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Erucism in New Zealand: exposure to gum leaf skeletoniser (Uraba lugens) caterpillars in the differential diagnosis of contact dermatitis in the Auckland Region

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There are no indigenous caterpillars known to be associated with erucism, but the recently established gum leaf skeletoniser (Uraba lugens) has venom-containing spines that cause adverse reactions in humans. Symptoms are usually characterised by a stinging sensation, followed by itching and the formation of wheals. Exposure to U. lugens should be considered by medical practitioners in the differential diagnosis of contact dermatitis in the Auckland region.
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THE NEW ZEALAND
MEDICAL JOURNAL
Vol 119 No 1241 ISSN 1175 8716
NZMJ 8 September 2006, Vol 119 No 1241 Page 1 of 6
URL: http://www.nzma.org.nz/journal/119-1241/xxxx/ © NZMA
Erucism in New Zealand: exposure to gum leaf skeletoniser
(Uraba lugens) caterpillars in the differential diagnosis of
contact dermatitis in the Auckland region
José Derraik
Abstract
There are no indigenous caterpillars known to be associated with erucism, but the
recently established gum leaf skeletoniser (Uraba lugens) has venom-containing
spines that cause adverse reactions in humans. Symptoms are usually characterised by
a stinging sensation, followed by itching and the formation of wheals. Exposure to
U. lugens should be considered by medical practitioners in the differential diagnosis
of contact dermatitis in the Auckland region.
Introduction, biological notes and distribution
‘Erucism’ is the term generally used to refer to the adverse reactions resulting from
contact with urticating caterpillars, the larval forms of the insect order Lepidoptera
(moths and butterflies).1,2 Although erucism is a relatively common public health
problem throughout the world,1 there are no indigenous species of Lepidoptera in
New Zealand whose caterpillar is known to cause adverse reactions in humans (Brian
Patrick, Otago Museum, personal communication; 2006).3 As a result, erucism has
never been a human health issue in this country, and is therefore a condition
somewhat unknown to local medical practitioners.
The situation has changed however, since the establishment of the gum leaf
skeletoniser Uraba lugens Walker (Lepidoptera: Nolidae), an Australian moth whose
caterpillar feeds on the foliage of gum trees (Eucalyptus) and other closely related
genera.4 The younger larvae avoid feeding on the oil glands and veins found in the
leaves, which are consequently ‘skeletonised’.3 More mature larvae will however eat
the whole leaf.3
Uraba lugens is a significant pest for Eucalyptus forestry. Infestation by U. lugens
may kill young trees if there is repeated defoliation.5 This process on larger trees may
reduce wood production for several seasons.6 Outbreaks of this species seem to
periodically occur in natural forests in Australia, but these eventually recover, even
though defoliation can be severe.7
Uraba lugens was first discovered in New Zealand in 1992, and it is now firmly
established in the Auckland region, over an area of at least 20,000 ha.4 Due to its wide
distribution, eradication was deemed to be not feasible.8 Uraba lugens is now the
focus of a long-term management programme aiming particularly at filling current
knowledge gaps and controlling the existing population.8
The approximate distribution of U. lugens currently goes as far north as Takapuna and
as far south as the Bombay Hills, including the area between the Hunua Ranges in the
east and the Manukau Heads and Waitakere Ranges in the west.7 The highest density
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of this organism seems to occur in southwest Auckland.9 Results from climatic
models indicated that U. lugens could potentially establish throughout New Zealand.
