Loxoscelism Research Articles

ID: 329655 Stellate Ganglion Blocks to Treat CRPS and Neuropathy Caused by Brown Recluse Spider Bite

ID: 329655 Stellate Ganglion Blocks to Treat CRPS and Neuropathy Caused by Brown Recluse Spider Bite

Novel insights into the application of recombinant mutated phospholipases D as antigens for developing new strategies against Loxoscelism

Loxoscelism is the pathological condition triggered by a brown spider bite. The venom of these spiders is rich in phospholipases D (PLDs), which can induce virtually all local and systemic manifestations. Recombinant mutated PLDs from clinically relevant Loxosceles species in South America have been investigated as potential antigens to develop novel therapeutic strategies for loxoscelism. However, certain gaps need to be addressed before a clinical approach can be implemented. In this study, we examined the potential of these recombinant mutated PLDs as antigens by testing some variations in the immunization scheme. Furthermore, we evaluated the efficacy of the produced antibodies in neutralizing the nephrotoxicity and sphingomyelinase activity of brown spider venoms. Our findings indicate that the number of immunizations has a greater impact on the effectiveness of neutralization compared to the amount of antigen. Specifically, two or three doses were equally effective in reducing dermonecrosis and edema. Additionally, three immunizations proved to be more effective in neutralizing mice lethality than one or two. Moreover, immunizations mitigated the signs of kidney injury, a crucial aspect given that acute renal failure is a serious systemic complication. In vitro inhibition of the sphingomyelinase activity of Loxosceles venoms, a key factor in vivo toxicity, was nearly complete after incubation with antibodies raised against these antigens. These findings underscore the importance of implementing an effective immunization scheme with multiple immunizations, without the need for high antigen doses, and enhances the spectrum of neutralization exhibited by antibodies generated with these antigens. In summary, these results highlight the strong potential of these antigens for the development of new therapeutic strategies against cutaneous and systemic manifestations of loxoscelism.

The use of therapeutic plasma exchange in systemic loxoscelism induced treatment resistant hemolytic anemia: A case report

Brown recluse spider bites can lead to severe reactions such as skin necrosis,hemolytic anemia, and multiorgan failure, which can be life-threatening. Therapeutic plasma exchange has been reported to provide clinical benefit for such cases. In thisreport, we present a case of a brown recluse spider bite that was successfully treated with therapeutic plasma exchange and compare it with previous case reports.

Brown spiders (Loxosceles) are taking hold in Pernambuco, Brazil: a case series, 2018-2022.

To describe accidents involving brown spider (genus Loxosceles) bites notified by the Pernambuco Poison Information and Care Center (CIATox-PE), Brazil, from January 2018 to December 2022. This was a case series study of brown spider bites notified by the CIATox-PE. The study included 22 cases with median age of 35 years, the majority being female (13); the cases occurred in rural and urban areas (12 versus 10), at night (10); Petrolina was the municipality with the highest number of notifications (6); spider bites occurred mainly in the lower (11) and upper (9) limbs, almost exclusively inside households (21); specific serum therapy was not indicated for 8 cases because the time for its effectiveness had already elapsed. Loxoscelism cases occurred more frequently in females, in both rural and urban areas and mainly at home, with delays in seeking medical care. The 22 cases described represent an alert for the presence of a venomous species not reported in previous studies in Pernambuco. The severity of cases may be associated with delays in seeking medical care, especially due to the population's lack of information. Identify the presence of brown spiders in households in the region and the potential severity of poisonings. Alert health professionals to recognize the clinical picture with a view to appropriate early treatment. Develop research on poisoning by venomous animals and educational actions alerting the population to prevent these accidents and updating health professionals on care.

A Nocardia brasiliensis Infection Secondary to a Loxosceles reclusa Bite: A Spinal Cord Stimulation Case Report

Background: Nocardia brasiliensis, an uncommon human pathogen, is rarely seen in infections secondary to insect bites or stings. However, Nocardia brasiliensis can infect an individual through an ulcerative wound, such as one mediated by the phospholipase D toxin immune response following a Loxosceles reclusa (i.e., brown recluse spider) bite. Case Report: This report presents the case of a patient who underwent a spinal cord stimulator (SCS) trial with an unknown brown recluse spider bite on her left foot. We describe the Nocardia brasiliensis cutaneous infection following a brown recluse bite and the effective management of the infection through long-term antibiotic use, which allowed for the eventual successful implantation of the SCS. Conclusion: The present case urges health care providers to conduct thorough, full-body examinations prior to any surgical procedure to identify and treat all remote infections prior to SCS implantations, as advised by the Neurostimulation Appropriateness Consensus Committee’s recommendations for infection prevention. Key words: Nocardiosis, Loxosceles reclusa, Nocardia brasiliensis, spinal cord stimulation, case report

