Caterpillar Envenomation

Background
More than 165,000 species of caterpillars in the order Lepidoptera
(phylum Arthropoda, class Insecta) exist. About 150 are of medical importance.
This importance lies in the ability of many species to induce an irritant or toxic
dermatitis in humans and in the ability of some species to sting. Caterpillars are
the larval forms of moths and butterflies. After hatching from their eggs,
caterpillars pass through 4-5 instars (stages between molts) before they pupate in a
cocoon. The adult moth or butterfly emerges from the cocoon to reproduce the
next generation. More than 50 species in the United States alone are capable of
inflicting a painful sting. Seasonal epidemics of dermatitis can occur when
caterpillars are numerous.
The most dangerous caterpillar in the United States is the puss caterpillar
or asp (Megalopyge opercularis; shown in the image below), the larval form of
the flannel moth. It is found throughout the Southeast, from Maryland to Mexico.
Stings from this species are common from June through September.

Caterpillar envenomations. Puss caterpillar or asp. Photo courtesy of the Arizona

Poison and Drug Information Center.

Pathophysiology
Human disease from caterpillars or moths usually arises from direct
contact, exposure to substances or animals that have been infested with
caterpillars or their webs, or contact with airborne caterpillar debris.
Diaz classifies the diseases caused by caterpillars into 5 groups: erucism,
lepidopterism, dendrolimiasis, ophthalmia nodosa, and consumptive coagulopathy
with secondary fibrinolysis.
Erucism (caterpillar dermatitis) is characterized by a localized, pruritic,
maculopapular contact dermatitis and urticaria, and follows contact with toxic
hairs, spines, or hemolymph, either directly or following aerosolization.
Lepidopterism is a systemic illness that occurs following such contact, and it is
typified by diffuse urticaria, upper airway inflammation, nausea, vomiting,
headache, and bronchospasm.
Dendrolimiasis is a more chronic illness that follows contact with the
Asian Dendorlimus pini caterpillar. Patients with this disorder demonstrate a
pruritic maculopapular rash and migratory polyarthritis/polychondritis, which can
progress to chronic osteoarthritis. Occasionally, acute scleritis occurs as well.
Ophthalmia

nodosa

presents

with

acute

conjunctivitis,

progressing

to

panophthalmitis, following penetration of the cornea by urticating hairs.

Consumptive coagulopathy with secondary fibrinolysis occurs most commonly
following stings by the South American Lonomia caterpillar whose venom
activates factor X and prothrombin. Patients can demonstrate bleeding from
almost any anatomic site and may develop acute (and possibly chronic) renal
failure.
Caterpillar venoms are produced by glandular cells in the epithelium and
are stored in and injected by urticating hairs and spines (setae). Some species
produce toxic hemolymph, which can cause human disease.
In some patients, immunoglobulin E (IgE) antibodies are produced following
contact, resulting in a hypersensitive state and the production of generalized
urticaria on subsequent re-contact. A few caterpillars lacking urticating hairs are
capable of inducing a contact dermatitis (type IV hypersensitivity).

Some caterpillars and moths release their toxic hairs into the environment,
where the hairs can be inhaled. Pets or contaminated objects also can carry
venomous hairs. In any of these situations, contact with the hairs can cause rhinitis
or respiratory disease. Seasonal epidemics of respiratory disease have occurred in
Latin America because of this phenomenon. The pathologic response leading to
erucism or lepidopterism consists of acute inflammation and cellular infiltration
around hairs that have penetrated the skin or conjunctiva or have been inhaled into
the respiratory tract.
In the skin, diffuse vascular dilatation occurs, with subsequent edema
formation in the superficial dermis and ballooning of keratinocytes within the
epidermis that can lead to vesiculation. In the eye, hairs have a remarkable
penetrating capacity and may work their way into the cornea, anterior chamber, or
lens, where an intense inflammatory response occurs secondary to the nature of
the foreign material and direct toxic effects.
Caterpillar venom-filled spines, found only in the larval forms (adult
moths and butterflies do not sting), are hollow structures with a single basal
poison cell that produces toxin. When pressed into the skin, the tip of the spine
fractures, and the venom is injected under pressure. Toxicity declines significantly
after the creature's death, but irritant or toxic hairs may retain the ability to cause
dermatitis for years. Likewise, the toxic hemolymph of some caterpillars retains
its potency for prolonged periods after the animal's death.
Caterpillar venoms are poorly studied but may contain peptides,
hyaluronidase, phospholipase A, and biogenic amines such as histamine or
histamine-releasing substances. Some, such as the South American Lonomia
species, contain fibrinolytic proteases and coagulation activators that can
stimulate a consumptive coagulopathy and renal failure in victims.

