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Bites of brown recluse spiders and suspected necrotic arachnidism
... Among the 11 Loxosceles species found in the USA, the brown recluse spider accounts for the majority of envenomation cases. 1 Brown recluse spider is commonly found in the southeast part of the United States of America (USA) and is rarely found in the Michigan area. [1][2][3] This spider is usually nonaggressive and bites only when provoked. ...
... Among the 11 Loxosceles species found in the USA, the brown recluse spider accounts for the majority of envenomation cases. 1 Brown recluse spider is commonly found in the southeast part of the United States of America (USA) and is rarely found in the Michigan area. [1][2][3] This spider is usually nonaggressive and bites only when provoked. 2,3 Though most of the bites are asymptomatic, rarely there can be severe cutaneous, hemolytic, and systemic manifestations. ...
... 2,3 Though most of the bites are asymptomatic, rarely there can be severe cutaneous, hemolytic, and systemic manifestations. 1,[3][4][5][6][7][8][9][10][11][12] The diagnosis is done based on clinical evaluation coupled with the identification of species. 1 So far, no case of deep vein thrombosis has been reported following a brown recluse spider bite. Herein, we present the rare case of recurrent deep vein thrombosis (DVT) following a brown recluse spider bite in the Michigan area. ...
Key Clinical Message
Clinicians should be aware of the occurrence of deep vein thrombosis following brown recluse spider bite.
... There is no diagnostic test available to quickly help the physician make a diagnostic or therapeutic decision, but a rapid diagnosis is crucial for satisfactory treatment [7], [12]. In the present paper, a case, which we presumed to be due to the bite of Loxosceles rufescens, is evaluated in the light of literature [13], [14], [15], [16], [17], [18], [19], [20], [21]. ...
... In fact, this skin plaque and ulceration can be also associated to different medical conditions, including bacterial diseases (for example, Staphylococcus aureus, Staphylococcus epidermidis, anthrax, syphilis, and tularemia), viral infectious diseases (Herpes simplex and Herpes zoster), parasitosis (Lyme's disease, sporotrichosis, aspergillosis, and mucormycosis), skin cancer, vascular or diabetic ulceration, adverse drug skin reactions, traumatic skin injury, and autoimmunitary diseases such as the "pyoderma gangrenosum" [18], [19], [22], [23], [24], [25], [26]. ...
... In these cases, is very helpful the consultation of other specialists such as a toxicologist, dermatologist and infectivologist. Some features of the skin lesion may be related to an insect bite, particularly a spider one [18], [27] (Figure 5). https://www.id-press.eu/mjms/index ...
BACKGROUND: The spiders of the Loxosceles genus, commonly denoted as “brown spiders” or “Mediterranean recluse” or “brown recluse,” belong to the spider family Sicariidae, suborder Labidognatha, order Araneida, class Arachnida, and phylum Arthropoda. This spider is widespread in Africa and South/Central America, but it is also distributed in North America, in the West Indies, in the Mediterranean Europe, and in China. CASE REPORT: Here, we report the case of a severe dermonecrotic loxoscelism identified in Southern Italy, probably due to the bite of Loxosceles rufescens. The patient was a women admitted at hospital ER because of a little skin erythema that evolved toward a severe necrosis and ulceration within 20 days. After clinical and laboratory data excluded other local and systemic diseases, she was treated with a systemic and local therapy using corticosteroids and antibiotics with the diagnosis of loxoscelism. The healing from the local skin lesion occurred within 2 months, but the local pain, weakness, and discomfort lasted for a long time. CONCLUSION: It is the fisrt time that a possible case of systemic loxoscelism with skin generalized urticaria is reported in Italy.
... Loxosceles reclusa (LR), commonly known as the brown recluse spider, is endemic to specific geographic areas. Most envenomations in North America occur in the south central United States, notably within the states of Missouri, Kansas, Arkansas, and Tennessee [1,2]. Misidentification of other spiders for LR, and misidentification of other skin lesions as LR bite sites, leads to clinical confusion [3]. ...
... The predicament of making the diagnosis of LR envenomation has been documented before in areas that are nonendemic [5]. One author has stated, "the unverified diagnosis of a spider bite in areas where LR spiders are nonendemic is insufficient proof of the local existence of brown recluse spiders … " [1]. ...
... The benefit of therapeutic plasma exchange has been demonstrated in recent case reports [16,17], and direct and indirect antibodies to platelets have been found in LX [18]. These series of reports supports the hypothesis that the syndrome of LX is an immunological and inflammatory storm triggered by the venom that may manifest as hemolysis, acute renal injury and DIC, but also with alternative immunological and inflammatory effects [1,2]. ...
Introduction
Loxosceles reclusa (LR), commonly known as the brown recluse spider, is endemic to the south central United States. We present a case of LR envenomation in a healthy adult male outside the usual geographic range, with atypical dermatologic and delayed, prolonged systemic loxoscelism (LX). This case demonstrates the importance of expanding the depth of knowledge of LR envenomations.
Case report
A previously healthy 27 year-old male presented to an emergency department (ED) in central Virginia two hours after a LR envenomation to his left proximal arm. He was treated with diphenhydramine and discharged on oral methylprednisolone for a 5-day taper. On post-bite Days 1 and 2, the patient developed subjective fevers, chills, arthralgias, and myalgias, followed by a blanching, pruritic, morbilliform rash throughout his trunk and lower extremities. Post-bite Day 3, the patient presented to the ED again because of marked erythema of face and the right lateral thigh, and posterior and anterior trunk. Vital signs and laboratory analysis were generally unremarkable. The patient was observed overnight, and discharged with a prescription for prednisone 60 mg per day. On post-bite Day 7, the patient noted a petechial rash on the palms and soles and returned to the ED with a fever of 102.6 °F, a heart rate of 130 beats per minutes, and systolic blood pressure ranging 80–90 mmHg. After considering this may be an atypical presentation of LX, corticosteroids were increased to methylprednisolone 1 mg/kg IV every 6 h. The patient’s condition slowly improved and he was discharged on post-bite Day 10. On post-bite Day 24, he had nearly complete resolution of skin findings.