Brown Recluse Spider Bite: A Case Report of Severe Hemolysis and Sepsis

Abstract Introduction/Objective The brown recluse spider, Loxosceles reclusa, is commonly found in the southern and central United States and is known for its venomous bite. It has six eyes, uniformly colored abdomen and legs, is around 1 cm in length and prefers to live in warm, dark and dry places. Its bite in humans can cause skin necrosis as well as more severe manifestations including acute hemolytic anemia, disseminated intravascular coagulation (DIC), rhabdomyolysis and renal failure. Methods/Case Report We present a case report of a 27 year old male with no known past medical history who was referred from another medical center with a critical hemoglobin of 3.6 g/dl and acute hemolytic anemia that was not responsive to packed red blood cell transfusion and intravenous immunoglobulin treatment. He reported of having bitten by a brown recluse spider 8 days ago on the right scapular region. He started developing wound and pain in the area 2 days later when he was admitted to the hospital for a day and treated with antibiotics. His white blood cell count (WBC) at the time was mildly elevated with near normal hemoglobin and was incidentally found to have COVID 19 positivity. After being discharged, he developed fever with chills, dark urine, body ache, headache, nausea and vomiting. When presented to our hospital, laboratory review exhibited normocytic normochromic anemia with elevated bilirubin and decreased haptoglobin showing a hemolytic picture. The patient also displayed severe leukocytosis (WBC count: 53.50) with absolute neutrophilia, lymphocytosis, and monocytosis. Monocyte distribution width (MDW) was 30.02. These changes were attributed to be reactive to venom effect and sepsis. The patient showed significant improvement with plasmapheresis. Results (if a Case Study enter NA) NA. Conclusion The diagnosis of systemic loxoscelism is often difficult and delayed. Brown recluse spider bites may not always present with sharp stings to be noticed and reported by the patient. Presence of another infectious condition, like COVID 19 in this case, may divert the diagnosis. An elaborate patient history, physical examination for bite wound and patient education may help in identifying the cause early. Spider bites should be considered as a differential diagnosis in a patient with dermonecrosis and abrupt onset hemolysis or sepsis. Prompt treatment can prevent development of DIC, renal failure and life threatening conditions.

Systemic loxoscelism induced warm autoimmune hemolytic anemia: clinical series and review

ABSTRACT Objectives Describe the development of warm autoimmune hemolytic anemia warm (AIHA) secondary to a brown recluse spider (Loxosceles reclusa) bite is known as systemic loxoscelism; and review epidemiology, clinical manifestations, diagnostic work-up, pathophysiology, and treatment options associated with warm AIHA secondary to systemic loxoscelism. Methods Cases series of two cases of warm AIHA due to systemic loxoscelism and a review of the current literature: epidemiology, clinical manifestations, diagnostic work-up, pathophysiology, and treatment options associated with warm AIHA secondary to systemic loxoscelism. Results Presented here are two cases of warm AIHA due to systemic loxoscelism. Each patient was generally healthy appearing and presented with symptomatic anemia in the setting of brown recluse spider bites. Both patients were eventually found to have warm AIHA. Upon recognition of the diagnosis, the patients were started on corticosteroids and aggressive intravenous fluid hydration. In addition, they received transfusions of packed red blood cells. Their clinical courses improved, and they recovered to eventually be discharged home. Conclusion Envenomation by a brown recluse spider, Loxosceles reclusa, can result in systemic loxoscelism which can cause warm AIHA. The diagnosis of warm AIHA is confirmed by the direct antiglobulin/Coomb's test. Warm AIHA can be a life-threatening disease process. Hemodynamic support with intravenous fluids and RBC transfusion is the initial step in the management of these patients. Corticosteroids are the mainstay of current management. Second line treatments include rituximab. Rarely patients require splenectomy for refractory disease. Corticosteroids should be tapered over a three-month period.

