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Centipede Envenomation

Author: Robert L Norris, MD, Associate Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center
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Updated: Nov 19, 2008

Introduction

Background

Approximately 3000 species of centipedes are found in the class Chilopoda, phylum Arthropoda. They are among the less well-studied arthropods. Centipedes are elongated multisegmented arthropods with a single pair of legs on each body segment. They are distributed widely, especially in warm temperate, and tropical regions. Centipedes spend much of their time underground or in rock piles and usually come out at night to actively hunt their prey. They are capable of very fast movement when exposed. The most dangerous species belong to the genus Scolopendra, with the largest members (Scolopendra gigantea) reaching lengths of 26 cm.

Pathophysiology

The venom delivery apparatus consists of a modified pair of front legs (ie, forcipules) just behind the mandibles. Venom is produced in a gland at the base of each forcipule and is injected through ducts when the forcipules are driven into the victim's tissues. The venoms have not been studied extensively but, at least in some species, contain 5-hydroxytryptamine, hemolytic phospholipase A, and a cardiotoxic protein. The venom of the North American giant desert centipede, Scolopendra heros, contains a cytolysin. Most likely, other important components are present in these venoms, which require further study. In addition to venom, some species exude defensive substances from glands found along the body segments. These secretions are usually nontoxic to humans, although at least one species of the genus Otostigmus secretes a vesicating substance.

Frequency

United States

No data available.

International

While good data are sparse, in some regions of the world, centipede stings are not infrequent. Medeiros et al reported 98 such stings presenting to Hospital Vital Brazil, Butantan Institute, São Paulo, Brazil, between 1990 and 2007.¹

Mortality/Morbidity

Most species are relatively innocuous.

• Fatalities are extremely rare following centipede stings. A death was reported in a 7-year-old Filipino girl who was stung on the head by a centipede of the large species Scolopendra subspinipes, which may reach 23 cm in length.
• A case of electrocardiographic (ECG) changes suggestive of ischemia has been reported in a 60-year-old man after a sting by a 12-cm centipede in Turkey.² While there was a slight associated elevation in serum CK-MB and myoglobin, troponin I, troponin T, and delayed exercise stress testing were all normal, and the ECG returned to normal a few hours later. Another 20-year-old man in Turkey presented to an ED with chest pain approximately 24 hours after a reported centipede sting.³ His ECG revealed inferior ST-segment elevation, and he had a positive rise in his CK-MB and troponin T levels. His echocardiogram was normal, and he did well after conservative therapy (without thrombolysis or angioplasty). Delayed coronary angiography revealed normal coronary arteries. The patient was noted to be "completely symptom free" at 17 months. He was felt to have suffered a myocardial infarction, possibly related to coronary vasospasm, inflammatory changes, or multifactorial effects.
• A case of rhabdomyolysis complicated by compartment syndrome and acute renal failure requiring temporary hemodialysis has been reported following the sting of the giant desert centipede, Scolopendra heros.⁴ Prolonged, isolated proteinuria without any other evidence of renal dysfunction has also been reported in a young female following Scolopendra sting.
• Langley reported 5 centipede-related deaths recorded in the National Center for Health Statistics.⁵ CDC Wonder database in the United States between 1991 and 2001, though he had no supporting documentation to confirm that these deaths were truly due to centipedes.

Clinical

History

The history of a centipede sting is usually straightforward. The victim (frequently a gardener) typically sees the creature. Patients may note the following:

• Severe pain (worse with larger specimens)
• Local tissue swelling
• Redness
• Swollen, painful lymph nodes
• Headache
• Palpitations
• Nausea and/or vomiting
• Anxiety
• Local pruritus

Physical

Physical findings due to centipede envenomation may include the following:

• Local edema
• Small puncture wounds
• Erythema
• Lymphangitis and/or lymphadenopathy
• Possibility of local necrosis
• The patient may be noticeably uncomfortable or anxious

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