Dr. Kopping presents today’s Morning Report!
Spiders…who needs that many legs, am I right?
- Several medically important specimens throughout the world
- I live in North America, which should I care about most?
- Black Widow
- Brown Recluse
- Hobo spider
- I live in North America, which should I care about most?
- Black Widow (Latrodectus mactans)
- Likes temperate/tropical climates
- Found in stone walls, crevices, wood piles, barns, trash heaps
- Think “places where bugs hang out”
- Classic red “hour glass” shape on ventral suface
- Ventral markings are species specific and vary between other widow spiders
- Female much more dangerous than males given much larger size and fangs that can penetrate human skin
- 6 active components which ultimately lead to leakage of NT’s such as NE, DA, ACh causing the symptoms described below
- Usually not aggressive, nocturnal
- Bites occur when disturbed or inadvertent contact in shoes/clothing
- Initial bite not that impressive, range from pin prick to unnoticed
- In systemic poisoning, severe pain starts at the site of envenomation and progresses centrally
- Rapid symptom/pain onset is usually concerning for severe envenomation
- Grade 1- asymptomatic to local pain, normal vitals
- Grade 2- migration of pain centrally, diaphoresis at the bite site, normal vitals
- Grade 3- above with abnormal VS, diaphoresis distant from bite, generalized myalgias to back/chest/abdomen, priapism
- Classic scenario is rigid abdomen, often confused with acute peritonitis, especially in children unable to relay history
- Life threatening complications- Severe HTN, respiratory distress, MI, CV collapse, gangrene
- Muscle cramps usually last several hours, but can recur for several days to weeks after envenomation
- Treatment mainly supportive +/- antivenom for critical patients
- Pain/muscle spasm control
- Grade 1 likely only needs cold pack and NSAIDs
- Opiates and BZDs for Grade 2 or 3
- There is an antivenom available- controversial use
- Rapidly effective, but high risk of anaphylaxis and serum sickness
- Horse IgG
- Morbidity very high, but mortality is low
- Recommend in very high risk patients (pregnant women with threatened ab, hypertensive crisis, intractable pain, priapism)
- Rapidly effective, but high risk of anaphylaxis and serum sickness
- Pain/muscle spasm control
References
- Hahn I. Chapter 119. Arthropods. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. http://accessemergencymedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=454&Sectionid=40199539. Accessed April 29, 2015.
- “Black Widow vs. Brown Recluse” http://www.medicinenet.com/black_widow_brown_recluse_pictures_slideshow/article.htm
- Latrodectus. (2015, April 28). In Wikipedia, The Free Encyclopedia. Retrieved 23:01, April 29, 2015, from http://en.wikipedia.org/w/index.php?title=Latrodectus&oldid=659701443
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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