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      Outbreak Report of Airborne Caterpillar Dermatitis in a Kindergarten

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          Abstract

          Background: The oak processionary caterpillar is found in several European countries. The larva of Thaumetopoea processionea Lepidoptera from the third to sixth larval instar develops poisonous hair (setae), filled with an urticating toxin that could lead to serious dermatitis, conjunctivitis and pulmonary problems (summarized as lepidopterism) on contact. Objectives: To determine the incidence of caterpillar dermatitis in a kindergarten population with three infested oak trees located in its enclosure. Methods: We made a survey by the use of a questionnaire that was handed out to all parents with children regularly visiting that kindergarten. Results: Twenty-four out of 47 (51%) questionnaires were returned and 10/24 (42%) children showing symptoms of lepidopterism were reported: 8/10 (80%) dermatitis, 5/10 (50%) pruritus, 5/10 (50%) respiratory distress, 4/10 (40%) malaise and/or fever and 1/10 (10%) conjunctivitis. Seven out of 10 visited a physician but the correct diagnosis was not posed in any case. Four out of 7 received medication (topical and/or systemic antihistaminics and/or steroids). Conclusions: Lepidopterism, an airborne disease caused by the setae of the processionary caterpillar, is a growing public health problem because of the increasing numbers of outbreaks, and it is still underestimated. Children seem to suffer more often from general symptoms and airway affection than adults.

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          The oak processionary caterpillar as the cause of an epidemic airborne disease: survey and analysis.

          T Kinaciyan, Frederick W. Spiegel, A Schopf … (2003)
          Thaumetopoea processionea L. (order Lepidoptera), the oak processionary moth, is found in oak forests in most European countries. Its third to sixth larval instars are armed with poisonous hairs (setae) containing an urticating toxin (thaumetopoein) potentially harmful to humans. Because T. processionea infests trees at the edges of forests or standing alone people frequently come into contact with its setae. In the woodland bordering on the western suburbs of Vienna conditions favouring its increase have led to frequent outbreaks of lepidopterism. To determine the incidence of lepidopterism in a suburban environment with three separate caterpillar-infested oak trees and to ascertain the frequency of the various symptoms of lepidopterism and the manner of contact with setae. We conducted a telephone survey of all the households/institutions located within 500 m of the infested trees. To gain more information on patients' symptoms and on situations likely to lead to increased contact with setae we asked those who reported cutaneous reactions to complete a questionnaire. As part of the environmental study we described the outbreak site, examined patients and, with tape-strip samples taken from the surface of the soil, looked for setae persisting in the environment. Of 1025 people surveyed 57 (5.6%) reported one or more symptoms of lepidopterism: 55 (96%) reported pruritus, 54 (95%) dermatitis, eight (14%) conjunctivitis, eight (14%) pharyngitis and two (4%) respiratory distress. The questionnaire was returned by 37 (69%) of the individuals with dermatitis. Of those, 16% had reacted with weal formation, 49% with papular rash and 22% with toxic irritant dermatitis. In 13% of respondents it was not possible to define the reaction. The risk factor analysis showed that airborne contamination was the most important cause: 97% of people had frequently passed an infested tree, 57% lived near a tree (in a neighbouring garden) and 32% had a tree in their own garden. Direct contact with larvae was of minor importance (38%). In four of the tape-strip samples intact setae were identified 1 year after the infestation. Lepidopterism caused by T. processionea is a public health problem of increasing significance. In years with outbreaks of the pest it can reach epidemic proportions in communities located near infested trees. Contact with airborne setae was mainly responsible for the occurrence of the disease.
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            An epidemic airborne disease caused by the oak processionary caterpillar.

            Sascha Meyer, Sven Gottschling (2006)
            The oak processionary caterpillar (Thaumetopoea processionea Lepidoptera) is found in several European countries. It usually lives in oak forests or on single-standing oak trees. The larva of from the 3rd to 6th developmental stage (instar) develops poisonous hair (setae), filled with an urticating toxin that may lead to serious dermatitis, conjunctivitis, and pulmonary affection (summarized as lepidopterism) on contact with the setae. In June 2004 more than 40 people including young children developed symptoms of lepidopterism after resting within 20 m of an infested oak tree. Only a few people had touched the caterpillars. All those with clinical symptoms of lepidopterism could be treated as outpatients, but several needed systemic steroids because of the severity of their complaints. Lepidopterism, an airborne disease caused by the setae of the processionary caterpillar, is a growing public health problem because of the increasing numbers of outbreaks.
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              Cutaneous reactions to pine processionary caterpillar (Thaumetopoea pityocampa) in pediatric population.

              Loren Rivera-Vega, E. Sánchez-Velázquez, Jason Miranda … (2003)
              Cutaneous lesions caused by pine processionary caterpillar (Thaumetopoea pityocampa, TP) are frequent in pinewood areas. However, no epidemiological studies have been performed so far in the pediatric population. In this study, we evaluated the relevance of reactions to pine processionary caterpillar in the pediatric population of our environment and determined the possible role of an IgE-mediated mechanism. A questionnaire was developed and given to 1,101 children and adolescents ranging from 3 to 17 years of age from rural areas with large pine forests. A total of 653 questionnaires were answered by the children or their parents. The search for immunoglobulin E (IgE)-mediated cases was based on the presence of a suspected reaction to caterpillar and confirmed by in vivo (skin prick) and in vitro (immunoblotting) tests. Sixty of the 653 people interviewed (9.18%) identified a cutaneous reaction from exposure to the processionary caterpillar. Within this group only four cases (6.7%) were because of an IgE-mediated mechanism. The predominant clinical feature of these patients with allergy to caterpillar was contact urticaria. We present the first study of cutaneous reactions to pine processionary caterpillar in a large pediatric population. This is a frequent pathology in pinery zones and only in a minority of the cases are because of an IgE-mediated allergic mechanism. This fact contrasts with studies in adults, where this percentage is much greater.
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                Author and article information

                Journal
                Journal ID (publisher-id): DRM
                Journal ID (nlm-ta): Dermatology
                Journal ID (doi): 10.1159/issn.1018-8665
                Title: Dermatology
                Publisher: S. Karger AG
                ISSN (Print): 1018-8665
                ISSN (Electronic): 1421-9832
                Publication date Subscription-year: 2007
                Publication date (Print): June 2007
                Publication date (Electronic): 21 June 2007
                Volume: 215
                Issue: 1
                Pages: 5-9
                Affiliations
                aUniversity Children’s Hospital, bRegional Poison Center, and cDepartment of Dermatology,Saarland University, Homburg, Germany
                Article
                Publisher ID: 102027 Other ID: Dermatology 2007;215:5–9
                DOI: 10.1159/000102027
                PubMed ID: 17587833
                SO-VID: 916f81b5-cea2-4bbe-933c-7dccd4e87e0f
                Copyright © © 2007 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 17 November 2006
                Date accepted : 01 April 2007
                Page count
                Figures: 4, Tables: 2, References: 16, Pages: 5
                Categories
                Subject: Clinical and Laboratory Investigations

                ScienceOpen disciplines: Oncology & Radiotherapy,Pathology,Surgery,Dermatology,Pharmacology & Pharmaceutical medicine
                Keywords: Setae,Lepidopterism,Contact dermatitis,Oak processionary caterpillar
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Pathology, Surgery, Dermatology, Pharmacology & Pharmaceutical medicine
                Keywords: Setae, Lepidopterism, Contact dermatitis, Oak processionary caterpillar

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