9. ENVENOMATION SYNDROME
• Severe pain
• Erythema
• Swelling
• Pruritis
• Lymphadenopathy
• Headache
• N/V
• Palpitations
• Rare ulceration
• Necrosis
• Rhabdomyolysis
Bush SP, King BO, Norris RL, Stockwell SA. Centipede envenomation. Wilderness Environ Med. 2001 Summer;12(2):93-9. PubMed PMID: 11434497.
10. Fung HT, Lam SK, Wong OF. Centipede bite victims: a review of patients presenting to two emergency departments in Hong Kong. Hong Kong Med J. 2011 Oct;17(5):381-5. PubMed PMID: 21979475.
11. TREATMENT
• Non-scalding heat
• 40-45 C
• Analgesics
• Anti-histamines
• Cleansing
• Lifesaving tetanus
• Wound care as needed
Bush SP, King BO, Norris RL, Stockwell SA. Centipede envenomation. Wilderness Environ Med. 2001 Summer;12(2):93-9. PubMed PMID: 11434497.
12. Chaou CH, Chen CK, Chen JC, Chiu TF, Lin CC. Comparisons of ice packs, hot water immersion, and analgesia injection for the treatment of centipede envenomations in Taiwan. Clin Toxicol
(Phila). 2009 Aug;47(7):659-62. doi: 10.1080/15563650802084821. PubMed PMID: 19640231.
13. WELLS' SYNDROME
• 68 F bit on left hand
• Bullous lesions on hands
• 2 weeks in derm clinic
• Persistent itching
• New violaceous lesions
• Leukocytosis
• Eosinophil predominant
• Treated with steroids
• Some improvement at 1 week
• Lost to followup
Friedman IS, Phelps RG, Baral J, Sapadin AN. Wells' syndrome triggered by centipede bite. Int J Dermatol. 1998 Aug;37(8):602-5. PubMed PMID: 9732008.
14. MYOCARDIAL INFARCTION
• 60 M bitten on toe
• Went to ED 1 hr later with weakness,
leg pain
• With IV access pt became
diaphoretic, dizzy, hypotensive
• EKG showed inferior ST elevation
• Chest pain subsequently resolved
• EKG normalized
• Cardiac enzymes negative
• Stress test negative
• 20 M bitten on leg
• 24 hrs later presented to ED with
chest pain
• ST elevation II, III, aVF, V6
• Chest pain resolved, EKG
normalized
• Elevated enzymes x3
• Negative cath
• Likely spasm
Ozsarac M, Karcioglu O, Ayrik C, Somuncu F, Gumrukcu S. Acute coronary ischemia following centipede envenomation: case report and review of the literature. Wilderness Environ Med. 2004
Summer;15(2):109-12. Review. PubMed PMID: 15228064.
Yildiz A, Biçeroglu S, Yakut N, Bilir C, Akdemir R, Akilli A. Acute myocardial infarction in a young man caused by centipede sting. Emerg Med J. 2006 Apr;23(4):e30. PubMed PMID: 16549562;
PubMed Central PMCID: PMC2579533.
20. CATERPILLARS
Diaz JH. The epidemiology, diagnosis, and management of caterpillar envenoming in the southern US. J La State Med Soc. 2005 May-Jun;157(3):153-7. Review. PubMed PMID: 16173315
21. BUCK MOTH
Gerald J. Lenhard, Bugwood.org.James Castner, University of Florida.
22. IO MOTH
M.C. Thomas, Division of Plant Industry. Patrick CoinM.C. Minno, Division of Plant Industry
23. ENVENOMATION
• Stinging sensation
• Pruritis
• Rash
• Dizziness
• Diaphoresis
• Abdominal pain
Hossler EW. Caterpillars and moths: Part II. Dermatologic manifestations of encounters with Lepidoptera. J Am Acad Dermatol. 2010 Jan;62(1):13-28; quiz 29-30. doi: 10.1016/j.jaad.2009.08.061.
Review. Erratum in: J Am Acad Dermatol. 2010 Apr;62(4):666. PubMed PMID: 20082887.
37. MYSTERY CASE
• 2 yo girl stung by caterpillar in a furniture store in France
• Inflammatory edema of the finger, normal VS
• Caterpillar brought in, described as “unusual”
• Regional poison center unable to identify
• Identified using the Internet
• Saddleback caterpillar
• Carried across the Atlantic Ocean on garden plants (likely Areca trees)
Claudet I, Maréchal C. A transatlantic caterpillar. Pediatr Emerg Care. 2009 Mar;25(3):186-7.
46. LONOMIA OBLIQUA
• Southern Brazil
• Venom
• Procoagulant
• Fibrinogenolytic
• Proteolytic
• Hemolytic
• Severe hemorrhagic syndrome
• Consumptive coagulopathy
• Ecchymosis
• Acute kidney injury (AKI)
Berger M, Santi L, Beys-da-Silva WO, Oliveira FM, Caliari MV, Yates JR 3rd, Vieira MA, Guimarães JA. Mechanisms of acute kidney injury induced by experimental Lonomia obliqua envenomation.
Arch Toxicol. 2014 May 6. [Epub ahead of print] PubMed PMID: 24798088.
Rubio, G.B.G., 2001. Epidemiological surveillance of distribution of the caterpillar Lonomia obliqua Walker, 1855, in the State of Parana , Brazil. Cad. Saude Publica 17 (4), 1036 Letter.
