Venomous arthropod handbook

b. PUSS CATERPILLAR
(Megalopyge opercularis)

Identification. The puss caterpillar is the larva of a lepidopterous group commonly referred to as “flannel moths.” In some parts of the United States the larva is incorrectly referred to as an “asp.” When fully mature, the larvae are near white to dark gray in color, 2 to 3 cm (0.8-1.2 in) long, and completely covered dorsolaterally with hairs that cause them to resemble elongate tufts of cotton. Some of the hairs are venomous, and when they penetrate the skin a “toxin” passes from an underlying gland through the hairs at the points of contact. The color variation of the larvae in this species is dependent upon larval age, locality, and time of year. In Texas, where this species is most abundant, the spring/summer generation of caterpillars is usually lighter in color than the fall generation.

Distribution. This species has been recorded primarily from the Southeastern States, including Alabama, Arkansas, Florida, Georgia, Louisiana, Maryland, Mississippi, Missouri, North Carolina, South Carolina, Texas, and Virginia.

Biology/Behavior. In most of the southern area of its range, the puss caterpillar is thought to have two generations per year. The first generation develops in the spring and early summer, while the second generation develops in the fall. After emerging from a cocoon and mating, the female moth lays her eggs on a suitable host plant. In a few days the eggs hatch into larvae, which develop by feeding on the leaves of a wide range of trees and shrubs. The natural enemies of the puss caterpillar usually keep its numbers under control; however, every 4 or 5 years the caterpillars become more numerous, and the number of envenomizations associated with them increases.⁶⁶

Avoidance/Control. Always wear protective clothing such as gloves and a long-sleeved shirt when working in areas heavily infested with puss caterpillars. During periods of M. opercularis abundance, children should be instructed to stay away from infested trees and shrubs and not to handle caterpillars. If necessary, heavy puss caterpillar infestations may be treated with an appropriate insecticide.

Envenomization Reaction/Treatment. (See appendix.)

c. SADDLEBACK CATERPILLAR
(Sibine stimulea)

Identification. The saddleback caterpillar is easy to recognize since its brown sluglike body is covered mid-dorsally with markings that resemble a brown or purplish saddle sitting on a green and white saddle blanket. Upon close examination, stout spines can be observed along the caterpillar’s lateral body margin and on its four tubercles. Many of these spines are hairs that are connected at their bases with individual poison glands. Just prior to pupation and subsequent development into a moth, the caterpillar is 2-3 cm (0.8-1.2 in) long.

Distribution. In general, the saddleback caterpillar in the United States is distributed southeast of a diagonal line drawn from Massachusetts through the middle of Texas.⁶⁸

Biology/Behavior. From May to November, Sibine stimulea caterpillars may be found feeding on the leaves of a large variety of trees, shrubs, and other plants. Envenomization usually occurs when the victim accidentally contacts vegetation infested with these caterpillars. At the instant the victim’s skin contacts the caterpillar, the spine tips break off, thus allowing toxin to flow out of the hollow spines and into or onto the skin.

Avoidance/Control. When working in infested areas, wear gloves, a long-sleeved shirt, and long pants to prevent accidental envenomization. During periods of local heavy infestations, children should be instructed to avoid trees, shrubs, and other vegetation commonly infested with these caterpillars. Local entomologists may be contacted to obtain information on the most effective insecticide for saddleback caterpillar control in a given area.

Envenomization Reaction/Treatment. (See appendix.)

BIBLIOGRAPHY

General

1. Barnard, J.H. Cutaneous responses to insects. JAMA 196:3 (1966).

2. Borror, D.J., and D.M. DeLong. An introduction to the study of insects, 2d ed. New York: Holt, Rinehart and Winston, 1964.

3. Dodge, N.N. Poisonous dwellers of the desert. Popular Series No. 3, Southwestern Monuments Assoc., Box 1562, Globe, Ariz., 1955.

4. Frazier, C.A. Diagnosis and treatment of insect bites. Clin Symp 20:75-100 (1968).

5. Frazier, C.A. Insect allergy: Allergic reactions to bites of insects and other arthropods. St. Louis: Warren H. Green, Inc., 1969.

6. Frazier, C.A. Treatment guide: Common biting and stinging insects and other arthropods. West Point, Pa.: Merck Sharp & Dohme, 1972.

7. Frazier, C.A. Cutaneous manifestations of insect allergy. Cutis 13:1038-1047 (1974).

8. Horen, W.P. Insect and scorpion sting. JAMA 221:894-898 (1972)

9. Infections and bites: Parasites, arthropods and animals, Section 18. In D.J. Demis et al. (eds.). Clinical dermatology, vol. 4. Hagerstown, Md.: Harper & Row, 1974.

