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• W2113233506 abstract "Caterpillars and moths (order Lepidoptera) are uncommonly recognized causes of adverse cutaneous reactions, such as localized stings, papular dermatitis, and urticarial wheals. These reactions are typically mild and self-limited; however, in South America, the sting of Lonomia caterpillars can cause a potentially fatal hemorrhagic diathesis related to massive fibrinolysis. In addition, ocular inflammation and prominent arthralgias have been reported to be caused by caterpillar exposures. Therapies for mucocutaneous reactions to Lepidoptera are largely empiric, with the exception of antivenin against Lonomia obliqua envenomation. Part II of this two-part series on caterpillars and moths reviews the varied symptoms caused by Lepidopteran exposures, reviews the differential diagnosis, and discusses appropriate treatment algorithms.Learning objectivesAfter completing this learning activity, participants should be able to recognize the most common species that cause caterpillar- and moth-related reactions, categorize the reactions based on the clinical manifestations, and choose the most appropriate therapy. Caterpillars and moths (order Lepidoptera) are uncommonly recognized causes of adverse cutaneous reactions, such as localized stings, papular dermatitis, and urticarial wheals. These reactions are typically mild and self-limited; however, in South America, the sting of Lonomia caterpillars can cause a potentially fatal hemorrhagic diathesis related to massive fibrinolysis. In addition, ocular inflammation and prominent arthralgias have been reported to be caused by caterpillar exposures. Therapies for mucocutaneous reactions to Lepidoptera are largely empiric, with the exception of antivenin against Lonomia obliqua envenomation. Part II of this two-part series on caterpillars and moths reviews the varied symptoms caused by Lepidopteran exposures, reviews the differential diagnosis, and discusses appropriate treatment algorithms. After completing this learning activity, participants should be able to recognize the most common species that cause caterpillar- and moth-related reactions, categorize the reactions based on the clinical manifestations, and choose the most appropriate therapy. Capsule Summary•The clinical patterns caused by caterpillars and moths are localized stinging reactions, papular urticaria and dermatitis, urticarial wheals, hemorrhagic diathesis, ophthalmia nodosa, dendrolimiasis and pararamose, bites, and oral exposure.•The differential diagnosis for these reactions is broad, and a history of caterpillar or moth exposure is helpful in making an appropriate diagnosis.•Treatments for these reactions remain empiric, but an effective antivenin exists for Lonomia obliqua stings.Lepidoptera are one of the most diverse groups of insects, but they are an uncommon cause of human disease. Their effects on humans are as myriad as their diversity. In the first part of this two-part series, I defined the terminology related to caterpillar- and moth-related disease, reviewed the epidemiology of caterpillar and moth envenomation, and discussed known pathologic mechanisms of disease caused by these insects. Part II of this review will provide more clinical information on each clinical pattern of disease caused by Lepitoptera and provide information on the species of caterpillar or moth that is potentially responsible for each pattern. In this way, the reader may use either the clinical impression or correct identification of the offending species to guide both management and therapy. An overview of published therapies is provided at the end of this review. •The clinical patterns caused by caterpillars and moths are localized stinging reactions, papular urticaria and dermatitis, urticarial wheals, hemorrhagic diathesis, ophthalmia nodosa, dendrolimiasis and pararamose, bites, and oral exposure.•The differential diagnosis for these reactions is broad, and a history of caterpillar or moth exposure is helpful in making an appropriate diagnosis.