Medical Problems And Treatment Considerations For The Red .
ENTO-00503/14Medical Problems and TreatmentConsiderations for the Red Imported Fire AntBastiaan M. DreesExtension Entomologist EmeritusTexas A&M AgriLife Extension ServiceDISCLAIMER: This fact sheet reviews informationregarding medical problems caused by the redimported fire ant. It is not intended to providetreatment recommendations for fire ant stingsor reactions that may develop as a result of astinging incident. Readers are encouraged to seekhealth-related advice and recommendations fromtheir medical doctors, allergists, or other appropriate specialists.Imported fire ants cause medical problems whensterile female worker ants sting and inject avenom that can cause localized sterile blisters,whole body allergic reactions such as anaphylacticshock, and, occasionally, death. Fire ant speciesinclude the red imported fire ant, Solenopsisinvicta Buren (Hymenoptera: Formicidae); theblack imported fire ant, Solenopsis richteri Forel;and the hybrid between S. invicta andS. richteri.In Texas, S. invicta is the only imported fire ant,although several species of native fire ants occurin the state. These include the tropical fire ant,S. geminata (Fabricius) and the desert fire ant,S. xyloni McCook, which are also capable ofstinging (see Texas Pest Ant Identification: AnIllustrated Key to Common Pest Ants and Fire AntSpecies for identification keys).Over 40 million people live in the southeasternUnited States in areas infested by the redimported fire ant. Each year, an estimated 14million people are stung. According to theScripps Howard Texas Poll (March 2000), 79percent of Texans had been stung by fire ants inthe year of the survey, while 20 percent of Texansreport not ever having been stung. West Texanswere least likely to have been stung by fire ants(61 percent) compared with 90 percent in central,89 percent in east, 86 percent in gulf, 78 percentin South, and 72 percent in north Texas.A survey of 1,286 health practitioners in SouthCarolina estimated that more than 33,000 people(94 per 10,000 population or 0.94 percent) seekmedical attention for imported fire ant stings,and of these, 660 people (1.9 per 10,000 population or 0.02 percent) are treated for anaphylaxis(Caldwell et al. 1999). Anaphylaxis occurs in0.6 to 6 percent of people who are stung, andthese reactions have caused more than 80 deaths(deShazo et al. 1999).In 1998, the average household cost for importedfire ant problems per Texas household in urban
areas was 150.79, with 9.40 spent on medicalcare costs. The total annual metroplex (Austin,Dallas, Ft. Worth, Houston, and San Antonio)expenditures for medical care costs was 9 percent, or 47.1 million of the 526 million totalexpenditure cost due to the red imported fire ant(see Economic Assessments of Red Imported FireAnt on Texas’ Urban and Agricultural Sectors).climb up any vertical objects such as grassblades, sticks, or legs of people or animals standing on or near the nest. Under mild to hightemperature conditions, this reaction is almostimmediate. However, the reaction can be delayedwhen temperatures are cooler (less than 55 F,causing cold-blooded ants to move more slowly)or extremely hot (over 95 F, causing worker antsto reside deeper in the soil). Generally, these antscan begin to sting within 10 to 20 seconds afterclimbing upon their victims.Avoid Being StungThe best tip for avoiding medical emergenciesassociated with fire ants is to prevent beingstung. Do not disturb ant nests. Although most peopleavoid large visible ant mounds, they can inadvertently step on smaller mounds or nests withlittle “worked” soil. Colonies can also form underrocks, wood, or other debris on the ground. Furthermore, stepping on a mound may be almostunavoidable in some areas where there are morethan 200 mounds per acre, as found in areasinfested with the multiple queen (polygyne) formof the fire ant.Learn to recognize threatening situations andcontrol them where they are a potential problem (see How Can I Tell If I Have Fire Ants?and publications and fact sheets on the TexasImported Fire Ant Research and Management Project website).Be