To date, the population is not known to be established outside the Auckland region,
but specimens have recently been captured in pheromone traps in Katikati (Bay of
Plenty) and Warkworth (Northland).18
The Auckland populations of U. lugens have two generations per year (bivoltine),
with larvae usually present from January to March (summer) and May to October
(winter).10 Uraba lugens caterpillars vary in length from 1 to 25 mm depending on the
stage of development.3. There are between 11 and 13 larval stages.4,5
Uraba lugens are extremely hairy caterpillars with yellow and brown markings, and
when mature they retain the head capsules of previous instars that are pushed up to
top of the head, which makes U. lugens easy to identify (Figure 1).5 Each body
segment of the larvae has 10 tubercles, four of which are located dorsally and have
short, stiff, brown-tipped bristles that are hollow and contain venom that can be
injected into the human skin upon contact.3
Figure 1. Uraba lugens caterpillars (Photo courtesy of Ensis)
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Exposure, symptoms of envenomation, and possible treatment
The exposure of people to stinging caterpillars is greater when these creatures are
occurring at high densities, as numerous caterpillars may be found in the direct
vicinity of an infested tree. Large infestations of stinging caterpillars can become a
serious public health issue, and in some severe cases it has led to the closure of
schools.2
Figure 2. Wheals formed approximately 30 minutes after exposure to the
urticating spines of Uraba lugens (Photo courtesy of Ensis)
Most cases of harmful exposure to caterpillars seem to occur in young children, and in
one study of 365 cases of exposure to Lophocampa caryae Harris (Lepidoptera:
Arctiidae), 80% of the records were paediatric exposures.11 Caterpillars are a source
of curiosity to children due to their easy accessibility and slow mobility,11 and also
due to these creatures’ generally bright colours. Young children tend to have thinner
skin and smaller bodies than adults, both of which may increase the extent of the
reaction.12
Approximately 150 species of Lepidoptera from more than a dozen families have
been described to cause some form of injury to humans.1,13 The caterpillars of many
species have chitinous spines that are capable of penetrating human epidermis, and
injecting venom parenterally.13 Exposure to stinging caterpillars can result in a variety
of reactions, which vary according to the species,14 but adverse reactions range from
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moderate to severe local effects, usually characterised by severe pain, and less
commonly systemic effects,14 including renal failure and intracerebral hemorrhage.1
The nature of U. lugens venom is largely unknown,12 but it contains histamine and
most likely also a proteinaceous substance.3 Skin contact with the envenomating
bristles of U. lugens will immediately cause a sharp stinging sensation, which may be
severe.3 Local pain is followed by the associated formation of flat itching wheals
(Figure 2),15 which may remain visible for a few weeks.3
The skin reaction may cause a high degree of discomfort, and an adult woman
described the reaction as “violent and distressful for 3–4 days”.3 As a result, adverse
reactions to U. lugens venom may be particularly distressing for young children. It is
important to note that even the spines on the youngest caterpillars are capable of
stinging, and that these continue to sting even after the insect is dead, and also
following the shedding of skin.3
Ingestion of caterpillars of other species by children has been described in the
literature,1,14,16 with some adverse effects consisting of pain, difficulty swallowing,
drooling, and shortness of breath.16 There seem to be no records of U. lugens
ingestion, but it would be likely to require hospitalisation. While life-threatening
reactions are unlikely to occur, the possibility of serious adverse reactions, such as
anaphylaxis, cannot be discarded.12 Although severe and systemic reactions to
U. lugens have not been described, eye lesions could be potentially serious and should
be dealt with by a specialist. Note that there is no evidence of sensitisation from
repeated exposures to U. lugens.3
Contact with some caterpillar species such as the white-stemmed gum moth
(Chelepteryx collesi) leads to a very large number of hairs becoming embedded in the
skin.17 Even though for some species attempts to remove the hairs seem to be
unsuccessful,17 the careful removal of spine(s) with adhesive tape is a commonly
prescribed initial treatment of urticating caterpillar stings.2,14 However, this is not
likely to be an issue with U. lugens, as there seem to be no reports of its spines
becoming embedded in human skin, especially in Southcotts’s detailed descriptions of
numerous cases of exposure.3 Instead, the application of ice packs, and oral or topical
administration of antihistamines to attenuate itching and burning sensation, is
advised.1,2,14 Intense inflammatory reaction may be locally relieved by topical or oral
corticosteroids.1,2
Current incidence and recommendations
There are no available data on the incidence of exposure to U. lugens in New Zealand.
Biosecurity New Zealand has information on at least two confirmed cases, where
members of the public have contacted the agency following adverse reactions to an
‘unknown’ caterpillar (Mark Ross, personal communication; 2006). However, based
on the distribution of the caterpillars in the Auckland region and its relatively high
density in some areas, one could expect the actual number of cases to be considerably
higher. The author would welcome information on any confirmed cases of exposure
to U. lugens in New Zealand.
Even though U. lugens is the target of a long-term management programme, this
species is well-established in the Auckland region and will not be eradicated. Since
Auckland is the most populated region in the country, human exposure to the
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caterpillars is likely to occur on a regular basis, particularly among children. As a
result, general practitioners should consider exposure to U. lugens in the differential
diagnosis of contact dermatitis, where symptoms such as wheals are present.
Prevention is an important tool, and in cases where exposure to U. lugens is
confirmed, the access of children to areas adjacent to infested trees should be
restricted, and a reputable pest controller should be contacted for mitigating action. In
case the infested tree is located on public land, the local or regional authority should
be notified.
