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PloS One 2017Systemic 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...
OBJECTIVE
Systemic 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.
METHODS
We 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).
RESULTS
During 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).
CONCLUSION
Systemic 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.
Topics: Adolescent; Animals; Bilirubin; Brown Recluse Spider; Case-Control Studies; Child; Cross-Sectional Studies; Disseminated Intravascular Coagulation; Electronic Health Records; Female; Hemoglobins; Hemolysis; Humans; L-Lactate Dehydrogenase; Male; Phenotype; Retrospective Studies; Spider Bites; Spider Venoms; Survival Analysis; Young Adult
PubMed: 28422977
DOI: 10.1371/journal.pone.0174941 -
The Journal of Investigative Dermatology Jun 2007The fear of spiders is ancient and common throughout much of the world. Skin ulceration and necrosis due to Loxosceles spider envenomation ("bites") is among the best... (Review)
Review
The fear of spiders is ancient and common throughout much of the world. Skin ulceration and necrosis due to Loxosceles spider envenomation ("bites") is among the best known sequelae of a usually accidental encounter. Therapies for Loxosceles envenomations either are not well documented or have adverse side effects that limit their use by generalists. Based on in vitro and in vivo studies in rabbits injected with purified or recombinant sphingomyelinase D2, Paixão-Cavalcante et al. (2007) propose in this issue that topical tetracyclines could become safe, efficacious therapy for cutaneous loxoscelism.
Topics: Animals; Bites and Stings; Humans; Matrix Metalloproteinases; Phosphoric Diester Hydrolases; Pyoderma; Skin Diseases; Spider Venoms; Tetracyclines
PubMed: 17502857
DOI: 10.1038/sj.jid.5700724 -
JACC. Case Reports Jan 2022We describe a case of myocarditis associated with a brown recluse spider bite in a 31-year-old man. Cardiac magnetic resonance revealed late gadolinium enhancement in...
We describe a case of myocarditis associated with a brown recluse spider bite in a 31-year-old man. Cardiac magnetic resonance revealed late gadolinium enhancement in the lateral wall and inferior wall. There was also regional elevation of the myocardial T2 and extracellular volume indicative of myocardial edema. ().
PubMed: 35036944
DOI: 10.1016/j.jaccas.2021.10.003 -
Toxins Apr 2017Cutaneous loxoscelism envenomation by spiders is characterized by the development of a dermonecrotic lesion, strong inflammatory response, the production of...
Phospholipase D from Loxosceles laeta Spider Venom Induces IL-6, IL-8, CXCL1/GRO-α, and CCL2/MCP-1 Production in Human Skin Fibroblasts and Stimulates Monocytes Migration.
Cutaneous loxoscelism envenomation by spiders is characterized by the development of a dermonecrotic lesion, strong inflammatory response, the production of pro-inflammatory mediators, and leukocyte migration to the bite site. The role of phospholipase D (PLD) from in the recruitment and migration of monocytes to the envenomation site has not yet been described. This study reports on the expression and production profiles of cytokines and chemokines in human skin fibroblasts treated with catalytically active and inactive recombinant PLDs from (rLlPLD) and lipid inflammatory mediators ceramide 1-phosphate (C1P) and lysophosphatidic acid (LPA), and the evaluation of their roles in monocyte migration. Recombinant rLlPLD1 (active) and rLlPLD2 (inactive) isoforms induce interleukin (IL)-6, IL-8, CXCL1/GRO-α, and CCL2/monocyte chemoattractant protein-1 (MCP-1) expression and secretion in fibroblasts. Meanwhile, C1P and LPA only exhibited a minor effect on the expression and secretion of these cytokines and chemokines. Moreover, neutralization of both enzymes with anti-rLlPLD1 antibodies completely inhibited the secretion of these cytokines and chemokines. Importantly, conditioned media from fibroblasts, treated with rLlPLDs, stimulated the transmigration of THP-1 monocytes. Our data demonstrate the direct role of PLDs in chemotactic mediator synthesis for monocytes in human skin fibroblasts and indicate that inflammatory processes play an important role during loxoscelism.
Topics: Animals; Arthropod Proteins; Cell Line; Cell Movement; Ceramides; Cytokines; Fibroblasts; Humans; Lysophospholipids; Monocytes; Phospholipase D; RNA, Messenger; Recombinant Proteins; Skin; Spider Venoms; Spiders
PubMed: 28379166
DOI: 10.3390/toxins9040125 -
Eplasty Aug 2008Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive....
BACKGROUND
Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury.
