Most people develop some redness and itching after a mosquito bite. Unfortunately, some children will have what’s known as a large local reaction, or “Skeeter syndrome.” This happens due to an allergy to mosquito saliva. These patients develop redness and swelling within hours of a mosquito bite. The swelling can be very large (like an entire arm or leg) and typically worsens over 1-2 days. In the worse reactions there can be bruising and even blistering!

It’s not always easy even for your doctor to tell the difference between “Skeeter syndrome” and a skin infection. One of the big differences is the timeline. Skin infections usually happen several days after a bite or an injury, but “Skeeter syndrome” usually starts within a few hours of a bite. Most often children with a large local reaction will complain about intense itching. Only in the more severe cases are pain and fever seen with allergy. It’s not common, but some even develop severe allergic reactions to mosquito bites that lead to difficulty breathing.

Large local reactions are best treated with oral antihistamines (Benadryl or Zyrtec) and topical over-the-counter steroid cream (hydrocortisone 1 percent). Fingernails need to be trimmed very short, because scratching causes local skin damage that can become infected. Cold compresses several times a day help alleviate some of the discomfort. In patients who have a history of this type of reaction, I recommend daily antihistamines such as Zyrtec during the time of the year when bites are difficult to avoid. This doesn’t totally prevent the reaction, but can help keep the swelling from being as extreme. I don’t recommend topical antihistamines (Benadryl cream) because some people develop a contact allergy that actually worsens the problem

So, when should you come to the doctor? 

Any child with significant eyelid swelling or swelling that is limiting activity or skin blistering deserves an office visit because they require further evaluation and sometimes even need oral steroids or more potent prescription topical steroids. Red/swollen/hot areas of skin that are associated with pain or fever should also be examined to rule out a bacterial infection.

Tick bites don’t usually cause itching like mosquitos, but are more of a concern due to infections they can transmit. Ticks are predicted to be more prevalent this summer due to the winter being relatively warm. Ticks can transmit several infections with Lyme being one that is often discussed.

If you find a tick on your child it should be removed with tweezers by grasping the tick as close to the skin as possible and pulling straight up. Different types of ticks spread different infections. For example, infected deer ticks can spread Lyme after being attached for 36 hours or longer. Certain areas of the country have a much higher rate of local tick infection than others. Texas is not a part of that area, but cases of Lyme do occur every year.

It is best if children bathe after coming in from playing outside to wash off ticks prior to attachment. It’s a good idea to look in hidden areas such as behind the ears and on the scalp. Remove ticks if you find them and watch for a rash. Certainly, a rash that looks like a bull’s eye or a target (erythema migrans) is concerning for Lyme infection and needs to be seen for further testing.

Insect bite avoidance is important (and hard)! The large local reactions are definitely very uncomfortable, but infections transmitted by mosquitos such as West Nile or Lyme from ticks are potentially very dangerous. Using DEET containing insect repellant and wearing long sleeves during peak mosquito times are helpful.

As always, see your pediatrician if you are worried about a bite or rash and we are happy to help.

Related:

• The deets on DEET from a pediatrician
• Protecting Your Child From Ticks

Is it possible that some of us are mosquito magnets, while others seem to naturally repel their attacks?

Is there something about you that mosquitoes particularly prefer over other people? The answer is probably yes, according to Nina M Dacko, MS, Vector Control Supervisor, of the Environmental Health Division for Tarrant County Public Health.

“This question’s answers are not fully understood, but there are many things that make people “more attractive” to mosquitoes,” Dacko said.

Dacko said some of these include:

• Perfumes
• Fragrances
• Scented body lotions
• Sprays - especially those that smell like flowers (mosquitoes do feed on nectar after all)
• Sweat (lactic acid)
• Smelly feet (octanol)
• The smell of someone’s breath

“These vary from person to person since some people sweat more than others and some release more carbon dioxide,” Dacko said. “It even comes down to which bacteria are living on the surface of your skin.”

But it may not be only your smell that makes you a mosquito-magnet. It may also come down to your genetics. It has been suggested O type blood is the most attractive to mosquitoes, though science isn’t sure why.

To stay free of those pesky bites and any diseases that mosquitoes may carry, the Tarrant County Public Health office offers these suggestions:

• Use an EPA approved repellent
• Wear long sleeves and pants
• Avoid being outdoors during dusk and dawn when mosquitoes are the most active

Last year, TCPH reported two associated deaths for the season. 

