3.14.1) SUMMARY
A) WITH POISONING/EXPOSURE 1) Macule/papule formation occurs after bites by some spiders. Pain, edema, pruritus, and erythema are common. Some bites produce necrotic tissues. Urticaria may occur after tarantula exposure. Lymphangitis is an uncommon complication.
3.14.2) CLINICAL EFFECTS
A) ERUPTION 1) WITH POISONING/EXPOSURE a) Erythema occurs with many bites, including those from the Lycosidae (wolf spiders) (Campbell et al, 1987) (Wong et al, 1987).
b) ACHAEARANEA SPECIES: Localized erythema, without swelling, occurred in 4 of 5 patients who were bitten by Achaearanea species of spiders (Isbister & Gray, 2003).
c) STEATODA SPECIES: An erythematous, indurated patch, approximately 10 cm in diameter, occurred at the bite site of a woman who was bitten on the left shoulder blade by a Steatoda grossa spider (Graudins et al, 2002).
d) CHEIRACANTHIUM SPECIES: In a retrospective review of 20 cases of confirmed Cheiracanthium spider bites, pain (intense; similar to a bee sting), redness and swelling at the site were common. Itching was also relatively common in bites by C mildei and C inclusum species. Two cases of systemic effects including nausea, vomiting, and headache were reported. No cases of dermonecrotic lesions were observed (Vetter et al, 2006).
B) LYMPHANGITIS 1) WITH POISONING/EXPOSURE a) Lymphangitis may occur after some spider bites, but is an uncommon complication.
b) LYCOSA SPECIES: In one case, a lymphangitis occurred after 3 days. It was treated with antibiotics (Redman, 1974).
C) SKIN NECROSIS 1) WITH POISONING/EXPOSURE a) Indolent ulcers are seen after some spider bites, especially bites of Loxosceles (violin) spiders (Kunkel, 1988). See the "NECROTIC ARACHNIDISM" management, if a Loxosceles spider bite is suspected. 1) LOXOSCELES: Reports of necrotic or gangrenous arachnidism attributed to Loxosceles species may also be traceable to other spider species or ticks. This is especially true in areas where Loxosceles is NOT endemic.
2) INCIDENCE: One hospital reported 55 cases of necrotic arachnidism over 10 years. Bites were caused by a variety of spiders, with varying severity. Some warranted hospitalization.
b) ARGIOPE ARGENTATA: Bites produce a sharp pain, erythema, and vesicle formation (Minton, 1972). Necrotic lesions have also been reported (Anderson, 1982). c) CHIRACANTHIUM SPECIES: A small vesicle may form. Small petechiae may appear near the center of the weal. A crust forms, with a necrotic area underneath, and redness and swelling surrounding the bite site (Alexander, 1984) (Minton, 1972) (Furman & Reeves, 1957). 1) The macule at the bite site may persist for several days. The bite site gradually heals within a month (Waldron, 1965; Russell & Waldron, 1967; Spielman & Levi, 1970).
2) A more recent retrospective review of confirmed cases of Cheiracanthium spp. bites resulted in NO dermonecrotic lesions (Vetter et al, 2006).
d) LAMPONA SPECIES: Blistering, ulceration, pain, and skin necrosis were found in 14 cases of spider bites thought to be from the white-tailed spider (note: only 3 cases were confirmed). One patient required amputation of the hand and distal forearm. In 9 of the patients, the necrosis recurred (Pincus et al, 1999). Another patient had 2 recurrences of necrotic arachnidism in the 12 months following a bite by a white-tailed spider (Chan, 1998). e) LYCOSA SPECIES: Bites from these spiders produce a laceration at the bite site, and the area may become necrotic (Anderson, 1982) (Russell & Waldron, 1967)(Minton, 1972). In one case, sloughing of necrotic skin was observed in 1 week (Redman, 1974). f) PEUCETIA VIRIDANS: Bites sometimes produce a pustule-like sore that develops into a small ulceration. The sore heals over several days, without treatment (Wong et al, 1987; Hall & Madon, 1973). g) STEATODA SPECIES: Bites may give rise to a syndrome similar to that seen following Loxosceles bites. In the US, bites generally do not produce more than local pain, induration, pruritus, and the near breakdown of tissue at the bite site (Russell, 1991). D) EDEMA 1) WITH POISONING/EXPOSURE a) Edema, erythema, and pruritus are common findings after spider bites.
b) ARGIOPE SPECIES: The bite produces a momentary sharp pain, followed by swelling and erythema (Gorham & Rheney, 1968).
c) BADUMNA INSIGNIS: White et al (1989) reported 5 bites that produced a mild sting to sharp pain for a short duration, followed by redness, pruritus, and edema at the bite site.
d) CHIRACANTHIUM SPECIES: Pain from the bite may persist for several hours (Russell, 1991). An erythematous wheal appears within 30 minutes, and pruritus is common. Skin temperature at the bite site is elevated.
e) DELENA CANCERIDES: A bite from a huntsman spider (Delena cancerides) resulted in a swollen, erythematous, and tender bite site, with pain radiating up the affected extremity. The patient recovered following administration of antihistamines (Woo & Smart, 1999).
f) HERPYLLUS ECCLESIASTICUS: An adult bitten on the shoulder experienced sharp pain, itching, erythema, and swelling at the site. Signs resolved within 9 days (Majeski & Durst, 1975).
g) ISOPEDA SPECIES: These spider bites produced only local symptoms of slight pain, stinging, and erythema for less than 30 minutes (White et al, 1989).
