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Weinstein SA. Hypersensitivity vs. uncommonly severe local envenoming by the red-back spider, Latrodectus hasselti Thorell, 1870 (Araneae: Theridiidae). Toxicon 2024; 249:108077. [PMID: 39182727 DOI: 10.1016/j.toxicon.2024.108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
The genus Latrodectus (Araneae: Theridiidae) consists of 35 widow spider species with global distribution. Envenoming by medically important species, latrodectism, commonly features bite site erythema and diaphoresis, variably severe pain that may be persistent, myalgia/cramping and/or myoclonus, autonomic symptoms, abdominal distress; severe envenoming can be prolonged and include serious effects such as oliguria, hypertension and, rarely, myocarditis/myocardial injury. Red-back spiders (Latrodectus hasselti) are the most common cause of envenoming in Australia and can cause the spectrum of effects noted for other medically important widow spiders. A 34-yr-old woman with a history of previous L. hasselti envenoming and treatment with antivenom was envenomed in her left ankle by a verified L. hasselti (hiding in her boot) while attending an appointment with her primary care physician. She reported some of the common effects of latrodectism including severe, prolonged pain, bite site diaphoresis, and malaise; however, she also developed marked edema that involved the entire left foot. She also exhibited mild hypertension and autonomic/non-specific effects limited to nausea, headache, and anxiety. She was effectively treated with red-back spider antivenom (a total of 4 ampoules) and supportive care; full resolution of the edema required almost 5 days. The uncommon clinical evolution of L. hasselti local envenoming observed in this patient may have been caused by a mixed picture of venom-induced effects and Type I hypersensitivity, but alternatively could be a rare, solely venom-induced manifestation. While provision of patient-centred care for anyone envenomed by Latrodectus spp. requires careful history collection and assessment of comorbidities, differentiation of atopic and direct venom effects may be challenging in some envenomed patients with established complex allergy history.
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Affiliation(s)
- Scott A Weinstein
- Young Adult Institute and Premier HealthCare, 220 East 42nd St, 8th Floor, New York, NY, 10017, USA.
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2
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Ruschig M, Nerlich J, Becker M, Meier D, Polten S, Cervantes-Luevano K, Kuhn P, Licea-Navarro AF, Hallermann S, Dübel S, Schubert M, Brown J, Hust M. Human antibodies neutralizing the alpha-latrotoxin of the European black widow. Front Immunol 2024; 15:1407398. [PMID: 38933276 PMCID: PMC11199383 DOI: 10.3389/fimmu.2024.1407398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
Poisoning by widow-spider (genus Latrodectus) bites occurs worldwide. The illness, termed latrodectism, can cause severe and persistent pain and can lead to muscle rigidity, respiratory complications, and cardiac problems. It is a global health challenge especially in developing countries. Equine serum-derived polyclonal anti-sera are commercially available as a medication for patients with latrodectism, but the use of sera imposes potential inherent risks related to its animal origin. The treatment may cause allergic reactions in humans (serum sickness), including anaphylactic shock. Furthermore, equine-derived antivenom is observed to have batch-to-batch variability and poor specificity, as it is always an undefined mix of antibodies. Because latrodectism can be extremely painful but is rarely fatal, the use of antivenom is controversial and only a small fraction of patients is treated. In this work, recombinant human antibodies were selected against alpha-latrotoxin of the European black widow (Latrodectus tredecimguttatus) by phage display from a naïve antibody gene library. Alpha-Latrotoxin (α-LTX) binding scFv were recloned and produced as fully human IgG. A novel alamarBlue assay for venom neutralization was developed and used to select neutralizing IgGs. The human antibodies showed in vitro neutralization efficacy both as single antibodies and antibody combinations. This was also confirmed by electrophysiological measurements of neuronal activity in cell culture. The best neutralizing antibodies showed nanomolar affinities. Antibody MRU44-4-A1 showed outstanding neutralization efficacy and affinity to L. tredecimguttatus α-LTX. Interestingly, only two of the neutralizing antibodies showed cross-neutralization of the venom of the Southern black widow (Latrodectus mactans). This was unexpected, because in the current literature the alpha-latrotoxins are described as highly conserved. The here-engineered antibodies are candidates for future development as potential therapeutics and diagnostic tools, as they for the first time would provide unlimited supply of a chemically completely defined drug of constant quality and efficacy, which is also made without the use of animals.
