What's Eating You? Noble False Widow Spider (Steatoda nobilis).

Noble false widow spider (Steatoda nobilis) bites have been documented to cause symptoms ranging from pain and pruritus to systemic bacterial infection resulting in death. This species is found in a broad range of environments, often alongside human activity, and the spiders most often bite defensively when disturbed or when the body is compressed. Due to the rapid expansion of noble false widow spiders and their relatively recent emergence in the United States, it is important for dermatologists to be aware of how to manage their bites.

A loxoscelism case received therapeutic apheresis and hyperbaric oxygen therapy.

Loxosceles reclusa (L.reclusa) is known to bite humans, and its venom includes several enzymes that cause clinical symptoms. Loxoscelism, a condition due to being bitten by Loxosceles spiders, commonly known as recluses, can involve a range of clinical conditions, from local cutaneous lesions to severe systemic involvement. The diagnosis of loxoscelism is usually made by anamnesis and clinical findings. Magnetic resonance imaging is recommended for patients at high risk of necrotizing fasciitis. Treatment modalities are still controversial and there is no standardized treatment approach. Reported here, our case of loxoscelism involved a 24-year-old man presenting with a Loxosceles spider bite, dermonecrotic lesion, vomiting, diarrhea, acute renal injury, and rhabdomyolysis, who was successfully treated with hyperbaric oxygen therapy, therapeutic apheresis, hemodialysis, wound debridement, and cutaneous autografting. Early diagnosis and multidisciplinary approach can be life-saving in spider bites that can cause systemic involvement. Loxoscelism should be considered in patients with skin necrosis, acute renal injury, and rhabdomyolysis.

Cutaneous-hemolytic loxoscelism following brown recluse spider envenomation: new understandings.

Background: Brown recluse spider (BRS) (Loxosceles reclusa) envenomation can cause local dermonecrotic lesions, constitutional symptoms, and potentially fatal hemolysis (i.e., cutaneous-hemolytic loxoscelism). As the incidence of hemolysis is low and the spider habitat is limited, little is known regarding the clinical course of cutaneous-hemolytic loxoscelism.Methods: We performed a retrospective observational study of patients following BRS envenomation over an eight-year period. Demographics, clinical course, laboratories, and interventions were assessed. Wilcoxon rank-sum tests and Pearson chi-square tests were used in the univariate analyses. Logistic regression assessed the independent contribution of symptoms in a multivariate analysis.Results: Of the 97 patients, 40.2% (n = 39) developed hemolysis; the majority (66.7%) were 18 years old or younger. Univariate analysis revealed that constitutional symptoms were associated with hemolysis, but multivariate analysis showed only myalgia (aOR: 7.1; 95% CI: 2.2-22.7; p < .001) and malaise (aOR: 12.76; 95% CI: 1.4-119.9; p = .026) were independently associated with hemolysis. The median time to hemolysis onset was 1.0 days (IQR: 1.0-2.5) and all occurred within a week of envenomation. Hemolysis durations were longer in patients DAT positive for IGG antibodies (7.5 vs. 4.0 days; p = .042). Most (76.9%) of hemolyzing patients received blood. In patients with cutaneous-hemolytic loxoscelism, hematuria occurred in 32.4%, rhabdomyolysis occurred in 60.9%, and elevated transaminases with normal hepatic synthetic function occurred in 29.4% but all of these patients developed rhabdomyolysis. Hemolysis was both intravascular and extravascular. Complications (hyperkalemia, INR ≥2.0, metabolic acidosis requiring bicarbonate, hypotension requiring vasopressors, and hypoxia requiring intubation) occurred only in patients with profound hemolytic anemia (hemoglobin <4 g/dL); one patient died.Conclusions: Constitutional symptoms occur in both cutaneous and cutaneous-hemolytic loxoscelism, although they occur more frequently in patients who develop hemolysis. Children may be at a higher risk of hemolysis after envenomation. Renal involvement (as evidenced by hematuria) and rhabdomyolysis may occur more frequently than has been previously reported. Hemolysis was both intravascular and extravascular.

Brown recluse (L. rufescens) can bite in Northern Italy, too: first case report and review of the literature.

The brown recluse, or fiddleback (violin) spider, is a poisonous spider of the Loxosceles genus that resides in warmer regions and old structures making the warm Mediterranean climate a natural habitat for the European species, L. rufescens Even in infested households, however, bites are rare, as they are nocturnal and unaggressive. In 2015, the first supposed death by L. rufescens occurred in Italy, but before and even after such bite, the literature on these spiders has been under-represented. This case report documents a confirmed bite by a violin spider on a medical student in Pavia, Italy. The presentation in this case was initially with general systemic, flu-like symptoms, then as cellulitis with lymphangitis that persisted for nearly 2 weeks until resolving without prolonged or complicated pathology. We present the first documented case of a L. rufescens bite in Northern Italy, to the best of our knowledge.

