Brown Recluse Spider Bites

Forks, T P

doi:10.3122/15572625-13-6-415

Cited by 32 publications

(16 citation statements)

References 13 publications

(16 reference statements)

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“…[9] Steroids have been used to prevent kidney failure and hemolysis, but their efficacy is subject to debate. [9, 31] Other treatments that may be considered are dapsone, hyperbaric oxygen, and surgical excision. [9] Adverse side effects have been attributed to dapsone including hemolysis, anemia, and hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 99%

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

et al. 2017

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ObjectiveSystemic loxoscelism is a rare illness resulting from the bite of the recluse spider and, in its most severe form, can lead to widespread hemolysis, coagulopathy, and death. We aim to describe the clinical features and outcomes of the largest known cohort of individuals with moderate to severe loxoscelism.MethodsWe performed a retrospective, cross sectional study from January 1, 1995, to December 31, 2015, at a tertiary-care academic medical center, to determine individuals with clinical records consistent with moderate to severe loxoscelism. Age-, sex-, and race-matched controls were compared. Demographics, clinical characteristics, laboratory measures, and outcomes of individuals with loxoscelism are described. Case and control groups were compared with descriptive statistics and phenome-wide association study (PheWAS).ResultsDuring the time period, 57 individuals were identified as having moderate to severe loxoscelism. Of these, only 33% had an antecedent spider bite documented. Median age of individuals diagnosed with moderate to severe loxoscelism was 14 years old (IQR 9.0–24.0 years). PheWAS confirmed associations of systemic loxoscelism with 29 other phenotypes, e.g., rash, hemolytic anemia, and sepsis. Hemoglobin level dropped an average of 3.1 g/dL over an average of 2.0 days (IQR 2.0–6.0). Lactate dehydrogenase and total bilirubin levels were on average over two times their upper limit of normal values. Eighteen individuals of 32 tested had a positive direct antiglobulin (Coombs’) test. Mortality was 3.5% (2/57 individuals).ConclusionSystemic loxoscelism is a rare but devastating process with only a minority of patients recalling the toxic exposure; hemolysis reaches a peak at 2 days after admission, with some cases taking more than a week before recovery. In endemic areas, suspicion for systemic loxoscelism should be high in individuals, especially children and younger adults, presenting with a cutaneous ulcer and hemolysis or coagulopathy, even in the absence of a bite exposure history.

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Section: Discussionmentioning

confidence: 99%

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

et al. 2017

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“…Dapsone cannot be used in patients with glucose-6-dehydrogenase deficiency, as these patients already have an increased risk of hemolysis. Researchers who support its use recommend that it be reserved for moderate to severe or rapidly progressing cases only, and never used in children (3,5,10). As few human studies have been conducted, the use of dapsone remains controversial due to its questionable efficacy and significant side effect profile.…”

Section: Dapsonementioning

confidence: 97%

“…In endemic areas where the BRS population is dense, envenomation is infrequent, leading many to believe that the occurrence of bites in non-endemic areas is even less likely (3,4). Many lesions attributed to the BRS actually result from other causes, making these bites appear more common than their actual incidence (3,5,6) (Table 1).…”

Section: Introductionmentioning

confidence: 94%

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Suspected Brown Recluse Envenomation: A Case Report and Review of Different Treatment Modalities

Andersen

Campoli

Johar

et al. 2011

The Journal of Emergency Medicine

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“…1 A few bites trigger serious systemic reactions including hemolysis, methemoglobinemia, rhabdomyolysis, hemoglobinuria, platelet aggregation, and renal failure. [2][3][4][5] Local and systemic reactions to brown recluse spider bites are caused by the body's reaction to the toxins produced by the spider, primarily sphingomyelinase D, which becomes incorporated into cell membranes in the skin and subcutaneous tissue, triggering an inflammatory response mediated by the ceramide phosphate pathway. One researcher has reported that Clostridium perfringens can be cultured from the fangs and venom of the spider in a significant number of cases, suggesting the possibility that secondary infection may play a role in some cases.…”

mentioning

confidence: 99%

Management of Brown Recluse Spider Bites in Primary Care

Mold¹,

Thompson²

2004

The Journal of the American Board of Family Medicine

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Background: Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness.Methods: Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures included time to healing and occurrence of scarring. Regression methods were used to evaluate the impact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and highdose vitamin C) after controlling for bite severity and other predictors.Results: Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21% had permanent scarring. One hundred seventy-four received a single treatment modality. Among this group, 12 different modalities were used. After controlling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Systemic corticosteroids and dapsone were associated with slower healing. Predictors of scarring were higher severity, presence of necrosis, and diabetes. Dapsone was associated with an increased probability of scarring.

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Brown Recluse Spider Bites

Cited by 32 publications

References 13 publications

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort

Suspected Brown Recluse Envenomation: A Case Report and Review of Different Treatment Modalities

Management of Brown Recluse Spider Bites in Primary Care

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