Management of severe pain after dermal contact with caterpillars (erucism): a prospective case series

Branco, Maira Migliari; Borrasca-Fernandes, Carla Fernanda; Prado, Camila Carbone; Galvão, Taís Freire; Silva, Marcus Tolentino; Capitani, Eduardo Mello De; Hyslop, Stephen; Bucaretchi, Fábio

doi:10.1080/15563650.2018.1520998

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…Stings from true venomous caterpillars result in immediate local symptoms within minutes including pain, erythema, and swelling secondary to venom components deposited when the hair breaks the host’s skin. 1,5,6 The immediate pain caused in this case supports the presence of venom in the hairs of the white flannel moth caterpillar.…”

Section: Discussionsupporting

confidence: 56%

“…One study in South America found that local injections of lidocaine may also quickly alleviate severe pain. 6 Although there is an antivenom for the dangerous Lonomia obliqua caterpillar found in South America, which can cause life threatening coagulopathy, none exists for North American caterpillars. 7 Systemic Lepidopterism and anaphylaxis are less common than the localized dermatitis seen in this case, but it is pertinent to monitor for symptoms after an encounter and seek medical care immediately if symptoms arise.…”

Section: Discussionmentioning

confidence: 99%

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The Sting of a White Flannel Moth Caterpillar (Norape ovina)

Michienzi

Holstege

Cole

et al. 2022

Wilderness & Environmental Medicine

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The purpose of this report is to describe a case of urticarial dermatitis, or erucism, caused by the white flannel moth caterpillar (Norape ovina) in central Virginia. Many caterpillars are known to cause erucism, with the puss caterpillar (Megalopyge opercularis) being the most reported culprit in the United States. White flannel moth caterpillars are expected to cause erucism as they belong to the same family as the puss caterpillar (Megalopygidae) and have similar venom-containing hairs, but no reports of the reaction or clinical course have been documented in the medical literature. A subject was stung by a white flannel moth caterpillar after it fell on his neck while clearing brush with a machete. The subject experienced immediate pain and developed a raised, erythematous rash where the caterpillar had fallen. The rash, referred to as erucism, was painful for 1 d and improved slowly over the course of 2 wk, but a small area of discoloration remained 2.5 mo after contact. Symptoms were managed by the subject at home and no medications were administered. The white flannel moth caterpillar inflicts erucism similar to that caused by the more commonly mentioned puss caterpillar. If only local symptoms are sustained from contact with a white flannel moth caterpillar, it can be safely and effectively managed with overthe-counter medications similar to the management for erucism induced by other caterpillar species. Irrigation and removal of urticating hairs with adhesive tape may help reduce the pain and is recommended, though not performed in this case.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

The Sting of a White Flannel Moth Caterpillar (Norape ovina)

Michienzi

Holstege

Cole

et al. 2022

Wilderness & Environmental Medicine

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“…El manejo inicial de estos pacientes implica el lavado del área con agua o compresas frías, elevación del miembro afectado, corticosteroides tópicos (hidrocortisona, dexametasona) y antihistamínicos orales (difenhidramina, hidroxicina) (5) . También se puede el uso de anestésicos con lidocaína infiltrados o tópicos (8,12) .…”

Section: Discussionunclassified

Accidente Lonómico: Reporte de dos casos

Arango

Agudelo²,

Rodríguez³

et al. 2022

CES Med

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Introducción: dentro de los insectos del orden lepidóptero, la familia Saturniidae tiene más de 2.400 especies, allí se encuentran Hylesia y Lonomia. Objetivo: presentar dos casos de pacientes con accidente lonómico, el manejo y desenlace para reconocer la importancia de estos eventos en las regiones silvestres de la Orinoquia colombiana. Casos clínicos: paciente de 8 años proveniente de área rural quien refería contacto en región palmar de mano derecha con gusanos quién 48 horas después de dicho contacto presentó equimosis en extremidades, flictena sangrante en talón derecho, cefalea, escalofríos y artralgias, además se evidenciaron tiempos de coagulación prolongados. Paciente de 13 años de características similares a las del caso previamente descrito sin presentar manifestaciones clínicas, pero que presentaba tiempos de coagulación prolongados. Se consideró que cursaba con accidente lonómico por lo que se aplicaron 5 ampollas de suero antilonómico polivalente a cada una sin registrar reacciones adversas. En ambos casos cursaron con evolución clínica adecuada con disminución a rangos de seguridad de tiempos de coagulación. Conclusiones: el veneno lonómico actúa en la cascada de coagulación produciendo manifestaciones hemorrágicas de gravedad variable. El suero antilonómico es el único tratamiento eficaz, a pesar de estar disponible desde hace más de 20 años en Brasil hay un 5% de progresión a síndromes hemorrágicos severos y un 1.5 a 2% de mortalidad. A pesar de tener gran relevancia clínica en las Américas existe subregistro, es importante conocer sus manifestaciones y el manejo para así poder evitar complicaciones mortales.

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“…This treatment may be combined with local anesthesia in the emergency department. 9 This clinical case describes an exceptional sting by a nonindigenous saddleback caterpillar in Corsica. Caterpillars such as A stimulea can be imported across oceans on plants such as Areca or Ficus trees.…”

Section: Discussionmentioning

confidence: 99%

Unusual Sting by a Nonindigenous Caterpillar in Europe

Torrents

Reynoard

Schmitt

et al. 2022

Wilderness & Environmental Medicine

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On the French island of Corsica, a 57-y-old woman without significant medical history was stung on the left thumb while she was taking care of an ornamental Ficus benjamina plant. Immediately, she felt intense pain in her hand. She saw a strange caterpillar, later identified by the local poison center as Acharia stimulea. The pain in her hand was evaluated as 8 of 10 using the numerical pain rating scale; only a slight erythema was visible on her skin. Symptoms disappeared within 2 h with use of local anti-inflammatory ointment and oral painkillers. Three other caterpillars emerged out of the soil of the potted plant during the following week. This sting by a saddleback caterpillar is exceptional in Corsica. French garden store owners and healthcare professionals should be informed that caterpillars can be imported across the oceans to Europe on different plants.

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Management of severe pain after dermal contact with caterpillars (erucism): a prospective case series

Cited by 10 publications

References 14 publications

The Sting of a White Flannel Moth Caterpillar (Norape ovina)

The Sting of a White Flannel Moth Caterpillar (Norape ovina)

Accidente Lonómico: Reporte de dos casos

Unusual Sting by a Nonindigenous Caterpillar in Europe

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