Animal & Insect Bites: Toxicology Reference Guide

Snakes (Ophidia)

Cobra (Naja species)

Main Toxins: α-neurotoxins, cardiotoxins, phospholipase A2

- Neuromuscular paralysis (descending) - Ptosis and ophthalmplegia - Respiratory failure - Local tissue necrosis - Cardiovascular collapse in severe cases

Time to symptoms: Minutes to hours

Treatment: Species-specific antivenom, respiratory support

Eastern Diamondback Rattlesnake (Crotalus adamanteus)

Main Toxins: Hemorrhagins, myotoxins, neurotoxins

- Severe local pain and edema - Ecchymosis and tissue necrosis - Coagulopathy (DIC) - Hypotension - Rhabdomyolysis

Time to symptoms: Immediate to 6 hours

Treatment: CroFab antivenom, supportive care

Black Mamba (Dendroaspis polylepis)

Main Toxins: Dendrotoxins, cardiotoxins

- Rapid neurotoxicity - Fasciculations - Respiratory paralysis - Tachycardia followed by bradycardia - Shock

Time to symptoms: 15-30 minutes

Treatment: Polyvalent antivenom, mechanical ventilation

Spiders (Arachnida)

Black Widow Spider (Latrodectus species)

Main Toxins: α-Latrotoxin

- Severe muscle cramping - Diaphoresis - Hypertension - Tachycardia - "Facies latrodectismica"

Time to symptoms: 30-60 minutes

Treatment: Antivenin (Latrodectus mactans), benzodiazepines

Brown Recluse Spider (Loxosceles reclusa)

Main Toxins: Sphingomyelinase D

- Painless initial bite - Developing necrotic lesion - "Red, white, and blue sign" - Hemolysis - Rarely systemic loxoscelism

Time to symptoms: 2-8 hours for pain, 3-4 days for necrosis

Treatment: Supportive, debridement if necessary

Brazilian Wandering Spider (Phoneutria species)

Main Toxins: PhTx3 neurotoxins

- Severe local pain - Autonomic storm - Priapism in males - Cardiac abnormalities - Respiratory distress

Time to symptoms: Minutes

Treatment: Antivenom if severe, pain management

Scorpions

Deathstalker Scorpion (Leiurus quinquestriatus)

Main Toxins: α-toxins, chlorotoxin

- Severe local pain - Autonomic storm - Cardiovascular toxicity - Neuromuscular agitation - Pancreatitis in children

Time to symptoms: Minutes

Treatment: Antivenom, supportive care

Arizona Bark Scorpion (Centruroides sculpturatus)

Main Toxins: Neurotoxic peptides

- "Washing machine" syndrome - Cranial nerve dysfunction - Respiratory distress - Somatic skeletal neuromuscular dysfunction - Unusual eye movements

Time to symptoms: 10-60 minutes

Treatment: Anascorp antivenom, supportive care

Indian Red Scorpion (Hottentotta tamulus)

Main Toxins: Tamulustoxin

- Autonomic storm - Pulmonary edema - Myocardial dysfunction - Priapism - Cold extremities

Time to symptoms: 30-60 minutes

Treatment: Prazosin, supportive care

Marine Animals

Blue-ringed Octopus (Hapalochlaena species)

Main Toxins: Tetrodotoxin

- Rapid respiratory failure - Paralysis with consciousness - Hypersalivation - Hypotension - Minimal local symptoms

Time to symptoms: Minutes

Treatment: Respiratory support, no antivenom available

Box Jellyfish (Chironex fleckeri)

Main Toxins: Chirotoxin, CfTX-1,2

- Immediate severe pain - Tentacle print marks - Cardiovascular collapse - Respiratory failure - Cutaneous necrosis

Time to symptoms: Seconds to minutes

Treatment: Vinegar application, antivenom, life support

Stonefish (Synanceia species)

Main Toxins: Verrucotoxin, stonustoxin

- Excruciating local pain - Edema and cyanosis - Cardiac arrhythmias - Paralysis - Shock

Time to symptoms: Immediate

Treatment: Hot water immersion, antivenom if severe

Hymenoptera (Bees, Wasps, Ants)

Giant Asian Hornet (Vespa mandarinia)

Main Toxins: Mandaratoxin, mastoparan

- Severe local pain - Tissue necrosis - Rhabdomyolysis - Multiple organ failure - Anaphylaxis in sensitive individuals