10. James, M.T., and R.F. Harwood. Herm’s medical entomology, 6th ed. London: Collier-MacMillan, 1970.

11. Lyon, J.B. Insect bites and stings. Practitioner 200: 670-677 (1968).

12. Micks, D.W. Insects and other arthropods of medical importance in Texas. Tex Rep Biol Med 18:624-635 (1960)

13. Millikan, L.E., and R.S. Berger. Clinical and laboratory diagnosis of arthropod bites. CRC Crit Rev Clin Lab Sci 5:201-225 (1974).

14. Parrish, H.M. Deaths from bites and stings of venomous animals and insects in the United States. Arch Intern Med 104:198-207 (1959).

15. Parrish, H.M. Analysis of 460 fatalities from venomous animals in the United States. Am J Med Sci 245:129-141 (1963).

16. Perlman, F. Insects as allergen injectants: Severe reactions to bites and stings of arthropods. Calif Med 96:1-10 (1962).

17. Riley, W.A., and O.A. Johannsen. Medical entomology, 2d ed. New York: McGraw-Hill, 1938.

18. Russell, F.E. Injuries by venomous animals. Am J Nurs 66:1322-1326 (1966).

19. Scott, H.G. Envenomization. DHEW CDC Publ No. (HSM) 72-8121, 1972.

Blister Beetles

20. Lehmann, C.F., et al. Blister beetle dermatosis. Arch Dermatol 71:36-38 (1955).

21. Rosin, R.D. Cantharides intoxication. Br Med J 4:33 (1967)

Centipedes

22. Cloudsley-Thompson, J.L. Spiders, scorpions, centipedes and mites. New York: Pergamon, 1958.

23. Pineda, E.V. A fatal case of centipede bite. J Philipp Med Assoc 3:59-61 (1923).

24. Remington, C.L. The bite and habits of a giant centipede (Scolopendra subspinipes) in the Philippine Islands. Am J Trop Med 30:453-455 (1950).

Hemiptera

25. Hall, M.C. Lesions due to the bite of the wheel-bug, Arilus cristatus (Hemiptera, Reduviidae). Arch Intern Med 33:513-515 (1924).

26. Marks, M.B. Stinging insects: Allergy implications. Pediatr Clin North Am 16:177-191 (1969).

27. Nichols, N., and T.W. Green. Allergic reactions to “kissing bug” bites. Calif Med 98:267-268 (1963).

28. Parsons, D.J. Bedbug bite anaphylaxis misinterpreted as coronary occlusion. Ohio Med J 51:669 (1955).

29. Readio, P.A. Studies on the biology of the Reduviidae of America north of Mexico. Univ Kans Sci Bull 17:5 (1927).

30. Shields, T.L., and E.N. Walsh. “Kissing bug” bite. Arch Dermatol 74:14-21 (1956).

31. Smith, F.D., et al. Insect bite by Arilus cristatus, a North American Reduviid. Arch Dermatol 77:324-330 (1958).

32. Wray, D.L. Two cases of Hemiptera biting humans (Hemiptera, Reduviidae). Entomol News 82:228 (1971).

Hymenoptera

33. Barnard, J.H. Studies of 400 hymenoptera sting deaths in the United States. J Allergy Clin Dermatol 52:259-264 (1973).

34. Barr, S.E. Allergy to hymenoptera stings. JAMA 228:718-720 (1974).

35. Busse, W., et al. Protection following honeybee venom immunotherapy in a case of beesting anaphylaxis. (Abstract) J Allergy Clin Immunol 53:104 (1974).

36. Busse, W.S., et al. Immunotherapy in bee-sting anaphylaxis: Use of honeybee venom. JAMA 231:1154-1156 (1975).

37. Charavejasarn, C.C., et al. Stinging insect hypersensitivity. II. Studies of bee venom antigenicity. (Abstract) J Allergy Clin Immunol 53:104 (1974).

38. Controlling wasps. U.S. Department of Agriculture, Home and Garden Bull No. 122, 1972.

39. Favorite, F.G. The imported fire ant. Public Health Rep 73:445-448 (1958).

40. Insect-sting allergy: Questionnaire study of 2,606 cases. JAMA 193:109-114 (1965).

41. Lichtenstein, L.M., et al. Treatment of honeybee anaphylactic sensitivity with honeybee venom: A case report. (Abstract) J Allergy Clin Immunol 53:104-105 (1974).

42. Majeski, J.A., et al. Acute systemic anaphylaxis associated with an ant sting. South Med J 67:365-366 (1974).

43. McCormick, W.F. Fatal anaphylactic reactions to wasp stings. Am J Clin Pathol 39:485-491 (1963).

44. McLean, J.A. Management of insect sting reactions. Mod Treat 5:814-824 (1968).

45. Morse, R.A., et al. Protective measures against stinging insects. NY State J Med 59:1546-1548 (1959).

46. Reisman, R.E. Stinging insect allergy—treatment failures. J Allergy Clin Immunol 52:257-258 (1973).

47. Spencer, J.T. Treatment of yellow jacket stings. JAMA 206:649 (1968).

48. Torsney, P.J. Treatment failure: Insect desensitization. J Allergy Clin Dermatol 52:303-306 (1973).

49. Valentine, M.D., et al. Blocking antibody to bee venom: Induction by venom and not by whole body extracts. (Abstract) J Allergy Clin Immunol 53:105 (1974).