According to the Centers for Disease Control and Prevention (CDC), in 2016 there were:

• 354 human West Nile Virus cases in Texas
• North Texas accounted for the most WNV cases in the state
• Dallas county had 61 WNV cases, more than any other county in Texas
• Tarrant County had 44, the second largest number of WNV cases in the state
• The number of cases peaked in August

West Nile Virus can affect anyone, although people age 50 and older run a higher risk of developing a severe infection.

About 20 percent of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1 percent of infected people develop inflammation of the brain or surrounding tissues. The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures or paralysis.

“West Nile Virus infection is found in local mosquitoes. It is acquired from mosquito bites and not from infected people," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "Most children who are infected with this virus do not develop symptoms. It has been circulating in mosquitoes in the United States for many years and is not new."

Precautions to take

With heightened concerns of mosquito-borne illness, Tarrant County Public Health and County officials are asking for help to protect their community from mosquitoes.

The Tarrant County “Be Mosquito Free” campaign hopes to eradicate mosquitoes through taking simple precautions such as:

• Wearing long sleeves and pants
• Dumping standing water
• Using EPA-approved insect repellent
• Keeping vegetation trimmed

TCPH’s video Mosquitoes Love Water has NEW tips to show residents how to take control of their property and help protect their neighbors. You can also view the following videos: Eliminate Mosquito Breeding Sites and Barrier Treatments to Prevent Mosquitoes.

Other resources:

• West Nile Virus Fact Sheet (English)
• My Kid Minute: What You Need To Know About Mosquitoes
• The deets on Deet
• Chikunguna Fact Sheet (English)
• Zika Virus Fact Sheet (English)
• Zika Virus Fact Sheet (Spanish)
• Mosquito Facts (English)
• Mosquito Facts (Spanish)
• Backyard Checklist (English and Spanish)
• Keep Mosquitoes Away (English and Spanish) 
• Skeeter Syndrome


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The patient lives in Cameron County in the Rio Grande Valley and was confirmed last week by a lab test to be infected. She is not pregnant and reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors.

“This is not surprising. We knew this would happen eventually because Texas is so close to Mexico,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Mosquitoes don’t have borders. The good news is at this time of the year, we should get our first freeze soon and the mosquitoes in the Fort Worth/Dallas area should die out for the winter."

For more information:

• Texas Announces Local Zika Virus Case in Rio Grande Valley
• The deets on DEET from a pediatrician
• Should we be afraid of Zika?
• 11 facts about the Zika virus

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

That’s how I remembered this:

Blood, frogs, lice, flies, disease, boils, hail, locusts, darkness, death.

You might ask, why was I learning the order of the plagues? Obviously, for a bible quiz game we used to play in Sunday school. Because I’m ultra-competitive, even when it comes to Sunday school.

The recent weather in North Texas has many questioning if we are witnessing plagues or if the Apocalypse is upon us.

Fortunately, it looks like the worst of the drenching rain (and hopefully the flooding as well) are behind us. As the waters recede, the rising threat will be mosquitoes and mosquito borne illness.

What’s the big deal with standing water?

Standing water is the breeding ground for mosquitoes. There are four stages of life for mosquitoes. The adult flying stage is the only one that does not rely upon water for survival. The eggs, larva and pupal stages must live in standing water.

Any standing water - water in a bird bath, pond or standing water from improper drainage can be a place for mosquitoes to breed.

Why do mosquitoes bite?

Female mosquitoes bite because they need a source of protein before they can produce eggs. Otherwise, like males, they can feed on nectar or sap.

When females bite, their long mouthpart breaks through the skin and gets into the small blood vessels just underneath. They also inject a small amount of saliva into the wound to make entry easier and to keep the blood from clotting.

What harm do bites cause our children?

Local reaction - While not technically an allergy, some kids will have a large local reaction with swelling and redness at the site of mosquito bites. These can be itchy and cause distraction in school or lack of sleep when severe.

Local infection – It’s not uncommon to see local infection in kids who have scratched mosquito bites, leaving a gap in skin, which can lead to infection. If the swelling worsens after the first few days or if there is significant warmth from the site of the bites, you should see your pediatrician to see if antibiotics are necessary.

