eMedicine Specialties > Emergency Medicine > Environmental
Caterpillar Envenomation: Treatment & Medication
Updated: Nov 19, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Prehospital Care
- The involved skin should be immediately washed with soap and water, and dried without contacting the skin (eg, use a hair dryer).
- Local cooling measures can be applied to reduce pain. This may be enhanced by applying topical isopropyl alcohol or ammonia.
- Following ocular exposure, the eyes should be irrigated immediately with copious water.
- Following dermal exposure to irritant or toxic hairs or setae of caterpillars or moths, sticky tape (especially duct tape) can be applied to the site in an effort to remove retained setae. Alternative effective methods of removal include use of rubber cement, clear fingernail polish, or facial peels (each applied, allowed to dry, then peeled away).
- If acute symptoms follow respiratory exposure, supportive care is in order as necessary, including oxygen, antihistamines, and beta-agonist inhalers, if available.
- Anaphylaxis should be treated in standard fashion.
- Following caterpillar stings, the extremity should be splinted and elevated, and ice should be applied to reduce pain.
- Any potentially constrictive jewelry should be removed before swelling progresses.
Emergency Department Care
- Wash the skin with soap and water as mentioned above if this has not already been done in the field.
- Ensure appropriate tetanus immunization status.
- Treat skin exposure as follows:
- Apply sticky adhesive tape (especially duct tape) to the site to remove all remaining hairs or spines possible. Other measures of removal as described previously for prehospital care can also be tried.
- Acute dermatitis can be treated with antihistamines (H1 and/or H2 blockers), although their efficacy is controversial. Additionally, topical steroids may be employed. Systemic steroids may be necessary in patients with severe or persistent cutaneous symptoms. Application of antipruritic products containing menthol may be soothing.
- Prostaglandin-synthetase inhibitors, such as aspirin or indomethacin, have been reported to reduce associated discomfort, but should be avoided if any evidence of coagulopathy is present.
- Treat respiratory exposure as follows:
- Symptoms can be managed with antihistamines (H1 and/or H2 blockers) and beta agonist aerosols/inhalers if wheezing is present.
- If significant symptoms occur, supplemental oxygen administration may be needed, and systemic steroids may be useful.
- Treat ocular exposure as follows:
- Instill a topical anesthetic and irrigate the eyes immediately with copious saline.
- Perform a slit lamp examination with fluorescein. The patient should receive close ophthalmologic follow-up care to rule out retained setae or hairs.
- Eye complications resulting from a retained migrating hair can be severe, and surgical removal may be necessary.
- Treat stings as follows:
- Management is primarily symptomatic and supportive. Splint and elevate the involved extremity; ice can be applied to reduce pain and swelling. Efforts, as outlined above, should be instituted to remove any retained spines or hairs.
- Narcotic analgesics may be required for pain relief. Anecdotal reports exist of the successful use of calcium gluconate (eg, 10 mL of a 10% solution by slow intravenous [IV] administration) to relieve muscle pain following M opercularis stings. Antihistamines (H1 and/or H2 blockers) may reduce concomitant pruritus.
- Treat rare cases of caterpillar or moth-related anaphylaxis in standard, aggressive fashion, including airway management, epinephrine, oxygen, antihistamines, steroids, IV fluids, and vasopressors as needed.
Consultations
- Consultations usually are not necessary following most caterpillar contacts.
- Ophthalmology may be needed for prompt consultation if ocular involvement is present.
Medication
Epinephrine and systemic antihistamines (eg, diphenhydramine, cimetidine), topical or systemic steroids, menthol-containing creams, and prostaglandin-synthetase inhibitors, such as aspirin and indomethacin, all may be beneficial in treating dermatitis. Rhinitis resulting from respiratory exposure may respond to antihistamines and systemic steroids. These are also useful for lower respiratory symptoms. Beta-agonist aerosols or inhalers (eg, albuterol) may be beneficial for wheezing. Analgesics may be required for caterpillar stings. The choice of agent should depend on the severity of symptoms. Mild cases may be treated adequately with oral opiates such as hydrocodone or oxycodone, while more severe pain initially may require parenteral agents such as morphine sulfate.
