Centipedes — 蜈蚣,
2020-10-12 20:29 編輯
Local reactions — 局部反應, 蜈蚣咬傷造成發炎反應(非細菌感染造成), 咬傷數分鐘後出現局部發癢, 紅腫, 水腫.
症狀通常在咬傷後數小時出現. 通常數小時內會消失, 局部發炎反應可能是由唾液內的刺激物造成. 例如factor Xa抑制劑會出現抗凝血反應, 消化酶(例如澱粉酶,酯化酶), 凝集素, 多醣類歐
The normal reaction to an insect bite is an inflammatory reaction at the site of the punctured skin, which appears within minutes and consists of pruritic local erythema and edema. A single punctum may be visible. Dual puncta can be seen with spider bites and centipede envenomations. Symptoms usually subside within a few hours. Local reactions are caused by irritant substances concentrated in insect saliva (eg, anticoagulants such as factor Xa inhibitors, digestive enzymes such as amylases and esterases, agglutinins, and mucopolysaccharides) [3]. In some cases, a local reaction is followed by a delayed skin reaction consisting of local swelling, itching, and redness.
昆蟲咬傷造成的局部反應, 建議先以肥皂和清水沖洗, 可冰敷消腫, 可使用含爐甘石粉calamine或局部麻醉劑(pramoxine) 的外用藥膏,凝膠, 乳液以改善搔癢, 但避免例行性使用局部麻醉劑和抗組織胺藥物, 這些成分有可能導致皮膚容易曬傷, 造成接觸性過敏反應.
註解: 爐甘石洗劑（Calamine lotion）：淡紅色的混懸液，放置後會沉澱，用前需要搖勻。 用於急性瘙癢性皮膚病，如蕁麻疹和痱子。 每1000毫升含爐甘石150克、氧化鋅50克、甘油50毫升，輔料為純化水。 爐甘石有收斂、止癢、抑菌和輕度防腐等作用；氧化鋅有收斂、殺菌、促進皮膚癒合的作用；甘油有保濕的作用。
Treatment — Insect bites and local reactions should be washed with soap and water. Reduction of local edema may be induced with cooling (ice or cold pack). Topical creams, gels, and lotions, such as those containing calamine or pramoxine, can be helpful in reducing pruritus if necessary. However, routine use of topical anesthetic and antihistamine preparations should be avoided because they can sensitize the skin following sun exposure and induce allergic contact sensitivity [4].
對於搔癢的個案, 可給予少量口服抗組織胺, 抗組織胺優於鎮定劑, 小兒患者應盡量避免使用鎮定劑
成人如果出現持續性搔癢, 可考慮每四小時至六小時給予口服 hydroxyzine(第一代抗組織胺) 10-25 mg
可同時使用 H1B 和 H2B. 例如 famotidine
Minimally sedating oral antihistamines (eg, cetirizine or fexofenadine, once or twice daily) may be helpful for patients with troublesome itching and are preferred over sedating agents, particularly in small children. However, the sedating agent hydroxyzine (hydrochloride or pamoate) (10 to 25 mg every four to six hours, as needed) may be helpful for controlling persistent pruritus in adults, perhaps largely due to the sedating effects. H1 and H2 antihistamines (eg, famotidine) may be used concurrently.
大面積塗抹抗組織胺可能會造成體內濃度過高引起毒性反應, 抗組織胺過量可能造成 抗乙醯膽鹼毒性作用. 局部使用抗組織胺可能誘發接觸性過敏
Concurrent use of oral H1 antihistamines and topical antihistamines applied over large surface areas should be avoided, because this combination can cause systemic anticholinergic toxicity and topical antihistamines can induce contact hypersensitivity from application of the medication, precluding future systemic administration of the H1 antihistamine.
如果局部腫大嚴重, 可考慮給予口服類固醇, 但類固醇通常用於症狀嚴重的個案
Dramatic local swelling and induration can be reduced with a brief course of oral glucocorticoids, although this should be reserved for severe cases.
蜈蚣咬傷通常會自然痊癒. 比照一般外傷處置. 之前有遇過咬傷部位一直有淺的潰瘍無法痊癒的個案. 查詢 uptodate 發現蜈蚣毒素在少數案例會出現嚴重局部反應. 造成組織壞死. 起水泡. 不過無特殊的治療可避免出現併發症.
Unusual local reactions
●Uncommonly, local reactions evolve to become vesicular (picture 1), bullous (picture 2 and picture 3), or necrotic (picture 4) [5,6]. Tissue necrosis generally results from the injection of venom, which occurs with some spider bites and centipede bites.