Conclusions
LR envenomation can cause a variety of dermatological and systemic manifestations of toxicity. It is critical for toxicologists to be aware of the variety of presentations and findings to appropriately assess and treat LX.
... Presentamos 4 casos, de los cuales 2 tenían el conocimiento de haber sido mordidas por araña y 2 desconocían el animal con el que habían tenido el accidente. Sin embargo por la historia clínica y las características clínicas de la lesión, "placa marmórea o livedoide" (áreas intercaladas de palidez y equimosis) de bordes irregulares, bien definidos, circundada por eritema y edema indurado, dolorosa a la palpación [1,4,[9][10][11][12] , se pudo determinar el diagnósticode envenenamiento por Loxosceles. ...
... Con respecto al tratamiento para los pacientes con loxoscelismo debemos de recordar que existe una serie de eventos fisiopatológicos desencadenados por el veneno de Loxosceles y que son mediados por esfingomielinasas, proteasas, peptidasas, factores difusores, entre otros y que los antivenenos específicos son capaces de neutralizar; sin embargo en nuestro país no contamos con los mismos [9][10][11][12] . Es por ello que en nuestros 4 pacientes utilizamos tratamientos altenativos al antiveneno, con el objetivo de bloquear dichos eventos fisiopatológicos. ...
... Es por ello que en nuestros 4 pacientes utilizamos tratamientos altenativos al antiveneno, con el objetivo de bloquear dichos eventos fisiopatológicos. Se mantuvo una adecuada hidratación para prevención de la hemólisis, rabdomiólisis y nefrotoxicidad; dapsona para bloquear el paso de neutrófilos al tejido dañado y con ello disminuir la lesión dermonecrotica, los corticosteroides bloquearon la liberación de citoquinas y quimiocinas disminuyendo con ello la inflamación local y el daño tisular [1,9,11,13] . ...
La mordedura por araña del género Loxosceles produce dermonecrosis en el sitio de la lesión y complicaciones sistémicas secundarias a reacciones enzimáticas de su veneno, lo que aumenta la tasa de mortalidad. El objetivo es reportar cuatro casos de loxoscelismo atendidos en el Hospital General San Juan de Dios, donde los pacientes tuvieron una evolución satisfactoria a pesar de la inexistencia del antiveneno como manejo ideal de la toxicidad.
... Frequent bite locations include upper arm, thorax and inner thigh. 2 At the point of envenomation there is minimal pain, sometimes described as "just a pinch." Pain sometimes increases to moderate or severe levels within one to two days. ...
... Treatment of Loxosceles envenomation remains controversial. 2 Supportive care includes elevation of the wound, cleansing with soap and water, general wound care, tetanus vaccination, and monitoring for secondary bacterial infection. Systemic steroids are sometimes used to control pruritus and discomfort associated with widespread rash. ...
... There is no consistent evidence to recommend using dapsone to limit necrosis, and it can exacerbate hemolytic anemia in patients with G6PD defi ciency. 2 Antibiotics are rarely indicated unless a secondary cellulitis occurs. Surgical debridement is sometimes performed but has not been shown to consistently improve outcomes. ...
This case describes an unusual presentation of a woman with viscerocutaneous (VCT) loxoscelism and exanthematous pustulosis. Due to a complex presentation resembling sepsis and errant information, she was unnecessarily treated with multiple antibiotics and intravenous immunoglobulin (IVIG) which may have complicated her course. Given recent reports of quick progression and death from a similar presentation, it is imperative that clinicians be familiar with signs, symptoms and complications of VCT loxoscelism, which can include hemolysis and acute exanthematous pustulosis.
... The typical "brown recluse spider bite" patient often describes waking up with a small bump, red mark, or bite mark that progressively increases in size, soreness or pain, redness, and swelling with later development of a necrotic core (3)(4)(5)(6). Very few patients report seeing the spider bite them, let alone bring the spider in to confirm its species and instead are empirically diagnosed with a brown recluse spider bite (1,2,(7)(8)(9)(10). However, a strong effort by physicians who are experts on spider and other arthropod bites has vehemently rejected the notion that brown recluse spiders are causing these lesions (1,2,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). ...
... Very few patients report seeing the spider bite them, let alone bring the spider in to confirm its species and instead are empirically diagnosed with a brown recluse spider bite (1,2,(7)(8)(9)(10). However, a strong effort by physicians who are experts on spider and other arthropod bites has vehemently rejected the notion that brown recluse spiders are causing these lesions (1,2,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). They argue that spiders, by nature, are not aggressive and will not attack unless provoked and should thus always be found in one's close proximity. ...
... They argue that spiders, by nature, are not aggressive and will not attack unless provoked and should thus always be found in one's close proximity. Furthermore, physicians have reported brown recluse spider bites across the country, but the spiders have definitively been found only in a few states in the southern and central U.S. (7). Several studies have demonstrated that the number of diagnoses of spider bites far exceeds the actual number of brown recluse spiders (8)(9)(10). ...
... which is much more poisonous [6]. The initial bite of a brown recluse spider is typically painless, although some patients describe sharp pain or burning. ...
