Management of the Brown Recluse Spider Bite

Rees, Riley S.; Shack, R. Bruce; Withers, Emma; Madden, John F.; Franklin, John D.; Lynch, John B.

doi:10.1097/00006534-198111000-00018

Cited by 74 publications

(33 citation statements)

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“…It is a low-molecular-weight, water-soluble protein expected to spread rapidly within the subcutaneous tissues. 8 Purified venom fractions were found to be cytotoxic to endothelial cells and red blood cells. The venom attracts neutrophils (PMN), which bind to the endothelium, but do not leave the vasculature.…”

Section: Discussionmentioning

confidence: 99%

Brown Recluse Spider Bite to the Face

Madion

Marshall

Jenkins

et al. 2005

Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Brown Recluse Spider Bite to the Face

Madion

Marshall

Jenkins

et al. 2005

Journal of Oral and Maxillofacial Surgery

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“…Decreased therapeutic efficacy with delay in polyclonal IgG antivenom treatment has previously been observed in the rabbit model using intact antibody. 11,13,14 At least two hypotheses may explain the time-dependent decrease in therapeutic effect. First, if venom has spread in dermal tissue over time, an id injection of antivenom at the original envenomation site may not have physical access for complete neutralization of venom.…”

Section: Discussionmentioning

confidence: 99%

“…Rees et al administered rabbit derived antiLoxosceles polyclonal IgG Ab intradermally (id) to rabbits 6-48 hours after envenomation with L. reclusa venom. 11 These authors noted decreases in Ab-treated lesion size in rabbits treated up to 24 hours after envenomation, though the difference at 24 hours was minute, and a statistical analysis was not conducted. 11 Rees et al subsequently compared lesion sizes in human spider bite victims treated with anti-Loxosceles polyclonal IgG Ab.…”

mentioning

confidence: 99%

“…11 These authors noted decreases in Ab-treated lesion size in rabbits treated up to 24 hours after envenomation, though the difference at 24 hours was minute, and a statistical analysis was not conducted. 11 Rees et al subsequently compared lesion sizes in human spider bite victims treated with anti-Loxosceles polyclonal IgG Ab. 12 In this investigation, lesion sizes were compared among patients treated with id Ab, those treated with dapsone and Ab, and those treated with dapsone alone.…”

mentioning

confidence: 99%

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Intradermal Anti‐Loxosceles Fab Fragments Attenuate Dermonecrotic Arachnidism

Gomez

Miller

Trachy

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: Bites from the brown recluse spider and other arachnids from the genus Loxosceles frequently induce necrotic skin lesions that can be recalcitrant to treatment and disfiguring. The authors used a rabbit model of dermonecrotic arachnidism to address the therapeutic efficacy of intradermal (id) polyclonal anti-Loxosceles Fab fragments (␣Loxd Fab) raised against Loxosceles deserta spider venom. Methods: Fab fragments were prepared by papain digestion and affinity chromatography from the IgG fraction of L. deserta antivenom raised in rabbits. Eighteen inbred New Zealand white rabbits were assigned to six groups of three. The rabbits received L. deserta venom (3 g, id) injections into each flank. Cohorts of rabbits received single id injections (at one venom site/rabbit) of 30 g ␣Loxd Fab at different times (T = 0, 1, 2, 4, 8, and 12 hours) after venom injection. In each rabbit the opposite flank was left untreated. As an additional control, one group of rabbits (T = 0) received nonspecific Fab (30 g, id) in the opposite flank. Dermal lesions were quantified as a function of time through the use of a series of digital photographs and imaging software. In addition, myeloperoxidase (MPO) activity, a measure of neutrophil accumulation, was determined in lesion biopsies. Lesion areas and MPO activities were analyzed by repeated-measures analysis of variance (ANOVA). Results: Lesion areas and MPO activity were markedly reduced when ␣Loxd Fab was administered very early after venom injections. As the interval between venom inoculation and antivenom treatment increased, the therapeutic benefit of ␣Loxd Fab decreased. The final time tested that demonstrated therapeutic efficacy of ␣Loxd Fab was T = 4 hours. Lesion attenuation was no longer apparent when ␣Loxd Fab was given 8 hours post inoculation. Conclusions: Intradermal administration of ␣Loxd Fab attenuates Loxosceles-induced dermonecrotic lesion formation when given up to 4 hours after venom inoculation in this rabbit model.

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“…Although few prospective laboratory [86][87][88] or clinical studies exist, 39,55 early use of dapsone (ie, soon after envenomation or as lesions develop) initially was shown to decrease the amount of pain, necrosis, induration, and need for surgical excision at doses of 50 to 300 mg per day. 57,89,90 Another study found no difference in outcome at all in 17 patients. 63 In animal studies, dapsone was found to decrease the size of necrotic lesions, as well as the degree of induration and necrosis, in guinea pigs 16 hours after venom injection, 86 well beyond the 6-hour theoretical venom injury period.…”

Section: Polymorphonuclear Cell Inhibitorsmentioning

confidence: 96%