Along Came a Spider. . by ProQuest


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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
                                                                                                                                    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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