This document summarizes information about centipedes, caterpillars, and other arthropods that can cause envenomation in humans. It describes common species that cause envenomation syndromes, including centipedes, caterpillars like puss moths and saddleback caterpillars, and millipedes. Symptoms of envenomation can include pain, swelling, rash, and in rare cases, systemic effects like myocardial infarction from centipedes. Treatment involves washing, heat therapy, analgesics, antihistamines, and monitoring for more severe reactions. The giant silkworm moth Lonomia obliqua found in Brazil can cause a severe bleeding syndrome in humans through

1. CENTIPEDES, CATERPILLARS,
AND OTHER CREEPY
CRAWLERS
Justin Hensley, MD

2. • Arthropods and insects of medical importance
• Envenomation syndromes
• Treatment regimens

3. CENTIPEDES

5. PERUVIAN GIANT YELLOW-LEG CENTIPEDE

6. CHINESE RED-HEADED CENTIPEDE

7. TEXAS RED-HEADED CENTIPEDE
Scolopendra heros arizonensis
© 2007 Aaron Goodwin
© 2012 Andrew Hoffman

8. OTHER CENTIPEDES
• Cormocephalus spp
• Ethostigmus spp
• Crytops spp
• Otostigmus spp

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.

16. © 2012 Tristan Sauvatier

17. CENTIPEDE WINE
• 49 M
• Drank 600mL fortified wine
• Slept on the floor
• Awoke with bullous rash, bilateral
hand paresthesias
• Leukocytosis, rhabdomyolysis, acute
kidney injury
• Improved over 9 day hospitalization
• Persistent neuropathy
• Likely from drunken bender
Wang IK, Hsu SP, Chi CC, Lee KF, Lin PY, Chang HW, Chuang FR. Rhabdomyolysis, acute renal failure, and multiple focal neuropathies after drinking alcohol soaked with centipede. Ren Fail.
2004 Jan;26(1):93-7.

18. INGESTION
• 6 mo male
• “Floppy and pale”
• Mother found a centipede encased
in feces
• Ingestion confirmed as centipede
and feces had “turned blue”
• Vomited multiple times, taken to
pediatrician
• Promptly referred to emergency
department
• Generalized hypotonia with normal
reflexes
• Admitted and “observed”
• Normal by 48 hours
Barnett PL. Centipede ingestion by a six-month-old infant: toxic side effects. Pediatr Emerg Care. 1991 Aug;7(4):229-30. PubMed PMID: 1758778.
© 2012 Jan Dauphin

19. BAD LITERATURE

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.

24. TUSSOCK MOTH
Donald W. Hall, University of Florida Lyle Buss, University of Florida

25. TUSSOCK MOTH
© 2010 Ali Iyoob

26. ENVENOMATION
• Rash
• Occasional dermatitis
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.

27. © University of Florida
PUSS MOTH
Donald W. Hall, University of Florida.

28. PUSS MOTH
Donald W. Hall, University of Florida.

29. ENVENOMATION
• Severe burning pain
• Edema
• Erythema
• Grid-like hemorrhagic papular rash
• Up to 1/3rd have systemic reactions
• Lymphadenopathy
• Headache
• Abdominal pain
• Muscle spasm
• Vertigo
• Respiratory distress
• Swallowing difficulty
• Convulsions
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.

30. © 2007 Sasha Azevedo Armed Forces Pest Management Board.

32. OTHER STINGING FLANNEL
CATERPILLAR
• White Flannel Moth (Norape ovina)

33. HAG MOTH
Wagner, DL, 2005. Caterpillars of Eastern North America. Princeton University Press.
Greg Dwyer © 2006 Nolie Schneider

34. Lyle J. Buss, University of Florida

35. © Gary Larsen
© 2006 Jacques S. Doucet

36. SADDLEBACK CATERPILLAR MOTH

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.

38. SPINY OAK SLUG
Shaina Noggle Alison Hunter Shaina Noggle

39. ENVENOMATION
• Intense pain
• Urticaria
• Vesicles
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.

40. OTHER STINGING SLUG
CATERPILLARS
• Nason's Slug (Natada nasoni)
• Stinging Rose Caterpillar (Parasa indetermina)
• Crowned Slug Caterpillar (Isa textual)

41. OTHER STINGING FAMILIES
• Nymphalid Butterflies - Family Nymphalidae
• Spiny Elm Caterpillar (Nymphalis antiopa)
• Dagger Moths - Family Noctuidae
• Smeared Dagger Moth (Acronicta oblinita)
• Prominents and Datanas - Family Notodontidae
• Variable Oakleaf Caterpillar (Lochmaeus manteo)
• Smoky Moths - Family Zygaenidae
• Laurelcherry Smoky Moth (Neoprocris floridana)
• Tent Caterpillars - Family Lasiocampidae
• Forest Tent Caterpillar (Malacosoma disstria)
• Eastern Tent Caterpillar (Malacosoma americanum)

42. CATERPILLAR ENVENOMATION
• Medical effects from contact with
butterflies or moths
• Venom
• Specialized hairs
• Causes
• Histamine
• Kinin activators
• ????
• Treatment
• Most resolve spontaneously
• Tape to remove setae
• Symptomatic treatment
• Epinephrine
• Corticosteroids
• Analgesics
• Antihistamines
• Calcium
• Lifesaving tetanus
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.
Rosen T. Caterpillar dermatitis. Dermatol Clin. 1990 Apr;8(2):245-52. Review. PubMed PMID: 2191798.

43. 5 SYNDROMES OF CATERPILLAR
ENVENOMATION
• Erucism
• Lepidopterism
• Dendrolimiasis
• Ophtalmia nodosa
• Consumptive coagulopathy
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.
Diaz, J.H., 2005. The evolving global epidemiology, syndrome classification, management, and prevention of caterpillar envenoming. Am. J. Trop. Med. Hyg. 72, 347–357.

44. GIANT SILKWORM MOTH
Centro de Informações Toxicológicas de Santa Catarina

45. © Terry Vermelha

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

49. MILLIPEDES

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.

53. QUESTIONS?
• hensley@tamhsc.edu
• Something
• ebmgonewild.com