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By Rod Brouhard Spiders get a bad rap, but there are two whose bites can be true threats In 2006, there were more than 82,000 calls to U.S. poison control centers reporting spider bites.1 Maybe you ran a few of those calls. What species is the most common in your neighborhood? Have you seen the dreaded Springﬁeld recluse? How about the Philadelphia or Sacramento recluses? These are all closely related to the Los Angeles, Chicago some sort of inﬂammation that has nothing to do with spiders. and New York recluses. Related, of course, because they don’t Spider bites dwell more in the realm of the emergency Photo by James Gathany exist. Ever since purveyors of urban myth discovered e-mail department than the back of an ambulance, but acute enven- and YouTube, recluse spiders (also known as brown recluses, omation does happen and can be quite painful. There is a brown spiders or Loxosceles spiders) are blamed for almost possibility of death in some poisonous spider bites, but as all lesions of unknown origin.2 We even get calls to 9-1-1 for a group they are much more likely to be colossally annoying “spider bites” from patients who are, in reality, suffering from than fatal. 70 MARCH 2010 EMS www.emsresponder.com spider bites SPIDER MYTHS AND (Tegenaria agrestis) is notoriously If not recognized and treated, black REALITIES hard to identify—harder even than widow bites have the rare potential Almost all spiders are poisonous.3 the brown recluse—and is gaining to be fatal.4, 7 Since bites in general However, in most cases, the venom is ground as a supposed producer of are not common, it is important to either too weak, in too small a quan- necrotic arachnidism.5 consider black widow bites when tity or too speciﬁc to insects to be toxic Physicians are not immune to the patients present with sudden-onset to humans. Even in species that have hype. There have been misdiagnoses abdominal or back pain (especially if toxic venom, their fangs and other of lesions as spider bites, even when associated with cramping) and hyper- mouth parts may not be big or strong the spider in question didn’t live in tension (especially without a history enough to bite humans.4 the area. For instance, while several of hypertension). In spiders, size doesn’t matter— brown recluse bites have been diag- Diaphoresis is fairly common in some of the biggest are the least nosed in the San Francisco Bay area, black widow bites, and patients dangerous. Those hairy tarantula- no recluse or hobo spiders have been may present with odd patterns. size monsters that crawled around found there.6 Black widow bite victims have been on Indiana Jones are teddy bears observed sweating only over the bite compared to a black widow.4 BLACK WIDOWS area or just on the extremity where There are known to be only two Black widow spiders (of the genus the bite occurred.4 They will some- medically signiﬁcant species of Latrodectus) are different than times present diaphoretic only on the spider in the United States. Most recluse spiders because their venom face or neck and dry everywhere else.5 widespread is the black widow, common throughout the entire country. Cousins of the black widow affects the body systemically rather
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