Brown Recluse bite!

I was in the middle of eating breakfast...suddenly I'm not hungry anymore.

Good luck, phish.

I did a quick search on the recluse and came across this almost immediately... putting these photo's in doubt. But what do I know? If it creeps or crawls I kill it.

Source:

http://spiders.ucr.edu/hyperbole2003.html

The alleged brown-recluse-caused thumb wound

Another Internet Spider Hoax?

I have recently received many emails regarding an alleged brown recluse spider bite to a thumb. Here is my response.



I have received this set of images from many people starting in June 2003. It is possible that this is a recluse bite however, the stories surrounding this series of images are starting to acquire the makings of an urban legend. I have now heard that this wound supposedly was a recluse bite that occurred at a military base in Missouri, in Wisconsin, Texas, Montana, Ohio, California, Alberta Canada, Costa Rica and supposedly was a hobo spider bite in British Columbia. Obviously, this one series of pictures cannot be a recluse bite in all of these places so one should REALLY question the validity of this information that is circulating. Unfortunately, I have heard that readily-accepting people are using these images for presentations in paramedic classes etc. which may be spreading misinformation rather than educating people. The picture of the spider itself is not of the spider that caused the wound but is a stock photo from an Ohio university website. This image was used in 2002 in a very hyperbolic news story in Long Island. Although it is possible that this is a recluse bite, no one can seem to verify where the alleged bite occurred, whether a spider was caught in the act of biting or at the scene of the crime, whether the victim was tested for additional etiologic agents of necrosis such as bacterial infection, if a doctor actually made the diagnosis or it was a self-diagnosis from the victim, if the diagnosis came from an area of the country that actually has brown recluses, etc.



However, the main effect that this set of images will have is to cause paranoia in the non-arachnological public, bring out all the "hell, yeah" stories of people who have some alleged brown recluse story and will proliferate once again the hyperbolic message about recluses. One of the forms of this series that I saw was a statement something like, "warn people - save a life". Once again, hyperbole. I have recently added a webpage to my spiders.ucr.edu website lifting quotes from an article by Phillip Anderson, a Missouri dermatologist who specialized on brown recluse bites for over 30 years. Basically here is a summary from his article and several since then by other authors.



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Almost all brown recluse bites heal very nicely without medical intervention.
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Only 3% of brown recluse bites require skin grafts.
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Despite the fact that lots of people believe that brown recluses are deadly, there are only about 8 reported deaths from possible brown recluse bites in the medical literature, Philip Anderson states that there is still not one VERIFIED death from a brown recluse bite and none of the alleged fatal cases are convincing.
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Often physicians will make a recluse bite worse by going in and messing with it by removing tissue and that outcome for most recluse bite situations is very promising with general care. One condition of skin necrosis, pyoderma gangrenosum, definitely gets worse when tissue is removed.



I get lots of people contacting me stating that their doctors diagnosed them with recluse bites and then gave antibiotics. Although antibiotics are not a bad idea overall, they do nothing to counteract the effects of venom. Antibiotics kill bacteria. The correct treatment for recluse bites is simply RICE therapy (rest, ice, compression and elevation). So therefore when a doctor prescribes antibiotics for a “brown recluse bite”, the doctor is either treating it like a bacterial infection or prescribing the incorrect remedy.



The analogy I like to use with these images is that of a car accident. If you show a car wreck where the driver was going 130 miles an hour and then hit a bridge, the car would be totally wrecked into dozens of twisted pieces, body parts strewn all over the place and it would be horrendous. If people reacted to this the way they are reacting to the thumb picture, then they would make the assumption that every car wreck is just as catastrophic, cars are to be feared and no one should ever drive because they will end up obliterated across two counties. However, we all know that many car accidents are just bumper scrapers or fenderbenders, more serious accidents involve broken windows and minor injuries, even more serious and lesser common accidents involve smashed up cars and broken bones and maybe death. Similar to recluse bites, most bites are minor and heal by themselves, some are more serious and require more healing time and leave a scar, even more serious and less common bites require extensive supportive medical care and possibly skin grafts. However, the typical case for a brown recluse bite is minor in effect and prospects for healing are excellent.