... Treatment for spider bites consists of cleansing of the site, analgesia for mild to moderate pain, and tetanus prophylaxis as appropriate. No consensus exists for treatments other than supportive care [6]. Collection and identification of the spider is paramount to establishing a diagnosis and allows for discernment of venomous potential. ...
A 63-year-old man presented with two days of palpable purpura over the right anterior shin and calf with notable point tenderness on the distal mid-calf without any palpable deep abnormality. Localized right calf pain worsened with walking and was associated with headache, chills, fatigue, and low-grade fevers. A punch biopsy of the anterior right lower leg showed necrotizing neutrophilic vasculitis of superficial and deep vessels. Direct immunofluorescence showed non-specific focal granular deposition of C3 within vessel walls. Three days after presentation, a live spider was found and microscopically identified as a male hobo spider. The patient suspected the spider arrived via packages shipped from Seattle, Washington. The patient was treated with a prednisone taper with full resolution of his cutaneous symptoms. Given the unilaterality of his symptoms and otherwise unexplained etiology, the patient was diagnosed with acute unilateral vasculitis secondary to hobo spider bite. Microscopic examination is required for identification of hobo spiders. Although not deadly, there have been several reports of cutaneous and systemic reactions resulting from hobo spider bites. Our case illustrates the importance of considering hobo spider bites in areas outside of their native regions, as they are known to travel in packaged items.
... Recommendations of early debridement are now contraindicated as it can lead to greater scarring and longer healing times. Several additional remedies have been recommended (e.g., hyperbaric oxygen, electrical shock, nitroglycerine), but none have been proven effective (Swanson and Vetter 2005) in part due to the lack of untreated control groups in any of the studies; additionally, withholding treatment in order to perform clinical research would be unethical. The leprosy drug, dapsone, was commonly used in loxoscelism cases but has been shown to be of little benefit (Elston et al. 2005); in addition, dapsone causes a drop in hemoglobin (similar to a loxoscelism sign), can be detrimental to those with glucose-6-phosphate dehydrogenase deficiency, and can induce methemoglobinemia. ...
... Conditions that have been or could be mistaken for loxoscelism (Modified fromSwanson and Vetter 2005) ...
... Recommendations of early debridement are now contraindicated as it can lead to greater scarring and longer healing times. Several additional remedies have been recommended (e.g., hyperbaric oxygen, electrical shock, nitroglycerine), but none have been proven effective (Swanson and Vetter 2005) in part due to the lack of untreated control groups in any of the studies; additionally, withholding treatment in order to perform clinical research would be unethical. The leprosy drug, dapsone, was commonly used in loxoscelism cases but has been shown to be of little benefit (Elston et al. 2005); in addition, dapsone causes a drop in hemoglobin (similar to a loxoscelism sign), can be detrimental to those with glucose-6-phosphate dehydrogenase deficiency, and can induce methemoglobinemia. ...
... Conditions that have been or could be mistaken for loxoscelism (Modified fromSwanson and Vetter 2005) ...
... La distribución de las arañas del género Loxosceles es amplia. La Loxosceles reclusa es la causante de la mayoría de los casos en Norteamérica [3][4][5][6][7][8][9][10][11][12] ...
Background:
Loxoscelism is an important public health problem in Chile and South America, due to the higher rate of cutaneous-visceral involvement. The diagnosis of loxoscelism is mostly clinical without established diagnostic criteria. There is little evidence to support any treatment used in this condition.
Aim:
To characterize the clinical features and epidemiology of loxoscelism among patients consulting at the Emergency and Dermatology Services of a clinical hospital between 2013 and 2017.
Material and methods:
Review of medical records of patients registered in the electronic clinical record system with a confirmed diagnosis of loxoscelism. Epidemiological, clinical, laboratory tests and treatment variables were analyzed.
Results:
We reviewed data from 200 patients. Ninety-four percent presented cutaneous loxoscelism and 5.5% cutaneous-visceral loxoscelism. Systemic symptoms were present in 73% of patients with cutaneous-visceral loxoscelism. Patients who developed systemic symptoms had an 18 times higher risk of developing cutaneous-visceral loxoscelism. Laboratory abnormalities were more common in patients with cutaneous-visceral loxoscelism. Not all patients with hematuria had cutaneous-visceral loxoscelism. Most patients required analgesia. Anti-loxosceles serum was not used in any patient.
Conclusions:
Many questions remain to be answered regarding the diagnosis and treatment of the disease. Studies are required to validate diagnostic criteria for loxoscelism, predictors for visceral involvement and response to treatment.
... La mayoría (excepto Atrax robustus) evitan el contacto con el hombre y poseen un aparato inoculador poco desarrollado para atacar a mamíferos de mayor tamaño. No obstante, sólo 30 microgramos de proteína contenidos en el veneno pueden producir desde síntomas locales leves, hasta la muerte en pacientes susceptibles (extremos de la vida o comórbidos) (7,8). A pesar de su importancia clínica y relativa frecuencia en la región, existe un subregistro importante debido a que no es objeto de vigilancia obligatoria, lo que dificulta la obtención de datos epidemiológicos confiables (9). ...