Avoidance is a fundamental preventive tool, and children should be educated not to
touch or handle U. lugens caterpillars. It should be also noted that this species’
potential establishment in Eucalyptus plantations in New Zealand may lead to
occupational safety and health concerns, as a result of the likelihood of exposure to
forestry workers.12
Author information: José G B Derraik, Advisor (Human Health), Risk Analysis
Group, Pre-Clearance Directorate, Biosecurity New Zealand, Wellington
Acknowledgements: I thank John Fountain (National Poisons Centre, University of
Otago), Doug Lush (Ministry of Health), and Ian Gear and Mark Ross (Biosecurity
New Zealand) for revising this manuscript and providing valuable feedback.
Ensis Forest Biosecurity & Protection has kindly allowed their photographs to be
included in this article. Thanks also to Brian Patrick (Otago Museum) for input.
Correspondence: José G B Derraik, Biosecurity New Zealand, PO Box 2526,
Wellington. Fax: (04) 894 0733; email: jose.derraik@maf.govt.nz
References:
1. Diaz JH. The evolving global epidemiology, syndromic classification, management, and
prevention of caterpillar envenoming. Am J Trop Med Hyg. 2005;72:347–57.
2. Goddard J. Physician's guide to arthropods of medical importance. 4th ed. Boca Raton: CRC
Press; 2003.
3. Southcott RV. Lepidopterism in the Australian region. Rec Adelaide Children's Hosp.
1978;2:87–173.
4. Potter KJB, Stephens AEA. Suitability of valued eucalypt species for the larval development
of the gum leaf skeletoniser, Uraba lugens. N Z Plant Prot. 2005;58:184–90.
5. Phillips C. Gum leaf skeletonizer – Uraba lugens Walker. Forest Insects. 1992;16. Available
online. URL:
http://www.forestry.sa.gov.au/privateforestry/insect_fact_sheets/Fact_Sheet_html/FHS%2016
%20Gumleaf%20skeletonizer.htm Accessed August 2006.
6. Ross M. Gum leaf skeletoniser found in Onehunga. Biosecurity. 2003;41:6.
7. Suckling DM, Gibb AR, Dentener PR, et al. Uraba lugens (Lepidoptera: Nolidae) in New
Zealand: pheromone trapping for delimitation and phenology. J Econ Entomol.
2005;98:1187–92.
8. Ross M. Gum leaf skeletoniser long-term management approved. Biosecurity. 2003;47:8.
9. Ross M. Gum leaf skeletoniser: long-term management programme producing results.
Biosecurity. 2004;53:12.
10. Mansfield S, Kriticos DJ, Potter KJB, Watson MC. Parasitism of gum leaf skeletoniser
(Uraba lugens) in New Zealand. N Z Plant Prot. 2005;58:191–6.
11. Kuspis DA, Rawlins JE, Krenzelok EP. Human exposures to stinging caterpillar: Lophocampa
caryae exposures. Am J Emerg Med. 2001;19:396–8.
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12. Aer’aqua Medical Services. Report on health effects on exposure to gum leaf skeletoniser
urticating hairs: Unpublished report prepared for the Ministry of Agriculture and Forestry; 12
May 2004.
13. Vega ML, Vega J, Vega JM, et al. Cutaneous reactions to pine processionary caterpillar
(Thaumetopoea pityocampa) in pediatric population. Pediatr Allergy Immunol. 2003;14:482–
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14. Balit CR, Geary MJ, Russell RC, Isbister GK. Prospective study of definite caterpillar
exposures. Toxicon. 2003;42:657–62.
15. Southcott RV. Some harmful Australian insects. Med J Aust. 1988;149:656–62.
16. Lee D, Pitetti RD, Casselbrant ML. Oropharyngeal manifestations of lepidopterism. Arch
Otolaryngol Head Neck Surg. 1999;125:50–2.
17. Balit CR, Geary MJ, Russell RC, Isbister GK. Clinical effects of exposure to the white-
stemmed gum moth (Chelepteryx collesi). Emerg Med Australasia. 2004;16:74–81.
18. Berndt L. Gumleaf skeletoniser – potential for biological control. Biosecurity. 2006;69:13.
... Recently, Derraik has discussed in detail the public health issues regarding Uraba lugens Walker (Lepidoptera: Nolidae). 1 Commonly known as gum leaf skeletoniser, the caterpillars of this Australian moth feed on the foliage of gum trees (Eucalyptus) and other closely related plants. 2 Uraba lugens is firmly established in the greater Auckland region of New Zealand and, as a result, eradication is deemed to be not feasible. 1 Most cases of harmful exposure to caterpillars seem to occur in young children, as these creatures are a source of curiosity to children due to their easy accessibility and slow mobility, and also the caterpillars' generally bright colours. ...