Time to symptoms: Minutes to hours

Treatment: Supportive care, epinephrine if anaphylaxis

Fire Ants (Solenopsis invicta)

Main Toxins: Solenopsins, piperidine alkaloids

- Sterile pustules - Intense burning pain - Pruritus - Anaphylaxis in sensitive individuals - Secondary infections

Time to symptoms: Minutes

Treatment: Topical steroids, oral antihistamines

European Honey Bee (Apis mellifera)

Main Toxins: Melittin, apamin, phospholipase A2

- Local pain and swelling - Multiple stings: hemolysis - Rhabdomyolysis - Anaphylaxis - Delayed hypersensitivity

Time to symptoms: Immediate to 48 hours

Treatment: Stinger removal, epinephrine if anaphylaxis

Amphibians

Golden Poison Frog (Phyllobates terribilis)

Main Toxins: Batrachotoxin

- Severe pain - Cardiac arrhythmias - Muscle paralysis - Respiratory failure - Death if untreated

Time to symptoms: Minutes

Treatment: Supportive care, no antidote available

Fire-bellied Toad (Bombina species)

Main Toxins: Bombesin, bombinin

- Mucosal irritation - GI disturbance - Hypotension - Bradycardia - Local irritation

Time to symptoms: 15-30 minutes

Treatment: Supportive care, decontamination

Venomous Lizards

Gila Monster (Heloderma suspectum)

Main Toxins: Helodermatine, gilatoxin

- Excruciating local pain - Rapid edema - Hypotension - Nausea and vomiting - ECG changes

Time to symptoms: Minutes

Treatment: Pain management, supportive care

Note: Pediatric cases may require airway monitoring due to facial swelling

Mexican Beaded Lizard (Heloderma horridum)

Main Toxins: Horridum toxin, phospholipase A

- Severe local pain - Tachycardia - Hypotension - Diaphoresis - Angioedema

Time to symptoms: 5-15 minutes

Treatment: Wound care, cardiovascular support

Additional Venomous Snakes

Inland Taipan (Oxyuranus microlepidotus)

Main Toxins: Taipoxin, paradoxin

- Rapid neurotoxicity - Coagulopathy - Rhabdomyolysis - Acute kidney injury - Cardiac arrest

Time to symptoms: 30 minutes

Treatment: Urgent antivenom administration

Pediatric consideration: Faster progression to systemic symptoms

King Cobra (Ophiophagus hannah)

Main Toxins: Hannalgesin, phospholipase A2

- Progressive paralysis - Cardiovascular collapse - Ptosis - Respiratory failure - Coagulopathy

Time to symptoms: 15-30 minutes

Treatment: Species-specific antivenom, ventilatory support

Fer-de-lance (Bothrops asper)

Main Toxins: Hemorrhagins, myotoxins

- Severe local necrosis - Compartment syndrome - Acute kidney injury - DIC - Shock

Time to symptoms: Immediate to 6 hours

Treatment: Polyvalent antivenom, surgical debridement if needed

Freshwater Dangerous Animals

Electric Eel (Electrophorus electricus)

Main Effect: Electric discharge up to 860V

- Muscle paralysis - Respiratory arrest - Cardiac arrhythmias - Burns - Secondary drowning risk

Time to symptoms: Immediate

Treatment: Cardiac monitoring, supportive care

Freshwater Stingray (Potamotrygon species)

Main Toxins: Serotonin, phosphodiesterase

- Severe local pain - Tissue necrosis - Vasovagal response - Secondary infection - Muscle cramps

Time to symptoms: Immediate pain

Treatment: Hot water immersion, wound care

Additional Arthropods

Saddleback Caterpillar (Acharia stimulea)

Main Toxins: Histamine-releasing substances

- Intense burning pain - Radiating pain - Urticarial rash - Anxiety - Regional lymphadenopathy

Time to symptoms: Immediate

Treatment: Tape stripping, topical steroids

Assassin Bug (Triatominae species)

Main Toxins: Salivary toxins

- Local inflammation - Chagas disease risk - Anaphylaxis in sensitive individuals - Romaña's sign - Cardiac complications

Time to symptoms: Hours to days

Treatment: Antiparasitic therapy if infected

Giant Centipede (Scolopendra species)