El loxoscelismo es un evento toxinológico relativamente frecuente en los países tropicales. A pesar de que la mayoría son autolimitados, hay casos que pueden tener consecuencias locales o sistémicas graves. Lamentablemente el desconocimiento y la limitación en estrategias diagnósticas y terapéuticas aún representan desenlaces adversos en pacientes susceptibles. El objetivo de este trabajo es presentar un caso clínico de loxoscelismo grave en un paciente VIH, destacando la correlación entre la presentación clínica con las características toxinológicas del veneno. Se trató de un paciente masculino de 48 años previamente sano y con hábitos sexuales de riesgo, quien presentó accidente arácnido grave, posterior a mordedura por araña de género Loxosceles; con posterior evolución tórpida, desarrollo de trombosis venosa profunda, aumento progresivo de las transaminasas hasta el rango de hepatitis y diagnóstico de novo de VIH confirmado con Elisa de cuarta generación. Es el primer reporte de caso de aracnidismo en contexto de infección por VIH que lleva a discutir sobre una posible respuesta diferencial de esta población al efecto del veneno de araña.
... These spiders appear to have a preference to bite on the trunk, thigh or arms, and the thigh is the commonest site [19,20]. In rare occasions, bites from brown recluse spiders can cause clinically important dermal necrosis and subsequent scarring [21]. Wound chronicity and pyoderma gangrenosum occur rarely this may be due to an unusually severe allergic reaction [22]. ...
... The lesions are characterized by necrotizing wounds that are dark blue-violet in colour and become indurated, leading to the formation of scar tissue (Chaim et al. 2011). The brown recluse, Loxosceles reclusa Gertsch & Mulaik, 1940, which is endemic to the United States remains as one of the better studied species of this genus (Swanson and Vetter 2005). ...
The presence of Loxosceles rufescens (Dufour, 1820), commonly known as the Mediterranean recluse spider, is recorded from Socotra Island (Yemen) for the first time. This originally circum-Mediterranean species is potentially harmful to humans, considering the strong cytotoxicity of the venom and the species often inhabiting human settlements. It has been shown that L. rufescens can easily be introduced to non-native areas with transported goods, and is hence an alien invasive species to nearly all other continents and many Islands. From the region, it was recorded from mainland Yemen, Saudi Arabia and the United Arab Emirates. We conducted a wide survey and recorded the species across the entire Island of Socotra, in both natural and artificial habitats.
... (24) For comparison purposes, adequate treatment in cases involving another relatively common spider in the region (25), Loxosceles. spp., contemplates: rest, ice, compression and elevation (RICE) (26)(27)(28), although wound care and surgical intervention may be needed in severe cases (this is recommended from 6 to 8 weeks after the bite to allow tissue healing). (26) Treatment and manifestations are different considering the toxins present in this venom, including phospholipase-D, metalloproteinases and hyaluronidases, which explain the possibility of necrosis and ulcers. ...
Introduction: Accidents involving spiders bites usually cause mild medical reactions that lead to local symptoms and, less commonly, systemic effects. The most medically significant spiders belong to the genera Latrodectus and Loxosceles. This paper presents a possible case of steatodism in a young woman and her pet.
Case description: 26-year-old female patient, who reports a clinical history characterized
by paresthesia, malaise, fever, diarrhea and a painful papule in the left cheek after being bitten by a spider. Immediately after being bit, the patient hit the spider with the back of her hand and it fell to the ground, where her dog swallowed it. The dog presented with vomiting and general discomfort after ingestion. Symptomatic therapy was given for comfort, and neither the patient nor the dog required antivenin therapy. Both evolved favorably.
Discussion: The relevance of this case is the involvement of two mammals (a human and
her dog) due to the accidental contact with a spider, possibly of the genus Latrodectus or
Steatoda.
Conclusion: Two possible cases of steatodism are described. Since spider bites are a relatively frequent reason for medical consultation in Colombia, it is important to diagnose and manage them properly.
... Loxoscelism tedavisinde temel basamak elevasyon, etkilenen uzvun immobilizasyonu, buz uygulanması, yara bakımı ve tetanoz profilaksisidir (17). Hiperbarik oksijen tedavisi, dapson, antihistaminikler (ör. ...
Loxosceles spiders can live in the household and have the potential to casus harm to human beings. Systemic signs and symptoms have rarely been reported on spider bites in the literature. We present a formerly healthy four-month- old girl applied to the hospital with complaints of irritability, swelling of the neck and suspected insect bite. The patient was admitted to the pediatric intensive care unit because of edema in the neck and scalp, with respiratory distress and impaired consciousness. Case was intubated, and emprical antibiotherapy started due to the coagulopathy, circulatory failure, CRP positivity. Empirical scorpion serum and snake serum was applied to the patient living in rural areas. Several days after the admittance, the family reported that they found a spider in the tent so the diagnosis of the case which developed a dermonecrosis around the bite zone was clarified. Dermonecrosis was debrided and followed-up. The patient was discharged without any apparent sequelae except for dermonecrosis after one month of hospitalization. We found it worthwhile to submit our case due to severe systemic findings and dermonecrosis due to spider stings which are rarely reported in the literature.
Key Words: Child, Dermonecrosis, Disseminated Intravascular Coagulation, Spider bite
... Loxoscelism tedavisinde temel basamak elevasyon, etkilenen uzvun immobilizasyonu, buz uygulanması, yara bakımı ve tetanoz profilaksisidir (17). Hiperbarik oksijen tedavisi, dapson, antihistaminikler (ör. ...
Loxosceles spiders can live in the household and have the potential to cause harm to human beings. Systemic signs and symptoms have rarely been reported on spider bites in the literature. We present a formerly healthy four-month-old girl applied to the hospital with complaints of irritability, swelling of the neck and suspected insect bite. The patient was admitted to the pediatric intensive care unit because of edema in the neck and scalp, with respiratory distress and impaired consciousness. Case was intubated, and emprical antibiotherapy started due to the coagulopathy, circulatory failure, CRP positivity. Empirical scorpion serum and snake serum was applied to the patient living in rural areas. Several days after the admittance, the family reported that they found a spider in the tent so the diagnosis of the case which developed a dermonecrosis around the bite zone was clarified. Dermonecrosis was debrided and followed-up. The patient was discharged without any apparent sequelae except for dermonecrosis after one month of hospitalization. We found it worthwhile to submit our case due to severe systemic findings and dermonecrosis due to spider stings which are rarely reported in the literature.