Loxoscelismo cutáneo-visceral / Viscerocutaneous Loxoscelism

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Envenomation by the noble false widow spider Steatoda nobilis (Thorell, 1875) - five new cases of steatodism from Ireland and Great Britain.

OBJECTIVE: The noble false widow Steatoda nobilis is the only medically significant spider known to occur in the British Isles and Ireland, with a single case of steatodism ever reported from Great Britain. We present here five new cases of envenomations by S. nobilis, three from Ireland and two from Great Britain and describe symptoms not previously reported for the genus Steatoda. CASE PRESENTATION: Four adult males and one adult female with confirmed S. nobilis bites reported their symptoms to the authors. General practitioner chart was obtained for case #3. In all five cases, envenomations were immediately followed by a sharp and prolonged onset of pain, mild to extensive erythema and localised to extensive swelling around the bite site. Additional symptoms include moderate to intense pruritus, vasodilation of the capillaries around the bite site and a possible minor necrotic wound. CONCLUSION: In all cases, symptoms subsided within 48-72 h and no further complications were reported. Envenomations by S. nobilis seem to produce symptoms similar (but not identical) to those previously reported from other Steatoda sp. Considering their benign outcome, envenomations by S. nobilis should still be regarded as of moderate medical importance, requiring monitoring and pain management strategies.

Niche modelling of the Chilean recluse spider Loxosceles laeta and araneophagic spitting spider Scytodes globula and risk for loxoscelism in Chile.

In Chile, all necrotic arachnidism is attributed to the Chilean recluse spider Loxosceles laeta (Nicolet) (Araneae: Sicariidae). It is predated by the spitting spider Scytodes globula (Nicolet) (Araneae: Scytodidae). The biology of each of these species is not well known and it is important to clarify their distributions. The aims of this study are to elucidate the variables involved in the niches of both species based on environmental and human footprint variables, and to construct geographic maps that will be useful in estimating potential distributions and in defining a map of estimated risk for loxoscelism in Chile. Loxosceles laeta was found to be associated with high temperatures and low rates of precipitation, whereas although S. globula was also associated with high temperatures, its distribution was associated with a higher level of precipitation. The main variable associated with the distribution of L. laeta was the human footprint (48.6%), which suggests that this is a highly invasive species. Similarly to other species, the distribution of L. laeta reaches its southern limit at the Los Lagos region in Chile, which coincides with high levels of precipitation and low temperatures. The potential distribution of L. laeta in Chile corresponds to the distribution of cases of loxoscelism.

Swiss prospective study on spider bites.

Knowledge of spider bites in Central Europe derives mainly from anecdotal case presentations; therefore we aimed to collect cases systematically. From June 2011 to November 2012 we prospectively collected 17 cases of alleged spider bites, and together with two spontaneous notifications later on, our database totaled 19 cases. Among them, eight cases could be verified. The causative species were: Cheiracanthium punctorium (3), Zoropsis spinimana (2), Amaurobius ferox, Tegenaria atrica and Malthonica ferruginea (1 each). Clinical presentation was generally mild, with the exception of Cheiracanthium punctorium, and patients recovered fully without sequelae. In Switzerland, spider bites generally have a benign clinical course, which is characterised by minor effects, with rapid and complete recovery. Since only verified spider bites can be regarded as spider bites, in the case of clinically important arachnidism, the spider should be sent to an expert for identification. Our study may help to diminish spider fear and reassure people who have experienced a bite.

Accident caused by Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), native to the Caribbean, in Brazilian airport / Acidente causado por Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), nativo do Caribe, em aeroporto brasileiro

Describes the case of a 6-year-old girl who was stung by a Centruroides testaceus, a scorpion native to the Lesser Antilles, in the Guarulhos International Airport, São Paulo, Brazil, as she disembarked from a flight coming from the Caribbean. The patient presented only local symptoms (a small area of erythema and pain at the sting site), which were resolved after a few hours with analgesics, without the need for antivenom. Physicians who treat patients stung by scorpions should be alert to the possibility of such accidents being caused by non native species, especially those cases that occur near airports or ports.

Descreve-se um caso de menina de 6 anos de idade picada por um Centruroides testaceus, escorpião nativo das Antilhas, no interior do Aeroporto Internacional de Guarulhos, São Paulo, Brasil, após ter desembarcado de um vôo vindo do Caribe. A paciente apresentou apenas sintomas locais (pequena área de eritema e dor no local da picada), resolvidos em algumas horas com uso de analgésicos, não necessitando receber soro antiveneno. Os médicos que tratam pacientes picados por escorpiões devem estar precavidos quanto à possibilidade dos acidentes serem causados por espécies não-nativas, especialmente nos que ocorrem próximos a aeroportos ou portos.