Stings by the South American Lonomia species, which can cause consumptive coagulopathy with hemorrhagic diathesis and acute renal failure, may be treated with antifibrinolytics. If blood products are required, they must be given cautiously to avoid feeding fuel to an on-going consumptive coagulopathy. An antivenom against this species has been produced in Brazil.
Antihistamines
Prevent histamine response in sensory nerve endings and blood vessels. They are more effective in preventing histamine response than in reversing it.
Diphenhydramine (Benadryl, Benylin, Bydramine)
Used for symptomatic relief of allergic symptoms caused by histamine released in response to allergens.
Adult
25-50 mg PO q6-8h prn; not to exceed 400 mg/d
10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d
Pediatric
12.5-25 mg PO tid/qid or 5 mg/kg/d or 150 mg/m2/d divided tid/qid; not to exceed 300 mg/d
5 mg/kg/d or 150 mg/m2/d IV/IM divided qid; not to exceed 300 mg/d
Potentiates effect of CNS depressants; due to alcohol content, do not give syrup dosage form to patients taking medications that can cause disulfiramlike reactions
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction
Chlorpheniramine maleate (Chlor-Trimeton)
Competes with histamine for H1-receptor sites on effector cells in blood vessels and respiratory tract.
Adult
10-20 mg IV/IM/SC as a single dose; not to exceed 40 mg/d
4 mg PO q4-6h; not to exceed 24 mg/d
Sustained release: 8-12 mg PO q8-12h; not to exceed 24 g/d
Pediatric
2-6 years: 1 mg q4-6h IV/IM/SC in equally divided doses; not to exceed 6 mg/d
6-12 years: 2 mg PO q4-6h; not to exceed 12 mg/d PO
Sustained release: 8 mg PO hs
CNS toxicity increases with coadministration of other CNS depressants, TCAs, MAOIs, and phenothiazines
Documented hypersensitivity; acute asthma attacks; narrow-angle glaucoma; bladder neck obstruction; symptomatic prostate hypertrophy; stenosing peptic ulcer
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May cause significant confusional symptoms; not for administration to premature or full-term neonates
Cimetidine (Tagamet)
H2 antagonist that, when combined with an H1 type, may be useful in treating itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis that do not respond to H1-receptor antagonists alone. Use in addition to H1 antihistamines.
Adult
Patients with persistent symptoms: 300 mg IV followed by PO administration as outpatient q6h for 2 d or for as long as clinically indicated
Pediatric
25-30 mg/kg/d IV in 6 divided doses
Can increase blood levels of theophylline, warfarin, TCAs, triamterene, phenytoin, quinidine, propranolol, metronidazole, procainamide, and lidocaine
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Elderly patients may experience confusional states; may cause impotence and gynecomastia in young males; may increase levels of many drugs; adjust dose or discontinue treatment if changes in renal function occur
Corticosteroids
Onset of action is approximately 4-6 h, and they have limited benefit in the initial acute treatment of rapidly deteriorating anaphylactic patients. However, corticosteroids may benefit patients with persistent bronchospasm or hypotension.
Topical steroids can help reduce cutaneous inflammatory response in caterpillar-induced dermatitis.
Methylprednisolone sodium succinate (Solu-Medrol)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
Loading dose: 125-250 mg IV, followed by 0.5-1 mg/kg/dose q6h for up to 5 d
Pediatric
Loading dose: 2 mg/kg IV, followed by 0.5-1 mg/kg/dose q6h for up to 5 d
Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use
Prednisone (Deltasone, Orasone, Meticorten)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
1-2 mg/kg PO qd or divided bid until symptom resolution, followed by a 1-wk taper
Pediatric
Administer as in adults
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral, fungal, or tubercular infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Abrupt discontinuation may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur
Topical hydrocortisone (Westcort, Dermacort, Cortaid)
DOC for reducing cutaneous inflammatory response in caterpillar-induced dermatitis. Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.
