AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

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 the forcipules 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.

Mortality/Morbidity

Most species are relatively innocuous.

• Fatalities are extremely rare following scorpion 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. 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. 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. Prolonged, isolated proteinuria without any other evidence of renal dysfunction has also been reported in a young female following Scolopendra sting.

CLINICAL

Section 3 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

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

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

DIFFERENTIALS

Section 4 of 11  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

WORKUP

Section 5 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Lab Studies

• A bedside urine test for proteinuria is reasonable. The same test can detect myoglobinuria secondary to rhabdomyolysis in patients with significant swelling and pain of the affected extremity.
• If evidence of rhabdomyolysis is present, serum electrolytes, CPK, and renal function studies should be obtained.

Other Tests

• An ECG should be obtained if the patient has a history of cardiac disease, chest pain, or if there is any evidence of hemodynamic instability following centipede sting.

Procedures

• If swelling of the affected extremity is severe and a compartment syndrome is suspected, intracompartmental pressures should be objectively assessed.
• If a compartment syndrome is diagnosed, the limb should be elevated and plans should be made for fasciotomy. A brief trial of intravenous mannitol can be instituted in an effort to reduce pressures before surgery.

TREATMENT

Section 6 of 11  

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• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Prehospital Care

No specific first aid measures are available for centipede stings. Seek medical care if pain persists or systemic symptoms occur. Local application of ice may reduce some of the discomfort; however, others have anecdotally found that local heat application or immersion in hot (nonscalding) water is more comforting.

Emergency Department Care

• Management of centipede stings is entirely supportive.
• Pain may be managed with systemic analgesics, as necessary.
• Pain may be managed with local injectable anesthetics (eg, lidocaine, bupivacaine). These can be injected locally or used in performing a regional nerve block. A standard text should be consulted regarding techniques of regional anesthesia.
• Tetanus status should be updated.
• Prophylactic antibiotics are not necessary, but secondary infections should be cultured and treated with appropriate antibiotics (to cover gram-positive bacteria).
• Following initial care, examine the wound for any signs of secondary infection or necrosis.
• Patients should be observed for approximately 4 hours for evidence of systemic toxicity.

Consultations

In the rare case of severe swelling of a stung extremity where a possible developing compartment syndrome is a concern, surgical consultation for compartmental pressure testing should be obtained.

MEDICATION

Section 7 of 11  

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• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Analgesics and local anesthetics are used to ameliorate the pain associated with these stings. No antivenoms exist for centipede stings.

Drug Category: Analgesics

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained centipede envenomations.

Drug Category: Immunizations

Tetanus immunization should be instituted following a centipede envenomation.

Drug Category: Anesthetics

Indicated for pain relief. Stabilize the neuronal membrane and prevent initiation and transmission of nerve impulses, thereby producing local anesthetic action.

Drug Category: Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are most commonly used to relieve mild to moderate pain. Although effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam.

Drug Category: Osmotic diuretics

In the setting of documented compartment syndrome, osmotic diuretics such as mannitol may, when combined with elevation of the extremity, obviate the need for fasciotomy if pressures respond rapidly.

FOLLOW-UP

Section 8 of 11  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Further Inpatient Care

• If soft tissue swelling is severe or rhabdomyolysis is evident, the patient should be admitted and observed for development of compartment syndrome and management of myoglobinuria as needed.

Further Outpatient Care

• Observe patients for evidence of infection or necrosis.
• Manage local necrosis by sound conservative wound care.

Deterrence/Prevention

• Never touch or handle centipedes.
• Use caution when gardening, turning soil, or picking up rocks.
• Work gloves are very helpful in preventing stings.

Complications

• Secondary infection
• Wound necrosis (uncommon)
• Rare rhabdomyolysis, myoglobinuria, and acute renal failure
• Possible coronary vasospasm

Prognosis

• Prognosis is excellent in the vast majority of cases.

MISCELLANEOUS

Section 9 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Failure to update the patient's tetanus status when indicated
• Failure to provide appropriate instructions concerning wound management
• Failure to arrange follow-up care in the event of a secondary infection
• Failure to diagnose rhabdomyolysis or compartment syndrome in a victim of severe centipede sting
• Failure to obtain an ECG in the rare patient with chest pain or hemodynamic instability following centipede sting

MULTIMEDIA

Section 10 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  Giant desert centipede. Photo by Michael Cardwell.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

• Balit CR, Harvey MS, Waldock JM, Isbister GK. Prospective study of centipede bites in Australia. J Toxicol Clin Toxicol. 2004;42(1):41-8. [Medline].
• Bush SP, King BO, Norris RL, Stockwell SA. Centipede envenomation. Wilderness Environ Med. 2001;12(2):93-9. [Medline].
• Hare T. Poisonous Dwellers of the Desert. Southwest Parks & Monuments Association;1995:1-32.
• Hasan S, Hassan K. Proteinuria associated with centipede bite. Pediatr Nephrol. Apr 2005;20(4):550-1. [Medline].
• Logan JL, Ogden DA. Rhabdomyolysis and acute renal failure following the bite of the giant desert centipede Scolopendra heros. West J Med. Apr 1985;142(4):549-50. [Medline].
• McFee RB, Caraccio TR, Mofenson HC, McGuigan MA. Envenomation by the Vietnamese centipede in a Long Island pet store. J Toxicol Clin Toxicol. 2002;40(5):573-4. [Medline].
• Ozsarac M, Karcioglu O, Ayrik C, et al. Acute coronary ischemia following centipede envenomation: case report and review of the literature. Wilderness Environ Med. 2004;15(2):109-12. [Medline].
• Peters S. A Colour Atlas of Arthropods in Clinical Medicine. Wolfe Pub Ltd;1992:1-304.
• Yildiz A, Biceroglu S, Yakut N, et al. Acute myocardial infarction in a young man caused by centipede sting. Emerg Med J. Apr 2006;23(4):e30. [Medline].

Article Last Updated: Feb 8, 2007