Seasonality of brown recluse spiders, Loxosceles reclusa, submitted by the general public: implications for physicians regarding loxoscelism diagnoses.

Many medically important animals exhibit fluctuating seasonal abundance such that risk from envenomation or disease is not constant throughout the year. As indicated by homeowner submissions, brown recluse spiders, Loxosceles reclusa, show seasonal peaks of activity during summer and paucity in winter. This information should be incorporated as part of the diagnostic algorithm for physicians when considering the probability of loxoscelism in endemic Loxosceles areas especially if a skin lesion occurs when spiders are scarce.

Cutaneous loxoscelism caused by Loxosceles anomala.

A previously healthy 35-year-old female was bitten on the anterior right thigh by a brown spider while dressing her trousers; the spider was stored and later identified as an adult female Loxosceles anomala. Clinical evolution involved a relatively painless bite with mild itching, followed by local, indurated swelling and a transient, generalized erythrodermic rash at 24 h post-bite. The local discomfort was progressive, and involved changes in the lesion pattern, with pain of increasing intensity. The patient was admitted 60 h post-bite, showing an irregular blue plaque surrounded by an erythematous halo lesion, located over an area of indurated swelling. Considering the presumptive diagnosis of cutaneous loxoscelism, she was treated with five vials of anti-arachnidic antivenom i.v. without adverse effects. There was progressive improvement, with no dermonecrosis or hemolysis; complete lesion healing was observed by Day 55. The clinical features and outcome were compatible with cutaneous loxoscelism and similar to those reported for other Loxosceles species.

Loxoscelism and negative pressure wound therapy (vacuum-assisted closure): an experimental study.

Brown recluse spider (Loxosceles) bites cause lesions ranging from chronic necrotic ulcers to acute life-threatening sepsis. Based on our experience in treating acute and chronic wounds with negative pressure, we postulated that vacuum-assisted closure (VAC) would be valuable in this application. Chester pigs were procured and injected with purified brown recluse spider venom, 1 µl of venom in two anterior sites and 0·1 µl of venom in two posterior sites on their dorsum. For each concentration of venom, treatment consisted of either VAC or dry, non adherent dressings (control group). Each day, the wounds were inspected and measured. For wounds receiving 1·0 µl of venom, the control wounds decreased in surface area to 50% of initial size after 7 days and none had healed, whereas VAC-treated wounds were less than 50% after 48 hours and completely healed and reepithelialised after 8 days. Wounds with 0·1 µl of venom had 50% reduction after 5 days with no complete healing for control wounds, and the VAC wounds were 50% after 48 hours and all had closed and reepithelialised after 5 days. Our experimental study showed an accelerated healing time in the animals treated with the VAC as compared with controls.

Mechanistic insights on spider neurotoxins.

In physiology research, animal neurotoxins historically have served as valuable tools for identification, purification, and functional characterization of voltage-dependent ion channels. In particular, toxins from scorpions, sea anemones and cone snails were at the forefront of work aimed at illuminating the three-dimensional architecture of sodium channels. To date, at least six different receptor binding sites have been identified and--most of them--structurally assigned in terms of protein sequence and spatial disposition. Recent work on Australian funnel-web spiders identified certain peptidic ingredients as being responsible for the neurotoxicity of the crude venom. These peptides, termed delta-atracotoxins (delta-ACTX), consist of 42 amino acids and bind to voltage-gated sodium channels in the same way as classical scorpion alpha-toxins. According to the 'voltage-sensor trapping model' proposed in the literature, delta-ACTX isoforms interact with the voltage sensor S4 transmembrane segment of alpha-subunit domain IV, thereby preventing its normal outward movement and concurrent conformational changes required for inactivation of the channel. As consequence prolonged action potentials at autonomic or somatic synapses induce massive transmitter release, resulting in clinical correlates of neuroexcitation (e.g., muscle fasciculation, spasms, paresthesia, tachycardia, diaphoresis, etc.). On the other hand, the major neurotoxin isolated from black widow spiders, alpha-latrotoxin (alpha-LTX), represents a 132 kDa protein consisting of a unique N-terminal sequence and a C-terminal part harboring multiple ankyrin-like repeats. Upon binding to one of its specific presynaptic receptors, alpha-LTX has been shown to tetramerize under physiological conditions to form Ca2+-permeable pores in presynaptic membranes. The molecular model worked out during recent years separates two distinguishable receptor-mediated effects. According to current knowledge, binding of the N terminus of alpha-LTX at one of its specific receptors either triggers intracellular signaling cascades, resulting in phospholipase C-mediated mobilization of presynaptic Ca2+ stores, or leads to the formation of tetrameric pore complexes, allowing extracellular Ca2+ to enter the presynaptic terminal. Alpha-LTX-triggered exocytosis and fulminant transmitter release at autonomic synapses may then provoke a clinical syndrome referred to as 'latrodectism', characterized by local and incapacitating pain, diaphoresis, muscle fasciculation, tremor, anxiety, and so forth. The present review aims at providing a short introduction into some of the exciting molecular effects induced by neurotoxins isolated from black widow and funnel-web spiders.

