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Carvalho ÉS, Oliveira I, Nascimento TP, da Silva Neto AV, Leal BAS, Araújo FQ, Julião BFV, Souza ARN, Abrahim AW, Macedo BBO, de Oliveira JTS, Wen FH, Pucca MB, Monteiro WM, Sachett JAG. Prospecting Local Treatments Used in Conjunction with Antivenom Administration Following Envenomation Caused by Animals: A Systematic Review. Toxins (Basel) 2023; 15:toxins15050313. [PMID: 37235348 DOI: 10.3390/toxins15050313] [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: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Envenomation caused by venomous animals may trigger significant local complications such as pain, edema, localized hemorrhage, and tissue necrosis, in addition to complications such as dermonecrosis, myonecrosis, and even amputations. This systematic review aims to evaluate scientific evidence on therapies used to target local effects caused by envenomation. The PubMed, MEDLINE, and LILACS databases were used to perform a literature search on the topic. The review was based on studies that cited procedures performed on local injuries following envenomation with the aim of being an adjuvant therapeutic strategy. The literature regarding local treatments used following envenomation reports the use of several alternative methods and/or therapies. The venomous animals found in the search were snakes (82.05%), insects (2.56%), spiders (2.56%), scorpions (2.56%), and others (jellyfish, centipede, sea urchin-10.26%). In regard to the treatments, the use of tourniquets, corticosteroids, antihistamines, and cryotherapy is questionable, as well as the use of plants and oils. Low-intensity lasers stand out as a possible therapeutic tool for these injuries. Local complications can progress to serious conditions and may result in physical disabilities and sequelae. This study compiled information on adjuvant therapeutic measures and underscores the importance of more robust scientific evidence for recommendations that act on local effects together with the antivenom.
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Affiliation(s)
- Érica S Carvalho
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Isadora Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040903, São Paulo, Brazil
| | - Thaís P Nascimento
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Alexandre Vilhena da Silva Neto
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Brenda A S Leal
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
| | - Felipe Q Araújo
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
| | - Bruno F V Julião
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
| | - Andrea R N Souza
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Andreza W Abrahim
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
| | - Bruna B O Macedo
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Jéssica T S de Oliveira
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065130, Amazonas, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo 05501000, São Paulo, Brazil
| | - Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista 69310000, Roraima, Brazil
- Health Sciences Postgraduate Program, Federal University of Roraima, Boa Vista 69310000, Roraima, Brazil
| | - Wuelton M Monteiro
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
| | - Jacqueline A G Sachett
- School of Health Sciences, Amazonas State University, Manaus 69050030, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040000, Amazonas, Brazil
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065130, Amazonas, Brazil
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Köse A, Abacı E, Bozkurt Babus S, Yazıcı A. Skin Necrosis, Diffuse Urticaria, and Cellulitis Due to Presumed Loxosceles Spider Bite. Wilderness Environ Med 2021; 32:198-203. [PMID: 33966970 DOI: 10.1016/j.wem.2020.12.005] [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: 07/17/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
The clinical manifestations of a recluse spider bite range from local erythema to necrotic skin reactions; bites rarely lead to a systemic disease known as viscerocutaneous loxoscelism. A 29-y-old female patient was admitted to the emergency department with a wound, swelling, and pain on her left leg and a rash on her whole body as a result of a spider bite. On physical examination, a round, hard, black, irregularly shaped necrotic area was found in the bite zone on the lower posterior part of the left thigh, as were lesions in the form of erythematous papules around the area. There was a color change around the lesion, extending from posterior to medial of the thigh, and a papule on a diffuse erythematous surface on the trunk and arms. At follow-up, the necrotic area had become more apparent. After approximately 1 mo, the necrotic area was surgically debrided and a flap was formed on the necrotic tissue area. In this article, a case that was thought to be caused by a Loxosceles spider bite and which started with erythema, progressed to lymphangitis, cellulitis, and severe necrosis, and was surgically debrided, was evaluated in light of the clinical findings and previously reported cases of verified loxoscelism. In patients with a history suggestive of a bite and with these clinical findings, the diagnosis of a bite by Loxosceles spp. should be carefully considered based on clinical and epidemiologic findings.