aware of fire ants and take care to notstand on ant nests or food resources onwhich they are foraging.Colonies frequently migrate from one site toanother on the surface of the ground or in cracksduring dry periods. Ants in migrating coloniesare highly defensive and should be avoided. Also,during flooding conditions, colonies can float inclusters or “rafts,” posing a threat to anythingencountering them (see What happens to fireants during a flood? and Flooding and Fire Ants:Protecting Yourself and Your Family).Teach children and visitors about fire antsand their hazards.Wear protective clothing such as bootsduring outdoor activities and tuck pant legsinto your socks.Control ants where they occur in areas usedmost frequently by people or pets. Use insectrepellents on clothing or footwear (thesetreatments can temporarily discourage foraging ants).Teach people new to the area about thisthreat (see Welcome to Texas: Avoiding theSting of Fire Ants).Avoid High-Risk SituationsQuick defensive reaction. Imported fire antworkers aggressively defend their nests frominvaders. When fire ant mounds are disturbed,worker ants quickly rush to the surface and2
Watch for foraging ants. People weeding inlandscape beds or vegetable gardens, or merelywalking through tall vegetation can encounterforaging worker ants. These ants will readilysting, particularly when caught underneathclothes or pinched in folds of skin.In fire ant mounds, worker ants produce subterranean tunnels that lead to openings whereforagers emerge. Upon discovering neededresources, foraging ants recruit other workerants to those sites (see What do fire ants eat?).Thus, edges of bodies of water, trash cans, andareas with spilled food or sugary drinks attractlarge numbers of foraging workers.it slightly, causing a pricking sensation. Thenthe ant arches its back, doubles under its abdomen, and forces the stinger into the tissue.After inflicting the first sting, it may remove thestinger and, rotating or pivoting around its head,may sting several more times, leaving a circularpattern of sting sites.Expect indoor invasions. Fire ant workers caneasily enter structures through even tiny cracksand crevices. They forage in and around laundry, pet bowls, or other areas where they findfood and water resources. Occasionally, entirecolonies will migrate into structures and nestin wall voids or other locations. This is particularly common when outdoor conditions becomevery hot and dry or when flooding occurs in theimmediate landscape. During the night, fire antscan move into the beds of children or immobilepeople. A number of serious multiple stingingincidents have occurred indoors in Texas (Drees1995) and elsewhere (deShazo et al. 1999). Frequently, samples of ants are not collected whenthese indoor stinging incidents are discovered, making it impossible to determine if theimported fire ants were foraging from colonieslocated elsewhere, such as outdoors, or if theants were from a migrating colony as indicatedby the presence of brood (eggs, larvae, and pupaeamong the adult ants).Multiple stinging incidents from many ants.Because large numbers of worker ants are oftentogether, as in a nest, stinging incidents usuallyinvolve multiple stings. When a person steps intoa mound, hundreds of ants can rapidly crawl(1.6 centimeter per second) up their leg. Withinseconds, they begin stinging almost simultaneously. High numbers of stings can lead to severemedical reactions even in people with normalimmune systems. The elderly, infants, neurologically compromised people, and otherwiseimmobile or unaware individuals are at a higherrisk of multiple stinging incidents and should besupervised carefully.Removing Stinging AntsThe Stinging IncidentBecause worker ants use their jaws (mandibles)to gain leverage to sting, they are fixed tightly tothe skin or clothing. Merely jumping into wateror running water from a spigot across the antswill not remove them. The best method is to rubthem off briskly by hand or using a cloth.Individual worker ants can bite and sting severaltimes. When stinging, the worker attaches tothe skin with its chewing mouth parts (mandibles), pulling the skin, pinching it, and raising3