•Treatments for these reactions remain empiric, but an effective antivenin exists for Lonomia obliqua stings. Key points•Localized stinging reactions are caused primarily by caterpillars of three families: Saturniidae, Megalopygidae, and Limacodidae•Papular urticaria and dermatitis tend to be caused by contact with furry or bristly caterpillars•Urticarial wheals, angioedema, and anaphylaxis are most commonly reported with processionary caterpillars (genus Thaumetopoea)•A hemorrhagic diathesis can result from Lonomia stings•Moths with the ability to pierce human skin have been reported•Ophthalmia nodosa results from ocular contact with caterpillar setae•Dermatitis associated with prominent joint findings is reported with Dendrolimus and Premolis caterpillars•Oral exposure may occur in children and is usually mild Cutaneous reactions to Lepidoptera come in many forms, most commonly mild stings with a papular eruption, pruritic urticarial papules and plaques, or scaly erythematous papules and plaques in exposed areas. Consequently, the differential diagnosis is often broad, and diagnosis requires a high index of suspicion and thorough history. Patients may provide a history of caterpillar or moth exposure, and a general knowledge of the most common offending species in that area can be of great help. Accurately classifying human reactions to encounters with Lepidoptera is difficult because of poor documentation. There are only scant publications on the subject, and those that are available lack uniformity in either scope or investigation. The great diversity of offending species along with difficulty in accurate speciation adds to the problem. In tropical areas, where the diversity of Lepidoptera far exceeds that of temperate regions, Lepidoptera may be largely unclassified, and there may be a complete lack of documented medical records in these areas. A further difficulty is that some species are capable of producing myriad adverse effects: the caterpillars of the browntail moth (Euproctis chrysorrhea) are able to cause eczematous dermatitis, papular urticaria, urticarial wheals, vesicopustular eruptions, bruising, conjunctivitis, rhinitis, and possibly fatal allergic reactions.1Hall-Smith P.J. Graham P. Beware the furry caterpillar.Clin Exp Dermatol. 1980; 5: 261-262Crossref PubMed Scopus (8) Google Scholar, 2Blair C.P. The browntail moth, its caterpillar and their rash.Clin Exp Dermatol. 1979; 4: 215-222Crossref PubMed Scopus (34) Google Scholar, 3Alexander S. The browntail moth, its caterpillar and their rash.Clin Exp Dermatol. 1980; 5: 261Crossref PubMed Scopus (1) Google Scholar, 4Kephart C.F. The poison glands of the larva of the brown-tail moth (Euproctis chrysorrhoea Linn.).J Parasitol. 1914; 1: 95-103Crossref Google Scholar Most species, however, primarily cause one type of reaction, and it is with this in mind that the following classification is offered: localized stings, papular urticaria or dermatitis, urticarial wheals, hemorrhagic diathesis, ophthalmia nodosa, prominent arthritis/arthralgias, bite reactions, and oral exposure (Table I).Table IOverview of Lepidopteran reactionsReactionDescriptionLocalized stinging reactionsImmediate mild to severe pain that lasts hours to days; uncommonly associated with systemic symptomsPapular urticaria and dermatitisMild to moderate localized pruritic papules or eczematous patches; predominantly exposed areas; may last for daysUrticarial whealsEvanescent pruritic wheals with or without angioedema or anaphylaxisHemorrhagic diathesis (Lonomism)Localized stinging reaction followed by headache, mucocutaneous hemorrhage, potentially fatal alveolar or cerebral hemorrhage, or renal failureOphthalmia nodosaAcute unilateral chemosis, occasional granulomatous inflammation or uveitisDendrolimiasis and pararamoseNonspecific dermatitis associated with prominent joint involvement (arthritis or arthralgias)BitesRare; mild and self-limitedOral exposureTypically mild and self-limited lip or oral mucosal irritation Open table in a new tab The