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Affiliation(s)
- Maximilian Ruschig
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Jana Nerlich
- Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Leipzig University, Leipzig, Germany
| | - Marlies Becker
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Doris Meier
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Saskia Polten
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Karla Cervantes-Luevano
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Ensenada, Mexico
| | | | - Alexei Fedorovish Licea-Navarro
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Ensenada, Mexico
| | - Stefan Hallermann
- Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Leipzig University, Leipzig, Germany
| | - Stefan Dübel
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Maren Schubert
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Jeffrey Brown
- PETA Science Consortium International e.V., Stuttgart, Germany
| | - Michael Hust
- Departments of Biotechnology and Medical Biotechnology, Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
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Gamulin E, Mateljak Lukačević S, Halassy B, Kurtović T. Snake Antivenoms-Toward Better Understanding of the Administration Route. Toxins (Basel) 2023; 15:398. [PMID: 37368699 DOI: 10.3390/toxins15060398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Envenomations induced by animal bites and stings constitute a significant public health burden. Even though a standardized protocol does not exist, parenterally administered polyclonal antivenoms remain the mainstay in snakebite therapy. There is a prevailing opinion that their application by the i.m. route has poor efficacy and that i.v. administration should preferentially be chosen in order to achieve better accomplishment of the antivenom therapeutic activity. Recently, it has been demonstrated that neutralization not only in the systemic circulation but also in the lymphatic system might be of great importance for the clinical outcome since it represents another relevant body compartment through which the absorption of the venom components occurs. In this review, the present-day and summarized knowledge of the laboratory and clinical findings on the i.v. and i.m. routes of antivenom administration is provided, with a special emphasis on the contribution of the lymphatic system to the process of venom elimination. Until now, antivenom-mediated neutralization has not yet been discussed in the context of the synergistic action of both blood and lymph. A current viewpoint might help to improve the comprehension of the venom/antivenom pharmacokinetics and the optimal approach for drug application. There is a great need for additional dependable, practical, well-designed studies, as well as more practice-related experience reports. As a result, opportunities for resolving long-standing disputes over choosing one therapeutic principle over another might be created, improving the safety and effectiveness of snakebite management.
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Affiliation(s)
- Erika Gamulin
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia
| | - Sanja Mateljak Lukačević
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia
| | - Beata Halassy
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia
| | - Tihana Kurtović
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia
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4
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Sulaeman SJ, Graudins A. Evolution in the choice of therapies used to treat latrodectism: Redback spider antivenom or standard analgesic medications. Nothing to rave about. Emerg Med Australas 2023. [PMID: 36807536 DOI: 10.1111/1742-6723.14182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Redback spider (RBS) antivenom (RBSAV) use appears to have decreased since the results of the RAVE-2 antivenom efficacy study were released. The aims of this study were to assess change in RBSAV use over time and compare responses to treatment for antivenom and other analgesics. METHODS Retrospective audit of RBS bite referrals to a toxicology unit, from January 2010 to January 2022. Data included demographics, pain severity, treatment (analgesia or RBSAV), response to treatment, re-presentation rate, adverse events, change in antivenom use over time. RESULTS Of 270 presentations, 157 with moderate or severe pain were included (RBSAV n = 51, analgesia n = 106). Median age was 39 years, n = 81 (51%) female. Those receiving antivenom were more likely to report severe pain n = 46/51 (84%) versus n = 68/106 (58%) (P = 0.006). Eighty-three percent of antivenom doses were administered between 2010 and 2013. Analgesia-only group received various combinations of paracetamol, NSAIDs, and opioids. In those receiving RBSAV, 17/48 (35%), 26/48 (54%), 5/48 (10%) reported a partial, complete or no reduction in pain, respectively, versus 30/77 (39%), 43/77 (58%) and 4/77 (5%), for analgesia-only group. Post-treatment pain was not recorded in three RBSAV and 28 analgesia-only patients. Pain reduction was no different for intravenous and intramuscular antivenom. Re-presentation for ongoing pain was more common in the analgesia-only group, 16/106 (15%) versus 1/51 (2%) for antivenom (P = 0.013). CONCLUSION Antivenom use fell over the study period. There was no difference in pain relief between RBSAV and analgesia-only groups. RBSAV, regardless of route of administration, was no better than standard analgesics in pain reduction in the present study.