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Affiliation(s)
- Ataman Köse
- Department of Emergency Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey.
| | - Esin Abacı
- Department of Emergency Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Seyran Bozkurt Babus
- Department of Emergency Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayça Yazıcı
- Department of Dermatology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Ali AH, Kang MS, Aldahwi J, Reyes C. P-ANCA vasculitis with diffuse alveolar haemorrhage preceded by a spider bite. BMJ Case Rep 2020; 13:13/6/e233710. [PMID: 32554462 DOI: 10.1136/bcr-2019-233710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a patient with antineutrophilic cytoplasmic antibody (ANCA) vasculitis that was preceded by witnessed black widow spider bites. The patient initially presented with a diffuse painful skin rash that developed after a few hours post bite. He was treated initially with topical ointment for the suspected bite. However, subsequently a few days later the patient returned to the hospital with similar, but more progressive rash with haemoptysis and acute hypoxic respiratory failure requiring supplemental oxygen. Immunology work up showed elevated titre of peri-nuclear ANCA. Bronchoscopy revealed diffuse alveolar haemorrhage. The patient was treated successfully with methylprednisolone and rituximab.
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Affiliation(s)
| | | | | | - Candice Reyes
- Internal Medicine, UCSF Fresno Center for Medical Education and Research Edward and Ann Hildebrand Medical Library, Fresno, California, USA
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Lopes PH, Squaiella-Baptistão CC, Marques MOT, Tambourgi DV. Clinical aspects, diagnosis and management of Loxosceles spider envenomation: literature and case review. Arch Toxicol 2020; 94:1461-1477. [PMID: 32232511 DOI: 10.1007/s00204-020-02719-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/12/2020] [Indexed: 01/10/2023]
Abstract
The genus Loxosceles comprises 140 species widely distributed around the world. These spiders are nocturnal, sedentary and remarkably nonaggressive, although they cause accidents in humans with wide degrees of severity, generating signs and symptoms that define the clinical condition known as loxoscelism. Its local signs and symptoms were first reported in 1872, and over the years, a large medical literature has been accumulated; unfortunately, it is not always trustworthy. Assessing the reliability of such information, we reviewed 120 case reports of loxoscelism published in 84 articles over the past 20 years. This search allowed us to gather information on the clinical aspects, diagnosis and treatment of loxoscelism, showing that the severity of these accidents has multiple degrees and that it is influenced by many factors. Thus, coupled with epidemiological and species occurrence information, this study can be a useful tool for the clinical practice of loxoscelism. It may support and provide a multidisciplinary view that should be taken into consideration when establishing the therapeutic approach in cases of Loxosceles envenomation.
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Affiliation(s)
- Priscila Hess Lopes
- Laboratório de Imunoquímica, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP, 05503-900, Brazil
| | | | | | - Denise V Tambourgi
- Laboratório de Imunoquímica, Instituto Butantan, Av. Vital Brazil, 1500, São Paulo, SP, 05503-900, Brazil.
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Mikkelsen J, Schmidt G, Holmgaard R. Reconstructive considerations following a necrotic spider bite on the face: A case report. Int J Surg Case Rep 2017; 32:76-79. [PMID: 28259053 PMCID: PMC5334498 DOI: 10.1016/j.ijscr.2017.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022] Open
Abstract
Necrotic spider bites in the facial region can result in extensive soft tissue defects. Healing by secondary intention is slow in necrotic spider bite lesions on the face. 19-year-old female with suspected recluse spider bite on her face while sleeping. Single-stage reconstruction with a trimmed FTSG resulted in high patient satisfaction.
Introduction Spider bites as the cause of necrotic skin and soft tissue lesions occur very rarely in Central and Northern Europe. Recluse spiders, distributed almost worldwide, are one of two genera of spiders with confirmed capability of causing necrotic lesions. In the facial region, the resulting defects represent a potential reconstructive challenge, especially in younger patients. Methods This case report has been reported in line with the SCARE criteria. Presentation of case We describe a case of a 19-year-old female with a suspected bite from a recluse spider sustained during a recreational trip to Guatemala. She was bitten on the right upper aspect of the nose, and within a week developed a large necrotic lesion extending to the medial canthus. Following her return to Denmark the defect was reconstructed with a trimmed full-thickness skin graft. An initially planned second-stage reconstructive procedure was cancelled, as the patient was satisfied with the primary result. Discussion Most aspects of the extended reconstructive ladder were evaluated before selecting the optimal reconstruction for this patient. In younger patients, reconstructive surgery requires special considerations, primarily due to age-related limitations combined with generally high expectations to the aesthetic outcome. Conclusion In the few reported cases of necrotic spider bites in the facial region, active reconstructive measures have resulted in the best outcomes. Tissue expansion of local or regional skin may have a potential role, but in certain patients, simple reconstructive solutions will provide an aesthetically satisfactory result without requiring extensive or multi-stage surgeries, as demonstrated in this case.
