photo so you can’t make out a lot of detail
#EntomologyConsult: Is any testing needed if a child swallows a #flea?
This is a photo of my hand holding a vile. The label on the vile reads Ant, Fire Solenopsis invicta 10mL 1:20 W/V. At the top highlighted in yellow reads allergenic extract.
#EntomologyConsult: how many ants are you going to inject me with?
A brown spider with eight long legs sits on a completely white background. Looking in at the top of thorax, you do see the fiddle shape structure, characteristic of recluse spiders. There are two fuzzy pedipalps sticking out in front of the spider
#EntomologyConsult: Does it matter if it’s a brown #recluse #spider or a Mediterranean recluse spider?
#EntomologyConsult post-of-the-year award goes to @colebaril.ca for this post on M ulcerans transmission by aquatic bug bite. There was stiff competition this year, with many fascinating posts, and I look forward to another strong year of medical entomology posts!
This is a photograph of an arm. That 2/3 of the way down towards the wrist there was a small wound and from this wound as a streak of liquidy blood flowing down.
#EntomologyConsult: an insect flew onto a patient and bit them. The bite hurt, and caused significant bleeding. Do you know what did this?
I admit ignorance about the nature of substances used to keep the tick embedded. The success of “slow, gentle traction” on removal suggests that the tick can release if given motivation and opportunity. @megsquitophd.bsky.social or other tick experts able to right in on this cool #EntomologyConsult?
#EntomologyConsult: for bite reactions, do IgE-producing B cells affect T cells or is it the other way around? Depicted here is the foot of a patient with both immediate-type IgE reactions (left) and delayed-type T cell reactions (right)
A black mosquito with white stripes has a bloated blood-red abdomen. It is resting on and drinking from skin that takes up all of the background of the photo
#EntomologyConsult: what is the best treatment for #mosquito bites?
In my #EntomologyConsult work I got a question once about about staining of human skin in whip-shaped bruise-like patterns. I found this one report but would love to know if others have seen the oxidizing effects of millipedes on human skin! doi.org/10.1177/0009...
Looking down on a Tussic moth caterpillar. You see too long tufts of stiff black hairs coming out anterior and laterally from a red head. behind the red head is a fluffy yellow potty punctuated with three strange white blobs on the top. There is some dark stiff hairs pointed posteriorly to the caterpillar as well, but they are not as striking as the two toughs coming out of the front this is a weird looking caterpillar!
#EntomologyConsult: a child develops an itchy rash after playing with strange, hairy #caterpillars. Did hairs get stuck in the skin, needing removal?
A mostly yellow insect with black stripes is crawling along a cluster of small bright yellow flowers. The background is green vegetation but mostly out of focus.
#EntomologyConsult: a patient comes to allergy clinic directly from the ED after venom-induced anaphylaxis. Is it too soon to do allergy testing?