most people. However, some people are sensitiveto these proteins, and a sting can lead to a majorallergic reaction called anaphylactic shock (Vinson and Sorenson 1986; also see Baer et al. 1997,Hoffman et al. 1988).The Stinger, Poison Gland,and VenomThe “stinger” on worker ants is a modifiedegg-laying structure (ovipositor). Worker antsare sterile females incapable of producing eggs.A poison gland containing venom is attachedto the stinger. Queen and winged reproductive(unmated queen) ants also have a poison gland.However, they do not use their ovipositor as astinger as do worker ants. Male ants, wasps, andbees do not possess stingers.Reactions to StingsPeople vary greatly in their sensitivity to fireant stings. Some claim to be “resistant” to thevenom. Others are hypersensitive to it or mayhave other medical conditions (such as a heartcondition or diabetes) that can result in seriousmedical problems or even death from a singlesting. Secondary bacterial infection can also be aproblem and might require longer-term medicalattention. While most people can tolerate manystings, severe allergic reactions (anaphylaxis)occur in less than 1 percent of the people stungby fire ants.Localized skin reaction to venom. The site of thesting hurts for a few minutes and then reddens;then it swells into a bump or hive within 20 minutes. The intense burning sensation that occurswhen the venom is injected accounts for the popular name of “fire ant.”Within several hours to a day after being stung,most people develop a white fluid-filled sterile pustule characteristic of the imported fireant sting. No other Texas ants cause this typeImported fire ants produce venom in a glandconnected to the stinger. The venom containstwo major components: alkaloids and proteins.The oily aliphatic substituted alkaloids (i.e., thepiperidine alkaloid, Solenopsin A) are toxicto cells and cause a pustule to form by killingcells at the site of the injection. These dead cellsattract the body’s defensive white blood cells,which accumulate at the venom site and forma pustule. If the skin is broken by scratching,bacteria may enter, causing an infection. Thevenom also contains a protein component (lessthan 1 percent), which has little or no effect on4
of reaction to the venom. These pustules lastfor several days and may become infected andrequire medical attention. For most people, thepustule dries up in several weeks. For some people the pustule may lead to a brown scar that canlast for many months or leave a permanent scar.Some people stung (17 to 56 percent) developvenom-specific IgE and experience hard, itchinglumps at the site of subsequent stings called latecutaneous allergic reactions (Caro et al. 1957,deShazo et al. 1999). Although stings are notusually life threatening, they can easily becomeinfected if the skin is broken.Bite and Sting Treatment Options Whole body reactions. Symptoms of anaphylaxis can include dizziness, headache, low bloodpressure, nausea, shortness of breath, and sweating. If any of these symptoms occur, the personrequires immediate medical attention. Anaphylactic shock can lead to death. People whoshow symptoms of anaphylactic shock shouldseek advice from an allergist before enteringknown fire-ant-infested areas. Other syndromesattributed to fire ant stings include seizures,cerebrovascular incidents, neuropathy, andnephrotic syndrome (deShazo et al. 1999). For minor stinging incidents, with the onlysymptoms being pain and the development ofpustules, treat stings with over-the-counterproducts that relieve pain and prevent infection (see Appendix 1).For those suffering just pain and the development of pustules, a simple solution of halfbleach and half water applied immediatelyto the area can reduce the pain, itching, and,perhaps, pustule formation. It is essential toapply it quickly (Vinson and Sorenson 1986).If a sting causes severe chest pain, loss ofbreath, nausea, serious swelling, slurredspeech, or severe sweating, take the person toan emergency medical facility immediately.Preventing pustules. If you can remove fire antsas they are biting but before they