... Recently, Derraik has discussed in detail the public health issues regarding Uraba lugens Walker (Lepidoptera: Nolidae). 1 Commonly known as gum leaf skeletoniser, the caterpillars of this Australian moth feed on the foliage of gum trees (Eucalyptus) and other closely related plants. 2 Uraba lugens is firmly established in the greater Auckland region of New Zealand and, as a result, eradication is deemed to be not feasible. 1 Most cases of harmful exposure to caterpillars seem to occur in young children, as these creatures are a source of curiosity to children due to their easy accessibility and slow mobility, and also the caterpillars' generally bright colours. 1,3 It is therefore not surprising that cases of exposure of school children to U. lugens are emerging in New Zealand. ...
... 1 Most cases of harmful exposure to caterpillars seem to occur in young children, as these creatures are a source of curiosity to children due to their easy accessibility and slow mobility, and also the caterpillars' generally bright colours. 1,3 It is therefore not surprising that cases of exposure of school children to U. lugens are emerging in New Zealand. ...
Article
Full-text available
Recently, Derraik has discussed in detail the public health issues regarding Uraba lugens Walker (Lepidoptera: Nolidae). Commonly known as gum leaf skeletoniser, the caterpillars of this Australian moth feed on the foliage of gum trees (Eucalyptus), and other closely related plants. Uraba lugens is firmly established in the greater Auckland region of New Zealand and, as a result, eradication is deemed to be not feasible. Most cases of harmful exposure to caterpillars seem to occur in young children, as these creatures are a source of curiosity to children due to their easy accessibility and slow mobility, and also the caterpillars generally brigfit colours. It is therefore not surprising that cases of exposure of school children to U. lugens are emerging in New Zealand. This case report describes a recent incident in a West Auckland school.
... Cutaneous injury from exposure to insects is well recognised, 3 with conditions such as blister beetle dermatitis, 4 paederus dermatitis (rove beetles -Paederus spp.), erucism (caterpillars), 5 and lepidopterism (moths and butterflies). However, there seem to be no reports in the literature on adverse reactions due to contact with S. australis or with any other fulgoroid (planthopper) species. ...
... toxins that may cause adverse health effects in humans. 5 The adults of S. australis do not have spines so the exact mechanism of causing itch is unclear. Nymphs of many fulgoroids produce wax from special glands; these are hydrophobic and help conceal the insects. ...
... Concerns about U. lugens are multi-faceted. Not only is there a clear potential for significant defoliation damage to host trees (Potter & Stephens, 2005), but also it causes public health concerns as a result of the larvae bearing urticating hairs (Derraik, 2006). Another potentially significant but unexplored factor is the risk U. lugens poses to New Zealand's native flora. ...
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• The risk posed to New Zealand native flora by the recently-established pest of Australian origin Uraba lugens Walker (Lepidoptera: Nolidae) (gum leaf skeletonizer) was assessed. Weed biological control host range testing methods were applied to identify those New Zealand plant species potentially at risk. Native plants tested were primarily in the Myrtaceae, the family that contains all the Australian hosts of U. lugens. • Experimental methods included no-choice larval feeding assays and field cage and laboratory oviposition trials. Difficulty in ascertaining reliable oviposition preference data from cage oviposition trials limited the confidence with which the invader's field host range could be predicted. • Field surveys of plants attacked by U. lugens in the infested area supported the initial predictions but only some of the at-risk native Myrtaceae were present in the area. • The risk to native New Zealand plants is presented in terms of two mechanisms: development of self-sustaining populations and temporary spill-over of solitary larvae. Development of self-sustaining populations of the pest within native forests is deemed to be highly improbable. • Temporary spill-over impacts are most likely in urban areas within mixed species plantings or boundaries between native/exotic forests and coinciding with the mobile larval life stages. Spill-over impacts from U. lugens have only been recorded to date on Metrosideros excelsa.
... 13,34 In Australia and New Zealand, the gum leaf skeletonizer moth (Uraba lugens; Fig 13) is another member of Limacodidae whose stings cause pain, erythema, and wheal formation (Fig 14). [35][36][37][38] Australia is the home of several other stinging Limacodids, including the billygoat plum stinging ...