Adult
Apply sparingly to affected areas bid/qid
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; viral, fungal, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use, applying over large surface areas, application of potent steroids, and occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria
Bronchodilators
Via combined alpha-adrenergic and beta-adrenergic agonist action, sympathomimetics are effective in reversing acute bronchospasm of allergic or irritant origin.
An additional option in the management of persistent bronchospasm is via anticholinergics. These agents block the action of acetylcholine at parasympathetic sites in bronchial smooth muscle, causing bronchodilation.
Albuterol sulfate (Ventolin, Proventil)
Beta-agonist useful in treatment of bronchospasm refractory to epinephrine. Relaxes bronchial smooth muscle by acting on beta2 receptors with little effect on heart rate.
Adult
2-4 mg/dose PO divided tid/qid; not to exceed 32 mg/d
Inhalant: 1-2 inhalations q4-6h; not to exceed 12 inhalations/d
Nebulizer: 0.5 mL (2.5 mg) of 0.5% inhalation solution diluted in 1-2.5 mL of normal saline q4-6h; higher frequency may be used for intensive care patients
Pediatric
2-6 years: 0.1-0.2 mg/kg/dose PO divided tid; not to exceed 12 mg/d
6-12 years: 2 mg/dose PO divided tid/qid; not to exceed 24 mg/d
>12 years: Administer as in adults
Inhalant dose:
<12 years: Using a tube spacer, give 1-2 inhalations qid
>12 years: Administer as in adults
Nebulizer dose:
<5 years: 0.25-0.5 mL (1.25-2.5 mg) of 0.5% inhalation solution diluted in 1-2.5 mL of normal saline q4-6h in equally divided doses
>5 years: Administer as in adults
Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation by albuterol; cardiovascular effects may increase with MAOIs, inhaled anesthetics, TCAs, and sympathomimetic agents
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, diabetes mellitus, and cardiovascular disorders
Epinephrine (Adrenalin, EpiPen)
Alpha-agonist effects increase peripheral vascular resistance and reverse peripheral vasodilatation, vascular permeability, and systemic hypotension. Conversely, beta-agonist effects produce bronchodilatation, cause positive inotropic and chronotropic cardiac activity, and result in an increased production of intracellular cAMP.
Adult
Initial dose: 0.01 mL/kg IM/SC of 1:1000 solution, not to exceed 0.5 mL of 1:1000 solution (0.5 mg); if accessible, administer fraction of total dose (0.1-0.2 mL) at site of antigenic exposure
Severe anaphylaxis (laryngeal edema, respiratory failure, shock): 10 mL of 1:100,000 dilution of aqueous epinephrine IV over 10 min; if no improvement is seen, establish continuous infusion in which 1 mcg/min of a 4-mcg/mL concentration is started and increased to 4 mcg/min prn
Pediatric
Infuse 0.1 mcg/kg/min IV with increasing increments of 0.1 mcg/kg/min; not to exceed 1.5 mcg/kg/min
Increases toxicity of beta-blocking and alpha-blocking agents and that of halogenated inhalational anesthetics
Documented hypersensitivity; cardiac arrhythmias or angle-closure glaucoma; local anesthesia in areas such as fingers or toes because vasoconstriction may produce sloughing of tissue; do not use during labor (may delay second stage of labor)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in elderly patients, prostatic hypertrophy, hypertension, cardiovascular disease, diabetes mellitus, hyperthyroidism, and cerebrovascular insufficiency; rapid IV infusions may cause death from cerebrovascular hemorrhage or cardiac arrhythmias
Ipratropium bromide (Atrovent)
Synthetic quaternary anticholinergic ammonium compound chemically related to atropine; has antisecretory properties; when applied locally, inhibits secretions from serous and seromucous glands lining nasal mucosa.
Adult
Nebulizer: 1 U dose vial (500 mcg) tid/qid with doses 6-8 h apart
Metered dose inhaler: 2 inhalations q4-6h qid; not to exceed 12 inhalations in 24 h
Pediatric
Nebulizer: 250 mcg tid
Metered dose inhaler: 1-2 inhalations tid; not to exceed 6 inhalations in 24 h
Drugs with anticholinergic properties, such as dronabinol, may increase toxicity; albuterol increases effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in narrow-angle glaucoma, prostatic hypertrophy, and bladder neck obstruction
Analgesics
Pain control is essential to quality patient care. Most analgesics have sedating properties, which may be beneficial for patients who have sustained severe caterpillar stings.
Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bufferin)
Used for treatment of mild to moderate pain and headache.
Adult
325-650 mg PO q4-6h; not to exceed 4 g/d
Pediatric
10-15 mg/kg/dose PO q4-6h; not to exceed 60-80 mg/kg/d
Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses >2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs
Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; because of association of aspirin with Reye syndrome, do not use in children (<16 y) with flu
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause transient decrease in renal function and aggravate chronic kidney disease; extreme caution in patients with severe anemia, with history of blood coagulation defects, or who are taking anticoagulants
Morphine sulfate (Duramorph, Astramorph, MS Contin)
Parenteral opiates may be necessary to manage extreme pain in patients with severe stings.
Adult
0.1 mg/kg in 2-4 mg increments IV; titrate to desired effect
Pediatric
0.1 mg/kg IV; titrate to desired effect
TCAs, MAOIs, and other CNS depressants may potentiate adverse effects
Documented hypersensitivity; hypotension; potentially compromised airway with uncertain rapid airway control; nausea; emesis; constipation; urinary retention
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid in hypotension, respiratory depression, nausea, emesis, constipation, and urinary retention; caution in atrial flutter and other supraventricular tachycardias; has vagolytic action and may increase ventricular response rate
Hydrocodone and acetaminophen (Vicodin)
Drug combination indicated for relief of moderate to severe pain.
Adult
1-2 tab or cap PO q4-6h prn pain
Pediatric
Single dose not to exceed 10 mg of hydrocodone bitartrate or 2.6 g/d of acetaminophen
<12 years: Administer based on acetaminophen dose of 10-15 mg/kg/dose PO q4-6h prn
>12 years: Administer based on acetaminophen dose of 750 mg PO q4h
Not to exceed 5 doses in 24 h
Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or TCAs
Documented hypersensitivity; elevated ICP
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Tablets contain metabisulfite, which may cause hypersensitivity; caution in patients dependent on opiates since this substitution may result in acute opiate-withdrawal symptoms upon discontinuation; caution in severe renal or hepatic dysfunction
Nonsteroidal anti-inflammatory agents (NSAIDs)
NSAIDs can be effective in reducing discomfort associated with caterpillar-induced dermatitis.
Indomethacin (Indocin, Indochron ER)
Commonly prescribed NSAID used for reducing inflammatory responses. Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.
Adult
25-50 mg PO bid/tid
75 mg SR PO bid; not to exceed 200 mg/d
Pediatric
1-2 mg/kg/d divided PO bid/qid; not to exceed 4 mg/kg/d or 150-200 mg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; GI bleeding or renal insufficiency; coagulopathy
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur (discontinue if persistent leukopenia, granulocytopenia, or thrombocytopenia)
Cardiovascular agents
These agents may be used to support organ perfusion in hypotensive patients unresponsive to intravenous volume expansion.
Dopamine (Intropin)
May be required to support BP in the face of hypotension caused by anaphylactic/anaphylactoid reaction that is unresponsive to fluids and epinephrine.
Adult
5-20 mcg/kg/min IV; titrate to effect
Pediatric
Administer as in adults
Phenytoin, alpha-adrenergic and beta-adrenergic blockers, general anesthesia, and MAOIs increase and prolong effects
Documented hypersensitivity; patients diagnosed with pheochromocytoma or ventricular fibrillation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Closely monitor urine flow, cardiac output, pulmonary wedge pressure, and BP during infusion; prior to infusion, correct hypovolemia with either whole blood or plasma, as indicated; monitoring central venous pressure or left ventricular filling pressure may be helpful in detecting and treating hypovolemia
Toxoid
Used for tetanus immunization. A booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome.
Tetanus toxoid
Used to induce active immunity against tetanus in selected patients. Immunizing agents of choice for most adults and children >7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life.
Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.
In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is mid thigh laterally.