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Affiliation(s)
- Joachim Mikkelsen
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Grethe Schmidt
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Rikke Holmgaard
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Anticytoplasm neutrophil antibodies–positive vasculitis with diffuse alveolar hemorrhage related to a spider bite. Am J Emerg Med 2016; 34:339.e3-4. [DOI: 10.1016/j.ajem.2015.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
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Necrosis séptica de miembro inferior secundaria a picadura de araña reclusa parda. Cir Esp 2016; 94:e13-5. [DOI: 10.1016/j.ciresp.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/05/2014] [Indexed: 11/23/2022]
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Sari T, Temocin F. A rare cause of cellulitis (necrotic arachnidism): a report of two cases. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bajin MS, Arikan G, Parlak M, Tuncok Y, Yigit N, Durak I, Saatci AO. Necrotic arachnidism of the eyelid due toLoxosceles rufescensspider bite. Cutan Ocul Toxicol 2011; 30:302-5. [DOI: 10.3109/15569527.2011.577494] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Reports of spider bites appear throughout North America. Bites associated with the brown recluse spider (Loxosceles recluse) cause serious medical complications because the venom of this spider contains a powerful necrotising agent with the potential to cause severe cutaneous necrosis. Although not much is known regarding the application of negative pressure wound therapy (NPWT) to spider bites, this therapy has considerable literature support for its efficacy, cost-effectiveness and ease of use in chronic, difficult-to-heal wounds. A case study using NPWT to successfully treat a non healing upper arm wound presumed due to a venomous spider bite is presented here. The patient was successfully treated with a new, less costly NPWT product called the Versatile 1 and a new combination drain plus dressing called the Miller DermiVex drain, both manufactured by Blue Sky Medical (Carlsbad, CA).
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Dyachenko P, Ziv M, Rozenman D. Epidemiological and clinical manifestations of patients hospitalized with brown recluse spider bite. J Eur Acad Dermatol Venereol 2006; 20:1121-5. [PMID: 16987269 DOI: 10.1111/j.1468-3083.2006.01749.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Necrotic arachnidism represents a common health problem and standard treatments are usually safe and effective. OBJECTIVE The aim of this study was to review documented Loxosceles species spider envenomations and identify the natural history of affected patients. METHODS A retrospective single-centre study included 52 patients with necrotic arachnidism hospitalized in the dermatology department between 1997 and 2004. We examined the relationship between the epidemiological, clinical and laboratory parameters and degree of lesion severity, length of hospitalization and time to complete healing. RESULTS The bites occurred predominantly in rural areas, 67% between April and August. Only 35% of the patients sought medical care within 24 h post bite. Most bites were of the extremities (67%). Time to complete healing ranged from 14 days to more than 8 weeks (mean, 4.8 weeks). A marked relationship was found between age, comorbidities, lesion severity and time to complete healing (P < 0.01). Duration of hospitalization was significantly longer in patients with severe thigh lesions (P < 0.02). CONCLUSIONS Loxosceles species spider bites frequently induce necrotic, slowly healing ulcers on the fatty areas of the body. Early, appropriate systemic therapy may provide clinical benefit.
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Affiliation(s)
- P Dyachenko
- Department of Dermatology, Ha'emek Medical Center, Afula, Israel.
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Donepudi SK, Ahmed KA, Stocks RMS, Nelson D, Thompson JW. Aural involvement in loxoscelism: case report and literature review. Int J Pediatr Otorhinolaryngol 2005; 69:1559-61. [PMID: 15939487 DOI: 10.1016/j.ijporl.2005.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
An 11-year-old male presented with fever, rash, and a necrotic lesion on the lobule of the left ear. The lesion became tender and formed an eschar over 4 days. The patient developed leukocytosis, hemolytic anemia, and proteinuria, and was diagnosed with systemic loxoscelism from a brown recluse spider bite. He was managed with supportive therapy and improved in 4 days. Loxoscelism is a clinical diagnosis which should be suspected in an otherwise healthy patient with a necrotic wound, particulary in the endemic Southern and Midwestern United States. Physicians should be aware of this disease entity and its complications.
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Affiliation(s)
- Sreekrishna Kanth Donepudi
- Department of Otolaryngology--Head and Neck Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room B216, Memphis, TN 38163, USA
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