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1 23rd February 10:10
jwissmille
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Posts: 1
Default brown recluse spider bite or Lyme disease (renal coagulopathy erythema malaise cellulitis)


".......In the US: Although various species of Loxosceles are found throughout
the world, the Loxosceles reclusus is found from the east to west coasts of the
US, with predominance in the southern US.
Mortality/Morbidity....."

"....Although numerous cases of cutaneous and viscerocutaneous reactions have
been
attributed to spiders of the genus Loxosceles, confirming the identity of the
envenomating arachnid is difficult and rarely is accomplished...."


Authored by Thomas Arnold, MD, Medical Director, Louisiana Poison Control
Center, Associate Professor of Emergency Medicine, Department of Emergency
Medicine, Section of Clinical Toxicology, Louisiana State University Health
Sciences Center
Thomas Arnold, MD, is a member of the following medical societies: American
Academy of Emergency Medicine, American College of Emergency Physicians,
American College of Medical Toxicology, Louisiana State Medical Society, and
Society for Academic Emergency Medicine

Edited by Robert Norris, MD, Chief, Associate Professor, Department of Surgery,
Division of Emergency Medicine, Stanford University Medical Center; John T
VanDeVoort, PharmD, ABAT, Manager, Clinical Assistant Professor, Pharmacy
Department, Regions Hospital; James S Walker, DO, Program Coordinator,
Associate Professor, Department of Emergency Medicine, University of Oklahoma
Health Sciences Center, University Hospital; John Halamka, MD, Chief
Information Officer/CareGroup Healthcare System, Assistant Professor of
Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical
Center; and Raymond J Roberge, MD, MPH, FAAEM, Senior Toxicologist, Clinical
Associate Professor, Department of Emergency Medicine, St Francis Medical
Center of Pittsburgh

Author's Email: Thomas Arnold, MD
Editor's Email: Robert Norris, MD

INTRODUCTION


Background: Reports of severe envenomations by brown spiders in the U.S. began
to appear in the late 1800s, and they continue to be of significant clinical
concern in endemic areas.
Of the 13 species of Loxosceles in the US, at least 5 have been associated with
necrotic arachnidism. Loxosceles reclusus, or the brown recluse spider, is the
most common spider responsible for this injury.

Dermonecrotic arachnidism refers to the local skin and tissue injury noted with
this envenomation. Loxoscelism is the term used to describe the systemic
clinical syndrome caused by envenomation from the brown spiders.


Pathophysiology: Brown recluse spider bites can cause significant cutaneous
injury with tissue loss and necrosis. Less frequently, more severe reactions
develop, including systemic hemolysis, coagulopathy, renal failure, and,
rarely, death.

Brown recluse venom, like many of the other brown spider venoms, is cytotoxic
and hemolytic. It contains at least 8 components, including enzymes, such as
hyaluronidase, deoxyribonuclease, ribonuclease, alkaline phosphatase, and
lipase. Sphingomyelinase D is thought to be the protein component responsible
for the majority of tissue destruction and hemolysis. The intense inflammatory
response mediated by arachidonic acid, prostaglandins, and chemotactic
infiltration of neutrophils is amplified further by an intrinsic vascular
cascade involving the mediator C-reactive protein and complement activation.
These and other factors contribute to the local and systemic reactions of
necrotic arachnidism.

Although numerous cases of cutaneous and viscerocutaneous reactions have been
attributed to spiders of the genus Loxosceles, confirming the identity of the
envenomating arachnid is difficult and rarely is accomplished.


Frequency:


In the US: Although various species of Loxosceles are found throughout the
world, the Loxosceles reclusus is found from the east to west coasts of the US,
with predominance in the southern US.
Mortality/Morbidity:

Diagnostic tests to detect brown recluse venom in tissue are not readily
available. Therefore, mortality data are not reliable.
Although deaths have been attributed to presumed brown recluse envenomation,\0
severe outcomes are rare. Typical cases involve only local, soft tissue
destruction.
The more potent venom of the species Loxosceles laeta is responsible for
several deaths each year in South America.
Age: Systemic involvement, although uncommon, occurs more frequently in
children than adults.


