Wilderness Medicine

Centipede Bites

Background

1. Definition
   • Bite and envenomation by centipede species
2. Synopsis
   • Approximately 3,000 species
   • Multi-segmented; one pair of legs to each segment
   • Widely found
     • Temperate, warm, & tropical regions
   • Most dangerous are Scolopendra species
     • S. gigantea can be > 25 cm (10 in.)

Pathophysiology

1. Etiology/Risk Factors
   • Centipedes
     • Most dangerous are Scolopendra species
2. Pathology
   • Venom delivered by modified front legs (forcipules) (View image)
     • Poorly studied
     • Contains 5-hydroxytryptamine (some species)
     • Some venoms contain cytolysin
   • Some species also secrete defensive chemicals
     • Some can be vesicants
3. Epidemiology
   • Morbidity/Mortality
     • Only 1 recorded death (7 yo child)
   • Incidence/Prevalence
     • Mainly international travels
     • The 2018 Annual Report from the American Association of Poison Control Centers:
       • 428 exposures (adults and children)
       • <5 yo: 118 cases
       • 6-12 yo: 29 cases
       • 13-19 yo: 30 cases

Diagnostics

1. History/Symptoms
   • Victims usually recall bite/insect
   • Severe local pain and tissue swelling, redness
   • Painful, swollen nodes
   • Headache, N/V
   • Palpitations, anxiety
2. Physical Exam/Signs
   • Local edema, erythema
   • Lymphangitis/lymphadenopathy
   • Local necrosis can occur
   • Severe tenderness, agitation
3. Labs/Tests
   • No specific testing indicated
4. Differential Diagnosis
   • Spider bites
   • Bee / hymenoptera stings
   • Caterpillar stings
   • Cellulitis
   • Anaphylaxis

Treatment

1. Initial/Prep/Goals
   • Manage anaphylaxis as usual
   • Care is supportive
   • Tetanus prophylaxis
   • Local wound care
   • Prophylactic antibiotics not needed
2. Medical/Pharmaceutical
   • Oral analgesics
     • Acetaminophen
     • Acetaminophen + codeine, acetaminophen + hydrocodone
     • NSAIDs
       • Ibuprofen, naproxen
   • Local anesthetics
     • Lidocaine
     • Bupivacaine
       • Local infiltration
       • Regional blocks

Prevention

1. Do not touch/handle centipedes
2. Wear gloves when gardening or working in yard

Disposition

1. Admit if severe symptoms
2. Consults: none
3. Discharge/Follow-up instructions
   • Follow-up with Primary Care Physician 3-4 days
   • Watch for secondary wound infection/necrosis

References

1. Fradin MS, Carroll SP, Norris RL, Warrell DA, et al. Animals, Insects, and Zoonoses. In: Auerbach PS eds., Wilderness Medicine, 6th ed., Elsevier-Mosby:Philadelphia, PA, 2012;Part 6
2. Veraldi S, Chiaratti A, Sica L. Centipede bite: a case report. Arch Dermatol. Jul 2010;146(7):807-808
3. Knysak I, Martins R, Bertim CR. Epidemiological aspects of centipede (Scolopendromorphae: Chilopoda) bites registered in greater S. Paulo, SP, Brazil. Rev Saude Publica. Dec 1998;32(6):514-518
4. Medeiros CR, Susaki TT, Knysak I, et al. Epidemiologic and clinical survey of victims of centipede stings admitted to Hospital Vital Brazil (São Paulo, Brazil). Toxicon. Oct 2008;52(5):606-610
5. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, Hashem HA, Ryan ML. (2019) 2018 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th Annual Report, Clinical Toxicology, 57:12, 1220-1413

Contributor(s)

1. Ballarin, Daniel, MD

Updated/Reviewed: July 2020