Brown recluse spider
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| Brown recluse spider | ||||||||||||||
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| Loxosceles reclusa Gertsch & Mulaik, 1940 | ||||||||||||||
| Image:Distribution.loxosceles.reclusa.png |
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The brown recluse spider, Loxosceles reclusa, is a well-known member of the family Sicariidae (formerly placed in a family "Loxoscelidae"). It is usually between 6–20 mm (¼ in and ¾ in) but may grow larger. It is brown and sometimes an almost deep yellow color and usually has markings on the dorsal side of its cephalothorax, with a black line coming from it that looks like a violin with the neck of the violin pointing to the rear of the spider, resulting in the nickname "fiddleback spider" or "violin spider". Coloring varies from light tan to brown and the violin marking may not be visible.
Description
Since the "violin pattern" is not diagnostic, and other spiders may have similar marking (i.e. cellar spiders (family Pholcidae) and pirate spiders (family Mimetidae)), for purposes of identification it is far more important to examine the eyes. Differing from most spiders, which have eight eyes, recluse spiders have six eyes arranged in pairs (dyads) with one median pair and two lateral pairs. Only a few other spiders have 3 pairs of eyes arranged this way (e.g., scytodids), and recluses can be distinguished from these as recluse abdomens have no coloration pattern nor do their legs, which also lack spines.[1]
Habitat
Recluse spiders build irregular webs that frequently include a shelter consisting of disorderly threads. These spiders frequently build their webs in woodpiles and sheds, closets, garages, cellars and other places that are dry and generally undisturbed. They seem to favor cardboard when dwelling in human residences, possibly because it mimics the rotting tree bark which they naturally inhabit. They also go in shoes, inside dressers, in bed sheets of infrequently used beds, in stacks of clothes, behind baseboards, behind pictures and near furnaces. The common source of human-recluse contact is during the cleaning of these spaces, when their isolated spaces suddenly are disturbed and the spider feels threatened. Unlike most web weavers, they leave these webs at night to hunt. Males will move around more when hunting while females don't usually stray far from their web.
Distribution
The brown recluse spider is native to the United States from the southern Midwest south to the Gulf of Mexico.[1] The native range lies roughly south of a line from southeastern Nebraska through southern Iowa, Illinois, and Indiana to southwestern Ohio. In the southern states, it is native from central Texas to western Georgia. They are generally not found west of the Rocky Mountains.[1] A related species, the brown violin spider (Loxosceles rufescens), is found in Hawaii.[1]
Venomous bite
As indicated by its name, this spider is not aggressive and usually bites only when pressed against the skin, such as when tangled up within clothes, bath towels, or in bedding.[1] In fact, many wounds that are necrotic and diagnosed as brown recluse bites can actually be Methicillin-resistant Staphylococcus aureus (MRSA). Actual brown recluse bites are rare. Brown recluse bites may produce a range of symptoms known as loxoscelism. There are two types of loxoscelism: cutaneous (skin) and systemic (viscerocutaneous).
Most bites are minor with no necrosis. However, a small number of bites produce severe dermonecrotic lesions, and, sometimes, severe systemic symptoms, including organ damage. Rarely, the bite may also produce a systemic condition with occasional fatalities. Most fatalities are in children under 7 or those with a weaker than normal immune system. (For a comparison of the toxicity of several kinds of spider bites, see the list of spiders having medically significant venom.)
A minority of brown recluse spider bites form a necrotizing ulcer that destroys soft tissue and may take months to heal, leaving deep scars. The damaged tissue will become gangrenous and eventually slough away. The initial bite frequently cannot be felt and there may be no pain, but over time the wound may grow to as large as 10 inches (25 cm) in extreme cases. Bites usually become painful and itchy within 2 to 8 hours, pain and other local effects worsen 12 to 36 hours after the bite with the necrosis developing over the next few days.[1]
Serious systemic effects may occur before this time, as the venom spreads throughout the body in minutes. Mild symptoms include nausea, vomiting, fever, rashes, and muscle and joint pain. Rarely more severe symptoms occur including hemolysis, thrombocytopenia, and disseminated intravascular coagulation.[1] Debilitated patients, the elderly, and children may be more susceptible to systemic loxoscelism. Deaths have been reported for both the brown recluse and the related South American species L. laeta[1] and L. intermedia.[citation needed] Other recluse species such as the desert recluse (found in the desert southwestern United States) are reported to have caused necrotic bite wounds.[citation needed]
Numerous other spiders have been associated with necrotic bites in the medical literature. A partial list includes the hobo spider, the white-tailed spider, and the yellow sac spiders. However, the bites from these spiders are not known to produce the severe symptoms that often follow from a recluse spider bite, and the level of danger posed by each has been called into question.[1][1] So far, no known necrotoxins have been isolated from the venom of any of these spiders, and some arachnologists have disputed the accuracy of many spider identifications carried out by bite victims, family members, medical responders, and other non-experts in arachnology. There have been several studies questioning danger posed by some of these spiders. In these studies, scientists examined case studies of bites in which the spider in question was positively identified by an expert, and found that the incidence of necrotic injury diminished significantly when "questionable" identifications were excluded from the sample set.[1][1]
Bite treatment
First aid involves the application of an ice pack to control inflammation, the application of aloe vera to soothe and help control the pain, and prompt medical care. If it can be easily captured, the spider should be brought with the patient in a clear, tightly closed container so it may be identified. However, by the time the bite is noticed any spider found nearby is not likely to be the culprit.