Copyright 2001, eMedicine.com, Inc
POSTED:

1999 publication
Identifying and Misidentifying the Brown Recluse Spider
Rick Vetter
Dermatology Online Journal 5 (2): 7
Department of Entomology, University of California Riverside

Abstract
The brown recluse spider, Loxosceles reclusa, is often implicated as a cause of
necrotic skin lesions.[1-3] Diagnoses are most commonly made by clinical
appearance and infrequently is a spider seen, captured or identified at the
time of the bite.[1, 2, 4-6] The brown recluse lives in a cir***scribed area of
the U.S. (the south central Midwest) with a few less common recluse species
living in the more sparsely-populated southwest U.S.[7] In these areas, where
spider populations may be dense, recluse spiders may be a cause of significant
morbidity. However, outside the natural range of these recluse species, the
conviction that they are the etiological agents behind necrotic lesions of
unknown origin is widespread, and most often erroneous. In some states such as
California, unsubstantiated reports concerning recluse spider bites have taken
on the status of "urban legend" leading to overdiagnosis and, therefore,
inappropriate treatment.
______________________
From: JWissmille (jwissmille@aol.com)
Newsgroups: sci.med.diseases.lyme
View: Complete Thread (24 articles) | Original Format
Date: 1998/12/16


I don't know if a brown recluse spider can carry Lyme disease but I do know the
tickbite that transmits Lyme can look identical to the bite of a brown recluse
spider. There is a research article titled Lyme mimicking a brown recluse
spider bite or something close to that I don't have the reference right now.

Here is an old post of mine about this manifestation.--this is the last
sentence.

"The differential diagnosis of erythema
migrans includes cellulitis , tinea, (ringworm) contact dermatitis, fixed drug
reaction. granuloma annulare, reaction to an insect bite, or a Brown recluse
spider bite (48)."

from: Annals of Internal Medicine--Vol. 114--Number 6--March 15, 1991 pg.
490-498
title: Diagnosis of Lyme Disease Based on Dermatologic Manifestations
authors: Malane, MD, et al

"Erythema migrans occurs in 60 to 83 % of patients with Lyme disease
(8-10). Classic erythema migrans starts as a red macule or papule at the site
of the tick bite, which then expands, forming an erythematous, annular lesion
with partial clearing center (11, 42). An erythematous central punctum or a
larger macule will often remain at the bite site. Many patients with erythema
migrans are unable to recall the tick bite. The lesion is generally found in
body areas where ticks characteristically feed. Such areas include those where
tight fitting clothing begins (for example at underwear lines ) and
interiginous" (superficial inflammation of two skin surfaces taht are in
contact) "locations such as the axilla, groin, thigh, and buttocks (11). Ticks
infrequently feed on the palms, the soles, or the mucous membranes, Erythema
migrans begins approximately 3 to 30 days after a tick bite (11, 12, 42) The
inflamed border will migrate cenrifugally over days to weeks. The average size
of the lesion is 15 cm, but lesions as large as 68 cm in diameter have been
reported (11). Erythema migrans is usually flat; however , the edges may be
elevated or indurated (11, 42). Although erythema migrans is usually
asymptomatic , burning, prutitus" (itchy)", pain, tenderness, hyperesthesia, or
dysesthesia may occur (11, 12, 12, 43). In more than 50% of patients, the
lesion is associated with a flu-like illness characterized by fever, myalgia,
arthralgias, malaise, fatigue or headache(11, 43). When left untreated, the
lesion fades weeks to months later, with an average duration of 1 month (8, 11,
12). On fading there may be residual scaling or pigmentary change in the skin
(11, 12)..........
"The histologic findings associated with erythema migans are relatively
nonspecific; thus for histopathologic confirmation , the presence of
B.burgdoreferi needs to be shown by silver stain, labeled antibody staining or
culture(23). Spirochetes are most frequently found in the dermis of the
advancing margin of the lesion (34, 45) Histopathologic findings in specimens
from the periphery of the lesion include a superficial and deep perivascular
lymphocitic infiltrate that may contain plasma cells, histiocytes, and, less
commonly mast cells or neutrophils. (11, 42, 43, 45). istopathologic findings
in specimens from the center of the lesion are consistent with a reaction to an
arthropod bite, with eosinophils within the dermal infiltrate. Occasionaly
vasculitis" (patchy inflammation of walls of small blood vessles)" or
vesicular" (having blisters)" changes are also seen(11).
"Other, less classic presentations of the erythema migrans are common. The
central area of the lesion may show equal or greater erythema than the
periphery(11, 13, 43). A European study (12) found that the homogeneous
erythematous lesions persist for shorter duration than those with central
clearing. An erythema migrans lesion can have alternating rings of erythema
and clearing, thereby creating target configuration(11). Additionally, the
central portion of the erythema migrans lesion may show blue discoloration or
frank purpura,"(a skin rash resulting from bleeding into the skin from small
blood vessles-capillaries; the individual purple spots of the rash are called
petechiae.)" induration, "(hardening) "vesiculation," (blistering)"
necrosis," (death of cells in organ or tissue) "or ulceration (11-13, 43, 44,
46) . Uncommonly, petechiae, have also been seen within erythema migrans
lesions (46). Lesions may also have different shape or textures. Lesions may
appear oval or triangular in shape, especially when they follow the lines of
the clevage.
(Langer lines ) or are in intertriginous areas (34, 43, 47). Lesions may also
be more linear in configuration, especially when located on the scalp or when
expanding on an extremity (11,47). Scaling has been identified occasionally on
some lesions (13, 34, 43, 47).....The differential diagnosis of erythema
migrans includes cellulitis , tinea, (ringworm) contact dermatitis, fixed drug
reaction. granuloma annulare, reaction to an insect bite, or a Brown recluse
spider bite (48)."


