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Primary Care Jun 2023Stinging insects are a frequent cause of local and systemic hypersensitivity reactions, including anaphylaxis. For those with a history of life-threatening anaphylaxis,... (Review)
Review
Stinging insects are a frequent cause of local and systemic hypersensitivity reactions, including anaphylaxis. For those with a history of life-threatening anaphylaxis, venom immunotherapy is effective, safe, and can be life-saving. Arachnids are a much less common source of envenomation through bites or stings and are less likely to cause a hypersensitivity reaction. However, recognizing the clinical manifestations when they do present is important for accurate diagnosis and treatment, and, when indicated, consideration of other diagnoses.
Topics: Animals; Humans; Anaphylaxis; Hymenoptera; Insect Bites and Stings; Venom Hypersensitivity; Hypersensitivity; Desensitization, Immunologic
PubMed: 37105609
DOI: 10.1016/j.pop.2023.01.005 -
American Journal of Clinical Dermatology Jul 2023Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including... (Review)
Review
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
Topics: Humans; Acute Generalized Exanthematous Pustulosis; Diagnosis, Differential; Skin; Exanthema; Erythema
PubMed: 37156992
DOI: 10.1007/s40257-023-00779-3 -
American Family Physician Aug 2022Arthropods, including insects and arachnids, significantly affect humans as vectors for infectious diseases. Arthropod bites and stings commonly cause minor, usually...
Arthropods, including insects and arachnids, significantly affect humans as vectors for infectious diseases. Arthropod bites and stings commonly cause minor, usually self-limited reactions; however, some species are associated with more severe complications. Spider bites are rarely life-threatening. There are two medically relevant spiders in the United States. Widow spider (Latrodectus) envenomation can cause muscle spasm and severe pain that should be treated with analgesics and benzodiazepines. Antivenom is not widely available in the United States but may be considered for severe, refractory cases. Recluse spider (Loxosceles) bites are often overdiagnosed, should be treated supportively, and only rarely cause skin necrosis. Centruroides scorpions are the only medically relevant genus in the United States. Envenomation causes neuromuscular and autonomic dysfunction, which should be treated with analgesics, benzodiazepines, supportive care, and, in severe cases, antivenom. Hymenoptera, specifically bees, wasps, hornets, and fire ants, account for the most arthropod-related deaths in humans, most commonly by severe allergic reactions to envenomation. In severe cases, patients are treated with analgesia, local wound care, and systemic glucocorticoids. Diptera include flies and mosquitoes. The direct effects of their bites are usually minor and treated symptomatically; however, they are vectors for numerous infectious diseases. Arthropod bite and sting prevention strategies include avoiding high-risk areas, covering exposed skin, and wearing permethrin-impregnated clothing. N,N-diethyl- m-toluamide (DEET) 20% to 50% is the most studied and widely recommended insect repellant.
Topics: Animals; Antivenins; Arthropods; Benzodiazepines; Bites and Stings; Humans; Insect Bites and Stings; Spider Bites; United States
PubMed: 35977137
DOI: No ID Found -
Pediatric Emergency Care Feb 2021We report a case of geometrical skin lesions in a teenage patient.
BACKGROUND
We report a case of geometrical skin lesions in a teenage patient.
CASE
A previously healthy 14-year-old boy presented in our pediatric emergency department with unusual skin lesions on his left forearm. The patient said the lesions started 2 weeks earlier following a spider bite. His physical examination revealed an otherwise healthy child with no medical history with raised square lesions of the left forearm. The lesions were in different stages of healing and resembled second-degree burns. Examination showed no other lesions. Vital signs were normal. The patient was discharged after the lesions were dressed with antibiotic ointment. A follow-up consultation was scheduled a week later, but the patient did not attend the follow-up consultation. A senior emergency physician called the family and learned that the lesions were progressively healing and no other lesions appeared. The teen admitted he played the "salt and ice challenge."
DISCUSSION
The salt and ice challenge involves putting salt on the skin and then applying and/or pressing ice cubes on top of the salt. The challenge is to resist the pain consecutive to frostbite for as long as possible. The result is often second-degree burns and possible partial third-degree burns.
CONCLUSIONS
Because of the current popularity of this practice, emergency or family physicians, pediatricians, dermatologists, and burn or orthopedic surgery units might encounter these injuries. When young patients present with geometrical burn injuries and unexplained or bizarre circumstances, self-inflicted burn "challenges" should be considered.
Topics: Adolescent; Anti-Bacterial Agents; Burns; Child; Frostbite; Humans; Ice; Male; Ointments; Skin; Wound Healing
PubMed: 30672899
DOI: 10.1097/PEC.0000000000001722 -
Obstetrical & Gynecological Survey Dec 2021Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known... (Review)
Review
IMPORTANCE
Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.
OBJECTIVE
The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.
EVIDENCE ACQUISITION
Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.
RESULTS
Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.
CONCLUSIONS AND RELEVANCE
The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.
Topics: Animals; Antivenins; Female; Humans; Pregnancy; Snake Bites; Snakes; Spider Bites; United States
PubMed: 34942652
DOI: 10.1097/OGX.0000000000000959 -
JAMA Dermatology Feb 2020
Topics: Adult; Female; Humans; Skin Diseases; Spider Bites
PubMed: 31721992
DOI: 10.1001/jamadermatol.2019.3252 -
Advanced Emergency Nursing JournalAlthough there is an increased awareness of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), there remains a bias of the public and health-care...
Although there is an increased awareness of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), there remains a bias of the public and health-care workers to blame spiders as a cause of skin and soft tissue infection when there is no valid incriminated evidence for this assumption. MRSA is a formidable infection and remains a threat to human health. Recognition and proper treatment by practitioners remain of utmost importance to improve patient outcomes.
Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Spider Bites; Health Personnel
PubMed: 38285419
DOI: 10.1097/TME.0000000000000496 -
Cureus Dec 2022Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the...
Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the suspected presence of appropriate vectors. While most arthropod bites will only result in mild localized irritation, the potential to cause severe cutaneous and systemic effects should not be overlooked. We present one such case, in which a presumed brown recluse () bite on the neck resulted in severe illness with systemic manifestations. The patient presented to the emergency room minimally responsive with left-sided facial nerve palsy and septic shock. While the admitting physician initially prioritized stabilizing the patient, he noted the left-sided cervical cellulitis. Thorough history taking revealed that the patient had been worsening since being bitten by a spider three days prior to admission. After a month-long hospital stay and multidisciplinary treatment, the patient was transferred to a larger center with facial paralysis still present.
PubMed: 36601209
DOI: 10.7759/cureus.32162 -
The New England Journal of Medicine Nov 2021
Topics: Animals; Female; Fingers; Humans; Middle Aged; Necrosis; Spider Bites; Spiders
PubMed: 34758255
DOI: 10.1056/NEJMicm2108561