Scorpions

50. Masco, H.L. Scorpion bite treatment with chlorpromazine. JAMA 212:2122 (1970).

51. Stahnke, H.L. Scorpions. Tempe, Ariz.: Arizona State College Bookstore, 1949.

52. Vachon, M. The biology of scorpions. Endeavor April:80-89 (1953).

Spiders

53. Anderson, P.C. What’s new in loxoscelism? Mo Med 70:711, 712, 718 (1973).

54. Atkins, J.A., et al. Probable cause of necrotic spider bite in the Midwest. Science 126:73 (1957).

55. Auer, A.I., and F.B. Hershey. Surgery for necrotic bites of the brown spider. Arch Surg 108:612-618 (1974).

56. Cheng, A.K. USAF School of Aerospace Medicine, San Antonio, Tex. Personal communication, 1974.

57. Gladney, W.J. Controlling the brown recluse spider. U.S. Department of Agriculture Leaflet No. 556, 1972.

58. Hammon, P.J., and W.H. Newton. The brown recluse and the black widow spiders. Texas A&M Univ, Fact Sheet L-623 (1970).

59. Hershey, R.B., and C.E. Aulenbacher. Surgical treatment of brown spider bites. Ann Surg 170:300-308 (1969)

60. Horen, W.P. Arachnidism. Clin Med (Aug):41-43 (1966)

61. Russell, F. E., et al. Bites of spiders and other arthropods, Section 16, pp. 865-867. In H.F. Conn (ed.). Current therapy. Philadelphia: W.B. Saunders, 1974.

62. Taylor, E.H., and W.F. Denney. Hemolysis, renal failure and sudden death, presumed secondary to bite of brown recluse spider. South Med J 59:1209-1211 (1966).

63. The brown recluse. Public Health Service Publ No. 2062, 1970.

Urticating Caterpillars

64. Daly, J.A., and B.L. Derrick. Puss caterpillar sting in Arkansas. South Med J 68:893-894 (1975).

65. Kendall, R.O. San Antonio, Tex. Personal communication, 1975.

66. McGovern, J.P., et al. Megalopyge opercularis: Observations of its life history, natural history of its sting in man, and report of an epidemic. JAMA 175: 121-124 (1961).

67. Micks, D.S. Clinical effects of the sting of the “puss caterpillar” (Megalopyge opercularis S. & A.) on man. Tex Rep Biol Med 10:399-405 (1952).

68. Mitchell, R.T., and H.S. Zim. Butterflies and moths. New York: Golden Press, 1964.

APPENDIX: ARTHROPOD ENVENOMIZATION REACTIONS AND TREATMENT

The material presented in this appendix was prepared by Lt Col John C. Moseley, USAF, MC, Dermatologist, Wilford Hall USAF Medical Center, Lackland AFB, Texas.

BLACK WIDOW SPIDER

REACTIONS

IMMEDIATE: Pinprick sensation from the bite

LOCAL: Dull numbing pain; two red puncture marks at bite site. Pain peaks at 1-3 hours and persists 12-48 hours

REGIONAL:

1. Severe muscular pain and spasm

2. Rigid boardlike abdomen

3. Tightness in chest and pain on inspiration

GENERAL:

1. Rigidity and spasm of all large muscle groups; excruciating abdominal pain

2. Convulsions, paralysis

3. Shock

DEATHS: 4-5% of untreated cases due to neurotoxic effect of the venom

TREATMENT

LOCAL FIRST AID: Ineffective and unnecessary

SYSTEMIC:

1. Antivenin—1 vial IM (carefully follow package insert instructions) after testing for horse-serum sensitivity

2. Calcium gluconate—10 ml of 10% solution given IV immediately and prn to control muscle pain

3. Muscle relaxants—Give continuously over 8-16-hr period to relieve intensity of muscle spasm and pain

4. Treat for shock as necessary (Chart 2)

BROWN RECLUSE SPIDER

REACTIONS

IMMEDIATE: Very little pain, if any

LOCAL:

1. 2-8 Hours—Mild to severe pain with redness and vesiculation at bite site, followed by ischemia

2. 3-4 Days—Star-shaped firm area of deep-purple color with necrosis

3. 7-14 Days—Central area of depression and ulceration

4. 21 Days—Healing and scar formation. May not heal sufficiently and may require skin grafting

SYSTEMIC:

