Part 8

67. Micks, D.S. Clinical effects of the sting of the “puss caterpillar” (Megalopyge opercularis S. & A.) on man. Tex Rep Biol Med 10:399-405 (1952).

68. Mitchell, R.T., and H.S. Zim. Butterflies and moths. New York: Golden Press, 1964.

APPENDIX: ARTHROPOD ENVENOMIZATION REACTIONS AND TREATMENT

The material presented in this appendix was prepared by Lt Col John C. Moseley, USAF, MC, Dermatologist, Wilford Hall USAF Medical Center, Lackland AFB, Texas.

BLACK WIDOW SPIDER

REACTIONS

IMMEDIATE: Pinprick sensation from the bite

LOCAL: Dull numbing pain; two red puncture marks at bite site. Pain peaks at 1-3 hours and persists 12-48 hours

REGIONAL:

1. Severe muscular pain and spasm 2. Rigid boardlike abdomen 3. Tightness in chest and pain on inspiration

GENERAL:

1. Rigidity and spasm of all large muscle groups; excruciating abdominal pain 2. Convulsions, paralysis 3. Shock

DEATHS: 4-5% of untreated cases due to neurotoxic effect of the venom

TREATMENT

LOCAL FIRST AID: Ineffective and unnecessary

SYSTEMIC:

1. Antivenin—1 vial IM (carefully follow package insert instructions) after testing for horse-serum sensitivity 2. Calcium gluconate—10 ml of 10% solution given IV immediately and prn to control muscle pain 3. Muscle relaxants—Give continuously over 8-16-hr period to relieve intensity of muscle spasm and pain 4. Treat for shock as necessary (Chart 2)

BROWN RECLUSE SPIDER

REACTIONS

IMMEDIATE: Very little pain, if any

LOCAL:

1. 2-8 Hours—Mild to severe pain with redness and vesiculation at bite site, followed by ischemia 2. 3-4 Days—Star-shaped firm area of deep-purple color with necrosis 3. 7-14 Days—Central area of depression and ulceration 4. 21 Days—Healing and scar formation. May not heal sufficiently and may require skin grafting

SYSTEMIC:

1. Fever, chills, nausea, vomiting, weakness, joint pain 2. Morbilliform or petechial generalized eruption 3. Occasionally serious hematological disturbances—hemolytic anemia, thrombocytopenia

DEATHS: Reported; usually in children, due to renal failure and hematological abnormalities.

TREATMENT

LOCAL FIRST AID: None effective or necessary

LOCAL: Within 4 hours of the bite, locally excise bite site