Spider bites: Difference between revisions
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== | ==Background== | ||
*[[ | *Standard [[abscess]] are not typically due to spider bites and should not be diagnosed as such | ||
===Clinically important spider genera by geographic region=== | |||
==Clinically important spider genera by geographic region== | |||
* North America | * North America | ||
** Loxosceles | ** Loxosceles (e.g. [[brown recluse]]) | ||
** Latrodectus | ** Latrodectus (e.g. [[black widow]]) | ||
** Tegenaria | ** Tegenaria | ||
* South America | * South America | ||
** Loxosceles | ** Loxosceles | ||
** Latrodectus | ** Latrodectus | ||
** Phoneutria | ** [[Phoneutria]] (e.g. [[armed spider]]) | ||
* Africa | * Africa | ||
** Loxosceles | ** Loxosceles | ||
| Line 40: | Line 18: | ||
** Latrodectus | ** Latrodectus | ||
* Australia | * Australia | ||
** Atrax | ** Atrax (e.g. [[funnel-web spider]]) | ||
** Hadronyche | ** Hadronyche (e.g. [[funnel-web spider]]) | ||
** Latrodectus | ** Latrodectus | ||
* Asia | * Asia | ||
** Latrodectus | ** Latrodectus | ||
*Other | |||
**[[Tarantula spider bite]] | |||
===Visual Spider Identification=== | |||
<gallery mode="packed"> | |||
File:Tarantula640px-Brachypelma smithi 2009 G03.jpg|[[Tarantula]] | |||
File:Western Black Widow (Latrodectus hesperus).jpg|[[Black widow spider]] | |||
File:Brown Recluse.jpg|[[Brown recluse]] | |||
File:p nigreventer.jpeg|[[Armed spider]] (''phoneutria nigreventer'') | |||
File:Funnel Web Spider.png|[[Funnel-web spider]] (Hadronyche versuta) | |||
</gallery> | |||
==Clinical Features== | |||
===History=== | |||
* Determine circumstances of bite to assess consistency with spider habitat and behavior | |||
** Indoors vs outdoors | |||
** Day vs night | |||
** Geographic location (recent travel) | |||
* Appearance of the spider if seen | |||
* Dead spiders can be preserved in 70% EtOH and later identified by arachnologists or entomologist | |||
==Physical Exam== | ===Physical Exam=== | ||
* No pathognomonic signs proving lesion is a spider bite | * No pathognomonic signs proving lesion is a spider bite | ||
* Assess both bite site and for systemic signs | * Assess both bite site and for systemic signs | ||
| Line 64: | Line 62: | ||
** Muscle fasciculations, spasm, or tenderness | ** Muscle fasciculations, spasm, or tenderness | ||
== | ==Differential Diagnosis== | ||
{{Bites and stings DDX}} | |||
==Evaluation== | |||
===Workup=== | |||
===Diagnosis=== | |||
*Typically a clinical diagnosis | |||
==Management== | |||
* Clean area of bite | * Clean area of bite | ||
* [[Tetanus prophylaxis]] | * [[Tetanus prophylaxis]] | ||
| Line 73: | Line 80: | ||
* No proven benefit for [[corticosteroids]] | * No proven benefit for [[corticosteroids]] | ||
* No indication for antibiotics unless concern for [[cellulitis]] | * No indication for antibiotics unless concern for [[cellulitis]] | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Bites and Stings]] | *[[Bites and Stings]] | ||
==External Links== | |||
==References== | ==References== | ||
Latest revision as of 13:28, 29 May 2022
Background
- Standard abscess are not typically due to spider bites and should not be diagnosed as such
Clinically important spider genera by geographic region
- North America
- Loxosceles (e.g. brown recluse)
- Latrodectus (e.g. black widow)
- Tegenaria
- South America
- Loxosceles
- Latrodectus
- Phoneutria (e.g. armed spider)
- Africa
- Loxosceles
- Latrodectus
- Europe
- Loxosceles
- Latrodectus
- Australia
- Atrax (e.g. funnel-web spider)
- Hadronyche (e.g. funnel-web spider)
- Latrodectus
- Asia
- Latrodectus
- Other
Visual Spider Identification
Armed spider (phoneutria nigreventer)
Funnel-web spider (Hadronyche versuta)
.jpg)
Clinical Features
History
- Determine circumstances of bite to assess consistency with spider habitat and behavior
- Indoors vs outdoors
- Day vs night
- Geographic location (recent travel)
- Appearance of the spider if seen
- Dead spiders can be preserved in 70% EtOH and later identified by arachnologists or entomologist
Physical Exam
- No pathognomonic signs proving lesion is a spider bite
- Assess both bite site and for systemic signs
- Bite Site
- Location
- Spider bites more common when clothing is tight against skin
- Number of bites
- Multiple bites suggest parasitic insect and not spider
- Appearance of bite
- Erythema, pallor, hemorrhage, induration, tenderness, paresthesia, vesicles
- Location
- Systemic findings
- Abnormal vital signs (tachycardia possible with black widow)
- Altered mental status
- Abdominal pain
- Diaphoresis
- Generalized rash
- Muscle fasciculations, spasm, or tenderness
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Evaluation
Workup
Diagnosis
- Typically a clinical diagnosis
Management
- Clean area of bite
- Tetanus prophylaxis
- Analgesics
- Hydration
- Surgical follow up if indicated for debridement of necrotic area
- Antivenin is indicated only for specific envenomation
- No proven benefit for corticosteroids
- No indication for antibiotics unless concern for cellulitis
Disposition
See Also
External Links
References
- Boyer LV, Binford GJ, Degan JA. Spider Bites. In Auerbach PS, Cushing TA, Harris NS. Auerbach’s Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017: 993-1016.