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:

1. Wash sites with soap and water

2. Apply ice packs or cold compresses

3. Apply baking soda and water paste

SYSTEMIC:

1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 in children). Repeat in 5-10 min if necessary

2. Antihistamine (Benadryl, 50 mg IM)—Adult

3. Oral antihistamines (Chart 1)

4. Treat for shock as necessary (Chart 2)

BEES AND WASPS

REACTIONS

IMMEDIATE: Pain

LOCAL: Within 1-4 hours—Appearance and subsidence of wheal and red flare; may see intense local swelling in region of sting

SYSTEMIC:

1. Mild reaction—Generalized urticaria, itching, malaise, anxiety

2. Moderate reaction—Any of the above plus generalized edema, tightness in the chest, wheezing, abdominal pain, nausea, vomiting, dizziness

3. Severe reaction—Any of the above plus labored breathing, difficulty in swallowing, hoarseness or thickened speech, marked weakness, confusion, feeling of impending disaster

4. Shock—Cyanosis, fall in BP, collapse, incontinence, unconsciousness

5. Delayed serum-sickness-like reaction (10-14 days after sting)—Fever, lymphadenopathy, malaise, headache, urticaria, polyarthritis

ANAPHYLAXIS AND SUDDEN DEATH: Many cases reported, usually in adults

TREATMENT

LOCAL FIRST AID:

1. Remove bee stinger from sting site by gently scraping with fingernail or blade to prevent further venom injection from attached venom sac

2. Wash site with soap and water

3. Apply ice packs or ammonia in 10% solution

4. Apply baking soda and water paste

5. Elevate and rest involved limb

SYSTEMIC:

1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 ml in children). Repeat in 5-10 min if necessary

2. Analgesics (ASA, Tylenol) for pain

3. Antihistamines (Chart 1)—Useful only for urticarial and pruritic reactions

4. Treat for shock as necessary (Chart 2)

LONG-TERM MANAGEMENT: (for hypersensitive patients)

1. Medic-alert tag or bracelet

2. Emergency treatment kit and instructions for use

3. Program for desensitization

SCORPIONS

REACTIONS

IMMEDIATE: Severe sharp pain

LOCAL:

1. Dangerous neurotoxic species—Pins-and-needles sensation with no local swelling or discoloration (found in Arizona only)

2. Comparatively harmless species (not neurotoxic)—Local swelling and discoloration at sting site

SYSTEMIC (neurotoxic species only—within 1-3 hours):

1. Hypoesthesia and numbness or drowsiness

2. Itching of nose and throat

3. Impaired speech and tightness of jaw muscles

4. Restlessness and muscle twitching

5. Muscle spasms with pain, nausea, vomiting, incontinence, convulsions

6. Respiratory and/or circulatory distress

ANAPHYLAXIS: Rare, but reported with non-neurotoxic species

DEATHS: Occasional; due to neurotoxic species

TREATMENT

LOCAL FIRST AID:

1. Apply ice packs

2. Apply tourniquet if possible and as near sting site as possible. Loosen briefly every 10-15 minutes

WARNING: Do not use morphine or opiates since they increase toxic effects

SYSTEMIC:

1. Specific antivenin available for many dangerous species; administered early, may be lifesaving

2. Calcium gluconate—10 ml of 10% solution IV immediately and prn to control muscle pain

3. Phenobarbital—30-60 mg orally for sedation and control of convulsions

4. Treat for shock as necessary (Chart 1)

URTICATING CATERPILLARS

REACTIONS

IMMEDIATE: Severe burning pain

LOCAL:

1. Numbness and swelling of area inflicted with severe radiating pain

2. Possible double row of parallel red punctuate marks forming a gridlike tract along the path of the caterpillar

3. Swelling of regional lymph nodes

4. Late foreign-body reaction to unremoved spines

SYSTEMIC:

1. Nausea, vomiting, fever

2. Headaches

3. Shock and convulsions (rare)

DEATHS: None reported

TREATMENT

LOCAL FIRST AID:

1. Repeated stripping using adhesive or cellophane tape to remove spines

2. Apply ice packs

3. Apply baking soda and water paste

SYSTEMIC:

1. For severe pain give meperidine hydrochloride (Demerol, 50-100 mg PO or IM), morphine sulfate (0.25 subcutaneous), codeine phosphate (0.5 g PO)

NOTE: Aspirin is generally not effective

2. Shock (Chart 2)

CHART 1
ANTIHISTAMINES

Chart 2
Treatment of Anaphylaxis—Shock

Transcriber’s Notes

• Retained publication information from the printed edition: this eBook is public-domain in the country of publication.
• Corrected a few palpable typos.
• Generated a spine image from elements of the cover image.
• Reformatted several charts for better text flow on narrow screens.
• In the text versions only, text in italics is delimited by _underscores_.