following paragraphs and tables are organized first by predominant symptom and then by geographic location to help clinicians with accurate diagnosis and speciation. In the United States, localized stinging reactions caused by caterpillars are largely due to members of three families: Saturniidae, Megalopygidae, and Limacodidae (Table II). The Saturniidae are known as silkmoths, and the strictly American subfamily Hemileucinae contains all the known stinging Saturniidae. Composed of 49 genera and approximately 670 species from Canada to Argentina and Chile,5Lemaire C. The Saturniidae of America: Hemileucinae.Germany: Antiquariat Geock & Evers. 2002; Google Scholar all species may be capable of stings, although the caterpillars of most species have yet to be described. Larvae of at least seven genera (Automeris,6Hughes G. Rosen T. Automeris io (caterpillar) dermatitis.Cutis. 1980; 26: 71-73PubMed Google Scholar, 7Hossler E.W. Elston D.M. Wagner D.L. What's eating you? Io moth (Automeris io.Cutis. 2008; 82: 21-24PubMed Google Scholar Hemileuca,8Walker R.B. Thomas T. Cupit D. Giaquinto-Shreves J. An epidemic of caterpillar sting dermatitis in a rural West Virginia community.W V Med J. 1993; 89: 58-60PubMed Google Scholar Leucanella, Molippa, Dirphia, Cerodirphia,9Bowles DE, Swaby JA. Field guide to venomous and medically important invertebrates affecting military operations: identification, biology, symptoms, treatment. Available at: http://www.afpmb.org/pubs/Field_Guide/field_guide.htm. Accessed October 6, 2008.Google Scholar, 10Couppié P. Marty C. Sainte-Marie D. Pradinaud R. Poisonous caterpillars in French Guyana. 5 cases.Ann Dermatol Venereol. 1998; 125 ([in French]): 489-491PubMed Google Scholar, 11Shevchenko A. de Sousa M.M. Waridel P. Bittencourt S.T. de Sousa M.V. Shevchenko A. Sequence similarity-based proteomics in insects: characterization of the larvae venom of the Brazilian moth Cerodirphia speciosa.J Proteome Res. 2005; 4: 862-869Crossref PubMed Scopus (33) Google Scholar and Hylesia12Janzen D.H. Natural history of Hylesia lineata.J Kansas Entomol Soc. 1984; 57: 490-514Google Scholar) are known to sting.Table IISome common caterpillars that cause localized stingsCommon nameSpeciesLocationIo mothAutomeris io6Hughes G. Rosen T. Automeris io (caterpillar) dermatitis.Cutis. 1980; 26: 71-73PubMed Google Scholar, 7Hossler E.W. Elston D.M. Wagner D.L. What's eating you? Io moth (Automeris io.Cutis. 2008; 82: 21-24PubMed Google ScholarSouthern Canada, Eastern US to the Rocky Mountains, south to Costa RicaBuck mothHemileuca maia8Walker R.B. Thomas T. Cupit D. Giaquinto-Shreves J. An epidemic of caterpillar sting dermatitis in a rural West Virginia community.W V Med J. 1993; 89: 58-60PubMed Google ScholarEastern USPalometa peluda (little hairy pigeon)Hylesia spp.5Lemaire C. The Saturniidae of America: Hemileucinae.Germany: Antiquariat Geock & Evers. 2002; Google Scholar, 12Janzen D.H. Natural history of Hylesia lineata.J Kansas Entomol Soc. 1984; 57: 490-514Google Scholar, 56Benaim-Pinto C. Pernia-Rosales B. Rojas-Peralta R. Dermatitis caused by moths of Hylesia genus (Lepidoptera, Saturniidae) in northeastern states of Venezuela: I. Bioecology of Hylesia metabus (Cramer). Clinical features of lepidopterism determined by this species.Am J Contact Derm. 1991; 2: 213Crossref Google Scholar, 60Rodriguez-Morales A.J. Arria M. Rojas-Mirabal J. Borges E. Benitez J.A. Herrera M. et al.Lepidopterism due to exposure to the moth Hylesia metabus in northeastern Venezuela.Am J Trop Med Hyg. 2005; 73: 991-993Crossref PubMed Scopus (21) Google Scholar, 136Centers for Disease Control and PreventionMoth-associated dermatitis—Cozumel, Mexico.MMWR Morb Mortal Wkly Rep. 1990; 39: 219-220PubMed Google Scholar, 137Fernandez G. Morales E. Beutelspacher C. Villanueva A. Ruiz C. Stetler H.C. Epidemic dermatitis due to contact with a moth in Cozumel, Mexico.Am J Trop Med Hyg. 1992; 46: 560-563Crossref PubMed Scopus (10) Google Scholar, 138Lundberg U. Salazar V. Tovar M. Rodriguez J. Isolation and partial characterization of proteins with vasodegenerative and proinflammatory properties from the egg-nests of Hylesia metabus (Lepidoptera: Saturniidae).J Med Entomol. 