General infection - Because mosquitoes can carry diseases, bites from mosquitoes can transmit infection that can affect the entire body. Mosquito borne illnesses cause over one million deaths world wide, most commonly from malaria. Two other diseases that we have seen in Texas associated with mosquitos are West Nile Virus and Chikungunya.

Given the amount of rain and the season, mosquitoes will be inevitable this summer season. Read more here about the many different ways you can reduce your child’s risk of discomfort and serious illness: How to fight (and) win against mosquitoes.

Leaders from the Who called Zika a “public health emergency of international concern,” earlier in the week, because how fast the virus is spreading and the continued investigation into its link to babies born with abnormally small heads (microcephaly). Experts are also looking into the possible connection between Zika and a neurological condition called Guillain-Barré syndrome, which can cause paralysis.

No vaccine exists to prevent Zika virus. Mosquitoes that spread Zika virus bit mostly during daytime.

Click here for prevention information from the CDC.

Here's what we know from about the Zika virus from the Centers from Disease Control and Prevention:

1. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosqutoes that spread dengue and chikungunya.
2. The mosquitoes are aggressive daytime biters, prefer to bite people and live indoors and outdoors near people. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes then spread the virus to other people through bites.
3. A mother already infected with the Zika virus can pass on the virus to her newborn around the time of birth, but this is rare.
4. The CDC has not found any reports of the Zika virus spread through breastfeeding.
5. The CDC believes the virus could spread through blood transfusion. At this time, there have been no reports of this happening.
6. There has been one case of the virus spread through sexual contact.
7. The most common symptoms of Zika virus disease are fever, rash, joint pain and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week and severe disease requiring hospitalization is uncommon.
8. However, the Zika virus can be dangerous, especially to babies. Doctors are studying the link to the virus and microcephaly, a birth defect that causes abnormally small heads and brains.
9. There is no vaccine to prevent or medicine to treat Zika.
10. The CDC recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”
11. The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

“There is still a lot to learn about Zika virus and the potential risk to cause this particular birth defect,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “However, because it could spread to the United States, it is important that doctors and patients are aware of it. Like other diseases that were once thought to be isolated to tropical areas like chikungunya, many patients and doctors forget to think about them.”

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Then you walk inside, feel your arm itching and see the familiar red bumps on your arms. Mosquitoes! In December?

Why are we still seeing mosquitoes three weeks from Christmas?

For the answer, we asked Michael Merchant, Ph.D., a professor and Extension Urban Entomologist at Texas A&M University.

Merchant noticed mosquitoes over the weekend while out in the garden. But he wasn’t too surprised. After all, understanding pest management and insects is something he’s been an expert at for nearly 30 years.

“When the temperature drops below about 55 degrees, mosquitoes stop flying,” Merchant said. “We’ve already seen a major decline in mosquitoes, but we are still seeing a few of the hardier folks persisting.”

Mosquitoes don’t all die off during cold weather, they often just hide in protected spots to avoid freezing.

Mosquitoes are cold-blooded and like temperatures best in the 80s or warmer. Once the temperature drops below 55, they go away – or at least stop moving around as much. Some mosquitoes find holes or places inside to hide in until warmer weather. Others lay their eggs before the freezing weather and then die. The eggs then hatch in warmer winter.

But the risk isn’t over entirely. Merchant said it’s not unusual to see a few West Nile Cases in the Dallas/Fort Worth area into December, and this year’s warm weather has kept the insects around longer than usual.

The last bites of the year may even occur indoors. “A few mosquitoes always make their way indoors, often coming in from your doorways,” Merchant said. “Mosquitoes often hide in protected home entryways to get away from the cold.” From there it’s a short flight inside when the doors open and close.

Merchant suggests sweeping and vacuuming the upper part of your doors and around the doorway, as well as applying insecticides.

“For most of us, the threat of mosquitoes is almost over,” Merchant said. “Hopefully, by next week we will have a blast of cold weather and we won’t see them for a while.

For more information

To learn more on mosquito control around the home, Michael Merchant's website:

• Mosquito Safari Website. Go on a mosquito safari with this interactive AgriLife website. Mosquito Safari takes you on a walk through both urban and semi-rural landscapes to learn more about mosquito risks, biology and control options.
• Mosquito videos. Learn more about practical ways to make your home and landscape safer from mosquitoes, and see mosquito larvae breeding in a backyard setting.