--------------------------------------------------------------------------
------
".....The differential diagnosis of erythema
migrans includes cellulitis , tinea, (ringworm) contact dermatitis, fixed drug
reaction. granuloma annulare, reaction to an insect bite, or a Brown recluse
spider bite (48)......"

source: Lyme Disease 1991
Patient/Physician Perspectives from the U.S. and Canada

"....These rashes are rarely painful, as brown recluse spider bites
almost always are, and often itch..."

"......I feel that the best approach in an endemic area would be to assume
that the rash is Lyme and treat accordingly. It's better to err on the
side of overdiagnosis than to miss the diagnosis and have it haunt you
months or years later."

Skin Manifestations of Lyme Disease by John Drulle M.D.

"Since Lyme disease is a widely disseminated, multi-organ system disease,
skin involvement is common, and occurs in about half of those infected.......

"The pathognomonic (diagnostic) rash of early Lyme is called EM(erythema
migrans--in Latin LErythema means redness, and migrans means migratory or
expanding). It usually appears at the site of the tick, flea, fly, or
mosquito bite several days to a year or more later. (It was recently
reported that 18% of the cases of Lyme in Austria are due to bites of
non-tick vectors such as flies and perhaps mosquitos. Borrelia
burgdorferi -Lyme spirochete- has been isolated from these insects.) The
fact that one half of people who develope Lyme do not recall a tick bite
may be partially explained by non-tick vectors. The EM rash is usually
circular or oval, but irregularly shaped rashes are common. They may
spread or enlarge rapidly, but we have seen where pressure on the skin from
a tight garment impedes the progression of the rash causing irregularity of
shape. There may or may not be central clearing, and concentric rings of
different shades are often seen within the rash. There may be necrosis
(death of areas of tissue) or a blue violet shading at the site of the
bite. These rashes are rarely painful, as brown recluse spider bites
almost always are, and often itch. They are usually warm to the touch.
The rash may be completely flat, but occasionally the edges may be elevated
and be scaly or contain vesicular components. Ten variations of the EM
rash have been described by Dr Alan McDonald. Some of these are very
recognizable or "classic" in their appearance, but others may be confused
with other common skin infections such as ringworm, cellulitis, erythema
multiforme, eczema, or hives.