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Affiliation(s)
- Siba J Sulaeman
- Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Andis Graudins
- Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Dear JW, Dargan PI, Juurlink DN, Thanacoody RHK, Wood DM. Introduction to a series of Pro/Con papers in Clinical Toxicology. Br J Clin Pharmacol 2021; 88:56-57. [PMID: 34784060 DOI: 10.1111/bcp.15128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- James W Dear
- Pharmacology, Therapeutics and Toxicology, Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David N Juurlink
- Division of Clinical Pharmacology and Toxicology, Departments of Medicine and Pediatrics, University of Toronto, Toronto, Canada
| | - Ruben H K Thanacoody
- National Poisons Information Service (Newcastle unit), Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
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6
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Cocks J, Chu S, Gamage L, Rossaye S, Schutz J, Soon AWC. Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2021; 34:230-236. [PMID: 34558205 DOI: 10.1111/1742-6723.13869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the South Australian paediatric redback spider bite experience and to examine the hypothesis that redback antivenom (RBAV) treatment in children is clinically effective. METHODS Retrospective chart review of all children under 18 years of age presenting to the EDs of the three major paediatric or mixed hospitals in Adelaide, South Australia, with a discharge diagnosis of redback spider envenomation between 1 January 2010 and 31 March 2020. The main outcome measures include: patient and bite demographics; presenting symptoms and signs; treatment provided; clinical effects at 2 h post RBAV administration on pain, diaphoresis, blood pressure, heart rate and systemic features; overall clinical impression of RBAV effectiveness and resolution of symptoms prior to discharge. RESULTS There were 256 patient encounters involving 235 patients. Latrodectism was described in one-third (34%) of the cases. Sixty-one patients received RBAV and in 57 (93%) patients the RBAV had good clinical effect. Two hours post RBAV administration, pain resolved in 71%, hypertension resolved in 62%, diaphoresis resolved in 43% and tachycardia resolved in 82%. There were no cases of urticaria or anaphylaxis and one case of serum sickness. CONCLUSIONS This retrospective review of redback spider envenomation in South Australian children over a 10-year period has demonstrated clinical effectiveness of RBAV in paediatric patients across all age groups, observed in both clinician perceived results and measurable outcomes. RBAV remains an effective treatment for redback envenomation in children.
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Affiliation(s)
- Jane Cocks
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Simon Chu
- Emergency Department, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Lalith Gamage
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sasha Rossaye
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jacquie Schutz
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Aun Woon Cindy Soon
- Paediatric Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia
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7
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Alape-Girón A, Moreira-Soto A, Arguedas M, Brenes H, Buján W, Corrales-Aguilar E, Díaz C, Echeverri A, Flores-Díaz M, Gómez A, Hernández A, Herrera M, León G, Macaya R, Molina-Mora JA, Mora J, Narayanan A, Sanabria A, Sánchez A, Sánchez L, Segura Á, Segura E, Solano D, Soto C, Stynoski JL, Vargas M, Villalta M, Drexler JF, Gutiérrez JM. Heterologous Hyperimmune Polyclonal Antibodies Against SARS-CoV-2: A Broad Coverage, Affordable, and Scalable Potential Immunotherapy for COVID-19. Front Med (Lausanne) 2021; 8:743325. [PMID: 34552950 PMCID: PMC8450768 DOI: 10.3389/fmed.2021.743325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Alape-Girón
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
| | - Andrés Moreira-Soto
- Institute of Virology, Charité Medical University of Berlin, Berlin, Germany
| | - Mauricio Arguedas
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Hebleen Brenes
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Ministry of Health, Cartago, Costa Rica
| | - Willem Buján
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - Eugenia Corrales-Aguilar
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Cecilia Díaz
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
| | - Ann Echeverri
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - Marietta Flores-Díaz
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Aarón Gómez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Andrés Hernández
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - María Herrera
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Guillermo León
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Román Macaya
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - José Arturo Molina-Mora
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Javier Mora
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Aarthi Narayanan
- National Center for Biodefense and Infectious Diseases, College of Science, George Mason University, Fairfax, VA, United States
| | | | - Andrés Sánchez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Laura Sánchez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Álvaro Segura
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Eduardo Segura
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Daniela Solano
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Claudio Soto
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Ministry of Health, Cartago, Costa Rica
| | - Jennifer L. Stynoski
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Mariángela Vargas
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Mauren Villalta
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Jan Felix Drexler
- Institute of Virology, Charité Medical University of Berlin, Berlin, Germany
| | - José María Gutiérrez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
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8
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Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. METHODS A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. RESULTS The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. CONCLUSIONS Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
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Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
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9
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Friedman ER, Seidel S, Heiser S, Prybys K. Silently Suffering: A Pediatric Black Widow Spider Envenomation. J Emerg Med 2021; 61:e151-e154. [PMID: 33994256 DOI: 10.1016/j.jemermed.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/02/2021] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Black widow spiders are distributed worldwide and, although rarely fatal, account for significant morbidity. Diagnosis can be challenging, and children are at risk of increased morbidity due to their small size. CASE REPORT We present a case of a 3-year-old boy who was brought to our emergency department because of sudden ear pain followed by labored breathing, abdominal pain, refusal or inability to speak, and grunting respirations. A black widow spider bite was suspected based on additional history obtained, and the spider was found in his helmet, confirming the diagnosis. The patient had progressive respiratory distress and somnolence and was intubated and transferred to a local pediatric intensive care unit. Antivenom was not initially available and eventually declined by the family. The child received supportive care and recovered after several days. Why Should an Emergency Physician Be Aware of This? This case illustrates the potentially deadly effects a black widow envenomation could cause in a child, and that bite location can affect the constellation of symptoms. It is a reminder that toxins, including that of the black widow spider, should be on the differential for acute abdominal pain, especially with autonomic features.
