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SPIDER BITESIn the US, only the Black Widow and the Brown Recluse spiders have bites with serious consequence, the former for it’s neurotoxicity; the latter for its’ cytotoxicity producing nasty local woundsThere are other widows and recluses in the US and worldwide, but these are the 2 we have in this regionThese spiders are actually more likely to be encountered in a man-made, urban setting, not in the wilderness. In fact, the recluse is not endemic to the southwest, but rather, the lower central statesThere are lots of spiders that have annoying bites, producing pain, redness, and swelling, so capturing the offending culprit for identification can be very usefulWhen an un-witnessed “spider bite” presents itself, be skeptical and consider other options. Look for a puncture mark. In my experience, most of these are MRSA skin infections. If in the wilderness, be willing to wait and observe before contemplating rapid evacuation. Generally, follow the same approach for rattlesnake bite in the initial stage of treatment of the local woundBrown Recluse spiderLocal wound: subtle bite at first; over several hours, increasing pain, itch, redness, swelling and bruising. A central vesicle forms in 1-3 days, often with a red halo. From there, progressive, sometimes extensive tissue necrosis, which can extend below the skin, require surgical debridement, and skin grafting or amputation if in a digit.Treat initially only with cold compresses, not ice, and elevation of the body part. Avoid anything that could enhance skin irritation. Observe. ER visit not mandatory at first.Systemic reaction: fever/chills, nausea/vomiting, measles-like rash joint aches, in 1-2 days. More severe can be hemolysis, disseminated intravascular coagulation syndrome with renal and multi-organ failure, coma and death. This picture more likely in small child. Death is rare, none reported in USTreatment is supportive. No antivenom existsBlack Widow SpiderBite is modest, with only pain, redness, swelling, threated like bee stingEnvenomation of significance uncommon, up to 25% of bites to some degree, onset 30-60 minutes; so it may be wise to wait and observe, at firstMuscle spasms, can be severe, locally or in large areas like the abdomen, back, chest; not necessarily symmetric, so it can simulate an acute abdominal event, cardiac pain, kidney stone etc.. Fasciculations. Rhabdomyolysis if severeAlso, autonomic symptoms like nausea/vomiting, marked elevation of blood pressure (causing secondary acute cardiovascular events,) exacerbation of asthmaLactrodectus facies: swollen eyelids, tearing with spasms of facial muscles, simulating allergic reactionTreatment supportive in ER setting. A horse-based antivenom exists, is effective but causes severe allergic reactions in 25%No death reported in US in past 30 years.TarantulaThese large, hairy creatures are more cuddly than dangerous!Nonaggressive, they rarely bite. This can be painfulThere are urticating hairs on the belly that they can shoot in defense, causing a very irritating histamine reaction in the skin with redness and itching. Treat with cold compresses, antihistamines, and topical steroids.Barbs in the eye requires a visit to an ophthalmologist for removal etc. ................
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