"......I feel that the best approach in an endemic area would be to assume
that the rash is Lyme and treat accordingly. It's better to err on the
side of overdiagnosis than to miss the diagnosis and have it haunt you
months or years later."
" Waiting for other symptoms to develop may delay treatment and result in
persistence of symptoms or even more serious problems in the future.

"........I must note that a treatment effective in one person may not work
in another. This is generally true for any particular symptom of Lyme.

"Another type of chronic Lyme rash we have seen, occurs in some small
children. These tend to be widely disseminated, blotchy plaques, pink in
color. They do not spare the face. They have been seen in children born
with Lyme, especially if the mother was a bit late in pregnancy. These
rashes are usually misdiagnosed as eczema, and they do not respond to
topical or systemic steroids. They do respond quite well to oral or IV
antibiotics ....

"In summary, I believe the current official description of Lyme skin
manifestations is quite incomplete. We are anxiously awaiting the PCR test
to become more readily available, since I feel that we will find evidence
of active infection in many of these chronic skin rashes."
___________________________

".....Further studies utilizing larger sample sizes, more sensitive testing
measures, or spiders from an area more endemic with B. burgdorferi may further
prove or disprove that spiders are capable of harboring this organism...."

Title: Spiders and Borrelia burgdorferi: no evidence of reservoir occurrence in
central Arkansas.
Authors: Suffridge PJ, Smoller BR, Carrington PR
Source: Int J Dermatol 1999 Apr;38(4):296-7
Organization: Department of Dermatology, University of Arkansas for Medical
Sciences, Little Rock 72205, USA.

Abstract:
BACKGROUND: Although Ixodes ticks are considered the chief vector for Borrelia
burgdorferi in the USA, B. burgdorferi has also been identified in mosquitoes,
horse flies, and deer flies. We examined the possibility of these organisms
being harbored in two species of spider in central Arkansas. METHODS: Ten wolf
spiders (Lycosa gulosa) and two brown recluse spiders (Loxosceles reclusa) were
collected in central Arkansas during early summer and fixed in formalin.
Paraffin-embedded sections of the spiders were examined for spirochetes using
the modified Steiner spirochete staining method and examined for B. burgdorferi
using immunohistochemistry. RESULTS: All 12 spiders from both species were
found to be negative for all spirochetes including B. burgdorferi. CONCLUSIONS:
Spiders in our sample appeared not to harbor B. burgdorferi. Further studies
utilizing larger sample sizes, more sensitive testing measures, or spiders from
an area more endemic with B. burgdorferi may further prove or disprove that
spiders are capable of harboring this organism.

Keywords:
Animal, Antibodies, Bacterial, ****YSIS, Arkansas, Borrelia burgdorferi,
IMMUNOLOGY, Immunohistochemistry, Lyme Disease, ETIOLOGY, MICROBIOLOGY,
Spiders, CHEMISTRY, MICROBIOLOGY

Language: Eng

Unique ID: 99253864
____________________
"......... Central necrosis also may occur
and be misdiagnosed as a bite of the brown-recluse spider......"

from: Clinical Manifestations of Lyme Disease in the United States
authors: Trock, et al
Source: Connecticut Medicine June 1989 Volume 53, No. 6
"....Although the bite (and subsequent erythema migrans) may occur
anywhere, the tick has a predilection for the thigh, groin, or axilla. Facial
erythema migrans is more common among children. Atypical forms of erythema
migrans occur: ealy lesions may have indurated or vesicular centers , or MIMIC
STREPTOCOCCAL OR STAPHYLOCCAL CELLULITIS. Central necrosis also may occur
and be misdiagnosed as a bite of the brown-recluse spider. Rarely, transient
eruptions are seen in early Lyme disease and include, maculopapular rashes,
urticaria, " (hives)"malar rash, septal panniculitis (erythema nodosum), and/or
localized granuloma annulare. Although B. burgdorferi has been isolated from
the perimeter of erythema migrans, skin biopsy is a low-yeild procedure.
Histologically, erythema migrans has a non-specific appearance with a
perivascular infiltrate comprised of lymphocytes, plasma cells, eosinophils,
and histiocytes......."
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