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Bites by Loxosceles spiders in israel
Toxl°on, 1969, Vol. 6, pp. 234-241 . Perpemon Pnea. Printed in Ciroat Brima
BITES BY LOXOSCELES SPIDERS IN ISRAEL PnvtIAS EI~TT Department of Medicine, Kaplan Hospital, Rehovoth, Israel (Acctpttd for pubticatioa 2 December 1968)
Abslract~ven cases of spider bite by Loxoscetes rrfjtsctns are reported . The spider was identified in one of the cases. However, signs and symptoms were similar in all cases. Clinical manifestations consisted of local erythema, swelling, centralnecrosis andincreasedtemperature . One patient vomited repeatedly. Skin lesions eventually healed, and only one resulted in a defect whichhad to be repaired . INTRODUCTION
the years 1958-1964, 7 patients were admitted for skin lesions and mild general symptoms following suspected spider bites . Some of the patients experienced a sting before having been admitted, others even saw a spider, but only one brought the spider to the hospital . It was identified by Professor A. Shulov as Loxosceles rufescerts. As the signs and symptoms in all cases were essentially the same, we assumed that the patients were bitten by the same species. During this period, 2 cases of spider bite by Latrodectus tredecimguttatus were also admitted. They presented the typical manifestations of the bite by the black widow spider. To the best of my knowledge, only 1 case of Loxosceles envenomation has been reported in Israel, SFILJLOV et al. [l]. A typical case in the present series is cited. DURiNa
CASE REPORT
A 50-year-old female (Y.W.) was admitted on 10 October 1963 . Eighteen hours before her admission, while lying in bed, the patient experienced a burning pain on the left side of her neck. Searching for the cause she found a dead spider nearby. Subsequently, the burning pain increased, her temperature rose to 385°, she felt weak and was sent to the hospital . The spider was identified as Loxosceles rufescens . On admission, an erythematous, swollen area of 3 x 6 cm was found in the left lower cervical region. The swollen area was tender on palpation and contained a small, blackish necrotic spot at its centre . Blood pressure was 150/100 mm of mercury. Onphysical examination no further significant signs were found. The swelling and pain increased considerably and prednisone, 15 mg per day, was given. The signs and symptoms gradually disappeared and the patient left the hospital after a stay of 8 days . The 7 cases are summarized in Tables 1-3 . DISCUSSION
In the majority of the cases presented the patients were not aware of having been bitten ; 4 of them were bitten while asleep . All of the patients complained of pain, often burning 239
240
PINHAS EFRATI TABLE 1 .
Case
Age
Sex
Time before admission (days)
1 2 3 4 5 6 7
50 16 66 43 60 59 42
F M M F F F M
18 hr ? 5 1 1 5 5
TABLE
Case
GENERAL INFORMATION ON SUSPECTED iPIDER HTCE4
Erythema (cIn)
1 2 3 4
-+-(6 x 3)
2.
Necrosis (cm) +
-.-I-(10 x 15)
-F ~-I ~-
5 6
1 -I-
+ -I-
+ +(4 ~:6)
7
~-(!0 x 10)
;-
-;
+ +
3.
Circumstances of bite
Duration of hospitalization (days)
Neck Chest Leg Axilla Face Arm Thigh
Lying in bed 7 In bathroom ? Asleep Asleep Asleep
8 Unknown 7 7 IS 17 3
SYMPTOMS AND SIGNS OF SUSPECTED SPIDER RITES
Swelling
TABLE
Location of bite
(1 x 1)
Maximum temperature (°)
Fever (days)
Complications
Tender Enlarged and tender Enlarged
385 37 5 380 39 " 0
5 4 1 4
-
38'0 390
4 7
Enlarged
390
4
Deep skin necrosis Lymphangitis
Regional lymph nodes
LABORATORY FINDINGS OF SUSPECTED SPIDER BTTES
Cric
White cell count
Sedimentation of erythrocytes (Westergreen)
Blood glucose concentration (mg /)
I 2 3 4 5
6000 10,600 10,000 4200 9200
53/81 12/43 20/45 19/47 36/60
102 107 138-112 114
6 7
5600 23,000 (many staff cells)
-
ll9 -
Urine analysis Negative Negative Negative Negative 10-12 Leucocytes/ high power field SugaraNegative
NEOCROTIC LESION ON THE SKIN OF THE LEG IN PATIENT 3.
FIG. ~ .
4
FIG. Z.
ERYTHEMA AND NECROSIS OF SKIN ON RIGHT ARM OF PATIENT
ó. Tox. f.p. 240
Loxosceks Bites
241
in character, subsequently erythema, swelling and central necrosis appeared (Figs. 1 and 2) and the temperature rose. Patient 4 presented a typical lesion in her axilla and a few hours later she felt chilly and her temperature rose to 39°. She vomited several times, and in addition her face and upper lip became swollen. Eventually, all symptoms and signs disappeared. The local lesions usually cleared without sequelae . Only one patient had a large area of necrosis, 4 x 6 cm, and the skin defect had to be closed by secondary suture. Routine laboratory tests did not reveal any significant findings, except for leucocytosis (23,000 per mma) in one patient, a slight rise in blood glucose concentration (138 mg per cent) in another one and transient glucosuria in a third patient. No treatment was necessary apart from analgesics . Some patients had received antibiotics before the diagnosis was made. In 2 patients, prednisone (120 mg per day) was given. In one of them no effect was seen, while in the other symptoms disappeared quickly. [1]
REFERENCES Icxowrrz, M. S.nd PENEB-SALOMON, H., Observations of the influence of the venom of Loxosceles rufescens (Sicarüdae, Araneina) (Dufour 1820) on white mice. XI Int. Kong. Ent ., Wien, 2,499,1962 .
