1. Fever, chills, nausea, vomiting, weakness, joint pain 2. Morbilliform or petechial generalized eruption 3. Occasionally serious hematological disturbances—hemolytic anemia, thrombocytopenia _DEATHS:_ Reported; usually in children, due to renal failure and hematological abnormalities. TREATMENT _LOCAL FIRST AID:_ None effective or necessary _LOCAL:_ Within 4 hours of the bite, locally excise bite site _SYSTEMIC:_ 1. Systemic corticosteroids is the treatment of choice and must be administered immediately—methylprednisolone (Depo-Medrol) 80 mg IM, followed by prednisone 60 mg a day for 3 days and gradually tapered over a 10-14-day course of therapy 2. Heparin therapy may reduce the disseminated intravascular coagulation phenomenon 3. Analgesics for pain CENTIPEDES REACTIONS _IMMEDIATE:_ Pain, often intense _LOCAL:_ 1-4 hours—A two-puncture wound at the site with redness, swelling, and a burning aching pain that subsides in 4-5 hours _REGIONAL:_ Rare—Purpura of an entire limb _ANAPHYLAXIS AND DEATH:_ None reported in the United States TREATMENT _LOCAL FIRST AID:_ 1. Wash with soap and water 2. Apply ammonia in 10% solution 3. Apply cool wet dressings of a saturated magnesium sulfate solution _SYSTEMIC:_ Analgesics for pain TRUE BUGS (KISSING BUGS) REACTIONS _IMMEDIATE:_ Usually no sensation, occasionally mild pain _LOCAL:_ (Four distinct reactions depending on degree of sensitivity): 1. Papule with a central punctum 2. Small vesicles grouped around bite site with swelling and little redness 3. Giant urticarial lesion with central punctum and surrounding brawny edema 4. Hemorrhagic nodular-to-bullous lesions on hands and feet—the characteristic “kissing bug bites” _ANAPHYLACTIC SHOCK:_ Rare, but reported _DEATHS:_ None reported TREATMENT _LOCAL FIRST AID:_ Wash with soap and water _SYSTEMIC:_ Oral antihistamines (Chart 1) ANTS REACTIONS _IMMEDIATE:_ Fierce burning pain lasting minutes _LOCAL:_ (Fire Ants) Minutes—Wheal formation 2-4 Hours—Clear fluid-filled vesicles 8-10 Hours—Cloudy fluid-filled vesicles 12-24 Hours—Umbilicated pustules on a red base, with pain and tenderness 3-8 Days—Lesions resolve; may leave scars _SYSTEMIC:_ Due to allergic sensitization; severity and speed of onset related to degree of sensitivity. May see wheezing, urticaria, abdominal cramps, generalized edema, nausea, vomiting, dizziness, confusion, shock _ANAPHYLAXIS AND DEATH:_ Rare, but reported TREATMENT _LOCAL FIRST AID:_