Main Toxins: Serotonin, histamine, cardiotoxins

- Intense local pain - Erythema and edema - Lymphangitis - Tachycardia - Anxiety

Time to symptoms: Immediate

Treatment: Pain management, supportive care

Cnidarians (Jellyfish and Relatives)

Portuguese Man-of-War (Physalia physalis)

Main Toxins: Physalitoxin

- Linear whip-like lesions - Severe pain - Anaphylaxis - Muscle cramps - Cardiac arrhythmias

Time to symptoms: Immediate

Treatment: Vinegar application, hot water immersion

Sea Anemone (Actinia species)

Main Toxins: Actinoporins

- Local burning sensation - Erythema - Vesiculation - Systemic symptoms rare - Cross-reactivity with other cnidarians

Time to symptoms: Minutes

Treatment: Topical treatment, antihistamines

Additional Snakes (Regional Variants)

Saw-scaled Viper (Echis carinatus)

Main Toxins: Ecarin, hemorrhagins

- Severe coagulopathy - Gingival bleeding - Acute kidney injury - Cerebral hemorrhage - Local necrosis

Time to symptoms: 1-3 hours

Treatment: Anti-snake venom, blood products

Pediatric note: Higher risk of severe coagulopathy

Common Krait (Bungarus caeruleus)

Main Toxins: β-bungarotoxin, κ-bungarotoxin

- Minimal local signs - Descending paralysis - Abdominal pain - Respiratory failure - Autonomic dysfunction

Time to symptoms: 30 minutes to 4 hours

Treatment: Neostigmine trial, ventilatory support

Puff Adder (Bitis arietans)

Main Toxins: Cytotoxins, procoagulants

- Massive local swelling - Compartment syndrome - Bleeding diathesis - Shock - Tissue necrosis

Time to symptoms: Immediate to 24 hours

Treatment: Antivenom, fasciotomy if needed

Cone Snails & Mollusks

Geography Cone (Conus geographus)

Main Toxins: ω-conotoxin, μ-conotoxin

- Minimal local pain - Perioral numbness - Vision changes - Respiratory paralysis - "Silent" death risk

Time to symptoms: Minutes to hours

Treatment: Immediate respiratory support

Blue-ringed Octopus (Hapalochlaena maculosa)

Main Toxins: Tetrodotoxin, maculotoxin

- Painless bite - Rapid paralysis - Respiratory failure - Preserved consciousness - Fixed dilated pupils

Time to symptoms: 5-10 minutes

Treatment: Prolonged ventilatory support

Unusual Arthropod Envenomations

Bullet Ant (Paraponera clavata)

Main Toxins: Poneratoxin

- Excruciating pain (Schmidt pain index 4+) - Tremors - Local edema - Tachycardia - Neural inflammation

Time to symptoms: Immediate

Treatment: Regional nerve blocks, NSAIDs

Japanese Giant Hornet (Vespa mandarinia japonica)

Main Toxins: VEGF, mastoparan

- Severe pain - Tissue destruction - Multiple organ failure - Anaphylaxis risk - Acute kidney injury

Time to symptoms: Minutes

Treatment: Early airway assessment, support

Harvester Ant (Pogonomyrmex species)

Main Toxins: Alkaloids, proteins

- Intense local pain - Pustule formation - Lymphadenopathy - Anaphylaxis in sensitized - Serum sickness

Time to symptoms: Immediate to 24 hours

Treatment: Antihistamines, steroids if severe

Venomous Fish

Lionfish (Pterois species)

Main Toxins: Neurotoxic peptides

- Intense radiating pain - Paresthesias - Headache - Hypotension - Paralysis (rare)

Time to symptoms: Immediate

Treatment: Hot water immersion (45°C)

Weeverfish (Trachinus species)

Main Toxins: Dracotoxin

- Severe local pain - Edema - Syncope - Arrhythmias - Local cyanosis

Time to symptoms: Seconds to minutes

Treatment: Hot water immersion, local anesthesia

Scorpionfish (Scorpaena species)

Main Toxins: Hyaluronidase, tryptophan

- Immediate intense pain - Edema - Weakness - Cardiovascular effects - Respiratory distress

Time to symptoms: Immediate

Treatment: Hot water immersion, pain control

Unusual Marine Envenomations

Crown-of-Thorns Starfish (Acanthaster planci)

Main Toxins: Plancitoxin

- Severe pain - Hemorrhagic lesions - Regional edema - Nausea/vomiting - Paresthesias

