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CENTIPEDES

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) This management deals specifically with centipedes. Centipedes are phylum Arthropoda, class Chilopoda. There are four orders in the centipedes, Scutigeromorpha, Lithobiomorpha, Geophiulomorpha, and Scolopendromorpha (the effectively most venomous centipedes). Bites or stings of other insects or arthropods may appear similarly. Other related documents include:
    1) HYMENOPTERA STINGS
    2) LATRODECTUS ANTIVENIN
    3) LEPIDOPTERISM
    4) PAEDERUS BLISTER BEETLES
    5) SCORPIONS
    6) SPIDERS
    7) SPIDER-BROWN OR VIOLIN
    8) SPIDER-FUNNEL WEB
    9) SPIDER-TEGENARIA AGRESTIS
    10) SPIDER- WIDOW OR HOURGLASS
    11) TICKS
    12) TRIATOMA SPECIES

Specific Substances

    1) Chilopoda
    2) Cryptops iheringi
    3) Ethmostigus spinosus
    4) Feather centipedes (Scutigeropmorpha)
    5) Garden centipedes (Lithiobiomorpha)
    6) Geophilomorpha (soil centipedes)
    7) Giant centipedes (Scolopendromorpha)
    8) House centipedes (Scutigeropmorpha)
    9) Lithiobiomorpha (rock or garden centipedes)
    10) Lithobius forficatus
    11) Lithobius mordox
    12) Otocryptops ferrugineus
    13) Otocryptops stigums scabricauda
    14) Rhysida species
    15) Rock centipedes (Lithiobiomorpha)
    16) Scolopendra cingulata
    17) Scolopendra heros
    18) Scolopendra morsitans
    19) Scolopendra polymorpha
    20) Scolopendra subspinipes
    21) Scolopendra sumichrasti
    22) Scolopendra viridicornis
    23) Scolopendromorpha (tropical or giant centipedes)
    24) Scutigeropmorpha (house or feather centipedes)
    25) Scutigera forceps
    26) Scutigera morpha
    27) Soil centipedes (Geophilomorpha)
    28) Theatops spinicaudus
    29) Tropical centipedes (Scolopendromorpha)
    30) Tropical centipedes (Scolopendromorpha)
    31) Vietnamese centipede (common name for Scolopendra subspinipes)

Available Forms Sources

    A) SOURCES
    1) CHINESE TRADITION: As a means to promote health, creatures may be soaked in alcohol. A case was reported of a man who made wine from soaking a 14 cm centipede (Scolopendra subspinipes mutilans) in 53% alcohol. No clinical effects could be directly attributed to centipede exposure (Wang et al, 2004).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) SOURCES: Centipedes are multisegmented arthropods in the class Chilopoda. They are recognized by their long, dorsoventrally flattened body composed of 15 to 181 somites (each of which has a pair of legs), a head bearing a pair of multi-jointed antennae, and three pairs of mouth parts. The number of segments always odd and each segment, with the exception of the last one, has one pair of legs. Centipedes have been reported to reach sizes up to 23 cm. The venom fangs are in the first segment. Scolopendromorpha species are known as tropical or giant centipedes and are the most clinically relevant class. Scutigeropmorpha species are commonly known as house or feather centipedes, Geophilomorpha are known as soil centipedes, and the Lithiobiomorpha are known as rock or garden centipedes.
    B) TOXICOLOGY: Centipede species in tropical and subtropical regions have potent venoms and an effective delivery mechanism and may cause severe local symptoms. Centipede bites in temperate climates typically result in little more than mild local irritation. Centipede venoms have not be well characterized. They contain some enzymes and nonenzymatic proteins, probably small peptides. There is also a potentially cardiotoxic protein called toxin S. Non-protein substances in the venom include 5-hydroxytryptamine, histamine, lipids, and various polysaccharides. Anticoagulant and coagulant components have also been isolated.
    C) EPIDEMIOLOGY: Centipedes have a wide geographic range from tropical regions to the Arctic Circle. Bites are common, though systemic symptoms are rare. Clinically significant bites are almost entirely limited to tropical and subtropical regions.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Bitten patients may experience local burning pain, erythema, vesiculation, itching, and swelling. Nausea and vomiting are rarely associated with centipede bites. Lymphangitis and lymphadenopathy have rarely been reported.
    2) SEVERE TOXICITY: Pain can be severe in patients bitten by tropical or subtropical species. This pain remains local to the bite site. Local swelling and erythema is common. Allergic reactions to the venom, including anaphylactic reactions, have been described. Nausea and vomiting develop rarely. Single cases of rhabdomyolysis and renal failure, and acute coronary syndrome have been reported. Irregular pulse and acute myocardial infarction have been noted after centipede envenomation. A child developed transient lethargy and decrease tone after ingesting a centipede. Death has not been reported in the United States, though rare fatalities have occurred in some tropical countries.

