Loxoscelism Research Articles

Managing Arthropod Bites and Stings

Most arthropod bites and stings cause limited swelling, itching, Md pain, and redness and can be managed by ice application and tetanus prophylaxis as necessary. Stings by bees, wasps, and stinging ants can cause anaphylaxis that may require treatment with epinephrine and antihistamines and respiratory and cardiac maintenance measures. Widow spider bite management is controversial, but interventions for systemic reactions include calcium gluconate, methocarbamol, diazepam, narcotics, and antivenom. Victims of brown spider bites may need hospitalization if lesions enlarge rapidly or there are signs of systemic poisoning. Those stung by a bark scorpion may require oxygen, an intravenous line, pulse oximetry, and cardiac monitoring.

Clinical Presentation and Outcome of Brown Recluse Spider Bite

Study objective: To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites. Methods: We assembled a retrospective case series of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures were the need for skin grafting and the development of other complications. Results: The mean age of our subjects was 34±17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the remaining 76 (68%). Most wounds (59%) involved the leg. At the time of presentation, 81% had central discoloration and 37% necrosis. Sixteen patients (14%) were systemically ill, and 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infrequently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interval, 1% to 8%) required skin grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy; neither patient was taking dapsone. No deaths or serious complications occurred in our study group. Conclusion: In our series, long-term outcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majority of bites heal with supportive care alone, aggressive medical therapy does not appear warranted. [Wright SW, Wrenn KD, Murray L, Seger D: Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med July 1997;30:28-32.]

Brown Recluse Spider Bite

In Brief The case of a young man with a chronic, resistant, and unpredictable wound is described. The wound is believed to have been caused by the bite of a brown recluse spider. This article presents a brief overview of the potential sequelae of brown recluse spider bite and a pictorial review of this young man's wound during a 22-month period. A unique, complex lesion associated with a brown recluse spider bite and complicated by chronic venous sufficiency is described.

Brown recluse spider bite: A case study

The case of a young man with a chronic, resistant, and unpredictable wound is described. The wound is believed to have been caused by the bite of a brown recluse spider. This article presents a brief overview of the potential sequelae of brown recluse spider bite and a pictorial review of this young man's wound during a 22-month period.

Brown recluse spider envenomation: a prospective trial of hyperbaric oxygen therapy.

Loxosceles reclusa (brown recluse) spider bites can produce severe skin lesions that may necessitate extensive surgical repair. This study delineated the effects of hyperbaric oxygen (HBO) therapy on these lesions by performing a prospective controlled animal study. After approval by the Institutional Animal Care and Use Committee, 41 New Zealand white rabbits received 64 intradermal injections of 73 microL of raw venom extract mixed with physiologic buffered saline (Dulbecco's solution). Control injections were made with buffer. The animals were divided into 5 groups: 1) venom and no HBO; 2) venom and 1 immediate HBO treatment (100% O2); 3) venom and immediate HBO with 10 treatments (100% O2); 4) venom and then delayed (48 hr) HBO therapy with 10 treatments (100% O2); and 5) venom and immediate hyperbaric treatment with normal inspired PO2 for 10 treatments (8.4% O2). Three animals in group 2 also received a control sodium citrate buffer injection. HBO treatments were at 2.5 atm absolute (ATA) for 90 minutes twice daily. Daily measurements were made of the lesion diameter, and skin blood flow using a laser Doppler probe. There was no significant effect of HBO on blood flow at the wound center or 1-2 cm from the wound center. Standard HBO significantly decreased wound diameter at 10 days (p < 0.0001; ANOVA), whereas hyperbaric treatment with normoxic gas had no effect. Histologic preparations from 2 animals in each group revealed that there were more polymorphonuclear leukocytes in the dermis of all the HBO-treated animals when compared with the venom-alone and sodium-citrate controls. HBO treatment within 48 hours of a simulated bite from L. reclusa reduces skin necrosis and results in a significantly smaller wound in this model. The mechanism appears unrelated to augmented local blood flow between treatments.

A Case Study of Brown Recluse Spider Bite

ABSTRACT A case study involving a brown recluse spider bite demonstrates the role of a community pharmacist in modifying the therapeutic plan so as to result in a successful clinical outcome. This case illustrates the ongoing contribution of pharmacists to early diagnosis, implementation of appropriate therapeutic measures, and effective teamwork with the physician. In addition, the successful management of the case suggests that a targeted, well-designed continuing education program can help the pharmacist keep up with the latest developments in pharmaceutics and pharmacotherapy.