MATERIALS AND METHODS
We present a case of a previously unreported incidence of osteomyelitis of the mandible as a result of a brown recluse spider bite. A review of the literature and discussion of diagnosis and treatment of brown recluse spider bites are presented.
RESULTS
Osteomyelitis of the mandible causing a chronic wound was the presenting finding of a patient with a history of spider bite and exposure to brown recluse spiders. Operative debridement and wound closure resulted in successful treatment. Brown recluse spider envenomation varies in its presentation and treatment is based on the presenting clinical picture.
CONCLUSION
Treatment regimens for brown recluse spider bite envenomation should include the basics of wound care. Systemic antibiotics, topical antimicrobials, dapsone, and surgical debridement are valuable adjuncts of treatment, as indicated, based on the clinical course.
PubMed: 18820724
DOI: No ID Found -
Ostomy/wound Management Mar 2005Brown recluse spiders (Loxosceles reclusa) are responsible for virtually all documented cases of spider bites leading to significant necrosis. The actual spider bite... (Review)
Review
Brown recluse spiders (Loxosceles reclusa) are responsible for virtually all documented cases of spider bites leading to significant necrosis. The actual spider bite often goes unnoticed for as long as 4 to 6 hours, which makes diagnosis and, therefore, appropriate treatment, difficult. The spider bite generally results in either a necrotic wound or systemic symptoms that can lead to hemolysis. The patient described in this article experienced both complications. Dapsone and hyperbaric oxygen therapy brought the adverse response to the bite under control. The patient was hospitalized for 7 days during treatment for hemolysis and an extensive, necrotic wound. Efforts are underway to develop an assay to provide a definitive diagnosis for the brown recluse spider bite, but none is yet commercially available. Antivenom is scarce; capture of the offending spider appears to be most helpful in the diagnosis and proper treatment of spider bites.
Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Antivenins; Combined Modality Therapy; Dapsone; Debridement; Diagnosis, Differential; Diphenhydramine; Enzyme-Linked Immunosorbent Assay; Female; Hemagglutination Tests; Histamine H1 Antagonists; Humans; Hyperbaric Oxygenation; Incidence; Necrosis; Seasons; Skin Care; Skin Transplantation; Spider Bites; Spider Venoms; Time Factors; United States; Wound Healing
PubMed: 15984400
DOI: No ID Found -
Toxins Jan 2020Envenomations are complex medical emergencies that can have a range of symptoms and sequelae. The only specific, scientifically-validated treatment for envenomation is...
Envenomations are complex medical emergencies that can have a range of symptoms and sequelae. The only specific, scientifically-validated treatment for envenomation is antivenom administration, which is designed to alleviate venom effects. A paucity of efficacy testing exists for numerous antivenoms worldwide, and understanding venom effects and venom potency can help identify antivenom improvement options. Some spider venoms can produce debilitating injuries or even death, yet have been largely neglected in venom and antivenom studies because of the low venom yields. Coagulation disturbances have been particularly under studied due to difficulties in working with blood and the coagulation cascade. These circumstances have resulted in suboptimal spider bite treatment for medically significant spider genera such as and . This study identifies and quantifies the anticoagulant effects produced by venoms of three species (, and ) and that of . We showed that the venoms of all studied species are able to cleave the fibrinogen Aα-chain with varying degrees of potency, with and venom cleaving the Aα-chain most rapidly. Thromboelastography analysis revealed that only venom is able to reduce clot strength, thereby presumably causing anticoagulant effects in the patient. Using the same thromboelastography assays, antivenom efficacy tests revealed that the commonly used specific SMase D recombinant based antivenom failed to neutralize the anticoagulant effects produced by venom. This study demonstrates the fibrinogenolytic activity of and venom and the neutralization failure of antivenom, thus providing impetus for antivenom improvement.
Topics: Animals; Antivenins; Blood Coagulation; Fibrinogen; Spider Venoms; Spiders; Thrombelastography
PubMed: 32019058
DOI: 10.3390/toxins12020091 -
Journal of Investigative Medicine High... 2021Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of...
Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of clinical manifestations, anywhere from a painless papular lesion to life-threatening reactions. We report a possible spider bite presenting as leukostasis initially suspected to be acute leukemia. A 22-year-old female patient presented to the emergency department with confusion and right upper arm pain, redness, and swelling after a suspected spider bite. Initial labs showed WBC count of 103.5x10e3/µL, hemoglobin of 3.3 g/dL, positive Direct Coombs' test, creatinine of 1.8 mg/dL, transaminitis, and lactic acid of 20 mmol/L. Acute leukemia with leukostasis was suspected. She was started emergently on hydroxyurea in conjunction with prophylaxis for tumor lysis syndrome. However, peripheral smear showed left-shifted granulocytosis with lymphocytosis, monocytosis, and no blast cells or evidence of myelodysplasia. Bone marrow aspirate showed mildly hypercellular marrow with myeloid hyperplasia and no myelodysplasia. Flow cytometry analysis confirmed a left-shifted myeloid maturation pattern with 0.3% myeloblasts. BCR-ABL1 and JAK2 testing was negative. Hence, she had no evidence of leukemia but rather had leukostasis from a spider bite. Hydroxyurea was stopped and follow-up labs normalized. Sphingomyelinase D in the brown recluse spider venom is unique to Loxosceles and Sicarius and may be responsible for the unique clinical presentation of loxoscelism. The presentation of hyperleukocytosis complicated by shock with an unclear history poses a diagnostic challenge. In diagnostic uncertainty, consider delaying chemotherapy until a diagnosis can be confirmed to avoid potential harm.
Topics: Adult; Animals; Brown Recluse Spider; Female; Humans; Leukostasis; Spider Bites; Young Adult
PubMed: 34404267
DOI: 10.1177/23247096211039949 -
Australian Family Physician May 2005While most patients who present with a rash have no associated systemic illness, many systemic illnesses have skin manifestations at some stage. (Review)
Review
BACKGROUND
While most patients who present with a rash have no associated systemic illness, many systemic illnesses have skin manifestations at some stage.
OBJECTIVE
This article uses case vignettes to illustrate a problem oriented approach to five commonly presented skin conditions that have common and varied systemic associations. A logical sequence of management for each case is provided.
DISCUSSION
Often the skin manifestations of systemic disease are vague and nonspecific such as the toxic erythema that might follow a viral infection or a drug eruption. Sometimes it is the systemic manifestations that are vague and nonspecific, while the skin manifestations are highly specific and define the illness. There is currently no useful classification for cutaneous manifestations of systemic disease.
Topics: Adolescent; Adult; Diagnosis, Differential; Drug Eruptions; Erythema Nodosum; Female; Humans; Male; Middle Aged; Panniculitis; Photosensitivity Disorders; Purpura, Thrombocytopenic; Pyoderma Gangrenosum; Skin Diseases; Spider Bites; Vasculitis
PubMed: 15887934
DOI: No ID Found -
Journal of Intensive Care 2014Redback spiders (Latrodectus hasselti) (RBSs) are venomous spiders that have recently spread to Asia from Australia. Since the first case report in 1997 (Osaka), RBS...
BACKGROUND
Redback spiders (Latrodectus hasselti) (RBSs) are venomous spiders that have recently spread to Asia from Australia. Since the first case report in 1997 (Osaka), RBS bites have been a clinical and administrative issue in Japan; however, the clinical characteristics and effective treatment of RBS bites, particularly outside Australia remains unclear. This study aimed to elucidate the clinical characteristics of RBS bites and to clarify the effectiveness of the administration of antivenom for treatment.
METHODS
We performed a retrospective questionnaire survey from January 2009 to December 2013 to determine the following: patient characteristics, effect of antivenom treatment, and outcomes. To clarify the characteristics of patients who develop systemic symptoms, we compared patients with localized symptoms and those with systemic symptoms. We also examined the efficacy and adverse effects in cases administered antivenom.
RESULTS
Over the 5-year study period, 28 patients were identified from 10 hospitals. Of these, 39.3% were male and the median age was 32 years. Bites most commonly occurred on the hand, followed by the forearm. Over 80% of patients developed local pain and erythema, and 35.7% (10 patients) developed systemic symptoms. Baseline characteristics, vital signs, laboratory data, treatment-related factors, and outcome were not significantly different between the localized and systemic symptoms groups. Six patients with systemic symptoms received antivenom, of whom four experienced symptom relief following antivenom administration. Premedication with an antihistamine or epinephrine to prevent the adverse effects of antivenom was administered in four patients, which resulted in no anaphylaxis. One out of two patients who did not receive premedication developed a mild allergic reaction after antivenom administration that subsided without treatment.
CONCLUSIONS
Approximately one third of cases developed systemic symptoms, and antivenom was administered effectively and safely in severe cases. Further research is required to identify clinically applicable indications for antivenom use.
PubMed: 25705418
DOI: 10.1186/s40560-014-0062-3