Laboratory Monitoring

    A) No laboratory evaluation is necessary in the vast majority of centipede envenomated patients.

Treatment Overview

    0.4.7) BITES/STINGS
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Application of ice, heat, or intramuscular analgesics are equally efficacious at relieving local symptoms. Anecdotally, injection of 2 to 3 mL of 0.25 to 0.5% bupivacaine at the bite site is reported to be curative and is widely recommended by healthcare providers in these areas. Topical corticosteroids or antihistamines may be of value for persistent irritation or pruritus. Consider tetanus prophylaxis. Ingestion of centipedes is unusual and treatment is empirical.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) In patients with acute allergic reaction, oxygen therapy, bronchodilators, diphenhydramine, corticosteroids, vasopressors and epinephrine may be required. The bite site should be injected with 2 to 3 mL of 0.25 to 0.5% bupivacaine and oral opioid analgesics can be added for persistent pain. Parenteral analgesics should be considered second line after local anesthetic injection. Consider tetanus prophylaxis. Antibiotic treatment is not indicated for local irritation unless the patient presents several days after the bite with evidence of cellulitis.
    C) DECONTAMINATION
    1) PREHOSPITAL: The responsible arthropod should be removed from the patient and crushed to avoid envenomation of EMS providers or co-habitating individuals. Ice packs or heat can be applied to the bite site in an attempt to minimize pain.
    2) HOSPITAL: The responsible arthropod should be removed from the patient and crushed to avoid envenomation of hospital staff.
    D) AIRWAY MANAGEMENT
    1) Patients with angioedema of the airway or significant pulmonary wheezing unresponsive to epinephrine therapy should have early airway management, but these complications are extremely unusual.
    E) ENHANCED ELIMINATION
    1) There is no role for extracorporeal elimination.
    F) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients that are asymptomatic or with only mild local pain can be managed at home.
    2) OBSERVATION CRITERIA: Patients with allergic reactions should be observed for minimum of 4 hours. Patients requiring epinephrine for anaphylactic reactions should be observed for 12 to 24 hours post epinephrine dosing.
    3) ADMISSION CRITERIA: Only patients with systemic toxicity, manifested as anaphylactic reactions, may require admission.
    4) CONSULT CRITERIA: The local poison center may be consulted.
    G) PITFALLS
    1) Using systemic analgesics rather than local infiltration of anesthetics can lead to respiratory depression or other side effects. Failure to evaluate patients for allergic symptoms may lead to delayed diagnosis of anaphylaxis. Using antibiotics for local irritation symptoms may lead to adverse reactions.
    H) TOXICOKINETICS
    1) In the majority of patients, the symptoms resolve within 24 hours.
    I) DIFFERENTIAL DIAGNOSIS
    1) Stings or bites from other arthropods should be considered. Bee or wasp stings may yield similar local or allergic symptoms. Scorpion stings may lead to similar local symptoms, though the neurologic manifestations associated with scorpion envenomation do not occur in centipede envenomation. Black widow spider envenomation may lead to similar local symptoms, though centipede bites are not associated with the systemic muscle contraction associated with moderate to severe black widow envenomation. Brown recluse spiders bites are not typically associated with severe local pain and may cause more necrosis at the envenomation site when compared with centipede bites.

Range Of Toxicity

    A) A single bite may cause severe local pain and swelling.

