Spider bites: Difference between revisions

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
- Tarantula spider bite

Visual Spider Identification

Tarantula
Black widow spider
Brown recluse
Armed spider (phoneutria nigreventer)
Funnel-web spider (Hadronyche versuta)

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
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
- Snake bites
  - Crotaline (Pit Vipers)
  - Elapidae (Coral Snakes)
- Lizard bites
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

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.

Authors:

@@ Line 1: / Line 1: @@
-==Types==
+==Background==
-*[[Brown recluse spider bite]]
+*Standard [[abscess]] are not typically due to spider bites and should not be diagnosed as such
-*[[Black widow spider bite]]
-*[[Tarantula spider bite]]
+===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
+**[[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===
+* 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
+* 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==
 {{Bites and stings DDX}}
+==Evaluation==
+===Workup===
+===Diagnosis===
+*Typically a clinical diagnosis
+==Management==
+* Clean area of bite
+* [[Tetanus prophylaxis]]
+* [[analgesia|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==
 *[[Bites and Stings]]
+==External Links==
 ==References==
 <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.
 [[Category:Environmental]]
 [[Category:Toxicology]]