Lymphangitis From Scolopendra heros Envenomation: The Texas Redheaded Centipede

Delineating the Boundaries of Superficial Lymphangitis: A Retrospective Study of 11 Cases with a Review of Literature

Background

Lymphangitis is an inflammation of lymphatic channels caused by infectious or non-infectious agents, presenting with characteristic linear erythematous streaks draining toward regional lymph nodes.

Objective

To describe the clinical characteristics and etiological factors involved in acute superficial lymphangitis in a retrospective descriptive study. Materials and Methods: Records of patients were analyzed retrospectively who presented with linear erythematous streaks, diagnosed as superficial lymphangitis, in the outpatient department of dermatology during the last 5 years (January 2018-December 2022) in a tertiary care hospital. Patients were evaluated for their demographic profile, detailed history, complete physical examination, and standard blood tests (if necessary).

Results

A total of 11 patients were found, out of which 7 (63%) were males and 4 (37%) were females. The mean/median age of these patients was 30 years (range 9-52 years). The minimum duration of development of lymphangitis was within minutes in the case of a mosquito bite reaction and around 72 hours in the case of trauma or infection induced, with a median interval of 48 hours. The site most commonly involved was the upper extremity in 8 (72%) patients, followed by the trunk in 2 (18%) and the lower extremity in 1 (9%). Arthropod bite reactions (63%) were the most common etiological agent. All patients presented with linear erythematous streaks extending towards draining lymph nodes.

Conclusion

Lymphangitis is often considered to be a bacterial infection and is mostly treated with antibiotics; however, non-bacterial and non-infectious causes should be kept in mind while treating superficial lymphangitis to make judicious use of systemic antibiotics.

Natural toxins and One Health: a review

Background

The One Health concept considers the interconnectivity, interactions and interdependence of humans, animals and the environment. Humans, animals and other organisms are constantly exposed to a wide range of natural toxins present in the environment. Thus, there is growing concern about the potential detrimental effects that natural toxins could pose to achieve One Health. Interestingly, alkaloids, steroids and bioactive peptides obtained from natural toxins could be used for the development of therapeutic agents.

Methodology

Our literature search focused on the following keywords; toxins, One Health, microbial toxins, mycotoxins, phytotoxins, phycotoxins, insect toxins and toxin effects. Google Scholar, Science Direct, PubMed and Web of Science were the search engines used to obtain primary databases. We chose relevant full-text articles and review papers published in English language only. The research was done between July 2022 and January 2023.

Results

Natural toxins are poisonous substances comprising bioactive compounds produced by microorganisms, invertebrates, plants and animals. These compounds possess diverse structures and differ in biological function and toxicity, posing risks to human and animal health through the contamination of the environment, causing disease or death in certain cases. Findings from the articles reviewed revealed that effects of natural toxins on animals and humans gained more attention than the impact of natural toxins on the environment and lower organisms, irrespective of the significant roles that lower organisms play to maintain ecosystem balance. Also, systematic approaches for toxin control in the environment and utilization for beneficial purposes are inadequate in many regions. Remarkably, bioactive compounds present in natural toxins have potential for the development of therapeutic agents. These findings suggest that global, comprehensive and coordinated efforts are required for improved management of natural toxins through an interdisciplinary, One Health approach.

Conclusion

Adopting a One Health approach is critical to addressing the effects of natural toxins on the health of humans, animals and the environment.

Effectiveness of antibiotic prophylaxis in patients with centipede stings: a randomized controlled trial

OBJECTIVE

Centipede stings are a common problem in tropical countries. Current treatment guidelines do not include recommendations for antibiotic prophylaxis to prevent the associated bacterial infection since no previous study has assessed the effectiveness of antibiotic treatment in patients bitten by centipedes. Thus, this study aimed to compare the effectiveness of antibiotic prophylaxis over placebo for the skin infections that occur after a centipede sting.

METHODS

In this randomized, double-blind, multi-center clinical trial conducted in the emergency departments in four hospitals, patients with any history of a centipede sting were prospectively enrolled and divided randomly into two groups. One group received dicloxacillin and the other a placebo. The primary outcome was the incidence of wound infection 3 to 5 days after the centipede sting.

RESULTS

From December 2014 to October 2015, a total of 83 patients were enrolled in the study and were randomized into antibiotic (n=43) and placebo (n=40) groups. Two patients in the antibiotic group developed wound infections, while none showed wound infection in the placebo group (5% vs. 0%). The wound infection rate did not differ significantly between the two groups (P=0.496).

CONCLUSION

Antibiotic prophylaxis may be unnecessary in cases of centipede stings. Proper wound care is an adequate and appropriate treatment for patients with centipede stings. However, the patient should be re-evaluated for detection of secondary bacterial infection.

An unusual two-stage infection following a scolopendra bite

Background:

Scolopendrae represent the best-known genus of centipedes. They are nocturnal general feeders with strong mandibles and venomous fangs which leave visible puncture marks at the bite site. The bite accidents occur during the warm rainy season and mostly take place on the extremities. Following the bite, the most common symptoms are mild: limited localized erythema, pain, swelling, local itching and burning sensation. However, more severe local and systemic sequelae can not be excluded.

Method:

we report the case of a 63-year-old man with fever and a widespread edema of the right hand and forearm, happened as a consequence of a Scolopendra Subspinipes bite. During the weeks following the bite, he developed a severe unusual superinfection via hematogenous dissemination, which required a double surgical debridement and a targeted intravenous antibiotic therapy.

Results:

the complete clinical recovery took over two months.

Conclusions:

Many victims of Scolopendra envenomation do not seek medical attention since most symptoms will resolve spontaneously. The case presented falls within the spectrum of those rare cases which escalate due to bacterial superinfection.