... Loxoscelism tedavisinde temel basamak elevasyon, etkilenen uzvun immobilizasyonu, buz uygulanması, yara bakımı ve tetanoz profilaksisidir (17). Hiperbarik oksijen tedavisi, dapson, antihistaminikler (ör. ...
... Several treatment protocols that have been proposed and tested for bites by L. intermedia include dapsone, corticosteroids, antibiotics, and antivenom. Dapsone limits neutrophil migration and infiltration at the site of the bite [14]; corticosteroids produce a potent anti-inflammatory effect [15]; and antibiotics prevent secondary infections [16]. However, this polytherapy is not completely effective in reducing skin lesions and restoring the affected tissue. ...
Background
Accidents caused by spiders of the genus Loxosceles constitute an important public health problem in Brazil. The venom of Loxosceles sp induces dermonecrosis at the bite site and systemic disease in severe cases. Traditional medicine based on plant-derived products has been proven to reduce the local effects of envenomation. The present study verified the healing effects of copaiba oil on lesions induced by the venom of L. intermedia.
Methods
Cutaneous lesions were induced on the backs of rabbits by intradermal injection of L. intermedia venom. Copaiba oil was applied topically 6 hours after injection; the treatment was repeated for 30 days, after which animal skins were removed and processed for histopathological analysis. Blood samples were also collected before and 24 hours after venom inoculation to measure the hematological parameters.
Results
Compared to the control group, the platelet count was reduced significantly in all groups inoculated with venom, accompanied by a decreased number of heterophils in the blood. The minimum necrotic dose (MND) was defined as 2.4 μg/kg. Topical treatment with copaiba oil demonstrated a differentiated healing profile: large skin lesions were observed 10 days after venom inoculation, whereas formation of a thick crust, without scarring was observed 30 days after venom inoculation. Histopathological analysis showed no significant difference after treatment. Nevertheless, the copaiba oil treatment induced a collagen distribution similar to control skin, in marked contrast to the group that received only the spider venom injection.
Conclusions
We conclude that copaiba oil may interfere in the healing process and thus propose it as a possible topical treatment for cutaneous lesions induced by L. intermedia venom.
... Many cases of localized wounds and infections have been erroneously attributed to envenomations by Loxosceles reclusa envenomation in the United States. 3 Numerous cases are reported in regions outside the L. reclusa habitat. 4 As yet, no reliable test has been marketed to distinguish actual Loxosceles reclusa envenomations from similar wounds. ...
We report an atypical course of a likely brown recluse spider bite in a 79-year-old male. The Rader scale and Loxosceles reclusa venom detection by ELISA provide supporting evidence for a loxoscelism diagnosis. Obtundation and myocardial infarction occurred following a drop in hemoglobin to 6.5g/dL. The rapid loss of blood volume was considered a significant etiologic factor for both the obtundation and myocardial infarction. The neurological symptoms reversed rapidly after packed red blood cell transfusion.
... Furthermore, different studies have shown that many arachnid accidents are reported in non-endemic regions, where spiders of the reported genus have never been found by entomologists [14][15][16]. In addition, many conditions of different etiologies (such as infection by Staphylococcus) bring out skin injuries similar to lesions caused by spider bites, leading to wrong diagnosis by clinicians [12,17]. ...
Diagnostic tests for arachnid accidents remain unavailable for patients and clinicians. Together with snakes, these accidents are still a global medical concern, and are recognized as neglected tropical issues. Due to arachnid toxins' fast mechanism of action, quick detection and quantification of venom is required to accelerate treatment decisions, rationalize therapy, and reduce costs and patient risks. This review aims to understand the current limitations for arachnid venom identification and quantification in biological samples. We benchmarked the already existing initiatives regarding test requirements (sample or biomarkers of choice), performances (time, detection limit, sensitivity and specificity) and their validation (on animal models or on samples from envenomed humans). Our analysis outlines unmet needs for improving diagnosis and consequently treatment of arachnid accidents. Hence, based on lessons from past attempts, we propose a road map for raising best practice guidelines, leading to recommendations for future progress in the development of arachnid diagnostic assays. Key Contribution: This review aims to assimilate past experiences on arachnid accident diagnosis and propose directions for future development of a diagnostic kit in this field. Unmet needs are outlined; test requirements are discussed; and a road map for arachnid diagnostic assay development based on best practice guidelines is proposed.
... Loxoscelism is a clinical picture of poisoning produced by Loxosceles spiders venom that has a considerable im- pact on the population living in the Americas, from the United States to Chile [1,2]. In countries such as Brazil, it is a serious public health problem, with a high number of cases reported annually, with some of them corre- sponding to fatal cases [3][4][5]. ...
Background
Loxoscelism is a severe human envenomation caused by Loxosceles spider venom. To the best of our knowledge, no study has evaluated the presence of antibodies against Loxosceles venom in loxoscelism patients without treatment with antivenom immunotherapy. We perform a comparative analysis for the presence of antibodies capable of recognizing Loxosceles venom in a group of patients diagnosed with loxoscelism and in a group of people without loxoscelism.