Clinical Effects

Summary Of Exposure

    A) SOURCES: Centipedes are multisegmented arthropods in the class Chilopoda. They are recognized by their long, dorsoventrally flattened body composed of 15 to 181 somites (each of which has a pair of legs), a head bearing a pair of multi-jointed antennae, and three pairs of mouth parts. The number of segments always odd and each segment, with the exception of the last one, has one pair of legs. Centipedes have been reported to reach sizes up to 23 cm. The venom fangs are in the first segment. Scolopendromorpha species are known as tropical or giant centipedes and are the most clinically relevant class. Scutigeropmorpha species are commonly known as house or feather centipedes, Geophilomorpha are known as soil centipedes, and the Lithiobiomorpha are known as rock or garden centipedes.
    B) TOXICOLOGY: Centipede species in tropical and subtropical regions have potent venoms and an effective delivery mechanism and may cause severe local symptoms. Centipede bites in temperate climates typically result in little more than mild local irritation. Centipede venoms have not be well characterized. They contain some enzymes and nonenzymatic proteins, probably small peptides. There is also a potentially cardiotoxic protein called toxin S. Non-protein substances in the venom include 5-hydroxytryptamine, histamine, lipids, and various polysaccharides. Anticoagulant and coagulant components have also been isolated.
    C) EPIDEMIOLOGY: Centipedes have a wide geographic range from tropical regions to the Arctic Circle. Bites are common, though systemic symptoms are rare. Clinically significant bites are almost entirely limited to tropical and subtropical regions.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Bitten patients may experience local burning pain, erythema, vesiculation, itching, and swelling. Nausea and vomiting are rarely associated with centipede bites. Lymphangitis and lymphadenopathy have rarely been reported.
    2) SEVERE TOXICITY: Pain can be severe in patients bitten by tropical or subtropical species. This pain remains local to the bite site. Local swelling and erythema is common. Allergic reactions to the venom, including anaphylactic reactions, have been described. Nausea and vomiting develop rarely. Single cases of rhabdomyolysis and renal failure, and acute coronary syndrome have been reported. Irregular pulse and acute myocardial infarction have been noted after centipede envenomation. A child developed transient lethargy and decrease tone after ingesting a centipede. Death has not been reported in the United States, though rare fatalities have occurred in some tropical countries.

Vital Signs

    3.3.3) TEMPERATURE
    A) WITH POISONING/EXPOSURE
    1) FEVER
    a) Fever may be seen after the bite of Scolopendra morsitans (Jourdain, 1900).
    b) Fever (38.4 degrees C) was reported in a 33-year-old man following envenomation from Scolopendra subspinipes (Veraldi et al, 2010).

Heent

    3.4.2) HEAD
    A) WITH POISONING/EXPOSURE
    1) PERICORONITIS: An adult with considerable tooth pain and no visible decay had an extract. Under the crown was found a Lithobius forficatus centipede (Gelbier & Kopkin, 1972).

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) CONDUCTION DISORDER OF THE HEART
    1) WITH POISONING/EXPOSURE
    a) Irregular pulse has been noted after centipede envenomation (Jangi, 1984).
    B) ACUTE MYOCARDIAL INFARCTION
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: A 20-year-old man experienced severe left arm pain, diaphoresis, nausea, and vomiting after having been bitten on his right leg by a centipede. On presentation to the ED 24 hours later, he developed severe chest pain. An ECG showed sinus rhythm with sequential ST segment elevation, indicating an acute myocardial infarction. Laboratory data revealed elevated creatine kinase (CK) and CK-MB levels and a positive (>1 ng/mL) troponin-T. With supportive care, the patient recovered without sequelae (Yildiz et al, 2006).
    b) CASE REPORT: A 31-year-old man presented to the emergency department (ED) with a swollen and painful right foot 1 hour following a bite from a centipede. The patient also exhibited a rash that was localized to the bite site. Shortly after arrival to the ED, the patient experienced chest pain radiating down his left arm, followed by a cardiac arrest during his ECG. Following successful resuscitation, the patient was transferred to the intensive coronary care unit with continued angina. The ECG revealed sinus rhythm with ST segment elevation in leads DI, DIII, aVF, VF, V6, and aVL, and ST segment depression in leads V1-V3, leading to a diagnosis of infero-posterolateral myocardial infarction. An echocardiogram demonstrated akinesis of inferior and posterior segments of the left ventricle and hypokinesis of the lateral wall. Initial treatment included aspirin, IV heparin and IV nitroglycerin; however, due to persistent angina and ST elevation, tissue plasminogen activator was administered with subsequent resolution of signs and symptoms approximately 90 minutes later. After 12 hours, the patient's troponin I level peaked at 7.23 ng/mL and normalized after 72 hours. A coronary angiography revealed normal coronary arteries and a repeat echocardiography demonstrated slight hypokinesia of the inferior wall with 65% ejection fraction. The patient was discharged without medications and was asymptomatic at his 3-month follow-up visit (Ureyen et al, 2015).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) DROWSY
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: Ingestion of a Scutigera morpha centipede by a 6-month-old caused lethargy, and a pale, floppy child. It is unknown if the child was bitten internally (Barnett, 1991).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) NAUSEA AND VOMITING
    1) WITH POISONING/EXPOSURE
    a) Nausea and vomiting are rarely associated with centipede bites.
    b) CASE REPORT (INGESTION): Ingestion of a Scutigera morpha centipede by a 6-month-old caused brief vomiting (Barnett, 1991).
    c) CASE REPORT (BITE): An adult vomited twice in an hour after being bitten on the scrotum (Coffin, 1919).
    d) During a prospective study, involving 44 patients who were bitten by a centipede, nausea was reported in 2 patients (Balit et al, 2004).

