Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Death From a Brown Recluse Spider Bite
“Emergency Department Death From Systemic Loxoscelism” (Annals of Emergency Medicine 2012;60:439-441) describes the unfortunate death of a 3-year-old child resulting from a brown recluse spider bite. In this case report, the child died from severe hemolysis (destruction of red blood cells) and bleeding, which is a rare complication of brown recluse spider bite.
At least five species of recluse spiders are found in the United States. The brown recluse spider (Loxosceles reclusa) is the best known and found most commonly in the South and southern Midwest. However, interstate commerce has created habitats in many other parts of the country for the brown recluse and related species. The spider is brown, with an average body length of just under 1/2 inch. A characteristic dark violin-shaped marking (“fiddleback”) is found on the top of the upper section of the body. The brown recluse spider is found in dark, sheltered areas, such as under porches, in woodpiles, and in crates of fruit. It is most active at night. It commonly bites when it is trapped, but is not otherwise aggressive toward humans.
The bite of the brown recluse spider may cause very little pain at first, or a sharp sting may be felt. The stinging subsides over 6 to 8 hours, and is replaced by aching and itching. Within 1 to 5 hours, a painful red or purplish blister sometimes appears, surrounded by a bull’s-eye of whitish-blue (pale) discoloration, with occasional slight swelling. The red margin may spread into an irregular fried-egg pattern, with gravitational influence, such that the original blister remains near the uppermost part of the lesion. The victim may develop chills, fever, weakness, and a generalized red skin rash. Severe allergic reactions within 30 minutes of the bite occur infrequently. Over 5 to 7 days, the venom causes a violet discoloration and breakdown of the surrounding tissue, leading to an open ulcer that may take months to heal. If the reaction has been severe, the tissue in the center of the wound becomes destroyed, blackens, and dies.
The rare reaction, described in the paper noted above, is “systemic loxoscelism,” in which the venom binds to red blood cells and induces severe symptoms within 24 to 72 hours. These include a flu-like presentation with fever, chills, headache, fatigue, weakness, nausea, vomiting, muscle and joint aches, blood in the urine, yellow skin discoloration (jaundice), kidney failure, and even shock, seizures, and coma. This is more common in children and requires intensive medical therapy, which may not always be lifesaving.
Because the bite of the brown recluse spider typically causes severe tissue destruction, the victim should see a physician, who will prescribe medicine or another therapy as soon as possible. In the meantime, apply cold packs to the wound for as long as is practical and administer an antibiotic (erythromycin, azithromycin, or cephalexin). Do not apply a heating pad or hot packs. Depending on the severity of the reaction, the doctor will either advise medicines or surgical excision of the bite. Dapsone, a drug used to inhibit certain cells that are part of the inflammatory response, has been used effectively. Hyperbaric oxygen therapy is recommended by some clinicians.
Until you receive other advice, treat the wound with a thin layer of mupirocin or bacitracin ointment, or mupirocin cream, underneath daily dressing changes. Do not apply topical steroids. Some persons have touted application of topical nitroglycerin, but there is not yet sufficient scientific evidence to routinely support this therapy.
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