Lymphedema as Consequence of Loxosceles Brown Spider Bite: A Case Report and Literature Review

Introduction: Secondary lymphedema is defined as a chronic-progressive disease that causes rich protein edema of the limbs, this may be caused due to the damage or obstruction of lymphatic structures; complications associated with loxosceles spider bite may cause damage to the lymphatic system.
 Objective: To describe the clinical case of a patient with lower extremity lymphedema secondary to loxosceles' spider bite complications and to present a literature review on the topic.
 Case Presentation: A 24-year-old man received previous medical attention between 2020-and 2021 due to complications of a loxosceles brown spider bite. He arrived at our facilities in January 2022 to assess his case related to progressive volume leg increase and a chronic wound in the bitten site. After the clinical history analysis, physical examination, and a near-infrared lymphography study of the leg, damage to lymphatic structures was identified; secondary lymphedema was confirmed. It was possible to reverse and control the lymphedema volume and the wound evolved to complete closure. The case is presented along with a literature review on the topic.
 Conclusion: It is presented a case of lymphedema associated with a loxosceles brown spider bite, and successfully treated. Lymphedema related to a loxosceles spider bite and its complications is a clinical reality that might be underrecognized by scientific literature and clinicians; this condition should be properly studied and considered with adequate assessment strategies in patients after suffering the spider bite in extremities, especially in the mid and long-term.

Delayed Endothelial Immune Ring after Brown Recluse Spider Bite

Left brow eschar after 8 days (inset). Initial treatment was a tetanus shot and doxycycline for 1 week. Four weeks after the incident, the patient developed redness, discomfort, and blurred vision in his left eye presenting with central corneal swelling and an endothelial immune ring, without evidence of spider hair(s). Tobramycin/dexamethasone drops were used 3 times per day and tapered over 2 months with improvement after 1 week and complete resolution thereafter. We hypothesize that the (spider) antigen was introduced into the pericentral stroma via a fine spider hair (Magnified version of Figure is available online at www.aaojournal.org).

Laboratory Predictors of Hemolytic Anemia in Patients With Systemic Loxoscelism.

To develop a sensitive and specific protocol for detecting preclinical hemolysis in patients with brown recluse spider (BRS) bites by comparing a large cohort of individuals with brown recluse spider (BRS) bites with and without hemolytic anemia. A cross-sectional, retrospective analysis of clinical features and laboratory values, including urinalysis (UA) and peripheral blood results, and timing of positive laboratory values prior to a significant drop in hematocrit was performed to evaluate effective predictors of clinically significant hemolysis. In total, 275 patients with BRS bites were identified (64 with hemolytic anemia). Sensitivity and specificity of UA positive for blood (with and without microscopic hematuria) for detecting hemolysis were 72% and 75%, respectively. The combination of elevated serum total bilirubin (TB) and lactate dehydrogenase (LDH) had greater sensitivity (94%) and specificity (91%) for detecting patients developing hemolysis. When TB and LDH were evaluated prior to a significant decrease in hematocrit, they were positive in 82% of cases, while UA was positive for blood prior to a hematocrit decrease in 38% of cases. Serum TB and LDH levels are more effective at detecting preclinical hemolysis than UA and should be serially analyzed to triage patients with BRS bites before life-threatening hemolysis occurs.

Atypical systemic and dermatologic loxoscelism in a non-endemic region of the USA

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.

Cutaneous necrosis following brown recluse spider bite

Cutaneous necrosis following brown recluse spider bite

Loxoscelismo cutáneo-viscero-hemolítico con fallo renal agudo

The Loxoscelism is caused by the bite of spider Loxosceles laeta gender, of worldwide distribution. The poisoning can cause lesions dermonecrotic and less frequently a systemic illness that can be fatal.The mechanism of venom action is multifactorial. The characteristic dermonecrotic lesion results from the direct effects of the venom on the celular and basal membrane components , as well as the extracelular matrix.The initial interaction between the poison and tissues, causes complement activation , migration of polymorphic neutrophils, liberation of proteolytic enzymes, cytoquines, aggregation platelet, and blood flow alterations that result in edema and ischemia, with development of necrosis. There is no a definitive treatment for loxoscelism. However, the value of specific antivenom, to decrease lesion size and limit systemic illness even when such administration is delayed. We present a case of cutaneous-visceral loxoscelismo with unfavorable evolution.

Acute Cutaneous Necrosis: A Guide to Early Diagnosis and Treatment.