Management of the Brown Recluse Spider Bite to the Glans Penis

A significant number of people are bitten by the brown recluse spider (BRS) each year. Medical treatment regimens are sometimes unsatisfactory and surgical intervention is often necessary to debride the necrotic wound. This case study reports the treatment given to a 19-year-old active duty United States Army soldier who suffered a BRS bite to the glans penis. This patient received immediate medical attention and was started on intravenously administered diphenhydramine, methylprednisolone, calcium gluconate, and famotidine. Oral dapsone treatment was begun in the emergency room. Within 24 hours after his injury, the patient received his first hyperbaric oxygen treatment, which was continued twice daily for 5 days. Skin necrosis was avoided, the patient did not require any surgical intervention, and he was discharged after 8 days without sequelae.

Wound assessment of the Loxosceles reclusa spider bite

The purpose of this study was to determine the data that are most important for nurses to recognize in the assessment of a Loxosceles reclusa (brown recluse) spider bite. Given such assessment elements, it may be possible to decrease the severity of complications and complexity of care by providing the most appropriate therapy. This study involved a retrospective review of 39 identified patient charts. Aspects that were examined included demographics, wound assessments, and outcome data. Patients who came to the study facility within 48 hours of the bite and whose diagnosis was a probable or possible brown spider bite met inclusion criteria. Data analysis revealed that the majority of patients sustained bites on the extremities and that those bites produced the most commonly noted symptoms. This is the first study in which specific local and systemic symptoms have been quantified and related to the wound area. Because of varied treatment and limited follow-up, determining the relationship between wound assessment and outcome was problematic. Ongoing studies, in contrast to retrospective review, are needed to reduce the limitations of this study, such as the loss of patients to follow-up. Areas for further research include the replication of this study and detailed analysis of treatment variables in relation to wound outcome.

Severe Intravascular Hemolysis Associated With Brown Recluse Spider Envenomation:A Report of Two Cases and Review of the Literature

Envenomation by the brown recluse spider (loxoscelism) is classically associated with a necrotic ulcer. Systemic manifestations occur in a minority of cases, but are generally mild and self-limited. The hematologic complications of brown recluse spider bite range from mild hemolysis to fulminant intravascular hemolysis with or without evidence of disseminated intravascular coagulation. Intravascular hemolysis is a rare but occasionally lethal complication of brown recluse spider envenomation. This article presents two cases of severe hemolysis associated with loxoscelism occurring in two young women in Memphis, Tennessee. The second documented death in an adult from severe hemolysis due to a brown recluse spider bite is reported. A review of the literature emphasizing the pathogenic mechanisms of spider bite hemolysis is also included.

Brown recluse spider envenomation: Treatment with dapsone

Loxoscelism or necrotic arachnidism are the terms used to describe the effects of the brown recluse spider bite. Over recent years, there has been a steady increase in the number of reported brown recluse spider bites. It is not clear whether this represents an expanded range of the spider's habitat or greater physician awareness. Although most commonly found in the warm, south central region of the United States, Loxosceles reclusa can be a cause of necrotic arachnidism in northern urban settings. Therefore, the diagnosis should also be considered in these areas. This article discusses three cases of suspected brown recluse spider bites referred to a Chicago-based poison control center and briefly reviews the literature regarding the diagnosis, clinical presentation and treatment of loxoscelism.

Experimental brown spider bite in the guinea pig: Results of treatment with dapsone or hyperbaric oxygen

The brown recluse spider (Loxosceles reclusa) is a common inhabitant of the central United States. Loxoceles envenomation is a cause of significant medical problems, causing a necrotic skin lesion that often becomes a problem wound. Treatment of the skin lesion is controversial, with no current widely accepted therapy. The effects of treatment with hyperbaric oxygen or dapsone on brown spider bites were studied using guinea pigs. Progression and healing of experimental brown spider bites were measured in animals treated or pretreated with dapsone or hyperbaric oxygen and in controls. There was a significant decrease in lesion size in animals pretreated with hyperbaric oxygen at days 3,5, and 6 as compared to dapsone-pretreated animals or untreated controls. However, there were no differences noted between groups when treatment was begun 36 h after envenomation. There was a nonsignificant increase ( p = 0.12) noted in myeloperoxidase levels from lesions of animals pretreated with hyperbaric oxygen. No other differences in levels of catalase, glutathione, or superoxide dismutase activity were noted between treatment groups. These results suggest that hyperbaric oxygen may have potential in the treatment of brown spider bites; however, further study is necessary to prove its efficacy.