2007; 44: 440-449Crossref PubMed Scopus (16) Google ScholarMexico, Central, and South AmericaCup mothDoratifera vulnerans, D oxleyi, and D quadriguttata38Southcott R. Moths and butterflies.in: Covacevich J. Davie P. Pearn J. Toxic plants and animals: a guide for Australia. 1st ed. Queensland Museum, Brisbane, Australia1987: 243Google Scholar, 40Balit C.R. Geary M.J. Russell R.C. Isbister G.K. Prospective study of definite caterpillar exposures.Toxicon. 2003; 42: 657-662Crossref PubMed Scopus (19) Google ScholarAustraliaBillygoat plum stinging caterpillarThosea penthima39Isbister G.K. Whelan P.I. Envenomation by the billygoat plum stinging caterpillar (Thosea penthima).Med J Aust. 2000; 173: 654-655Crossref PubMed Scopus (8) Google ScholarAustraliaStinging nettle caterpillarDarna pallivitta18Chun S, Hara A, Niino-DuPonte R, Nagamine WT, Conant P, Hirayama C. Stinging nettle caterpillar. Available at: http://www.ctahr.hawaii.edu/oc/freepubs/pdf/IP-22.pdf. Accessed September 22, 2008.Google Scholar, 19Conant P, Hara AH, Nagamine WT, Kishimoto CM, Heu RA. Nettle caterpillar. Available at: http://www.hawaiiag.org/hdoa/npa/npa01-03-netcat.pdf. Accessed September 22, 2008.Google ScholarHawaii and Southeast AsiaSlug caterpillarLatoia (Parasa) lepida41Kazunari U. Dermatitis to caterpillar of Latoia lepida.Rinsho Derma (Tokyo). 2003; 45 ([in Japanese]): 1549-1550Google Scholar, 42Takeshi O. Yutaka Y. Tomomichi O. A case of dermatitis from a caterpillar (Latoia lepida).Jpn J Clin Dermatol. 2004; 58 ([in Japanese]): 257Google ScholarJapanPuss caterpillar, flannel moth caterpillar, asp, bicho peludo negroMegalopyge opercularis and M crispata21Eagleman D.M. Envenomation by the asp caterpillar (Megalopyge opercularis).Clin Toxicol (Phila). 2008; 46: 201-205Crossref PubMed Scopus (22) Google Scholar, 22Stipetic M.E. Rosen P.B. Borys D.J. A retrospective analysis of 96 “asp” (Megalopyge opercularis) envenomations in Central Texas during 1996.J Toxicol Clin Toxicol. 1999; 37: 457-462Crossref PubMed Scopus (21) Google Scholar, 23Bishopp F.C. The puss caterpillar and the effects of its sting on man.United States Department of Agriculture Department Circulation. 1923; 288: 1-4Google Scholar, 24el-Mallakh R.S. Baumgartner D.L. Fares N. “Sting” of puss caterpillar, Megalopyge opercularis (Lepidoptera: Megalopygidae): first report of cases from Florida and review of literature.J Fla Med Assoc. 1986; 73: 521-525PubMed Google Scholar, 25Gardner T.L. Elston D.M. Painful papulovesicles produced by the puss caterpillar.Cutis. 1997; 60: 125-126PubMed Google Scholar, 26Pinson R.T. Morgan J.A. Envenomation by the puss caterpillar (Megalopyge opercularis).Ann Emerg Med. 1991; 20: 562-564Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 27Severs G.A. Elston D.M. What's eating you? Megalopyge opercularis.Cutis. 2003; 71: 445-448PubMed Google Scholar, 28Holland D.L. Adams D.P. “Puss caterpillar” envenomation: a report from North Carolina.Wilderness Environ Med. 1998; 9: 213-216Abstract Full Text PDF PubMed Scopus (7) Google Scholar, 29McGovern J.P. Barkin G.D. McElhenney T.R. Wende R. Megalopyge opercularis: observations of its life history, natural history of its sting in man, and report of an epidemic.JAMA. 1961; 175: 1155-1158Crossref Scopus (26) Google Scholar, 30Neustater B.R. Stollman N.H. Manten H.D. Sting of the puss caterpillar: an unusual cause of acute abdominal pain.South Med J. 1996; 89: 826-827Crossref PubMed Scopus (16) Google ScholarSoutheastern US south to Central AmericaGum leaf skeletonizerUraba lugens35Derraik J. Erucism in New Zealand: exposure to gum leaf skeletoniser (Uraba lugens) caterpillars in the differential diagnosis of contact dermatitis in the Auckland region.N Z Med J. 2006; 119 (U2142)PubMed Google Scholar, 36Derraik J.G. Three students exposed to Uraba lugens (gum leaf skeletoniser) caterpillars in a West Auckland school.N Z Med J. 2007; 120 (U2656)Google Scholar, 37Common I.F.B. Moths of Australia. Melbourne University Publishing, Melbourne1990Crossref Google Scholar, 38Southcott R. Moths and butterflies.in: Covacevich J. Davie P. Pearn J. Toxic plants and animals: a guide for Australia. 