| Table 4-20 Select Arthropods and Other Creatures (Figures 4.41A–F, 4.42C, D and 4.43C, E) |
| | Common Name | | Scientific Name and Virulence Factor | | Clinical Presentation | | Treatment |
| | Scorpion | | Centruroides spp.
Virulence: two poison glands empty into stingers | | Pain and paresthesias, variable swelling at site of sting, ± neurologic or cardiop1ulmonary complications | | Remove stinger, local wound care, ice, antihistamines |
| | Myiasis | | Dermatobia hominis (botfly larva) | | Larva penetrates into skin causing pyogenic furuncle or “furuncular myiasis” | | Extract maggot manually or occlude with petrolatum |
| | Centipedes
(Class: Chilopoda) | | Scolopendra spp.
Scutigera spp.
Virulence: nocturnal carnivores; inject neurotoxic venom through ducts in jaws | | Two hemorrhagic puncture wounds at site of bite (form chevron shape), ± pain, edema, erythema, profuse bleeding, and associated paresthesias | | Symptomatic treatment and systemic antihistamine |
| | Millipedes
(Class: Diplopoda) | | Virulence: harmless vegetarians (do not bite) may emit toxic substance | | Contact dermatitis to noxious chemical with associated burning, blistering, and/or pigmentation, ± severe inflammation of eyes (if toxin squirted) | | Symptomatic treatment with copious lavage to affected site |
| | Snake bites | | Crotalidae family: rattlesnake, copperhead, and cottonmouth moccasin
Elapidae family: coral snake
Virulence: venom (mainly hydrolases) | | Rapid onset pain and swelling (within hour of envenomation), hemorrhage, and necrosis common with paired bite marks | | Antivenom therapy, tetanus prophylaxis, antibiotic if needed |
| | Bees, wasps, hornets | | Virulence: phospholipase
(honey bee venom) | | Range from mild pain with local edema to exaggerated reactions, ± generalized urticaria, angioedema, respiratory distress, shock | | Remove stinger, ice, symptomatic care |
| | Fire ants | | Solenopsis spp.
Virulence: hemolytic factor, solenopsins (piperidine alkaloids from venom of red fire ant) | | Sterile pustule with erythematous hemorrhagic halo, large urticarial lesions, systemic neurologic symptoms (if multiple bites), ± anaphylaxis, shock, and death | | Symptomatic care |
| | Bed bugs | | Cimex lectularius (Small, reddish-brown with oval-shape and banded appearance) | | Pruritic macules and papules typically involving exposed skin, often grouped in three (“breakfast, lunch, dinner”); peak occurrence before sunrise | | Symptomatic care for skin lesions; eliminate infestation |
| | Blister beetle | | Lytta vesicatoria
Virulence:cantharidin (blistering agent) | | Vesicles or bullae after contact with skin | | Symptomatic care |
| | Carpet beetle | | Anthrenus spp.
Attagenus spp.
(Shiny black and oval-shaped) | | May cause allergic papulovesicular dermatitis on exposed areas (due to adults or larvae) | | Symptomatic care |
| | Sea urchin | | Virulence: fragile spines, break easily into the skin | | Fragments of spines in skin, may cause synovitis and arthritis if near joints | | Remove spines |
| | Sea bather’s eruption | | Linuche unguicalata (thimble jellyfish larvae)
Edwardsiella lineate (sea anemone) | | Stinging larvae trapped beneath swim-wear → pruritic papules under covered areas (bathing suit distribution) | | Symptomatic |
| | Jellyfish stings | | Chironex fleckeri
(Pacific box jellyfish)
Physalia physalis
(Portuguese man of war)
Cyanea and Chrysaora
(sea nettles) | | Sting results in immediate pain, delayed cutaneous reactions, ± shock | | |
| | Tungiasis | | Tunga penetrans | | Flea burrows into upper dermis (resembles abscess with black center or punctum) and discharges eggs from center | | |
| | Caterpillars | | See Table 4-21 Urticating hairs (setae) | | Purely cutaneous reaction (erucisim) or systemic symptoms without cutaneous findings (lepidopterism) | | Removal of offending hairs (duct tape stripping), topical antipruritics |
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