Methods
The detection of L. laeta venom, Sicarius venom and recombinant phospholipases D from Loxosceles (PLDs) in sera from people with loxoscelism (Group 1) and from healthy people with no history of loxoscelism (Group 2) was evaluated using immuno-dot blot, indirect ELISA, and Western blot.
Results
We found naturally heterophilic antibodies (IgG-type) in people without contact with Loxosceles spiders or any clinical history of loxoscelism. Either serum pools or single sera from Group 1 and Group 2 analyzed by dot blot tested positive for L. laeta venom. Indirect ELISA for venom recognition showed titles of 1:320 for Group 1 sera and 1:160 for Group 2 sera. Total IgG quantification showed no difference in sera from both groups. Pooled sera and purified IgG from sera of both groups revealed venom proteins between 25 and 32 kDa and the recombinant phospholipase D isoform 1 (rLlPLD1), specifically. Moreover, heterophile antibodies cross-react with PLDs from other Loxosceles species and the venom of Sicarius spider.
Conclusions
People without contact with the spider venom produced heterophilic antibodies capable of generating a cross-reaction against the venom of L. laeta and Sicarius spiders. Their presence and possible interference should be considered in the development of immunoassays for Loxosceles venom detection.
Electronic supplementary material
The online version of this article (10.1186/s40409-018-0155-x) contains supplementary material, which is available to authorized users.
... Eye pattern is the most reliable finding for identification of Loxosceles spp spiders, which are usually described as having 6 eyes arranged in 3 pairs (dyads) distributed in a U-shaped pattern in the anterior part of the cephalothorax. 1 In our experience, this pattern can be correctly visualized with dermoscopy, confirming the diagnosis at a patient's bedside (Fig 1, B). Additionally, dermoscopy can also help rule out Loxosceles spiders, as patients may bring in other types of spiders that are not harmful to humans (Fig 2, A), which can lead to overdiagnosis. ...
Loxoscelism-associated hemolytic anemia is a rare but critical complication of brown recluse spider bites. It may lead to various systemic manifestations, including jaundice, dark urine, and anemia-related symptoms, in addition to general loxoscelism symptoms such as skin lesions, fever, myalgia, nausea, and vomiting. Prompt diagnosis is crucial and requires recognizing typical laboratory findings such as low hemoglobin, elevated lactate dehydrogenase, reduced haptoglobin levels, and possibly a positive direct antiglobulin test. There is no definitive guideline for the treatment of loxoscelism-associated hemolytic anemia. we report a case of a 32-year-old female who developed severe Coombs-positive autoimmune hemolytic anemia following a brown recluse spider bite, with an improvement in hemoglobin levels and hemolysis indices after the administration of systemic corticosteroids.
Case:
We report the case of a previously healthy 51-year-old man who presented to our hospital after worsening clinical appearance of his left ring finger, despite antibiotics and previous surgical drainage for suspected abscess at an outside institution 3 weeks ago. He was admitted to our hospital for surgical debridement and decompression. After suspicion of cutaneous loxoscelism based on the clinical record and corticosteroid administration, the patient presented a favorable evolution.
Conclusion:
Cutaneous loxoscelism caused by a spider bite is present in Europe, mainly in the Mediterranean area, and should be considered in cases of skin infections which do not respond to antibiotics.
A previously healthy 14-year-old boy developed right-sided neck pain, tachycardia, a diffuse erythematous rash, and subjective fevers over 2 days. He sought medical attention in a local urgent care clinic, where he had a negative Sars-CoV-2 antigen test and was referred to the local emergency department (ED) for persistent tachycardia and further workup. After fluid resuscitation, his tachycardia was not improved, so he was admitted to the Pediatric Hospital Medicine Service. Physical examination showed large areas of erythema and erythroderma of multiple body sites, perioral sparing, increased erythema in flexor skin folds, posterior soft palate petechiae, and a white strawberry tongue. There was a small, tender lesion with surrounding erythema without discharge on his right neck thought to be a possible entry point for infection. Laboratory results showed thrombocytopenia, normal white blood cell count, normal hemoglobin concentration, absolute lymphopenia, and an elevated C-reactive protein (CRP) to 130 mg/L. He was started on intravenous fluids and antibiotics for a presumed infectious cause of the rash and laboratory findings. The next morning, an expanded diagnostic workup was undertaken including electrocardiogram, echocardiogram, ferritin, triglycerides, liver enzymes, lactate dehydrogenase (LDH), brain natriuretic peptide, coagulation studies, and fibrinogen. With treatment and supportive care, his tachycardia and energy improved, so he was discharged with oral antibiotics and follow-up with the Infectious Disease Clinic in 2 days. When seen in follow-up, he was immediately admitted to the hospital for worsening fatigue, tachycardia, and new findings that prompted multiple consultations, and transfer to pediatric critical care services.
Diagnostic tests for brown spider accidents are unavailable and impact treatment decisions, increasing costs and patient risks. In this work, we used for the first time a fast, simple, and visual method based on the loop-mediated isothermal amplification assay (LAMP) to detect Loxosceles envenomation. Using the DNA from L. similis legs, we observed a high sensitivity using this test since as low as 0.32 pg of DNA could be detected. This pH-dependent colorimetric assay was 64 times more sensitive than PCR to detect spider DNA.
