Pain is the most common manifestation of caterpillar envenomation and was present in 86% of patients in one large study. 92 Paresthesias also affect most victims. Swelling may be present but is often absent. Itching, nausea, vomiting, abdominal pain, chest pain, dyspnea, headache, numbness, and vision problems have also been reported. A 4-year-old-female was transferred to a quaternary care pediatric hospital for presumed appendicitis. She was diagnosed with an asp envenomation to her finger, and once her pain was controlled, her gastrointestinal symptoms resolved. 93 Treatment of caterpillar envenomation is supportive. Oral NSAIDs often suffice, but some patients require oral or even parenteral opioids to achieve analgesia. Direct infiltration of the envenomation site using local anesthetics is an alternative that avoids the complications of opioids. Nerve blocks and transdermal lidocaine patches have also been used successfully.
Figure 23. Puss Caterpillar Envenomation
Source: Spencer Greene
CENTIPEDE ENVENOMATIONS
There are six species of venomous centipedes in the genus Hemiscolopendra and more than 50 venomous centipede species in the genus Scolopendra . One from the former genus and four from the latter are found in the U.S. 70 The Eastern bark centipede, Hemiscolopendra marginata , is found primarily in the Southeast and in Ohio, Indiana, Texas, and Oklahoma. Scolopendra heros (giant desert centipede, also known as the red-headed giant centipede) and S. polymorpha (common desert centipede) are native to the Southwest and occasionally are found in the Midwest. The Florida Key giant centipede, S. alternans , is found in Florida and throughout the Caribbean. S. viridis , the green centipede, is found throughout the Southeast. Figure 24. Giant Desert Centipede (Scolopendra Heros)
Various centipedes were responsible for 1,781 exposures reported to PCCs between 2015 and 2017. 1-3 Of these, 375 (21%) were in children younger than age six, and 788 (44%) were in children younger than age 20. Two patients had major effects. No fatalities were reported. Centipede venom is delivered through specialized appendages called forcipules that are adjacent to the mouth. The venom contains histamine, serotonin, and various proteins. 71 Localized findings following envenomation include pain and swelling. 70,71 Puncture marks may be visible and occasionally ooze blood. Tissue necrosis has been reported but is likely due to a secondary infection in patients who attempted to manipulate (i.e., incise) the wound. Systemic signs and symptoms may include pain, headache, dizziness, tachycardia, restlessness, nausea, and vomiting. Rhabdomyolysis leading to acute renal failure has been reported following S. hiros envenomation. Treatment is primarily symptomatic. Parenteral opioids may be necessary for severe pain. Tetanus immunization should be updated as needed. Antibiotics should not be administered prophylactically but should be administered to patients with evidence of secondary bacterial infection.
Source: Spencer Greene
MARINE ENVENOMATIONS
Although the majority of envenomations occur on land, the ocean is teeming with many venomous animals, including cone snails, octopods, echinoderms, sponges, fishes, and various cnidarians (e.g., jellyfish, anemones, and corals). Between 2015 and 2017, there were an average of 573 fish stings and 244 cnidarian stings reported annually to U.S. Fishes A variety of venomous fish are found off the U.S coast, including catfish, stingrays, lionfish, rockfish, and typical scorpionfish. The red lionfish ( Pterois volitans ), which is native to the Indo-Pacific region, has become an invasive species in the Gulf of Mexico and in the western Atlantic Ocean. It is also popular among private aquarists. The spinycheek scorpionfish ( Neomerinthe hemingwayi ) and the spotted scorpionfish ( Scorpaena plumieri ) are some of the other fishes also found in the Atlantic Ocean, while the California scorpionfish ( S. guttata ) and the Pacific spotted scorpionfish (S. mystes) are examples of venomous fishes native to the eastern Pacific Ocean.
poison centers. 1-3 On average, there were 50 (6.1%) affected children younger than age six, and 228 (30%) stings were in children younger than age twenty. In that time period, there were eight victims of fish envenoming who developed major effects, including one death. There were no major effects or envenomings attributed to cnidarian stings. There are three U.S. catfish species. The hardhead catfish ( Ariopsis felis ) is native to the Gulf of Mexico. The Gafftopsail catfish ( Bagre marinus ) is located in the western Atlantic Ocean, while the chilhuil ( B. panamensis ) is found in the eastern Pacific Ocean. There are also several species of freshwater catfish. Stingrays are a diverse group of cartilaginous fish located in the waters off all U.S. coasts. Like catfish, there are also several freshwater species. Common, medically significant stingrays include round stingrays (e.g., Haller’s round stingray [ Urobatis helleri] ), whiptail stingrays (e.g., the southern stingray [ Hypanus americanus] ), butterfly rays (e.g., the spiny butterfly ray [ Gymnura altavela] ) , and eagle rays (e.g., the Pacific white-spotted eagle ray [ Aetobatus laticeps ]).
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Book Code: RPTTX2024
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