Genitourinary

    3.10.2) CLINICAL EFFECTS
    A) RENAL FAILURE SYNDROME
    1) WITH POISONING/EXPOSURE
    a) The bite of the Giant Desert Centipede (Sclopendra species) produced rhabdomyolysis which led to renal failure in one case (Logan & Ogden, 1985a).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) PAIN
    1) WITH POISONING/EXPOSURE
    a) Envenomation may cause immediate local burning pain, erythema, bullae, superficial necrosis, rashes, and edema (Ureyen et al, 2015; Veraldi et al, 2010; Yildiz et al, 2006; Elston, 1999; Fowler, 1993). Local pain may be excruciating and may bleed profusely. Frequently paresthesia is present at the bite site (Elston, 1999).
    b) Local bites are generally pointed in shape (Elston, 1999).
    c) During a prospective study, involving 44 patients who were bitten by a centipede, severe pain was reported in 50% of patients who were bitten by centipedes with positive identification (n=14) and in 20% of patients who were bitten by centipedes that were not available for positive identification (n=30). The total median duration of pain in both groups was 30 minutes. The pain appeared to radiate proximally in 4 patients in the positively identified centipede group (27%) and in 4 patients in the not-identified centipede group (13%) (Balit et al, 2004).
    d) CASE REPORT: A 16-year-old boy was bitten on his index finger from a Vietnamese centipede (Scolopendra subspinipes), which immediately became erythematous, swollen, and very painful. Symptoms resolved following administration of lidocaine and diphenhydramine (McFee et al, 2002).
    B) SKIN NECROSIS
    1) WITH POISONING/EXPOSURE
    a) Hemorrhagic vesicles leading to necrosis at the bite site may occur (Elston, 1999). Necrosis at the sting site was reported in one case (Gomes et al, 1982).
    C) EDEMA
    1) WITH POISONING/EXPOSURE
    a) The local pain may be accompanied by erythema and edema that may last for several hours (Mohri et al, 1991; Remington, 1950).
    b) RECURRENT SYMPTOMS: There have been several cases where bites of tropical centipedes have produced recurring pain and swelling after a week or so, and lasting for 1 to 3 days. It is unknown if this effect is related to the venom, or to a secondary infection (Haneveld, 1957).
    c) During a prospective study, involving 44 patients who were bitten by a centipede, local swelling was reported in 6 of 14 patients (43%) who were bitten by a centipede that was positively identified, and in 13 of 30 patients (43%) who were bitten by a centipede that was not available for positive identification (Balit et al, 2004).
    D) BULLOUS ERUPTION
    1) WITH POISONING/EXPOSURE
    a) Bullae may be seen after bites.
    b) CASE REPORT: Several large bullae appeared around the bite site on the scrotum several hours after the exposure. Bullae were sterile, contained serum, but no cells. By the second day they ruptured, leaving the area tender and raw (Coffin, 1919).
    E) ERUPTION
    1) WITH POISONING/EXPOSURE
    a) Rashes may appear at the bite site, or elsewhere on the body (Elston, 1999).
    b) CASE REPORT: A man who was bitten on the scrotum developed a vesicular, papular rash over the thighs, ears, face, chest, neck, and arms at the site of each hair follicle. The rash gradually cleared over the next 5 days, without treatment (Coffin, 1919).
    F) CELLULITIS
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: A 33-year-old man developed severe edema, with erythema, vesicles, blisters, and pustules, of the right hand after being bitten by a centipede (Scolopendra subspinipes). At presentation, the patient also complained of severe pain, fever, and a general feeling of malaise. Laboratory analysis revealed leukocytosis and an elevated erythrocyte sedimentation rate, and a culture of the pustules indicated the presence of Staphylococcus aureus. With supportive care, including antibiotic therapy, the patient completely recovered approximately 10 days later (Veraldi et al, 2010).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) RHABDOMYOLYSIS
    1) WITH POISONING/EXPOSURE
    a) The bite of the Giant Desert Centipede (Sclopendra species) produced rhabdomyolysis which led to renal failure in one case (Logan & Ogden, 1985a).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) WITH POISONING/EXPOSURE
    a) Allergic reactions to the venom, including anaphylactic reactions, have been described (Supakthanasiri et al, 2004; Isbister, 2004).
    B) LYMPHANGITIS
    1) WITH POISONING/EXPOSURE
    a) Lymphangitis and lymphadenopathy may be seen, more commonly with the tropical centipedes (Haneveld, 1957).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No laboratory evaluation is necessary in the vast majority of centipede envenomated patients.
    4.1.2) SERUM/BLOOD
    A) OTHER
    1) No particular abnormalities are seen. A single case of rhabdomyolysis and renal failure has been reported (Logan & Ogden, 1985).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.6) DISPOSITION/BITE-STING EXPOSURE
    6.3.6.1) ADMISSION CRITERIA/BITE-STING
    A) Only patients with systemic toxicity, manifested as anaphylactic reactions, may require admission.
    6.3.6.2) HOME CRITERIA/BITE-STING
    A) Patients that are asymptomatic or with only mild local pain can be managed at home.
    6.3.6.3) CONSULT CRITERIA/BITE-STING
    A) The local poison center may be consulted.
    6.3.6.5) OBSERVATION CRITERIA/BITE-STING
    A) Patients with allergic reactions should be observed for minimum of 4 hours. Patients requiring epinephrine for anaphylactic reactions should be observed for 12 to 24 hours post epinephrine dosing.