1st ed. Queensland Museum, Brisbane, Australia1987: 243Google ScholarAustralia and New ZealandMourning cloak (US), Camberwell beauty (UK)Nymphalis antiopa17Mullen G.R. Moths and butterflies (Lepidoptera).in: Mullen G.R. Durden L.A. Medical and veterinary entomology. Academic Press, San Diego, CA2002: 364Crossref Google Scholar, 47Goldman L. Sawyer F. Levine A. Goldman J. Goldman S. Spinanger J. Investigative studies of skin irritations from caterpillars.J Invest Dermatol. 1960; 34: 67-79Abstract Full Text PDF PubMed Scopus (18) Google ScholarNorth America and EurasiaDanaid eggflyHypolimnas misippus38Southcott R. Moths and butterflies.in: Covacevich J. Davie P. Pearn J. Toxic plants and animals: a guide for Australia. 1st ed. Queensland Museum, Brisbane, Australia1987: 243Google ScholarSoutheast Asia, Africa, tropical Americas, and AustraliaUK, United Kingdom; US, United States. Open table in a new tab UK, United Kingdom; US, United States. The most well known member of the Hemileucinae is the io moth, Automeris io (Fig 1). It is commonly found throughout the summer from southern Canada throughout the eastern United States, and is also found as far south as Costa Rica.13Wagner D.L. Caterpillars of eastern North America: a guide to identification and natural history. Princeton University Press, Princeton, NJ2005Google Scholar Contact with caterpillars causes a nettle-like stinging sensation followed by a pruritic papulourticarial eruption that may last for hours.7Hossler E.W. Elston D.M. Wagner D.L. What's eating you? Io moth (Automeris io.Cutis. 2008; 82: 21-24PubMed Google Scholar, 13Wagner D.L. Caterpillars of eastern North America: a guide to identification and natural history. Princeton University Press, Princeton, NJ2005Google Scholar Dizziness, diaphoresis, and abdominal pain are rarely reported.14Everson G.W. Chapin J.B. Normann S.A. Caterpillar envenomations: a prospective study of 112 cases.Vet Hum Toxicol. 1990; 32: 114-119PubMed Google Scholar The similar A louisiana can sting and is found nearly year round along the Gulf of Mexico in Louisiana, Mississippi, and Texas. Also belonging to this family is the buck moth, Hemileuca maia (Fig 2), which is commonly found in the eastern United States. It causes mild to moderate stings similar to that of the io moth.8Walker R.B. Thomas T. Cupit D. Giaquinto-Shreves J. An epidemic of caterpillar sting dermatitis in a rural West Virginia community.W V Med J. 1993; 89: 58-60PubMed Google Scholar In the western United States, the closely related range caterpillar (H oliviae) may cause localized stings. There are 16 other species of Hemileuca in the United States and Canada, all of which possess stinging capability.15Tuskes P.M. Tuttle J.P. Collins M.M. The wild silk moths of North America: a natural history of the Saturniidae of the United States and Canada. Cornell University Press, Ithaca, NY1996Crossref Google ScholarFig 2Buck moth caterpillar (Hemileuca maia).View Large Image Figure ViewerDownload Hi-res image Download (PPT) In the family Limacodidae, the most well known caterpillar is the saddleback (Acharia stimulea; Fig 3), which is common throughout the eastern United States to Texas and Florida from late summer into October.13Wagner D.L. Caterpillars of eastern North America: a guide to identification and natural history. Princeton University Press, Princeton, NJ2005Google Scholar The stings are potent; contact causes intense pain and urtication or vesiculation (Fig 4).16Edwards Jr., E.K. Edwards E.K. Kowalczyk A.P. Contact urticaria and allergic contact dermatitis to the saddleback caterpillar with histologic correlation.Int J Dermatol. 