Epidemiology
United States. Although no accurate information is available, epidemics
of erucism and lepidopterism have been reported. These include school closings,
outbreaks of dermatitis and rhinitis in the thousands, and symptoms in more than
500,000 people caused by airborne caterpillar hair dispersion.

International. No accurate information is available, though it appears that

the incidence of human disease is increasing.

Mortality/Morbidity
Occasional case reports of death from erucism exist, but death is very rare
following stings by most species. Death may be secondary to a hypersensitivity
reaction or bleeding diathesis in cases involving caterpillars of the Saturniidae
family. In this family, South American Lonomia caterpillars have a high fatality
rate (approximately 1.7%) due to the toxicity of their venoms and the fact that
many exposures lead to multiple stings due to the communal nature of these
species. No deaths have been reported following M opercularis stings.
Reported

complications

include

panophthalmitis,

consumptive

coagulopathy, intracranial hemorrhage, renal failure, and osteochondritis.

Age
Children, being prone to want to play with caterpillars, may be at
increased risk of exposure.

Sumber : http://emedicine.medscape.com/article/772949-overview#a6

Alergi yang disebabkan Kupu-Kupu

Kupu-kupu adalah serangga yang termasuk ordo Lepidoptera yang
memepunyai s2 pasang sayap dan bersisik tebal. Stadium dewasa mempunyai
bentuk mulut untuk menghisap (shoponing), sedangkan stadium larva mempunyai
bentuk mulut untuk menggigit. Kupu-kupu mengalami metamorphosis lengkap
dan dibagi dalam 2 golongan yaitu kupu-kupu siang (butterfly) dan kupu-kupu
malam ( month).

1. Patologi dan gejala klinis

Larva kupu-kupu yang biasa disebut ulat bulu mempunyai bulu yang
mengandung toksin yang dapat menyebabkan kelainan pada manusia. Kelainan ini
disebut erusisme. Gejala-gejala erusisme atau dermatitis ulat (caterpillar
dermatitis) adalah urikaria, nyeri, gatal dan rasa panas. Hal ini disebabkan oleh
toksin yang merusak sel-sel tubuh sehingga tubuh mengelurkan histamine,
serotonin dan heparin sebagai reaksi terhadap toksin larva kupu-kupu. Jika bulu
ulat mengenai mata dapat terjadi konjungtivitis atau ulkus kornea. Kupu-kupu
dewasa dapat juga menyebabkan kelainan bila manusia kontak dengan bulu yang
terdapat dibagian ventral abdomennya. Kelainan karena kupu-kupu dewasa
disebut lepidopterisme. Gejala klinis lepidopterisme berupa dermatitis yang mirip
giant urrticaria oleh cacing schistosoma.
Beberapa spesies kupu-kupu yang larvanya mengandung bulu beracun
adalah : Megalopyge opercularis (di Amerika), Anaphe infracta (di Eropa), dan
parasa hilarata (di Asia). Contoh kupu-kupu penyebab lepidopterisme adalah
heylesia spp.

2. Diagnosis
Diagnosis detetapkan bila terdapat gejala klinis diserati riwayat kontak dengan
ulat bulu atau kupu-kupu.

3. Pengobatan
Lesi yang timbul jangan digaruk karena dapat mempercepat penyebaran
toksin. Seluruh tubuh yang mengalami reaksi segera direndam dalam air untuk
melarutkan toksin dan bulu-bulu larva yang melekat pada kulit. Untuk pengobatan
local dapat menggunakan larutan yodium, kortikosteroid dan atihistamin topical,
sedangkan untuk penderita pada keadaan berat, obat-obat tersebut dapat diberikan
secara oral atau parenteral.

4. Epidemiologi
Terdapatnya kasus erusisme dan lepidopterisme disuatu daerah dipengaruhi
oleh spesies kupu-kupu, keadaan daerah dan kebiasaan rakyat sebagai petani atau
pekerja kebun. Pencegahan dapat dilakukan dengan menghindari kontak langsung
dengan ulat bulu atau kupu-kupu. Pemberantasan kupu-kupu dilakukan dengan
insektisida terutama utuk stadium larvanya.

Sumber : Parasitologi Kedokteran UI

TUGAS PEN
NDAHULUAN PRAKTIKUM PARASI
SIT

ERUSISME :
KELA
AINAN AKIBAT TOKSIN
LA
LARVA
KUPU-KUPU

Oleh :
Desi Suryani Dewi
132010101102

UNIVERSITAS JEMBER
F
FAKULTAS
KEDOKTERAN
2015