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Lepidoptera, the second largest class of Insecta with over 180,000 species, is comprised of moths and butterflies, and their respective caterpillars. Lepidopteran reactions are the result of contact with moths, butterflies and caterpillars. Although largely harmless, they manifest as a range of dermatologic conditions and systemic symptoms. This chapter presents some of the common causative organisms in the United States and worldwide. Caterpillars (the larval form) are mostly implicated, although contact with some moths and butterflies may also cause dermatologic sequelae. Typically, treatment is avoidance, removal of hairs/setae and topical/oral corticosteroids and/or antihistamines. Overall, although many reactions are non-specific, the framework provided herein aids in compartmentalizing species and associated symptom complexes.
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Gumleaf skeletoniser, Uraba lugens (Lepidoptera: Nolidae), is a native Australian defoliator of many Eucalyptus and related species, and has recently established in New Zealand. Outbreaks of this species have caused significant damage to natural and commercially managed forests in Australia, and threaten plantations and amenity trees in New Zealand. With the arrival of this pest in New Zealand, research interest in U. lugens has increased. This stimulated this review and update, with previously unpublished data presented, on its taxonomy, biology, distribution, pest status and management. Host species and natural enemies are also listed, including previously unpublished records.
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Exposure to caterpillars results in a variety of clinical effects depending on the species involved. The aim of this study was to describe the clinical effects from caterpillar exposures within Australia. Cases were recruited prospectively from calls to a poison information centre. Subjects were included if they had a definite exposure and they had collected the caterpillar or cocoon. The caterpillars were identified to genus and species level where possible. There were 36 included cases: two were contact exposures to caterpillar contents, one was an ingestion of a caterpillar and the remaining 33 patients had definite reactions from caterpillar or cocoon exposure. There were five families of caterpillars identified in the study: Arctiidae, Limacodidae, Anthelidae, Lymantriidae and Sphingidae, many of which occur worldwide. Clinical effects ranged from severe pain to an urticarial response depending on the species involved. There were no adverse effects following ingestion in this study. Treatment consisted primarily of removal of the caterpillar or cocoon. Other treatment measures consisted of symptomatic treatment such as ice packs and antihistamines. This is the first prospective study of caterpillar exposures within Australia and demonstrates that exposures can result in a variety of reactions depending on the family and species involved.
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The White-stemmed gum moth (Chelepteryx collesi) can be found in eastern Australia. The clinical effects of injuries caused by its many spine-like hairs are poorly defined and concern about the numerous hairs that remain embedded following contact with the cocoon have led to heroic means of removal. To examine the clinical effects of injuries by the caterpillar or cocoon of the White-stemmed gum moth. Prospective observational study of caterpillar injuries from calls to the New South Wales Poisons Information Centre. Cases resulting from C. collesi exposure were included for analysis. Caterpillars and cocoons were expertly identified where available and a follow-up consultation of all patients was conducted. Information was collected on the circumstances of exposure, local and systemic effects and treatment. From the 26 included cases, seven had confirmed caterpillar contact (all children aged 1-11), six had confirmed cocoon contact and 13 had exposures consistent with C. collesi, but no caterpillar was caught. All cases occurred in summer. Of 13 confirmed exposures there was no difference between caterpillars and cocoons, and these were considered together. Affected areas were hands, feet, or both, following C. collesi being handled or trodden on. Pain was reported in all 13 cases, one with severe pain. In 10 cases pain duration was < 60 min. Six subjects had more than 100 hairs embedded (small black dots). In three cases, the hairs were surrounded by swelling and yellow discolouration. Despite the attempted removal of multiple hairs, they remained embedded for prolonged periods but caused no sequelae. The clinical effects of the White-stemmed gum moth were minor with local pain. Although hairs remained in all cases, they caused no problems. Complete removal of hairs is neither possible nor necessary, and painful and invasive methods should be avoided.
Article
Caterpillars are the wormlike, larval forms of butterflies and moths of the insect order Lepidoptera. Next to flies, lepidopterans are the most abundant arthropods with more than 165,000 species worldwide, and with most species posing no human threats. However, caterpillar species from approximately 12 families of moths or butterflies worldwide can inflict serious human injuries ranging from urticarial dermatitis and atopic asthma to osteochondritis, consumption coagulopathy, renal failure, and intracerebral hemorrhage. Unlike bees and wasps, envenoming or stinging caterpillars do not possess stingers or modified ovipositors attached to venom glands, but instead bear highly specialized external nettling or urticating hairs and breakaway spines or setae to defend against attacks by predators and enemies. Since the 1970s, there have been increasing reports of mass dermatolgic, pulmonary, and systemic reactions following caterpillar encounters throughout the world.