Time to symptoms: Minutes

Treatment: Spine removal, hot water immersion

Sea Urchin (Diadema species)

Main Toxins: Pedixins

- Immediate sharp pain - Spine retention - Granuloma formation - Joint inflammation - Secondary infection

Time to symptoms: Immediate to weeks

Treatment: Early spine removal, antibiotics if infected

Medically Important Caterpillars

Puss Caterpillar (Megalopyge opercularis)

Main Toxins: Multiple urticating proteins

- Immediate intense pain - Grid-like hemorrhagic pattern - Radiating pain - Anxiety/distress - Anaphylaxis (rare)

Time to symptoms: Seconds

Treatment: Tape removal of spines, oral steroids

Pediatric: Higher risk of systemic symptoms

Pine Processionary (Thaumetopoea pityocampa)

Main Toxins: Thaumetopoein

- Severe urticaria - Ophthalmia nodosa - Respiratory distress - Contact dermatitis - Tongue swelling

Time to symptoms: Minutes

Treatment: Decontamination, systemic antihistamines

Stinging Rose Caterpillar (Parasa indetermina)

Main Toxins: Histamine-releasing substances

- Burning pain - Linear lesions - Local edema - Vesicle formation - Regional lymphadenopathy

Time to symptoms: Immediate

Treatment: Cold compresses, topical steroids

Unusual Venomous Mammals

Platypus (Ornithorhynchus anatinus)

Main Toxins: Defensin-like peptides

- Severe local pain - Hyperalgesia - Edema - Pain refractory to morphine - Muscle wasting

Time to symptoms: Minutes

Treatment: Nerve blocks, supportive care

Slow Loris (Nycticebus species)

Main Toxins: Peptide similar to Fel d 1

- Anaphylaxis - Local edema - Respiratory distress - Cardiovascular effects - Delayed healing

Time to symptoms: Minutes to hours

Treatment: Anaphylaxis protocol if needed

Additional Marine Toxins

Sea Wasp (Chironex yamaguchii)

Main Toxins: CyTx-1, CyTx-2

- Immediate severe pain - Cardiac arrest risk - Dermonecrosis - Pulmonary edema - Irukandji-like syndrome

Time to symptoms: Seconds

Treatment: Vinegar, antivenom, life support

Fire Coral (Millepora species)

Main Toxins: Milleporin

- Burning pain - Urticarial rash - Vesiculation - Systemic symptoms - Post-inflammatory hyperpigmentation

Time to symptoms: Immediate

Treatment: Acetic acid, topical steroids

Bobbit Worm (Eunice aphroditois)

Main Toxins: Neurotoxic compounds

- Sharp pain - Numbness - Local tissue damage - Secondary infection - Chronic ulceration

Time to symptoms: Minutes

Treatment: Wound care, antibiotics if infected

Regional Snake Variants

Eastern Brown Snake (Pseudonaja textilis)

Main Toxins: Textilotoxin, prothrombinase

- Minimal local symptoms - Rapid collapse - Coagulopathy - Renal failure - Microangiopathy

Time to symptoms: 15 minutes to 2 hours

Treatment: Brown snake antivenom, coagulation support

Green Pit Viper (Trimeresurus albolabris)

Main Toxins: Hemorrhagins, procoagulants

- Local swelling - Ecchymosis - Compartment syndrome - Coagulopathy - Thrombocytopenia

Time to symptoms: 30 minutes to 6 hours

Treatment: Green pit viper antivenom, monitoring

Common Death Adder (Acanthophis antarcticus)

Main Toxins: Acanthoxin, neurotoxic PLA2

- Minimal local signs - Progressive paralysis - Ptosis - Respiratory failure - Autonomic effects

Time to symptoms: 30 minutes to 3 hours

Treatment: Death adder antivenom, ventilation

Venomous Insects

Tarantula Hawk Wasp (Pepsis species)

Main Toxins: Complex peptide mixture

- Immediate intense pain - Short duration - Local swelling - Temporary paralysis - Autonomic symptoms

Time to symptoms: Seconds

Treatment: Local pain management

Red Velvet Ant (Dasymutilla occidentalis)

Main Toxins: Complex venom mixture

- Severe local pain - Erythema - Regional lymphadenopathy - Referred pain - Emotional distress

Time to symptoms: Immediate

Treatment: Ice packs, analgesics