sting, they willnot inject venom and a pustule will not form.Once the venom has been injected, pustules willusually form regardless of treatment: “Topicalsteroids, diphenylhydrazmine, antibiotics, orepinephrine do not alter the course of pustularreactions” (Caro et al. 1957, Parino et al. 1981).Regardless, take action as soon as possible afterthe attack to get maximum benefits from treatment.Texas Allergy, Asthma and ImmunologySociety Addresses Fire Ant AllergiesAccording to the Texas Allergy, Asthma andImmunology Society (taais.org/patient-education/fire-ants/), “Fire ants cause severe, life-threatening reactions in people allergic to them. Morepeople have died from allergic reactions to fireants in Texas than anywhere in the U.S. . . . If youare allergic to fire ants, find out where you canget effective treatment and reduce your risk ofa serious reaction to a fire ant sting. . . . Fire antsare the most common cause of allergic reactionsto stinging insects in Texas. . . . “Severe allergicreactions (anaphylaxis) occur in 1–6% of peoplestung by fire ants and occasionally these reactionsmay be fatal.”Medical treatment considerations (for medical doctors). In patients without anaphylaxis, aconservative approach is suggested, similar tothat used for small numbers of stings, which,more often than not, are associated with acuteitching and burning followed by the developmentof sterile pustules. In such cases, remove the antsby washing the affected area with an antisepticsoap. Relieve itching with nonsedative antihistamines. Two of these, cetirizine (Zyrtec) andloratadine (Claratin), are available in liquid formfor use in children and patients with feedingtubes. Itching can also be treated with applications of topical corticosteroids such as 1 percenthydracortisone (0.1 percent triamcinolone),and topical anti-itch agents such as pramoxine5
HCl 1 percent (such as Anusol, Cacoryl). Takecare to not rupture the sterile pustules becauseresulting lesions occasionally become infected.Intravenous fluids or parenteral corticosteroidsfor fire ant stings are not recommended unlessthere is evidence of hypersensitivity to fire antvenom. These agents may lead to fluid retentionand cardiovascular compromise in patients withpreexisting cardiovascular insufficiency. The antsting sites rarely become infected and antibioticprophylaxis is therefore not routinely required.Acknowledgments“Symptoms of anaphylaxis should be treatedwith epinephrine, parenteral corticosteroids,and antihistamines, as is standard procedure”according to R. D. deShazo (deShazo et al 1999edited by Dr. B. Paull). Adrenalin is the first-aidtreatment of choice for the systemic allergicresponse with dyspnea and/or hypertension.It achieves the quickest reversal of the adverseevents and is very safe in a life-threateningsituation. Anyone who has had stinging-insect-induced anaphylaxis should carry an EpiPen(or EpiPen Jr for children; CSL) for immediatefirst-aid use if hypotension or dyspnoea occurs.Specific desensitization to prevent future anaphylaxis to imported fire ant stings in susceptible patients is effective (Freeman et al. 1992),and anyone suspected of imported fire ant stinganaphylaxis should be referred to an allergist forassessment” (Solley et al. 2002).Literature Citations and Sourcesof Additional InformationBarry Paull, M. D., Allergy Associates of BrazosValley, and J. K. Olson reviewed the originalmanuscript released in April 1999. This factsheet was last revised (minor formatting changesand agency name) in December 2002. This second revision (November 2012) changed no technical medical information, but provided links torelevant online fire ant information.Baer, H., T. Y. Liu and M. C. Anderson. 1979.“Protein Components of Fire Ant Venom (Solenopsis invicta).” Toxicon 17:397405.Caldwell, S. T., S. H. Schuman and W. M. Simpson, Jr. 1999. “Fire Ants: A Continuing Community Health Threat in South Carolina.” J. SouthCarolina Medical Assn. 95:231–235.Caro, M. R., V. J. Derbes, and R. Jung. 1957. “SkinResponse to the Sting of the Imported Fire Ant(Solenopsis saevissima).” AMA Archives of Dermatology 75:475–488.deShazo, R. D., C. Griffin, T. H. Kwan, W. A.Banks and H. F. Dvorak. 