47. • 22 F 4d hx of bruising
• Returned from Peru 7d previously
• Stepped on 5 caterpillars
• Immediately after she had burning
pain in her foot, radiating to her
thigh
• Hosp day 3: alveolar hemorrhage,
anuric AKI and hemodynamic
instability
• Expired same day
Chan K, Lee A, Onell R, Etches W, Nahirniak S, Bagshaw SM, Larratt LM. Caterpillar-induced bleeding syndrome in a returning traveller. CMAJ. 2008 Jul 15;179(2):158-61. doi: 10.1503/cmaj.071844.
PubMed PMID: 18625988; PubMed Central PMCID: PMC2443214.
48. • Reported death rate of 2.5%
• Treatment
• Antifibrinolytics
• Purified fibrinogen concentrates
• Antivenom
• DO NOT GIVE BLOOD
50. DEFENSE SECRETIONS
• Glomerida
• Alkaloids
• Callipodida and Chordemouidea
• Phenols
• Polydesmida
• Hydrogen cyanide
• Cyanogenic compounds
• Nitroalkenes
• Polyzoniida
• Alkaloids
• Terpenoids
• Julida, Spirobolida, and Spirostrepdida
• Benzoquinones
Blum MS, Woodring JP. Secretion of Benzaldehyde and Hydrogen Cyanide by the Millipede Pachydesmus crassicutis (Wood). Science. 1962 Oct 26;138(3539):512-3. PubMed PMID: 17753947.
De Capitani EM, Vieira RJ, Bucaretchi F, Fernandes LC, Toledo AS, Camargo AC. Human accidents involving Rhinocricus spp., a common millipede genus observed in urban areas of Brazil.
Clin Toxicol (Phila). 2011 Mar;49(3):187-90.
51. ENVENOMATION SYNDROME
• Mild pain
• Burning sensation
• Stained skin
De Capitani EM, Vieira RJ, Bucaretchi F, Fernandes LC, Toledo AS, Camargo AC. Human accidents involving Rhinocricus spp., a common millipede genus observed in urban areas of Brazil.
Clin Toxicol (Phila). 2011 Mar;49(3):187-90.
Lima CA, Cardoso JL, Magela A, Oliveira FG, Talhari S, Haddad Junior V. Exogenous pigmentation in toes feigning ischemia of the extremities: a diagnostic challenge brought by arthropods of the
Diplopoda Class ("millipedes").
52. TREATMENT
• Wash
• Analgesics
• Antihistamines
• No need for anticoagulants
• Irrigate eyes
• Steroid drops
• Ophthalmology referral
Hendrickson RG. Millipede exposure. Clin Toxicol (Phila). 2005;43(3):211-2.
Hudson BJ, Parsons GA. Giant millipede 'burns' and the eye. Trans R Soc Trop Med Hyg. 1997 Mar-Apr;91(2):183-5.
Venom is a complex mixture containing proteases, hyaluronidases, carboxypeptidases, histamine, serotonin, lipids, lipoprotein, esterases, polysaccharides, phospholipases, alkaline phosphatases among others Histamine contributes to pain and the haemodynamic toxicity in rodents exposed to histamine. The venom of Scolopendra subspinipes mutilans has anti-microbial activity.
Water, heating pad. Large doses of analgesia may be required.
Case series, 4 stings of one person
60 patients randomized
Author bitten. Reviewed all the literature. Letter to editor follow-up recommended lidocaine at bite.
Scutigera morpha from Melbourne, Australia
Cured >95%, Markedly 60-95%, Effective 20-60%
adult or larval forms Can be picked up from vegetation laden with insect debris. histamine-liberating toxin named thaumetopoein, kinin activators, and other as yet undefined proteins .
The bristles have a hollow canal that stores the venom The distal end of the bristle has thin, chitin-rich tip that breaks, releasing venom from canal
Caterpillar setae can be widely dispersed by winds, causing dermatitis or ophthalmia nodosa. Garments hung on clotheslines may collect airborne setae and cause dermatitis when the clothes are worn.
Erucism (local dermatitis and urticaria)
Lepidopterism (generalized urticaria and other systemic symptoms)
Dendrolimiasis (inflammatory polyarthritis and polychondritis and chronic osteoarthritis) Masson pine caterpillar (genus Dendrolimus) found in China.
Ophtalmia nodosa (conjunctivitis and intraocular migration of urticating hairs) Chemosis may progress to granuloma formation, iritis, vitritis, retinitis, or endophthalmitis.
Consumptive coagulopathy (imbalances in the coagulation and fibrinolytic systems, resulting in a hemorrhagic syndrome). Venezuela and Brazil
Lonomia obliqua
First started in 1980s in rural areas of the southernmost Brazilian states of Rio Grande do Sul, Santa Catarina and Paraná. Possibly secondary to deforestation. Usually, accidents occur when the victim unknowingly leans against a tree trunk containing hundreds of caterpillars and comes into contact with the caterpillar’s venomous bristles
Similar to DIC but without reduced platelets
She received mechanical ventilation, vasoactive agents and continuous renal replacement therapy. Her hematologic and coagulation abnormalities worsened, and there was evidence of progressive microangiopathic hemolytic anemia, consumptive thrombocytopenia and disseminated intravascular coagulation. She was treated with fibrinogen concentrate, aprotinin and washed packed red blood cells and platelets.
2 pairs of legs on each segment. 12000 species named, possibly 80k species exist.