Most centipede bites resolve without complications, although various sequelae are reported, including local infection and necrosis [79], myocardial infarction [77,78], rhabdomyolysis with renal failure [81], and allergic reactions, including anaphylaxis
Centipedes are found in moist and usually warm climates worldwide, and human envenomations are typically reported from Asia, Indonesia, India, Hawaii, South America, and Australia [51-56]. Centipedes inject venom through forcipules, which are pincer-like appendages extending from the insect's head that are used to immobilize prey. Centipedes are largely nocturnal, and most human stings occur during the night. Stings often affect the extremities, and two small puncture marks may be visible [52]. Stings are usually painful, and erythema and edema are common.
多數被蜈蚣咬傷的個案, 症狀僅短暫出現, 通常不需要治療, 根據一篇聖保羅研究, 94 名患者, 僅 1/3 因持續或嚴重疼痛需治療, 文獻有紀錄的治療方式包括全身性止痛藥, 抗組織胺, 冰敷. 將患處浸泡至熱水, 局部注射麻醉劑. 另一篇前瞻性研究收錄 60 名患者, 比較冰敷, 熱水, 或打 ketorolac 30mg,. 任何一種治療都會改善疼痛, 但作者認為冰敷最有效, 最不具侵犯性, 浸泡熱水的 22 人有三名出現症狀更惡化.
In many cases, symptoms are transient and do not require treatment. In a series of 94 patients presenting for emergency care in Sao Paulo, one-third required treatment for persistent or severe symptoms (usually pain) [56]. Reported therapies include systemic analgesics, antihistamines, application of ice packs, immersion of the affected body part in hot water, and local injection of anesthetics [55-58]. In a prospective study of 60 patients, subjects were randomized to one of three interventions: application of ice packs (15 minutes), hot water immersion (43 to 45°C [109.4 to 113°F] water bath for 15 minutes), or injection of ketorolac (30 mg) [57]. Each of the therapies reduced pain, although the authors concluded that ice packs were the most practical and least invasive and noted that 3 of 22 patients assigned to hot water immersion had worsening of symptoms.
多數蜈蚣咬傷不會留下後遺症, 但文獻記載有各式各樣的後遺症, 包括局部感染, 皮膚壞死, 心肌梗塞, 橫紋肌溶解合併腎衰竭, 過敏性休克.
Most centipede stings resolve without complications, although various sequelae are reported, including local infection and necrosis [55], myocardial infarction [53,54], rhabdomyolysis with renal failure [59], and anaphylaxis [17].
下面是新聞報導
中國大陸一名29歲的朱姓男子被蜈蚣咬傷，想起電視劇裡白娘子飲雄黃酒的情節，認為雄黃酒可以驅妖避邪，於是喝雄黃酒解毒，沒想到卻中毒更深。專家提醒，喝雄黃酒等同吃砒霜，切勿模仿。
楚天都市報報導，8日下午3時許，朱先生穿著拖鞋在社區裡散步，無意中踩到一條軟軟的東西，低頭一看，一條背部紅色，長約10公分的蟲從他右腳爬過，被咬傷的地方隨後一陣陣刺痛。
朱先生認為，那隻蟲很像蜈蚣，又想到以前電視劇裡白娘子飲雄黃酒的情節，以為雄黃酒「驅妖避邪」能夠解蜈蚣的毒，於是跛著腳走到附近藥房，買回10克雄黃兌白酒喝下。
晚飯過後，朱先生傷口紅腫更加明顯，連整個腳背都變得鮮紅，還隱約感覺頭有些暈，他趕緊搭乘計程車到醫院求診。
急診外科醫生郭清皓檢查後，診斷朱先生是被蜈蚣咬傷，在得知他在家中自行飲用雄黃酒後，隨即對朱先生進行洗胃，打破傷風、抗過敏和解毒治療。
急診科主任艾芬介紹，雄黃是中藥藥材，可用做解毒劑、殺蟲藥，但多為外用，臨床上現已很少用。古代民間有雄黃可「殺百毒、辟百邪」的說法，然而艾芬提醒，喝雄黃酒反而會中毒。
艾芬說，雄黃的主要成分是硫化砷，砷是提煉砒霜的主要原料，喝雄黃酒等於吃砒霜；雄黃含較強的致癌物質，即使小劑量服用，也會對肝臟造成傷害和中樞神經系統麻痺等，重者則會致人死亡。
她表示，端午氣候炎熱潮濕，蜈蚣等昆蟲活動頻繁，被蜈蚣咬傷易出現麻木、紅腫、疼痛、發熱，極少數患者還會出現昏迷和休克，建議先用清水沖洗傷口，不要慌亂，以免加速毒素的吸收。
http://www.ksnews.com.tw/index.php/news/detail/842239