Loxoscelism: From basic research to the proposal of new therapies.

Loxoscelism is caused by envenomation by spiders from Loxosceles genus. Clinical symptoms only appear a few hours after envenomation and can evolve in local reactions, such as dermonecrosis, and systemic reactions, such as intravascular haemolysis, intravascular coagulation and renal failure. Current therapies are not effective, often not based in scientific research and can be even detrimental. A lack of understanding of the mechanism of action of the venom of the Loxosceles spider had thus far prevented development of effective therapies. In this review we aim to give an overview of our contributions to the understanding of the mechanism of action of the Loxosceles venom and propose targets and therapeutics for medical intervention.

Activities against hemostatic proteins and adrenal gland ultrastructural changes caused by the brown widow spider Latrodectus geometricus (Araneae: Theridiidae) venom.

Brown widow spider (BrWS) (Latrodectus geometricus) venom produces intense systemic reactions such as cramps, harsh muscle nociceptive, nauseas, vomiting and hypertension. The proposed pathogenic mechanisms resulting in these accidents have principally been damages occurring at the nervous system. However, it is suspected that there is also damage of the adrenal glands, as a result of the experimental animal's clinical manifestations, which developed symptoms compatible with acute adrenal insufficiency. We have currently found that the adrenal gland is damaged by this venom gland homogenates (VGH) producing severe alterations on cortex cells resulting in death by acute adrenal insufficiency. In general, the ultrastructural study on the glands of mice under transmission electronic microscopy observations showed alterations in the majority of the intracellular membranes within 3 to 24h. BrWSVGH also showed specific actions on extracellular matrix proteins such as fibronectin, laminin and fibrinogen. In addition, zymogram experiments using gelatin as substrates detected gelatinolytic activity. The molecular exclusion fractionation of crude BrWSVGH resulted in 15 fractions, of which F1 and F2 presented alpha/beta-fibrinogenase and fibronectinolytic activities. Fractions F6, F14 and F15 showed only alpha-fibrinogenase activity; in contrast, the gelatinolytic action was only observed in fraction F11. Only metalloproteinase inhibitors abolished all these proteolytic activities. Our results suggest that adrenal cortex lesions may be relevant in the etiopathogenesis of severe brown widow spider envenoming. To our knowledge, this is the first report on adrenal gland damages, fibrinogenolytic activity and interrelations with cell-matrix adhesion proteins caused by L.geometricus VGH. The venom of this spider could be inducing hemostatic system damages on envenomed patients.

[Arthropod bite reactions and pyodermias]. / Iktusreaktionen und Pyodermien.

Tourists in the tropics often develop reactions to bites or stings of mosquitoes, fleas, mites, ants, bedbugs, beetles, larva, millipedes, spiders and scorpions. In addition, they may have fresh or salt water exposure to sponges, corals, jellyfish and sea urchins with resultant injury and inflammation. Bacterial skin infections (pyodermias) can follow bites or stings as well as mechanical trauma. The most common bacteria involved in skin infections are staphylococci and streptococci. For tourists, bacterial infections are often complicating a pruritic bite reaction and scratching. It is important to know the cause of the bite reaction and pyoderma in order to take appropriate therapeutic measures.

Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela

The first two cases of scorpion envenoming caused by Tityus neoespartanus (Buthidae) are described. The accidents took place within human environments (one inside a home and the other inside a school), in the village of La Sierra, Margarita Island, State of Nueva Esparta, northeastern Venezuela. Both cases were moderately severe and developed pancreatic involvement and electrocardiographic abnormalities. This report allows inclusion of Margarita Island among the endemic areas of scorpionism in Venezuela.

Descrevem se os dois primeiros casos de escorpionismo por Tityus neoespartanus (Scorpiones, Buthidae). Os acidentes ocorreram no ambiente antrópico (um no domicilio e outro na escola) na aldeia de La Sierra, Ilha de Margarita, Estado de Nueva Esparta, nordeste da Venezuela. Os dois acidentes, moderadamente graves, cursaram com acometimento pancreático e alterações eletrocardiografias. Este reporte permite incluir à Ilha de Margarita entre as áreas endêmicas de escorpionismo na Venezuela.