Acute cutaneous necrosis is characterised by a wide range of aetiologies and is associated with significant morbidity and mortality, warranting complex considerations in management. Early recognition is imperative in diagnosis and management of sudden gangrenous changes in the skin. This review discusses major causes of cutaneous necrosis, examines the need for early assessment, and integrates techniques related to diagnosis and management. The literature, available via PubMed, on acute cutaneous necrotic syndromes was reviewed to summarise causes and synthesise appropriate treatment strategies to create a clinician's guide in the early diagnosis and management of acute cutaneous necrosis. Highlighted in this article are key features associated with common causes of acute cutaneous necrosis: warfarin-induced skin necrosis, heparin-induced skin necrosis, calciphylaxis, pyoderma gangrenosum, embolic phenomena, purpura fulminans, brown recluse spider bite, necrotising fasciitis, ecthyma gangrenosum, antiphospholipid syndrome, hypergammaglobulinemia, and cryoglobulinemia. This review serves to increase recognition of these serious pathologies and complications, allowing for prompt diagnosis and swift limb- or life-saving management.

NOT RECLUSE—A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites

NOT RECLUSE—A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites

Potential Implications for Designing Drugs Against the Brown Spider Venom Phospholipase-D.

Loxoscelism refers to the clinical symptoms that develop after brown spider bites. Brown spider venoms contain several phospholipase-D isoforms, which are the main toxins responsible for both the cutaneous and systemic effects of loxoscelism. Understanding of the phospholipase-D catalytic mechanism is crucial for the development of specific treatment that could reverse the toxic effects caused by the spider bite. Based on enzymatic, biological, structural, and thermodynamic tests, we show some features suitable for designing drugs against loxoscelism. Firstly, through molecular docking and molecular dynamics predictions, we found three different molecules (Suramin, Vu0155056, and Vu0359595) that were able to bind the enzyme's catalytic site and interact with catalytically important residues (His12 or His47) and with the Mg2+ co-factor. The binding promoted a decrease in the recombinant brown spider venom phospholipase-D (LiRecDT1) enzymatic activity. Furthermore, the presence of the inhibitors reduced the hemolytic, dermonecrotic, and inflammatory activities of the venom toxin in biological assays. Altogether, these results indicate the mode of action of three different LiRecDT1 inhibitors, which were able to prevent the venom toxic effects. This strengthen the idea of the importance of designing a specific drug to treat the serious clinical symptoms caused by the brown spider bite, a public health problem in several parts of the world, and until now without specific treatment. J. Cell. Biochem. 118: 726-738, 2017. © 2016 Wiley Periodicals, Inc.

(207) Complex regional pain syndrome caused by necrotic arachnidism after a brown recluse spider bite: a case report

(207) Complex regional pain syndrome caused by necrotic arachnidism after a brown recluse spider bite: a case report