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Affiliation(s)
- Eric R Friedman
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland
| | - Stacey Seidel
- Department of Emergency Medicine, University of Maryland Upper Chesapeake Medical Center, Bel Air, Maryland
| | - Samantha Heiser
- University of Maryland Upper Chesapeake Medical Center, Bel Air, Maryland
| | - Katherine Prybys
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland
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10
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Keyler DE, Ahmad M, Rodriguez A, De Silva PMK. Latrodectus geometricus (Aranea: Theridiidae) envenoming: Rapid resolution of symptoms following F(ab') 2 antivenom therapy. Toxicon 2020; 188:76-79. [PMID: 33068558 DOI: 10.1016/j.toxicon.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
The Brown Widow spider (Latrodectus geometricus) is an invasive species whose geographic range has been expanding worldwide. It is a relative species of the Black Widow and Red-backed spiders of the genus Latrodectus. Despite its broad geographic distribution cases of Brown Widow envenomation have rarely been documented. The venom of L. geometricus is similar to the venom of L. mactans with the primary venom component being alpha-latrotoxin, and consequent envenoming by L. geometricus to humans has resulted in symptoms similar to those reported for other Latrodectus spp. Specific FDA approved Latrodectus antivenom (IgG) available in North America has been effectively used in treating venom-induced symptoms following L. mactans envenoming. The patient reported here involved a confirmed L. geometricus envenoming who was efficaciously treated with an alternately available F(ab')2 antivenom from Mexico.
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Affiliation(s)
- D E Keyler
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
| | - M Ahmad
- Metropolitan Methodist Hospital, San Antonio, TX, USA
| | - A Rodriguez
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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11
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Kim HS, Courtney DM, McCarthy DM, Cella D. Patient-reported Outcome Measures in Emergency Care Research: A Primer for Researchers, Peer Reviewers, and Readers. Acad Emerg Med 2020; 27:403-418. [PMID: 31945245 DOI: 10.1111/acem.13918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
Abstract
Patient-reported outcomes (PROs) are of increasing importance in clinical research because they capture patients' experience with well-being, illness, and their interactions with health care. Because PROs tend to focus on specific symptoms (e.g., pain, anxiety) or general assessments of patient functioning and quality of life that offer unique advantages compared to traditional clinical outcomes (e.g., mortality, emergency department revisits), emergency care researchers may benefit from incorporation of PRO measures into their research design as a primary or secondary outcome. Patients may also benefit from the ability of PROs to inform clinical practice and facilitate patient decision making, as PROs are obtained directly from the lived experience of other patients with similar conditions or health status. This review article introduces and defines key terminology relating to PROs, discusses reasons for utilizing PROs in clinical research, outlines basic psychometric and practical assessments that can be used to select a specific PRO measure, and highlights examples of commonly utilized PRO measures in emergency care research.
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Affiliation(s)
- Howard S. Kim
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - D. Mark Courtney
- Department of Emergency Medicine University of Texas Southwestern Medical School Dallas TX
| | - Danielle M. McCarthy
- Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL
- Center for Health Services & Outcomes Research Northwestern University Feinberg School of Medicine Chicago IL
| | - David Cella
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL
- Center for Patient‐Centered Outcomes Northwestern University Feinberg School of Medicine Chicago IL
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