Adult
Primary immunization: 0.5 mL IM; give 2 injections 4-8 wk apart and a third dose 6-12 mo after second injection
Booster dose: 0.5 mL q10y
Pediatric
Administer as in adults
Patients receiving immunosuppressants, including corticosteroids or radiation therapy, may remain susceptible despite immunization due to poor immune response; cimetidine may enhance or augment delayed-hypersensitivity responses to skin-test antigens; avoid concurrent use with systemic chloramphenicol since it may impair amnestic response to tetanus toxoid; concurrent use of tetanus immune globulin may delay development of active immunity by several days (interaction is nevertheless clinically insignificant and does not preclude concurrent use)
Documented hypersensitivity; a history of any type of neurologic symptoms or signs following administration of this product; FDA recommends that elective tetanus immunization be deferred during any outbreak of poliomyelitis because tetanus toxoid injections are an important cause of provocative poliomyelitis
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use to treat actual tetanus infections or for immediate prophylaxis of unimmunized individuals (use instead tetanus antitoxin, preferably human tetanus immune globulin); diminished antibody response to active immunization may be seen in patients receiving immunosuppressive therapy; better to defer primary diphtheria immunization until immunosuppressive therapy discontinued; routine immunization of symptomatic and asymptomatic HIV-infected persons is recommended
More on Caterpillar Envenomation |
| Overview: Caterpillar Envenomation |
| Differential Diagnoses & Workup: Caterpillar Envenomation |
 Treatment & Medication: Caterpillar Envenomation |
| Follow-up: Caterpillar Envenomation |
| Multimedia: Caterpillar Envenomation |
| References |
| « Previous Page | Next Page » |
References
Balit CR, Geary MJ, Russell RC, Isbister GK. Prospective study of definite caterpillar exposures. Toxicon. Nov 2003;42(6):657-62. [Medline].
Carrijo-Carvalho LC, Chudzinski-Tavassi AM. The venom of the Lonomia caterpillar: an overview. Toxicon. May 2007;49(6):741-57. [Medline].
Hare T. Poisonous dwellers of the desert. Presented at: Southwest Parks & Monuments Association. 1995:1-32.
Henwood BP, MacDonald DM. Caterpillar dermatitis. Clin Exp Dermatol. Jan 1983;8(1):77-93. [Medline].
Horng CT, Chou PI, Liang JB. Caterpillar setae in the deep cornea and anterior chamber. Am J Ophthalmol. Mar 2000;129(3):384-5. [Medline].
Peters S. A Colour Atlas of Arthropods in Clinical Medicine. Wolfe Publishing Ltd; 1992:1-304.
Pinson RT, Morgan JA. Envenomation by the puss caterpillar (Megalopyge opercularis). Ann Emerg Med. May 1991;20(5):562-4. [Medline].
Seibert CS, Shinohara EM, Sano-Martins IS. In vitro hemolytic activity of Lonomia obliqua caterpillar bristle extract on human and Wistar rat erythrocytes. Toxicon. Jun 2003;41(7):831-9. [Medline].
Shama SK, Etkind PH, Odell TM, et al. Gypsy-moth-caterpillar dermatitis. N Engl J Med. May 27 1982;306(21):1300-1. [Medline].
Sridhar MS, Ramakrishnan M. Ocular lesions caused by caterpillar hairs. Eye. May 2004;18(5):540-3. [Medline].
Steele C, Lucas DR, Ridgway AE. Endophthalmitis due to caterpillar setae: surgical removal and electron microscopic appearances of the setae. Br J Ophthalmol. Apr 1984;68(4):284-8. [Medline].
Stipetic ME, Rosen PB, Borys DJ. A retrospective analysis of 96 "asp" (Megalopyge opercularis) envenomations in Central Texas during 1996. J Toxicol Clin Toxicol. 1999;37(4):457-62. [Medline].
Further Reading
Keywords
caterpillar envenomations, caterpillar bite, caterpillar sting, Megalopyge opercularis, M opercularis, caterpillar dermatitis, erucism, dermatitis, lepidopterism, Lepidoptera, Arthropoda, Insecta, puss caterpillar, asp, Lonomia