1984. “Dermal Hypersensitivity Reactions to Imported Fire Ants.” J.Allergy Clin. Immunol. 74:841–847.deShazo, R. D., B. T. Butcher and W. A. Banks.1990. “Reactions to Stings of the Red ImportedFire Ant.” N. Engl. J. Med. 323:462–466.deShazo, R. D., D. F. Williams, E. S. Moak. 1999.“Fire Ant Attacks on Residents in Health CareFacilities: A Report of Two Cases.” Ann. Intern.Med. 131:424–429.Drees, B. M. 1995. “Red Imported Fire Ant Multiple Stinging Incidents to Humans Indoors inTexas.” Southwestern Entomol. 20:383–385.Freeman, T. M., R. Hylander, A. Ortiz and M. E.Martin. 1992. “Imported Fire Ant Immunother-6
apy: Effectiveness of Whole Body Extracts.” J.Allergy Clin. Immunol. 90:210–215.ReferencesHoffman, D. R. 1995. “Fire Ant Venom Allergy.”Allergy 50:535–544.Texas Pest Identification: An Illustrated Key toCommon Pest Ants and Fire Ant Speciesu.tamu.edu/ento-001Hoffman, D. R., D. E. Dove and R. S. Jacobson.1988. “Allergens in Hymenoptera Venom XX.Isolation of Four Allergens from Imported FireAnt (Solenopsis invicta) Venom.” J. Allergy Clin.Immunol. 82:818–827.Economic Assessments of Red Imported Fire Anton Texas’ Urban and Agricultural Sectorssswe.tamu.edu/PDF/SWE S25 P123-137.pdfHow Can I Tell If I Have Fire -antsLard, C., D. B. Willis, V. Salin and S. Robison.2002. “Economic Assessments of Red ImportedFire Ant in Texas’ Urban and Agricultural Sectors,” pp. 123–1372. In Program Highlights ofthe Texas Imported Fire Ant Research and Management Project, B. M. Drees (ed), SouthwesternEntomologist Supplement No. 25.Texas Imported Fire Ant Research andManagement Project websitefireant.tamu.eduParino, J., N. Kandawalla and R. F. Lockey.1981. “Treatment of the Local Skin Response toImported Fire Ant Sting.” South. Med. J. 74:1361–1364.What happens to fire ants during a -fire-ants-during-a-floodWelcome to Texas: Avoiding the Sting of FireAnts u.tamu.edu/ento-002Prahlow, J. A., and J. J. Barnard. 1998. “FatalAnaphylaxis Due to Fire Ant Stings.” Am. J.Forensic Med. Pathol. 19:137–142.Flooding and Fire Ants: Protecting Yourself andYour Familyu.tamu.edu/ento-006Rhoades, R. B., C. T. Stafford, F. K. James. 1989.“Survey of Fatal Anaphylactic Reactions toImported Fire Ants.” J. Allergy Clin. Immunol.84:159–162.What do fire ants -eatManaging Red Imported Fire Ants in lley, G. O., C. Vanderwoude and G. K. Knight.2002. “Anaphylaxis Due to Red Imported FireAnt Sting.” Medical J. Australia 176(11):521–523Stafford, C. T. 1996.” Hypersensitivity of FireAnt Venom.” Ann. Allergy Asthma Immunol.77:87–95.Broadcast Baits for Fire Ant tmFire Ant Control: The Two-Step Method andOther -034.htmVinson, S. B. and A. Sorenson. 1986. ImportedFire Ants: Life History and Impact. TexasDepartment of Agriculture, Austin, TX. 28 pp.7
APPENDIX 1.Over-the-Counter Products and Reported “Home Remediesfor Treating “Bites” and Stings of Red Imported Fire AntsOver-the-counter products: There are manyover-the-counter products promoted for treatinginsect bites and stings commonly formulated ascreams, lotions, ointments, or solutions containing one or more “active ingredients.” Someproduct labels specifically mention fire ant“bites” and stings, others are for general purpose.Available without a prescription, these productsshould be used according to directions providedon product labels. If the condition for whichthese preparations are used persists, or if infection, irritation, or rash develops, discontinuetheir use and consult a physician. Common active ingredients: The surface anesthetic, benzocaine, is a common ingredientthat inhibits the conduction of nerve impulsesfrom sensory nerves. The antihistamine, benadryl, also has some localized anesthetic activity,relieving itching. The corticosteroid, hydrocortisone, has anti-inflammatory, antipruritic(anti-itching), and vasoconstrictive actions whenapplied topically. Antiseptics prevent secondaryinfections. Calamine is an astringent.Home remedies: (These are provided for educational purposes only and do not constitutea recommendation for use by the Texas A&MAgriLife Extension Service) Non-commercialtreatments of stings and bites include