Brown recluse spider bites: Beneficial effects of hyperbaric oxygen: Maynor M, Abt J, Osborne P. J Hyperbaric Med. 1992;7:89–102

Brown recluse spider bites: Beneficial effects of hyperbaric oxygen: Maynor M, Abt J, Osborne P. J Hyperbaric Med. 1992;7:89–102

Hemolytic Anemia Following a Presumptive Brown Recluse Spider Bite

This case report describes a systemic reaction occurring in a 12-year-old female following presumed envenomation by a brown recluse spider (Loxosceles reclusa). The systemic reaction included self-limited hemolysis necessitating blood transfusion. The clinical course and management are described and compared with those of previously reported cases of systemic loxoscelism.

Passive hemagglutination inhibition test for diagnosis of brown recluse spider bite envenomation

Our goal was to recreate a passive hemagglutination inhibition (PHAI) test to diagnose brown recluse spider (BRS; Loxosceles reclusa) bite envenomation for treatment trials. Guinea pigs received intradermal injections of concentrated spider venom from the following species: Loxosceles reclusa, Argiope aurantia, Argiope trifasciata, Phidippus audax, and Lycosa frondicola. Skin lesion exudate was collected and tested with the BRS venom PHAI assay. From 51 separate collections of exudate, test sensitivity was 90% as long as 3 days after venom injection. Specificity was 100% with venom from the other spider species listed above in vivo (7 test samples) and in vitro (5 test samples), as well as with random bacterial exudate with and without added serial dilutions of BRS venom (10 test samples). The test was reproducible over repetitive assays to within one 10-fold dilution. A positive PHAI test result could function as an entry criterion for BRS bite victims in human treatment trials.

Spider bite with lymphangitic streaking. Brown or violin spider bite with atypical features

Spider bite with lymphangitic streaking. Brown or violin spider bite with atypical features

Hemolytic anemia and hemoglobinuria due to systemic loxoscelism: report of a case

Hemolytic anemia and hemoglobinuria are rare consequences of brown recluse spider bites. These systemic complications are frequently associated with skin necrosis at the envenomation site. In this case report, a 6-year-old boy developed these systemic features with formation of a small, typical brown recluse spider bite skin lesion without overt skin necrosis. In addition to the case report, the variety of clinical presentations, proposed pathogenesis, and treatment modalities of brown recluse spider bites are reviewed.

Epiglottic enlargement: Two unusual causes

We present two patients with airway obstruction due to supraglottic swelling; one was caused by a brown spider bite on an ear (loxoscelism) and the other from eating buffalo fish. In the latter patient it was likely due to scrombroid poisoning, a histamine-like reaction, but may have been an anaphylaxic reaction.

Morbidity of Brown Recluse spider bites. Clinical picture, treatment and prognosis.

A retrospective review was made of 35 cases of Brown Recluse spider bites treated during a period of 21 years. The most common location of the bite was on the lower limbs, particularly the thigh. The main systemic manifestations were fever, malaise and maculopapular rash, but there were no cases of hemolysis, coagulopathy, or of renal or neurologic involvement. Signs indicating a poor prognosis appeared to be lymphangitis, generalized maculopapular rash and location of the bite on the thigh or abdomen. Most cases were treated effectively by rest, elevation of the affected part of the body, local cleansing, and prophylactic antibiotics. On the basis of this experience it was concluded that only when lesions show a necrotic area measuring 2 to 3 cm should patients be treated with systemic corticosteroids. In most such cases, administration of corticosteroids for 14-21 days proved sufficient to avoid the need for surgery. Only 5 cases required surgical intervention.

Brown recluse spider bites in an urban wilderness

Loxoscelism or necrotic arachnidism are the terms used to describe the effects of the brown recluse spider bite. Over recent years, there has been a steady increase in the number of reported brown recluse spider bites. It is not clear whether this represents an expanded range of the spider's habitat or greater physician awareness. Although most commonly found in the warm, south central region of the United States, Loxosceles reclusa can be a cause of necrotic arachnidism in northern urban settings. Therefore, the diagnosis should also be considered in these areas. This article discusses three cases of suspected brown recluse spider bites referred to a Chicago-based poison control center and briefly reviews the literature regarding the diagnosis, clinical presentation and treatment of loxoscelism.

Persistent Segmental Cutaneous Anesthesia After a Brown Recluse Spider Bite

Patients with brown recluse spider bites commonly suffer from pain, muscular aching, and a variety of local dysesthesias during the acute and resolution phases of toxin-induced injury. This is our first well-documented observation of persistent cutaneous anesthesia caused by a spider bite. The anesthetic area conformed to the distribution of a specific nerve, the transverse cervical cutaneous nerve. The identification of the spider as a brown recluse and the location of the bite over the nerve's usual pathway strongly suggest that the venom was responsible for this complication.