1986; 25: 467Crossref PubMed Scopus (13) Google Scholar Less intense stings are caused by other members of the Limacodidae found in the eastern United States: Natada nasoni, Parasa chloris, P indetermina, Euclea delphinii, Isa textula, and Adoneta spinuloides (Fig 5, Fig 6, Fig 7, Fig 8, Fig 9).17Mullen G.R. Moths and butterflies (Lepidoptera).in: Mullen G.R. Durden L.A. Medical and veterinary entomology. Academic Press, San Diego, CA2002: 364Crossref Google Scholar In Hawaii, the stinging nettle moth (Darna pallivitta) was introduced in 2001 from Southeast Asia. Contact causes immediate stinging and wheal formation, which may take up to 5 days to resolve.18Chun S, Hara A, Niino-DuPonte R, Nagamine WT, Conant P, Hirayama C. Stinging nettle caterpillar. Available at: http://www.ctahr.hawaii.edu/oc/freepubs/pdf/IP-22.pdf. Accessed September 22, 2008.Google Scholar, 19Conant P, Hara AH, Nagamine WT, Kishimoto CM, Heu RA. Nettle caterpillar. Available at: http://www.hawaiiag.org/hdoa/npa/npa01-03-netcat.pdf. Accessed September 22, 2008.Google ScholarFig 4Saddleback caterpillar envenomation: author's forearm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 5Nason's slug (Natada nasoni).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 6Smaller parasa (Parasa chloris).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 7Stinging rose caterpillar (Parasa indetermina).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 8Spiny oak slug (Euclea delphinii).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 9Crowned slug (Isa textula).View Large Image Figure ViewerDownload Hi-res image Download (PPT) In the United States, the most severe stings belong to the caterpillar of the southern flannel moth Megalopyge opercularis (family Megalopygidae), commonly called the puss caterpillar. It is found in the eastern United States from the mid-Atlantic states through Texas into Mexico and central America throughout the summer but especially from September through October, when the highest numbers of stings are reported.20Goddard J. Physician's guide to arthropods of medical importance.2nd ed. CRC Press, Philadelphia1996Google Scholar, 21Eagleman D.M. Envenomation by the asp caterpillar (Megalopyge opercularis).Clin Toxicol (Phila). 2008; 46: 201-205Crossref PubMed Scopus (22) Google Scholar, 22Stipetic M.E. Rosen P.B. Borys D.J. A retrospective analysis of 96 “asp” (Megalopyge opercularis) envenomations in Central Texas during 1996.J Toxicol Clin Toxicol. 1999; 37: 457-462Crossref PubMed Scopus (21) Google Scholar, 23Bishopp F.C. The puss caterpillar and the effects of its sting on man.United States Department of Agriculture Department Circulation. 1923; 288: 1-4Google Scholar Caterpillars, also called “asps” or “bicho peludo negro,” are easily recognized by their wooly appearance and characteristic “tail” (Fig 10). There are spines hidden within the dense hair coat that cause severe burning pain, edema, erythema, and a characteristic grid-like hemorrhagic papular eruption (Fig 11).24el-Mallakh R.S. Baumgartner D.L. Fares N. “Sting” of puss caterpillar, Megalopyge opercularis (Lepidoptera: Megalopygidae): first report of cases from Florida and review of literature.J Fla Med Assoc. 1986; 73: 521-525PubMed Google Scholar, 25Gardner T.L. Elston D.M. Painful papulovesicles produced by the puss caterpillar.Cutis. 1997; 60: 125-126PubMed Google Scholar, 26Pinson R.T. Morgan J.A. Envenomation by the puss caterpillar (Megalopyge opercularis).Ann Emerg Med. 1991; 20: 562-564Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 27Severs G.A. Elston D.M. What's eating you? Megalopyge opercularis.Cutis. 2003; 71: 445-448PubMed Google Scholar, 28Holland D.L. Adams D.P. “Puss caterpillar” envenomation: a report from North Carolina.Wilderness Environ Med. 1998; 9: 213-216Abstract Full Text PDF PubMed Scopus (7) Google Scholar, 29McGovern J.P. Barkin G.D. McElhenney T.R. Wende R. Megalopyge opercularis: observations of its life history, natural history of its sting in man, and report of an epidemic.JAMA. 1961; 175: 1155-1158Crossref Scopus (26) Google Scholar Up to one-third of victims may have systemic reactions, including lymphadenopathy, headache, acute abdominal distress, muscle spasm, faintness, vertigo, respiratory distress, swallowing difficulty, shock-like symptoms, or convulsions.21Eagleman D.M. Envenomation by the asp caterpillar (Megalopyge opercularis).Clin Toxicol (Phila). 