h) LYCOSA SPECIES: Bites cause pain, erythema, and edema. There may be a laceration at the bite site (Russell & Waldron, 1967)(Minton, 1972). In one case, it took 6 days for the swelling to subside, and 10 days for the pain to stop (Redman, 1974).
i) PEUCETIA VIRIDANS: Bites produce a stinging sensation followed by burning and itching. An area up to 20 cm in diameter may become red and swollen. The sore heals over several days, without treatment (Wong et al, 1987; Hall & Madon, 1973).
j) PHIDIPPUS SPECIES: Bites produce pain, erythema, pruritus, and swelling. Swelling may become severe, and involve the entire hand, when only a finger has been bitten. The swelling usually subsides within 48 hours (Russell, 1991), but may last up to 2 weeks (Wong et al, 1987) (Russell, 1970).
k) STEATODA SPECIES: Erythema at the bite site and localized swelling occurred in 96% and 9% of the patients (n=23), respectively, following envenomation by Steatoda species spiders (Isbister & Gray, 2003).
l) TARANTULA: Bites can be almost painless or produce a deep, throbbing pain for an hour or so (Hunt, 1981; Wong et al, 1987). In one series, pain and local swelling were reported in several patients bitten by pet tarantulas (De Haro & Jouglard, 1998).
m) THIODINA SPECIES: An adult bitten on the thigh experienced a brief, immediate pain, followed by some itching and ecchymotic edema that gradually subsided over 2 weeks (Waldron, 1968).
n) TRACHELAS SPECIES: Bites generally cause local stinging and pain, with some slight swelling. All cases have resolved within 3 weeks (Wong et al, 1987). An adult developed facial swelling and a probable secondary infection that required penicillin. Symptoms resolved over 7 days (Uetz, 1973).
E) URTICARIA 1) WITH POISONING/EXPOSURE a) Urticaria is often seen with tarantulas. A number of species have urticaria-inducing hairs on the back of the abdomen (King, 1987). Contact may cause itching and wheals that persist for weeks.
b) The tarantulas may flick these hairs toward an aggressor as a defensive mechanism. The pet store tarantula is especially prone to produce edema and itching due to these hairs (Gertsch, 1979)( Cooke et al, 1973) (Kelley & Wasserman, 1998).
F) PAIN 1) WITH POISONING/EXPOSURE a) ACHAEARANEA SPECIES: Five patients who received Achaearanea spider bites experienced pain in all instances, with 3 of the patients reporting severe pain and 2 the patients reporting radiating pain in the proximal limb. The median duration of pain was 16 hours (interquartile range from 4 to 24 hours); however, 2 of the 5 patients reported pain lasting at least 24 hours (Isbister & Gray, 2003). b) STEATODA SPECIES: A prospective cohort study, identifying bites from Steatoda species of spiders, reported the occurrence of pain, sometimes severe, in all patients (n=23). The median duration of pain was 6 hours (interquartile range from 1 to 12 hours); however, 4 patients (17%) reported the duration of pain lasting at least 24 hours after Steatoda species envenomation. Three patients (13%) reported radiating pain of the affected extremity and 2 patients (9%) reported abdominal and/or chest pain (Isbister & Gray, 2003). 1) CASE REPORT: A 37-year-old man experienced severe pain that radiated to his knee and groin after being bitten on the toe by a Steatoda species spider. A red mark was observed at the bite site, and the patient also experienced nausea. Because the spider was misidentified as a red-back spider (Latrodectus), the patient received red-back spider antivenom intravenously approximately 4 hours after envenomation. The pain completely resolved 1 hour after administration of the antivenom. It is speculated that the red-back spider antivenom may be cross-reactive with Steatoda venom (Isbister & Gray, 2003).
2) CASE REPORT: A 22-year-old woman received a spider bite on her left shoulder blade, and, 10 minutes later, experienced localized pain that rapidly spread to her left arm and chest. Within 4 to 5 hours of the bite, the patient also developed hot and cold flushes, nausea, and vomiting. Physical examination showed an erythematous, indurated area, approximately 10 cm in diameter, on her left shoulder blade. Despite identification of the spider as a Steatoda species, the patient was given red-back spider antivenom (RBSAV) because of her symptom similarities to latrodectism typically seen with red-back spider (Latrodectus hasselti) envenomation. After 2 doses of RBSAV, the patient's chest and regional pain completely resolved (Graudins et al, 2002). The authors suggest that the Steatoda venom may be antigenically similar to Latrodectus hasselti venom and the alpha-Latrotoxin found in L hasselti venom, thereby responding to the administration of RBSAV.
c) CHEIRACANTHIUM SPECIES: In a retrospective review of 20 cases of confirmed Cheiracanthium spider bites, pain (intense; similar to a bee sting), redness, and swelling at the site were common. Itching was also relatively common in bites by C mildei and C inclusum species. Two cases of systemic effects including nausea, vomiting, and headache were reported. No cases of dermonecrotic lesions were observed (Vetter et al, 2006). d) PHONEUTRIA SPECIES: A 52-year-old man was bitten on the neck by a P nigriventer female spider (8 cm long) and developed immediate, intense, nonradiating pain, followed by blurred yellow vision, profuse sweating, priapism, tremors, and an episode of vomiting. Upon admission, the patient was agitated, with a blood pressure of 200/130 mmHg, and generalized tremors and local erythema at the site. Approximately 4 hours after envenomation, the patient received 5 vials of undiluted antiarachnid antivenom (Instituto Butantan, Sao Paulo, Brazil), and 2% lidocaine was used to treat localized pain. Within 1 hour, most of the patient's clinical symptoms had resolved (Bucaretchi et al, 2008). |