Monitoring

    A) No laboratory evaluation is necessary in the vast majority of centipede envenomated patients.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) PREHOSPITAL: The responsible arthropod should be removed from the patient and crushed to avoid envenomation of EMS providers or co-habitating individuals. Ice packs or heat can be applied to the bite site in an attempt to minimize pain.

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) HOSPITAL: The responsible arthropod should be removed from the patient and crushed to avoid envenomation of hospital staff.

Abstracts

Case Reports

    A) ROUTE OF EXPOSURE
    1) ORAL: One study reported the ingestion of a Scutigera morpha centipede by a 6-month-old child. The child became lethargic, pale, floppy and vomited. It is unknown if the child received the venom via a sting in the GI tract or via direct absorption. The child recovered with supportive care only (Barnett, 1991).

Range Of Toxicity

Summary

    A) A single bite may cause severe local pain and swelling.

Minimum Lethal Exposure

    A) Envenomation producing death has not been seen in the United States, but bites have produced death in other countries.
    B) CASE REPORTS
    1) PEDIATRIC: A 7-year-old was bitten by a Scolopendra subspinipes on the head. Within 29 hours, the child had died (Pineda, 1923).

Maximum Tolerated Exposure

    A) A single bite may cause severe local pain and swelling.

Pharmacology Toxicology

Toxicologic Mechanism

    A) Centipede venom has not been studied in detail. It contains some enzymes and nonenzymatic proteins, probably small peptides. There is also a cardiotoxic protein called toxin S.
    1) Non-protein substances in the venom include 5- hydroxytryptamine, histamine, lipids, and various polysaccharides. Anticoagulant and coagulant components have also been isolated (Jangi, 1984).

Animal Toxicology

Treatment

    11.2.2) LIFE SUPPORT
    A) GENERAL
    1) MAINTAIN VITAL FUNCTIONS: Secure airway, supply oxygen, and begin supportive fluid therapy if necessary.
    11.2.5) TREATMENT
    A) GENERAL TREATMENT
    1) Treatment should always be done on the advice and with the consultation of a veterinarian.
    2) Additional information regarding treatment of poisoned animals may be obtained from a Board Certified (ABVT) Veterinary Toxicologist (check with nearest veterinary school or veterinary diagnostic laboratory) or the National Animal Poison Control Center.
    3) ANIMAL POISON CONTROL CENTERS
    a) ASPCA Animal Poison Control Center, An Allied Agency of the University of Illinois, 1717 S. Philo Rd, Suite 36, Urbana, IL 61802, website www.aspca.org/apcc
    b) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    c) The following 24-hour phone number is available: (888) 426-4435. A fee may apply. Please inquire with the poison center. The agency will make follow-up calls as needed in critical cases at no extra charge.

