Giant Centipede Envenomation in Children
Introduction to Giant Centipede Envenomation
Giant centipedes (Scolopendra species) are venomous arthropods capable of delivering painful and potentially dangerous envenomation to children. These creatures are found worldwide in tropical and subtropical regions.
Key Points:
- Centipede venom contains a complex mixture of toxins including serotonin, histamine, lipids, proteinases, and cardiotoxins
- Children are at higher risk for severe reactions due to their smaller body mass and immature immune systems
- Most cases occur during summer months and in areas with warm climates
- Mortality is rare but morbidity can be significant, especially in young children
Epidemiology & Species Distribution
Common Species:
- Scolopendra subspinipes: Most common in Asia-Pacific region, reaching lengths up to 20cm
- Scolopendra heros: Prevalent in North America, particularly in southwestern regions
- Scolopendra gigantea: Found in South America and Caribbean, largest species reaching 30cm
Risk Factors:
- Living in tropical/subtropical regions
- Rural or semi-urban habitation
- Outdoor activities in endemic areas
- Poor housing conditions allowing arthropod entry
- Seasonal variation with peak incidence during warm months
Clinical Manifestations
Immediate Symptoms (0-2 hours):
- Intense local pain (reported as more severe than bee or wasp stings)
- Erythema and edema at bite site
- Local paresthesia and numbness
- Lymphangitis and lymphadenopathy
Early Systemic Symptoms (2-6 hours):
- Anxiety and agitation (particularly common in children)
- Nausea and vomiting
- Headache
- Tachycardia
- Local muscle cramping
Delayed Manifestations (6-24 hours):
- Persistent pain and swelling
- Rhabdomyolysis (rare)
- Compartment syndrome (rare)
- Vasovagal symptoms
Diagnosis & Assessment
Initial Assessment:
- Detailed history including time and location of bite
- Description or identification of centipede if possible
- Assessment of airway, breathing, circulation
- Vital signs with special attention to heart rate and blood pressure
Physical Examination:
- Characteristic paired puncture marks at bite site
- Measurement of extent of swelling and erythema
- Assessment of regional lymph nodes
- Neurovascular examination of affected limb
- Signs of systemic involvement
Laboratory Studies (if indicated):
- Complete blood count
- Basic metabolic panel
- Creatine kinase (if symptoms of rhabdomyolysis present)
- Coagulation profile (in severe cases)
Management Protocol
Immediate Interventions:
- Wound cleansing with antiseptic solution
- Application of cold compresses
- Immobilization of affected limb
- Pain management appropriate for age
Pharmacological Management:
- Analgesics:
- Acetaminophen: 10-15 mg/kg/dose every 4-6 hours
- Ibuprofen: 5-10 mg/kg/dose every 6-8 hours (if no contraindications)
- Consider opioids for severe pain
- Antihistamines:
- Diphenhydramine: 1 mg/kg/dose every 6 hours (max 50mg/dose)
- Cetirizine: 2.5-5mg once daily (age-dependent)
- Local anesthetic infiltration may be necessary
Monitoring Requirements:
- Vital signs every 15 minutes for first hour
- Observation for minimum 4-6 hours after bite
- Serial examination of bite site and affected limb
- Assessment for compartment syndrome
Complications & Special Considerations
Potential Complications:
- Anaphylaxis (rare but life-threatening)
- Secondary bacterial infection
- Compartment syndrome
- Rhabdomyolysis
- Post-traumatic stress disorder (especially in young children)
Risk Factors for Severe Reactions:
- Age < 6 years
- Previous centipede bite history
- Multiple bites
- Underlying allergic conditions
- Immunocompromised status
Prevention & Patient Education
Preventive Measures:
- Proper footwear when outdoors
- Regular inspection of bedding and clothing
- Sealing entry points in buildings
- Avoiding direct handling of centipedes
- Using protective gear during outdoor activities
Patient Education:
- Recognition of centipede species in local area
- First aid measures
- Warning signs requiring immediate medical attention
- Follow-up care instructions