2008; 46: 201-205Crossref PubMed Scopus (22) Google Scholar, 22Stipetic M.E. Rosen P.B. Borys D.J. A retrospective analysis of 96 “asp” (Megalopyge opercularis) envenomations in Central Texas during 1996.J Toxicol Clin Toxicol. 1999; 37: 457-462Crossref PubMed Scopus (21) Google Scholar, 23Bishopp F.C. The puss caterpillar and the effects of its sting on man.United States Department of Agriculture Department Circulation. 1923; 288: 1-4Google Scholar, 28Holland D.L. Adams D.P. “Puss caterpillar” envenomation: a report from North Carolina.Wilderness Environ Med. 1998; 9: 213-216Abstract Full Text PDF PubMed Scopus (7) Google Scholar, 29McGovern J.P. Barkin G.D. McElhenney T.R. Wende R. Megalopyge opercularis: observations of its life history, natural history of its sting in man, and report of an epidemic.JAMA. 1961; 175: 1155-1158Crossref Scopus (26) Google Scholar, 30Neustater B.R. Stollman N.H. Manten H.D. Sting of the puss caterpillar: an unusual cause of acute abdominal pain.South Med J. 1996; 89: 826-827Crossref PubMed Scopus (16) Google Scholar A fascinating catalog of reported stings can be found at http://www.bugsinthenews.com/puss_caterpillar_encounters.htm.31Cates J. Puss caterpillar encounters. Available at: http://www.bugsinthenews.com/puss_caterpillar_encounters.htm. Accessed June 26, 2009.Google Scholar In the northeast United States, the similar black-waved flannel moth (M crispata) causes a less severe sting.26Pinson R.T. Morgan J.A. Envenomation by the puss caterpillar (Megalopyge opercularis).Ann Emerg Med. 1991; 20: 562-564Abstract Full Text PDF PubMed Scopus (20) Google Scholar Other Megalopyge species, including M urens, M lanata, and M krugi, found in Central and South America, may also be capable of severe stings.10Couppié P. Marty C. Sainte-Marie D. Pradinaud R. Poisonous caterpillars in French Guyana. 5 cases.Ann Dermatol Venereol. 1998; 125 ([in French]): 489-491PubMed Google Scholar, 32Ardao M.I. Sosa Perdomo C. Pellaton M.G. Venom of the Megalopyge urens (Berg) caterpillar.Nature. 1966; 209: 1139-1140Crossref PubMed Scopus (12) Google Scholar, 33Henwood B.P. MacDonald D.M. Caterpillar dermatitis.Clin Exp Dermatol. 1983; 8: 77-93Crossref PubMed Scopus (19) Google Scholar A related species, the white flannel moth (Norape ovina; Fig 12), causes mild stings and is found from Virginia to Missouri and across the southeastern United States.13Wagner D.L. Caterpillars of eastern North America: a guide to identification and natural history. Princeton University Press, Princeton, NJ2005Google Scholar, 34Scott H.G. Stinging caterpillars.Pest Control. 1964; 32: 24-25Google ScholarFig 11Sting of puss caterpillar, with characteristic hemorrhagic “grid-like” appearance. (Photograph courtesy of Dirk M. Elston, MD, Geisinger Medical Center. Image is in the public domain.)View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 12White flannel moth (Norape ovina).View Large Image Figure ViewerDownload Hi-res image Download (PPT) In Australia and New Zealand, the gum leaf skeletonizer moth (Uraba lugens; Fig 13) is another member of Limacodidae whose stings cause pain, erythema, and wheal formation (Fig 14).35Derraik J. Erucism in New Zealand: exposure to gum leaf skeletoniser (Uraba lugens) caterpillars in the differential diagnosis of contact dermatitis in the Auckland region.N Z Med J. 2006; 119 (U2142)PubMed Google Scholar, 36Derraik J.G. Three students exposed to Uraba lugens (gum leaf skeletoniser) caterpillars in a West Auckland school.N Z Med J. 2007; 120 (U2656)Google Scholar, 37Common I.F.B" @default.
• W2113233506 created "2016-06-24" @default.
• W2113233506 creator A5015706595 @default.
• W2113233506 date "2010-01-01" @default.
• W2113233506 modified "2023-10-18" @default.
• W2113233506 title "Caterpillars and moths" @default.
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