There is no established treatment for necrosis. Routine treatment should include elevation and immobilization of the affected limb, application of ice, local wound care, and tetanus prophylaxis. Many other therapies have been used with varying degrees of success including hyperbaric oxygen, dapsone, antihistamines (e.g., cyproheptadine), antibiotics, dextran, glucocorticoids, vasodilators, heparin, nitroglycerin, electric shock, curettage, surgical excision, and antivenom. None of these treatments have been subjected to controlled, randomized trials to conclusively show benefit. In almost all cases, bites are self-limited and typically heal without any medical intervention.[1]
It is important to seek medical treatment if a brown recluse bite is suspected, as in the rare cases of necrosis the effects can quickly spread, particularly when the venom reaches a blood vessel. Cases of brown recluse venom traveling along a limb through a vein or artery are rare, but the resulting mortification of the tissue can affect an area as large as several inches, to the extreme of requiring excising of the wound. While it is possible, and even likely, that many cases of "brown recluse bites" are indeed misidentifications of other infections or envenemations, the brown recluse has justly earned its reputation.
Specific treatments
Dapsone is commonly used in the USA and Brazil for the treatment of necrosis. There have been conflicting reports about its efficacy and some have suggested it should no longer be used routinely, if at all.[1]
Wound infection is rare. Antibiotics are not recommended unless there is a credible diagnosis of infection.[1]
Studies have shown surgical intervention is ineffective and may worsen outcome. Excision may delay wound healing, cause abscesses, and lead to objectional scarring.[1]
Anecdotal evidence suggests benefit can be gained with the application of nitroglycerin patches.[1] The brown recluse venom is a vasoconstrictor, and nitroglycerin causes vasodilation, allowing the venom to be diluted into the bloodstream, and fresh blood to flow to the wound. Theoretically this prevents necrosis, as vasoconstriction may contribute to necrosis. However, one scientific animal study found no benefit in preventing necrosis, with results showing it increased inflammation and it caused symptoms of systemic envenoming. The authors concluded the results of the study did not support the use of topical nitroglycerin in brown recluse envenoming.[1]
Antivenom, available in South America, appears to be the most promising therapy. However, antivenoms are most effective if given early and because of the painless bite patients do not often present until 24 or more hours after the event, possibly limiting the effect of this intervention.[1]
Misdiagnoses
It is estimated that 80% of reported brown recluse bites may be misdiagnosed. The misdiagnosis of a wound as a brown recluse bite could delay proper treatment of serious diseases.[1] There is now a ELISA-based test for brown recluse venom that can determine if a wound is a brown recluse bite, although it is not commercially available and not in routine use.[1][1]
There are numerous documented infectious and noninfectious conditions (including pyoderma gangrenosum, bacterial infections by Staphylococcus and Streptococcus, herpes, diabetic ulcer, fungal infections, chemical burns, toxicodendron dermatitis, squamous cell carcinoma, localized vasculitis, syphilis, toxic epidermal necrolysis, sporotrichosis, and Lyme disease) that produce wounds that have been initially misdiagnosed as recluse bites by medical professionals; many of these conditions are far more common and more likely to be the source of mysterious necrotic wounds, even in areas where recluses actually occur.[1]
Reported cases of bites occur primarily in Arkansas, Texas, Kansas, Missouri, Colorado, and Oklahoma. There have been many reports of brown recluse bites in California (and elsewhere outside the range of the brown recluse); however the brown recluse is not found in California[1] (though a few related species may be found there, none of which has been shown to bite humans). To date, the reports of bites from areas outside of the spider's native range have been either unverified, or - if verified - specimens moved by travelers or commerce. Gertsch and Ennik (1983) report that occasional spiders have been intercepted in various locations where they have no known established populations; Arizona, California, Colorado, Florida, Maine, Minnesota, New Jersey, Mexico, New York, North Carolina, Wyoming and Tamaulipas (Mexico),[1] which indicates that these spiders may indeed be transported fairly easily, though the lack of established populations well outside the natural range also indicates that such movement does not lead to colonization of new areas. Many arachnologists believe that many bites attributed to the brown recluse in the West Coast are not spider bites at all, or possibly instead the bites of other spider species; for example, the bite of the hobo spider has been reported to produce similar symptoms, and is found in the northwestern United States and southern British Columbia in Canada. However, the toxicity of the hobo spider has been called into question as bites have not been proven to cause necrosis, and the spider is not considered a problem in its native Europe.[1] In addition, published work has shown that tick-induced Lyme disease rashes are often misidentified as brown recluse spider bites.[1]
Footnotes
External links
- Myth of the Brown Recluse (Fact, Fear, and Loathing in California)
- Description of brown recluse
- Illinois and Iowa Brown Recluse Project requesting specimens from public
- Brown Recluse Spider Pictures and comments about the damage this spider can do.
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