SxuLOV, A .,
BITES BY LOXOSCELES SPIDERS IN ISRAEL PnvtIAS EI~TT Department of Medicine, Kaplan Hospital, Rehovoth, Israel (Acctpttd for pubticatioa 2 December 1968)
Abslract~ven cases of spider bite by Loxoscetes rrfjtsctns are reported . The spider was identified in one of the cases. However, signs and symptoms were similar in all cases. Clinical manifestations consisted of local erythema, swelling, centralnecrosis andincreasedtemperature . One patient vomited repeatedly. Skin lesions eventually healed, and only one resulted in a defect whichhad to be repaired . INTRODUCTION
the years 1958-1964, 7 patients were admitted for skin lesions and mild general symptoms following suspected spider bites . Some of the patients experienced a sting before having been admitted, others even saw a spider, but only one brought the spider to the hospital . It was identified by Professor A. Shulov as Loxosceles rufescerts. As the signs and symptoms in all cases were essentially the same, we assumed that the patients were bitten by the same species. During this period, 2 cases of spider bite by Latrodectus tredecimguttatus were also admitted. They presented the typical manifestations of the bite by the black widow spider. To the best of my knowledge, only 1 case of Loxosceles envenomation has been reported in Israel, SFILJLOV et al. [l]. A typical case in the present series is cited. DURiNa
CASE REPORT
A 50-year-old female (Y.W.) was admitted on 10 October 1963 . Eighteen hours before her admission, while lying in bed, the patient experienced a burning pain on the left side of her neck. Searching for the cause she found a dead spider nearby. Subsequently, the burning pain increased, her temperature rose to 385°, she felt weak and was sent to the hospital . The spider was identified as Loxosceles rufescens . On admission, an erythematous, swollen area of 3 x 6 cm was found in the left lower cervical region. The swollen area was tender on palpation and contained a small, blackish necrotic spot at its centre . Blood pressure was 150/100 mm of mercury. Onphysical examination no further significant signs were found. The swelling and pain increased considerably and prednisone, 15 mg per day, was given. The signs and symptoms gradually disappeared and the patient left the hospital after a stay of 8 days . The 7 cases are summarized in Tables 1-3 . DISCUSSION
In the majority of the cases presented the patients were not aware of having been bitten ; 4 of them were bitten while asleep . All of the patients complained of pain, often burning 239
240
PINHAS EFRATI TABLE 1 .
Case
Age
Sex
Time before admission (days)
1 2 3 4 5 6 7
50 16 66 43 60 59 42
F M M F F F M
18 hr ? 5 1 1 5 5
TABLE
Case
GENERAL INFORMATION ON SUSPECTED iPIDER HTCE4
Erythema (cIn)
1 2 3 4
-+-(6 x 3)
2.
Necrosis (cm) +
-.-I-(10 x 15)
-F ~-I ~-
5 6
1 -I-
+ -I-
+ +(4 ~:6)
7
~-(!0 x 10)
;-
-;
+ +
3.
Circumstances of bite
Duration of hospitalization (days)
Neck Chest Leg Axilla Face Arm Thigh
Lying in bed 7 In bathroom ? Asleep Asleep Asleep
8 Unknown 7 7 IS 17 3
SYMPTOMS AND SIGNS OF SUSPECTED SPIDER RITES
Swelling
TABLE
Location of bite
(1 x 1)
Maximum temperature (°)
Fever (days)
Complications
Tender Enlarged and tender Enlarged
385 37 5 380 39 " 0
5 4 1 4
-
38'0 390
4 7
Enlarged
390
4
Deep skin necrosis Lymphangitis
Regional lymph nodes
LABORATORY FINDINGS OF SUSPECTED SPIDER BTTES
Cric
White cell count
Sedimentation of erythrocytes (Westergreen)
Blood glucose concentration (mg /)
I 2 3 4 5
6000 10,600 10,000 4200 9200
53/81 12/43 20/45 19/47 36/60
102 107 138-112 114
6 7
5600 23,000 (many staff cells)
-
ll9 -
Urine analysis Negative Negative Negative Negative 10-12 Leucocytes/ high power field SugaraNegative
NEOCROTIC LESION ON THE SKIN OF THE LEG IN PATIENT 3.
FIG. ~ .
4
FIG. Z.
ERYTHEMA AND NECROSIS OF SKIN ON RIGHT ARM OF PATIENT
ó. Tox. f.p. 240
Loxosceks Bites
241
in character, subsequently erythema, swelling and central necrosis appeared (Figs. 1 and 2) and the temperature rose. Patient 4 presented a typical lesion in her axilla and a few hours later she felt chilly and her temperature rose to 39°. She vomited several times, and in addition her face and upper lip became swollen. Eventually, all symptoms and signs disappeared. The local lesions usually cleared without sequelae . Only one patient had a large area of necrosis, 4 x 6 cm, and the skin defect had to be closed by secondary suture. Routine laboratory tests did not reveal any significant findings, except for leucocytosis (23,000 per mma) in one patient, a slight rise in blood glucose concentration (138 mg per cent) in another one and transient glucosuria in a third patient. No treatment was necessary apart from analgesics . Some patients had received antibiotics before the diagnosis was made. In 2 patients, prednisone (120 mg per day) was given. In one of them no effect was seen, while in the other symptoms disappeared quickly. [1]
REFERENCES Icxowrrz, M. S.nd PENEB-SALOMON, H., Observations of the influence of the venom of Loxosceles rufescens (Sicarüdae, Araneina) (Dufour 1820) on white mice. XI Int. Kong. Ent ., Wien, 2,499,1962 .
SxuLOV, A .,