References

General Bibliography

    1) Balit CR, Harvey MS, Waldock JM, et al: Prospective study of centipede bites in Australia. J Toxicol Clin Toxicol 2004; 42(1):41-48.
    2) Barnett PLJ: Centipede ingestion by a six-month-old infant: toxic side effects. Ped Emerg Care 1991; 7:229-230.
    3) Coffin SW: Notes on a case of centipede bite. Lancet 1919; 1:1117-1118.
    4) Elston DM: What's eating you? Centipedes (Chilopoda). Cutis 1999; 64:83.
    5) Fowler ME: Veterinary Zootoxicology, CRC Press, Boca Raton, Florida, 1993.
    6) Gelbier S & Kopkin B: Pericoronitis due to a centipede. A case report. Br Dent J 1972; 133:307-308.
    7) Gomes A, Datta A, & Sarang B: Occurence of histamine and histamine release by centipede venom. Indian J Med Res 1982; 76:888.
    8) Haneveld GT: Centipede bites. Br Med J 1957; 592.
    9) Isbister GK: Other Arthropods. In: Dart RC, ed. Medical Toxicology, 3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2004.
    10) Jangi BS: Centipede venoms and poisoning, in: Tu A (ed): Handbook of Natural Toxins Vol 2, Insect Poisons, Allergens, and Other Invertibrate Venoms, Marcel Dekker, New York, NY, 1984, pp 333.
    11) Jourdain S: Le venin des Scolopendres. Comptes Rendus Seances Acad Sci 1900; 131:1007-1008.
    12) Lieberman P, Nicklas R, Randolph C, et al: Anaphylaxis-a practice parameter update 2015. Ann Allergy Asthma Immunol 2015; 115(5):341-384.
    13) Lieberman P, Nicklas RA, Oppenheimer J, et al: The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126(3):477-480.
    14) Logan JL & Ogden DA: Rhabdomyolysis and acute renal failure following the bite of the Giant Desert Scorpion Scolopendra heros. West J Med 1985a; 142:549-550.
    15) Logan JL & Ogden DA: Rhabdomyolysis and acute renal failure following the bite of the giant desert centipede Scolopendra heros. West J Med 1985; 142:549-550.
    16) McFee RB, Caraccio TR, Mofenson HC, et al: Envenomation by the Vietnamese centipede in a Long Island pet store. J Toxicol Clin Toxicol 2002; 40(5):573-574.
    17) Mohri S, Sugiyama A, & Saito K: Centipede bites in Japan. Cutis 1991; 47:189-190.
    18) National Heart,Lung,and Blood Institute: Expert panel report 3: guidelines for the diagnosis and management of asthma. National Heart,Lung,and Blood Institute. Bethesda, MD. 2007. Available from URL: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
    19) Nowak RM & Macias CG : Anaphylaxis on the other front line: perspectives from the emergency department. Am J Med 2014; 127(1 Suppl):S34-S44.
    20) Pineda: J Phillipine Is Med Assoc 1923; 3:59-93.
    21) Product Information: diphenhydramine HCl intravenous injection solution, intramuscular injection solution, diphenhydramine HCl intravenous injection solution, intramuscular injection solution. Hospira, Inc. (per DailyMed), Lake Forest, IL, 2013.
    22) Remington CL: The bite and habits of a giant centipede (scolopendra subspinipes) in the Philippine Islands. Am J Trop Med 1950; 30:453-455.
    23) Supakthanasiri P, Ruxrungtham K, Klaewsongkram J, et al: Anaphylaxis to centipede bite. J Allergy Clin Immunol 2004; 113(2):S244-.
    24) Ureyen CM , Arslan S , & Bas CY : Cardiovascular collapse after myocardial infarction due to centipede bite. Wien Klin Wochenschr 2015; 127(13-14):577-579.
    25) Vanden Hoek,TL; Morrison LJ; Shuster M; et al: Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. Dallas, TX. 2010. Available from URL: http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S829. As accessed 2010-10-21.
    26) Veraldi S, Chiaratti A, & Sica L: Centipede bite: a case report. Arch Dermatol 2010; 146(7):807-808.
    27) Wang IK, Hsu SP, Chi CC, et al: Rhabdomyolysis, acute renal failure, and multiple focal neuropathies after drinking alcohol soaked with centipede. Renal Failure 2004; 26(1):93-97.
    28) Yildiz A, Biceroglu S, Yakut N, et al: Acute myocardial infarction in a young man caused by centipede sting. Emerg Med J 2006; 23(4):e30-.