The test was specific for Loxosceles once no cross-reaction was observed when testing DNA from different agents that cause similar dermonecrotic injuries. The test allowed the detection of Loxosceles intermedia DNA from hair, serum, and exudate samples obtained from experimentally-envenomed rabbit within 72 h. The method sensitivity varied according to the sample and the collection time, reaching 100% sensitivity in serum and hair, respectively, 1 h and 24 h after the experimental envenomation. Due to its ease of execution, speed, sensitivity, and specificity, LAMP presents an excellent potential for identifying Loxosceles spp. Envenomation. This can reduce the burden on the Health System and the morbidity for the patient by implementing the appropriate therapy immediately.In addition, this work opens up the perspective to other venomous animal accident identification using LAMP.
Importance:
Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.
Objective:
The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.
Evidence acquisition:
Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.
Results:
Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.
Conclusions and relevance:
The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.
We describe a case of myocarditis associated with a brown recluse spider bite in a 31-year-old man. Cardiac MRI (CMR) revealed late gadolinium enhancement in the lateral wall and inferior wall. There was also regional elevation of the myocardial T2 and extracellular volume indicative of myocardial edema. (Level of difficulty: intermediate).
Dapsone is a sulfonamide derived antibiotic that is a mainstay of therapy for leprosy and Pneumocystis jirovecii infection. This chapter will however focus on its use in numerous inflammatory skin diseases. Dapsone is highly effective in the management of inflammatory dermatosis with a predominant neutrophilic infiltrate, such as dermatitis herpetiformis. Although dapsone has many pharmacologic and idiosyncratic adverse events, a complete understanding of the drug's pharmacology as well as proposed mechanisms of action, will allow the clinician to use maximize the therapeutic benefit of dapsone and minimize the likelihood of significant adverse events.
Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.
Loxoscelism is one of the most important forms of araneism in South America. The Health Authorities from countries with the highest incidence and longer history in registering loxoscelism cases indicate that specific antivenom should be administered during the first hours after the accident, especially in the presence or at risk of the most severe clinical outcome. Current antivenoms are based on immunoglobulins or their fragments, obtained from plasma of hyper-immunized horses. Antivenom has been produced using the same traditional techniques for more than 120 years. Although the whole composition of the spider venom remains unknown, the discovery and biotechnological production of the phospholipase D enzymes represented a milestone for the knowledge of the physiopathology of envenomation and for the introduction of new innovative tools in antivenom production. The fact that this protein is a principal toxin of the venom opens the possibility of replacing the use of whole venom as an immunogen, an attractive alternative considering the laborious techniques and low yields associated with venom extraction. This challenge warrants technological innovation to facilitate production and obtain more effective antidotes. In this review, we compile the reported studies, examining the advances in the expression and application of phospholipase D as a new immunogen and how the new biotechnological tools have introduced some degree of innovation in this field.
The genus Loxosceles comprises 140 species widely distributed around the world. These spiders are nocturnal, sedentary and remarkably nonaggressive, although they cause accidents in humans with wide degrees of severity, generating signs and symptoms that define the clinical condition known as loxoscelism. Its local signs and symptoms were first reported in 1872, and over the years, a large medical literature has been accumulated; unfortunately, it is not always trustworthy. Assessing the reliability of such information, we reviewed 120 case reports of loxoscelism published in 84 articles over the past 20 years. This search allowed us to gather information on the clinical aspects, diagnosis and treatment of loxoscelism, showing that the severity of these accidents has multiple degrees and that it is influenced by many factors. Thus, coupled with epidemiological and species occurrence information, this study can be a useful tool for the clinical practice of loxoscelism. It may support and provide a multidisciplinary view that should be taken into consideration when establishing the therapeutic approach in cases of Loxosceles envenomation.
Introduction:
Spiders, especially those of the genus Loxoceles such as L. rufescens, endemic in Mediterranean regions, are frequently reported as causes of venom poisoning in humans in the south of France. The most common signs consist of cutaneous necrosis presenting initially as inflammatory cellulitis and progressing towards the emergence of a necrotic centre.
Patients and methods:
We report 4 cases, initially considered as spider bites due to their sudden occurrence and pain. Rigorous clinical examination coupled with collection of samples for laboratory analysis ultimately enabled the diagnosis to be corrected to one of suppurative skin infection caused by Staphylococcusaureus producing the cytotoxin Panton Valentine leucocidin.
Discussion:
These observations highlight the potential for confusion between spider bites and infections with PVL-producing S. aureus.
Hyperbaric oxygen therapy (HBOT) is used in the management of a wide array of disease states, including acute thermal burn injuries, carbon monoxide poisoning, and decompression sickness, to name a few. Although HBOT is approved by the Undersea and Hyperbaric Medical Society for the treatment of only 14 conditions, it has been used "off-label" in the management of a variety of dermatological diseases. This review investigates the utilization of HBOT in dermatology and appraises the evidence behind its use. We focus on the role of HBOT in treating necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum.
Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb. After surgical intervention and suitable antifungal treatment, the patient was discharged with resolution of accompanying pulmonary disease. Infections due to S. vasiformis are probably underdiagnosed. To avoid fatal outcomes, a high index of clinical suspicion in patients with quickly progressive necrotic lesions of soft tissues and systemic dissemination is important.
There are relatively few venomous spiders of note and spider bite is very uncommon in small animal patients. Despite this, clinical diagnosis of spider bite is made on a frequent basis. Given the geographical distribution of venomous spiders and an understanding of the pathophysiology of spider bites, it is clear that most clinical diagnoses of spider bite are incorrect. Recluse spiders that can cause necrotic skin lesions are limited to very specific geographical regions. Clinicians working outside these regions should not consider venomous spider bite as a rule‐out for skin lesions. Scorpion envenomation can cause significant morbidity through autonomic dysfunction and neuromuscular stimulation. Scorpion stings are poorly described in small animal patients but have been reported and these animals are likely to require supportive medical care.
