SESSION TYPE: Critical Care Global Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Centipedes are multisegmeted arthropods with a single pair of legs per segment and one pair of antennae .Centipede stings occur in the warmer climates throughout the world. The species of medical importance is Scolopendra Sp which has been described as the longest and the most aggressive tropical centipede. Centipede stings often occur as the victim is putting on clothes or while in bed.
CASE PRESENTATION: A 19 yr old female arrived in our tertiary care emergency room at 5:30am after being treated at a local hospital for an unknown insect bite on her right arm 6 hrs prior while asleep.She had complaints of vomiting,dyspnea and local pain.She received antihistamines,steroids,epinephrine and analgesics for anaphylactic shock and pain prior to arrival.Her presenting vitals were a heart rate of 145 beats per minute, BP 60/40 mmHg ,respiratory rate of 35/min and oxygen saturation of 85% on room air. She had bilateral crackles and her hemoglobin,WBC count,electrolytes and PT,INR were normal. EKG revealed ST depression in V3,V4,V5,V6 leads (>2mm).Chest radiograph showed pulmonary edema and echocardiogram showed global hypokinesia of the left ventricle with EF of 40%,while troponin-t(2.98)was slightly elevated . Treatment was initiated with digoxin,carnitine and dobutamine infusion to support her cardiac output and furosemide was given for pulmonary edema along with non-invasive ventilation.She improved with therapy and a repeat echocardiogram two days later showed EF of 62% with normal LV function.Subsequent history and bystander observation confirmed the visual appearance of the insect to be a centipede.
DISCUSSION: Gomes et al (1)used animal models to demonstrate significant cardiovascular effects of Scolopendra venom, mediated by histamine and a cardiodepressant factor designated as Toxin-S. Most authorities recognize the cardiodepressant Toxin-S to be the lethal factor (predatory), and the histamine/serotonin components to be pain mediators (defensive)(2). Systemic symptoms due to centipede bite may include anxiety, fever, dizziness, palpitations, and nausea. Extensive myonecrosis with subsequent compartment syndrome, rhabdomyolysis, and acute renal failure has been seen after a centipede bite.Japanese Scolopendra species have been reported to cause psychological disturbances and Korsakoff syndrome. A recent study suggests possible myocardial ischemia after a nonfatal centipede sting as a mechanism that could lead to death(3)
CONCLUSIONS: There have been only a few cases of centipede envenomation causing myocardial ischaemia reported. Our case was notable due to the acute presentation of pulmonary edema with cardiac injury with raised cardiac enzyme levels. This complication should be considered when treating such patients, and appropriate diagnostic studies should be obtained.
1) Gomes A, Datta A, Sarangi B, Kar PK, Lahiri SC. Occurrence of histamine and histamine release by centipede venom. Indian J Med Res. 1982;76:888.
2) Stankiewicz M, Hamon A, Benkhalifa R, et al. Effects of a centipede venom fraction on insect nervous system, a native Xenopus oocyte receptor and on an expressed Drosophila muscarinic receptor. Toxicon.1999;37:1431-1445.
3) Ozsarac M, Karcioglu O, Ayrik C, Somuncu F, Gumrukcu S. Acute coronary ischemia following centipede envenomation: Case report and review of the literature. Wilderness Environ Med. 2004;15:109-12
DISCLOSURE: The following authors have nothing to disclose: Munta Kartik, Sai Praveen Haranath, Rahul Amte, Palepu Gopal
No Product/Research Disclosure InformationApollo Hospitals, Department of Critical Care Medicine, Jubilee Hills, Hyderabad, India