Outbreak of lepidopterism at a Boy Scout camp

doi:10.1016/j.jaad.2006.06.002

Journal of the American Academy of Dermatology

Volume 56, Issue 6, June 2007, Pages 952-955

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Background

Lepidopterism refers to moth- or butterfly-associated illness, including contact dermatitis, urticaria, and occasional systemic reactions. Lepidopterism outbreaks are rare.

Objective

To investigate a lepidopterism outbreak associated with caterpillars of the Douglas-fir tussock moth (DFTM; Orgyia pseudotsugata) among Boy Scouts attending summer camp in New Mexico.

Methods

Retrospective cohort analysis; environmental investigation.

Results

Attendees were primarily male (100/107; 94%) and less than 18 years old (82/107; 77%). Itch, rash, or hives were reported by 56 of 102 (55%) of campers. Patients were more likely to report direct caterpillar contact (relative risk [RR]: 2.7; 95% confidence interval [CI], 1.3-5.5); playing a caterpillar-flicking game (RR: 1.9; 95% CI, 1.1-3.4); and sleeping at campsite 6, where caterpillars were most numerous (RR: 1.7; 95% CI, 1.3-2.4). All patients recovered.

Limitations

Data on disease status and risk factors were collected retrospectively.

Conclusion

Modifying behaviors associated with lepidopterism and avoiding areas of heavy infestation can reduce illness risk.

Section snippets

Methods

We formed a retrospective cohort of persons present at the camp between June 24 and July 30, 2000, by reviewing Boy Scout attendance records. A case was defined as self-reported onset of rash, itch, or hives while at the camp in a person who had been asymptomatic upon arrival.

Initial confirmation of an outbreak was performed by reviewing the camp's infirmary log to identify campers who had been treated there for rash, itch, or hives. A patient could only be counted once in this analysis, and

Confirmation of outbreak

The camp operated 4 separate week-long sessions (Fig 1) during the course of 5 calendar weeks. The majority (41/56; 73%) of initial patient visits to the infirmary for rash, itch, or hives occurred during session 3, which the index patient had attended. On the basis of this epidemic curve, we sent the written questionnaire to session 3 participants to investigate illness onset and risk factors in greater detail.

Session 3 analysis: Written questionnaire

A total of 125 persons were present at the camp during session 3. The questionnaire

Discussion

Epidemiologic and environmental data demonstrated that this outbreak of lepidopterism was caused by exposure to DFTM caterpillars. Risk factors for onset of rash, itch, or hives included campsite, which probably reflected variation in caterpillar density, and both passive contact (eg, finding a caterpillar on one's skin) and active contact (eg, playing the caterpillar-flicking game).

Outbreaks of lepidopterism caused by DFTM are rare. Our investigation was aided by the remote nature of the

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Epidemics of dermatitis from this caterpillar have been reported in Massachusetts, Connecticut, and Pennsylvania.14-16 Outbreaks of the Douglas-fir tussock moth caterpillar (Orgyia pseudotsugata) in the Pacific Northwest have caused several epidemics of papular urticaria amongst loggers,17,18 and more recently in a Boy Scout camp in New Mexico.19 In Venezuela, Hylesia moths may be so prevalent that schools and shops are closed early, and farmers and fisherman are unable to work because of a fear of rash and incapacitating itch.20

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A closely related caterpillar, the Douglas-fir tussock moth (O pseudotsugata) can be very common on conifer trees in the late spring in the Pacific Northwest United States.48-50 Contact with these caterpillars causes welts or papular urticaria, although sometimes dermatitis occurs.50-52 Some series describe the eruption as simply “rash” or “itch.”51

Caterpillars and moths (order Lepidoptera) are uncommonly recognized causes of adverse cutaneous reactions, such as localized stings, papular dermatitis, and urticarial wheals. These reactions are typically mild and self-limited; however, in South America, the sting of Lonomia caterpillars can cause a potentially fatal hemorrhagic diathesis related to massive fibrinolysis. In addition, ocular inflammation and prominent arthralgias have been reported to be caused by caterpillar exposures. Therapies for mucocutaneous reactions to Lepidoptera are largely empiric, with the exception of antivenin against Lonomia obliqua envenomation. Part II of this two-part series on caterpillars and moths reviews the varied symptoms caused by Lepidopteran exposures, reviews the differential diagnosis, and discusses appropriate treatment algorithms.

After completing this learning activity, participants should be able to recognize the most common species that cause caterpillar- and moth-related reactions, categorize the reactions based on the clinical manifestations, and choose the most appropriate therapy.
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The use of trade names is for informational purposes only and does not constitute endorsement by the Centers for Disease Control and Prevention. In addition, the findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Funding sources: None.

Conflicts of interest: None declared.

Presented as an oral presentation at the Centers for Disease Control Epidemic Intelligence Service Conference, Atlanta, GA, April 23-27, 2001.

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Report Outbreak of lepidopterism at a Boy Scout camp

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Methods

Confirmation of outbreak

Session 3 analysis: Written questionnaire

Discussion

Dermatol Clin

The evolving global epidemiology, syndromic classification, management, and prevention of caterpillar envenoming

Am J Trop Med Hyg

Caterpillar dermatitis

Clin Exp Dermatol

Douglas-fir tussock moth

Mortality of white fir following defoliation by the Douglas-fir tussock moth in California, 1957

US Pacific NW Region. Douglas- fir tussock moth: final environmental impact statement

Report
Outbreak of lepidopterism at a Boy Scout camp