Envenomations are a particular type of toxic exposure resulting from human contact with biologic substances produced in specialized glands or tissues from animals, usually by cutaneous or transdermal injection. The poisoned pregnant woman poses particular challenges to the emergency room physicians, toxicology experts, and obstetrician. The emergency treatment and stabilization of the mother should take priority over the monitoring and treatment of the fetus. Up to a certain extent, although the pregnant patient goes through an acute episode of overdose or poisoning during pregnancy, the fetus might continue to be exposed to the toxic agent and environment, sometimes for several weeks. Poisoning during pregnancy represents one‐third of a percent of all toxic exposures reported in the United States. The chapter presents toxicology, short‐term problems, long‐term problems and maternal considerations for acetaminophen, amphetamines, antidepressants, carbon monoxide, cocaine, ethanol, iron and organophosphates.
The public in southern coastal South Carolina provided specimens of what they thought were brown recluse spiders (Loxosceles reclusa). None of the spiders were brown recluses confirming the absence of brown recluses in South Carolina despite the perception of bites from these spiders.
Introduction:
Climate change has been scientifically documented, and its effects on wildlife have been prognosticated. We sought to predict the overall impact of climate change on venomous terrestrial species. We hypothesize that given the close relationship between terrestrial venomous species and climate, a changing global environment may result in increased species migration, geographical redistribution, and longer seasons for envenomation, which would have repercussions on human health.
Methods:
A retrospective analysis of environmental, ecological, and medical literature was performed with a focus on climate change, toxinology, and future modeling specific to venomous terrestrial creatures. Species included venomous reptiles, snakes, arthropods, spiders, and Hymenoptera (ants and bees). Animals that are vectors of hemorrhagic infectious disease (eg, mosquitos, ticks) were excluded.
Results:
Our review of the literature indicates that changes to climatic norms will have a potentially dramatic effect on terrestrial venomous creatures. Empirical evidence demonstrates that geographic distributions of many species have already shifted due to changing climatic conditions. Given that most terrestrial venomous species are ectotherms closely tied to ambient temperature, and that climate change is shifting temperature zones away from the equator, further significant distribution and population changes should be anticipated. For those species able to migrate to match the changing temperatures, new geographical locations may open. For those species with limited distribution capabilities, the rate of climate change may accelerate faster than species can adapt, causing population declines. Specifically, poisonous snakes and spiders will likely maintain their population numbers but will shift their geographic distribution to traditionally temperate zones more often inhabited by humans. Fire ants and Africanized honey bees are expected to have an expanded range distribution due to predicted warming trends. Human encounters with these types of creatures are likely to increase, resulting in potential human morbidity and mortality.
Conclusions:
Temperature extremes and changes to climatic norms may have a dramatic effect on venomous terrestrial species. As climate change affects the distribution, populations, and life histories of these organisms, the chance of encounters could be altered, thus affecting human health and the survivability of these creatures.
We report the case of a young adult patient who presented bites by Loxosceles spider and its hatchlings with a history of importance of such allergy anaphylaxis severe by sulfa drugs and NSAIDs, generalized anxiety disorder, who presented initial torpid with new lesions even 15 days after the accident and despite having used several pharmacological alternatives reported in the literature as useful (colchicine, antihistamines, steroids, blood thinners, antibiotics) had not been answered, to the use of oxygen for hyperbaric chamber with which brake the appearance of new and improved reepithelialization injury without surgery, with successful evolution.
ANTECEDENTES:
el loxoscelismo es una intoxicación por la mordedura de la araña Loxosceles reclusa, cuyo veneno contiene esfingomielinasa-D, causante de hemólisis y necrosis. Se reporta una serie de casos que describen su evolución clínica y respuesta al tratamiento.
OBJETIVO:
describir la evolución y características clínicas de pacientes con loxoscelismo sistémico y dermonecrótico, su respuesta al tratamiento y las complicaciones.
PACIENTES Y MÉTODO:
estudio que incluyó el análisis descriptivo de pacientes tratados en el servicio de Medicina Interna, Unidad Médica de Alta Especialidad Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, de 2010 a 2015.
RESULTADOS:
se atendieron ocho hombres (67%) y cuatro mujeres (33%), con edad media de 39.4 años (16-83 años). El sitio de mordedura en cinco casos (42%) fue el miembro pélvico izquierdo; cuatro casos en el miembro torácico derecho (33%), dos en la cara (17%) y uno en el miembro torácico izquierdo (9%). Nueve casos provenían del Estado de México, dos de la Ciudad de México y uno de Hidalgo. Manifestación clínica: flictenas (cinco casos), edema y eritema (tres), placa liveloide (tres) y necrosis (un caso). Nueve (75%) pacientes se trataron inicialmente en la unidad de cuidados intensivos. Se reportaron las siguientes complicaciones sistémicas: renales (67%), pulmonares con administración de aminas (33%) y hematológicas (8%). Diez casos recibieron faboterápico, con media de 1.5 viales (0 a 4); cinco casos (42%) recibieron dapsona y cuatro de ellos (33%) padecieron metahemoglobinemia; once (92%) pacientes requirieron lavado-desbridación y 7 (58%) injerto cutáneo; cuatro pacientes (33%) tuvieron infección agregada de la herida. El promedio de estancia hospitalaria fue 16.2 días (3 a 40 días).
CONCLUSIÓN:
la evolución y pronóstico de esta afección depende de una sospecha inicial, diagnóstico y tratamiento oportunos. El loxoscelismo debe incluirse en los diagnósticos diferenciales de lesiones necróticas y progresivas, con o sin afección sistémica.
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