placing anice cube over the skin to reduce pain. There aremany other reported “home remedies” for fireant stings. Most of these have not been scientifically evaluated or tested and are supportedmerely by testimonials. Some of these includedabbing the affected area with ammonia, meattenderizer (papain), or a paste made of salt orcrushed aspirin or stick deodorant. A collectionof these testimonials follows: “For those suffering pain and the development of pustules, a simple solution of half8bleach and half water applied immediatelyto the area can reduce the pain, itching, andpustule formation. It is essential to apply itquickly.” (Vinson and Sorenson 1986)Desert Essence Tea Tree Oil—Chatsworth,CA 91311 or Extinguish (100%) Tea TreeOil Relieves the pain and itch of Fire AntStings! Tea tree oil (Melaleuca alternifolia)is a natural oil that comes from the tea treegrown only in Australia. The oil’s medicinalproperties were discovered in the 1920s andresearched extensively until the end of the1930s. Tea tree oil has increased in popularityin the past 20 years. It is soothing and healing to insect bites and stings, poison ivy/oak,and other minor skin injuries. It is a naturalantiseptic/fungicide/germicide. Extinguish(not to be confused with Extinguish antbait by Wellmart International containings-methoprene) is very effective when usedon fire ant stings and other insect bites andstings such as chiggers, fleas, and mosquitoes,etc. It is most effective when applied directlyafter a sting with reapplication as needed.Extinguish relieves the itch, pain, and promotes healing. The bottle is small for easein carrying and use. For very sensitive skin,Extinguish can be diluted with olive oil. —Handout, Whole Food Store, Austin, TX.Fire ant remedy No. 289: soak one cotton ballin household ammonia and another in hydrogen peroxide. Beginning with the ammonia,alternate, applying the pads to the bites forfive-minute stints for about 20 minutes. —Austin American Statesman, June 8, 1998,Jane Greig columnImmediately apply 100 percent aloe gel(found at Walgreens or other pharmacies). —R. Foley, Tampa, FL.
“We use dishwashing liquid to treat fire antbites. My son was bit today, and within 10minutes, we washed it with soap and waterand applied dishwashing liquid. The swellingand itching subsided in about 10 minutes andhe’s fine now.”— J. M. Ira “Did you know that if you rub a fresh pieceof onion on a fire ant bite as soon as possible,it never swells up and quits stinging?” — C.Snell“I have joyously found Arnica Gel by Boiron.It is a homeopathic medicine and it takes thesting, burn, and itch out of fire ant bites.” —C. M. FillieliFor more information regarding fire ant management,see Extension publications Managing Red Imported Fire Ants in Urban Areas,Broadcast Baits for Fire Ant Control, or Fire Ant Control: The Two-Step Methodand Other Approaches posted on http://AgriLifeBookstore.org.The information given herein is for educational purposes only. Reference to commercial products or trade names is made withthe understanding that no discrimination is intended and no endorsement by the Texas A&M AgriLife Extension Service is implied.Texas A&M AgriLife Extension ServiceAgriLifeExtension.tamu.eduMore Extension publications can be found at AgriLifeBookstore.orgEducational programs of the Texas A&M AgriLife Extension Service are open to all people without regardto race, color, sex, religion, national origin, age, disability, genetic information, or veteran status.The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating.9
Imported fire ants cause medical problems when sterile female worker ants sting and inject a . laxis can include dizziness, headache, low blood pressure, nausea, shortness of breath, and sweat-ing. If any of these symptoms occ
The sequence of treatment processes through which wastewater passes is usually characterized as: 1. Preliminary treatment 2. Primary treatment 3. Secondary treatment 4. Tertiary treatment This discussion is an introduction to advanced treatment methods and processes. Advanced treatment is primarily a tertiary treatment.
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