Severe Hemolysis in Systemic Loxoscelism

Introduction: Brown recluse spider bites are encountered commonly in endemic areas of North and South America. Loxosceles reclusa is the species of Loxosceles most commonly seen in the states of MO, KS, OK, TX, AK, LA, KY, TN, MS, AL and parts of IL, IA, IN and GA. The incidence of hemolytic anemia with systemic loxoscelism in the USA seems to be significantly higher and more severe than the incidence and severity reported in studies from South America (13%-15% incidence). In our 6 cases of loxoscelism associated with severe hemolysis, we noticed that there are signs and symptoms that could be helpful to guide the follow up and facilitate early diagnosis.Method: We reviewed 6 cases of hemolytic anemia from Loxoscelism treated at the University of Missouri Hospitals. Of these 6 cases 4 were treated within 1 year. All of the cases presented with systemic and cutaneous manifestations. Each patient was initially treated symptomatically and discharged without a close follow up. This resulted in delayed presentations with symptoms of severe hemolytic anemia associated with significant morbidity [Syncope (1), Syncope with fracture (1), Hypotension needing ICU care (1), Necrotizing fasciitis (1), and severe hepatosplenomegaly with hyperbilirubinemia (1)]. We have summarized the systemic symptoms, peripheral blood smear and laboratory findings that correlate with hemolytic anemia.Results:Patients presented with Nausea (6/6), Vomiting (5/6), Fever (5/6), and Target lesion (6/6) within 48 hours after spider bite [Table 1]. Severe hemolysis developed at a median of 6.5 days after the spider bite. DAT was positive for IgG and C3 in all of the cases. Peripheral smear findings included leukocytosis with toxic granulations, Dohle bodies and left shift, Nucleated RBC, anisopoikilocytosis with some schistocytes, hemophagocytosis and normal to decreased platelets [Figure 1] [Figure 3]. When not recognized patients presented with sudden and severe hemolysis (median drop in Hb =7.5 g/dL) [Table2] resulting in hospitalization with severe morbidity (Figure 2).Table 1Initial PresentationSignificant MorbidityPatient 1Nausea and vomiting. Fever. Diffuse rash, RUQ pain Target lesion on backSevere Jaundice Hepatomegaly SplenomegalyPatient 2Nausea, vomiting and diarrhea. Fever Target lesion on left armSyncope Ankle fracturePatient 3Nausea, fatigue and malaise. Target lesion on right backRecurrent syncopePatient 4Nausea, Vomiting Fever Target lesion right arm.Severe Hypotension ICU carePatient 5Nausea, dry heaves Fever. Thigh pain Target lesion right thigh.Necrotizing fasciitis FasciotomyPatient 6Nausea, vomiting and fatigue. Fever. Target lesion right shoulder. [Display omitted] [Display omitted] [Display omitted] Table 2Patient 1Patient 2Patient 3Patient 4Patient 5Patient 6MedianAge34312125212223.5Days after bite to lowest Hemoglobin8566796.5Baseline Hb (g/dL)1112151313.815.713.4Lowest Hb (g/dL)5.74566.68.45.85MCV with lowest Hb (fL)701071009096.610198.3WBC (103/µL)12.64232.314.533.426.629.45Platelets (103/µL)16014123464261576197LDH (unit/L)hemolysed20809511348744346951T. Bili (mg/dL)35.413.251.83.77.4D. Bili (mg/dL)>109.2.3.50.31.4Ind. Bili (mg/dL)3.94.7AST (unit/L)1005225201120156ALT (unit/L)86951991104294Alk phos (unit/L)94886736160159Blood groupA PosA PosO PosB PosO PosDiscussion: Systemic loxoscelism from Loxosceles reclusa in USA is associated with a high incidence of severe hemolytic anemia. Increased awareness of the delayed presentation with hemolysis after initial signs of systemic loxoscelism could avoid life threatening events. Initial symptoms developed within 48 hours of the spider bite and led to medical attention in all of the reported cases.With appropriate follow up, peripheral smear review and labs at 5-7 days after the spider bite most of the cases would have been recognized early and could have potentially avoided life threatening complications.The different species of Loxosceles prevalent in South America could explain the difference in the incidence of hemolytic anemia. Studies from Brazil have reported the use of antivenom in about 50% of loxoscelism cases. Effectiveness of antivenom is not established and is seldom used in the USA but, could account for some differences in the incidence of hemolysis. DisclosuresNo relevant conflicts of interest to declare.

A randomized controlled trial of trypsin to treat brown recluse spider bites in Guinea pigs.

Brown recluse spider bites result in necrotic skin lesions for which there is no known antidote. Since venom toxins are proteins, a proteolytic enzyme like trypsin might be effective in reducing toxicity. The aim of this study was to conduct a randomized controlled trial of trypsin to treat brown recluse spider bites in guinea pigs. Subjects were 18 female guinea pigs. Anesthesia for injections was inhaled isoflurane. Analgesia was 0.05mg/kg of buprenorphine twice a day as needed. Intervention was intradermal injection of 30μg of brown recluse venom (Spider Pharm, Yarnell, AZ). Immediately after envenomation, subjects were randomized to two groups of nine: trypsin 10μg in 1mL normal saline and 1mL of normal saline. The primary outcome was lesion area over a 10-day time period. Statistical analysis was performed with repeated measures ANOVA. Mean lesion area was smaller but not statistically different in the placebo group. Maximum lesion size occurred at day 4 in both groups, when lesion area was 76.1 ± 108.2mm(2) in the placebo group and 149.7 ± 127.3mm(2) in the treatment group. P value was 0.15 for placebo vs. treatment. This study did not establish a role for trypsin as a treatment for brown recluse spider bites in a guinea pig model.

Brown Recluse Spider Bite: A Consideration in the Differential Diagnosis for Labial Swelling

The brown recluse spider (BRS), Loxosceles reclusa, is endemic to the Midwestern and southern United States. BRS venom can cause significant local necrosis and systemic hemolysis, especially in children. The majority of documented brown recluse spider bites (BRSBs) are located on extremities. We present a rare case of a BRSB involving the labia minora, confirmed by ELISA testing.