One of the very real problems with recluse bites (and any arthropod bite for that matter) is that the bite causes itching, the victim scratches, introduces a secondary bacterial infection from grungy fingernails and such, a horrific wound shows up and then the wound is solely blamed on the arthropod when the real culprit is the bite victim him/herself. Additionally, besides horrific lesions being very rare in recluse bite situations, horrific recluse-induced wounds are typically found in obese people because recluse venom really melts away adipose tissue. It does very little damage in muscular tissue. This wound is on the hand of a person who does not look obese as well as the hand is not an area of the body with lots of adipose tissue in comparison to the stomach and buttocks where most of the wounds in the obese occur. So, this is one strong argument against this injury being a recluse bite and therefore, possibly having a different causative agent.



So the final summary on this is that if it indeed is a brown recluse bite, then it is truly one of the rare, horrific ones however, there is not sufficient information provided with this image to ascertain whether it is credible or not. Yes, indeed, it is a horrible wound but unless a spider was found in the act of biting, there is no more reason to assume that this is a brown recluse bite than to assume that it is necrotizing bacteria or pyoderma gangrenosum or several other medical afflictions that manifest in the dermatologic eruption that can occur. And a recent article of mine shows how unlikely recluse bites are: a family in Kansas collected over two thousand brown recluses in 6 months, have been living there for 7 years and still have shown no evidence of a bite. This latter message is rarely advertised by the hyperbolic news media or the easily-scared general public because people have a tendency to overreact and want to believe the worse about a situation.



Please send this message back to whomever sent you the thumb images. Below my name is a list of my brown recluse publications, most of them in medical journals.



Rick Vetter

Entomology

Univ. Calif. Riverside

Riverside, CA 92521

Another common misconception is that brown recluses exist in California. They don't:

http://spiders.ucr.edu/myth.html

It looks like Colorado isn't a common area for them either.

OK, I can't miss this opportunity to chime in with some very limited experience, to be used for educational purposes only.

My daughter, Emily, came home one day from the first grade and told me how she had learned about this terrible spider which, if it bites you, can be deadly or cause your skin to fall off. She was all wide-eyed, intense, and frightened about the whole story they told her in class. It had obviously made quite an impression on her, as she kept rattling off details.

When she got done telling me about all the horrible things this spider bite can cause, I asked her what the name of the spider was.

"It's the Brown-Eyed Cluse Spider," she said.

"And it's that dangerous?" I asked her.

"Oh, yeah"

Almost busting a gut inside with her mispronounciation, I looked at her quite seriously and said " If it's that bad, do you really want to get close enough to see what color it's eyes are?"

Phish,

So yeah, it may well be a recluse bite, can't tell for certain based on your pic, but the story fits with the presentation, and the symptoms outside of the bite may well be part of the process. Trackhead gives pretty much the best advice, as would be expected with his background.

We sometimes give dapsone if the necrosis is starting to look like it's going to progress within 12-48 hours, since there are some uncontrolled trials/case reports that indicate it damps down the local inflammatory component of cutaneous loxoscelism (from the Latin name for the spider genus, Loxoceles). Steroids are sometimes given for the same reason, again without great data to back it up, but it's a more-or-less pretty benign treatment. Dapsone can have some side effects with certain people genetically prone to rare types of 'fragile blood' anemias, though. The antibiotics TH mentions are not for the spider bite itself, more to treat any potential for cellulitis (skin superinfection) caused by surface bacteria. Sometimes a tetanus shot is given for shits 'n grins, as well.

Otherwise, it's just supportive care - ice packs, anti-inflammatories (tylenol or Vitamin I), rest, elevation, etc for the vast majority of cases. As uglymonkey/Rick Vetter's note mentions, it's pretty damned unlikely you'll die, or even get a significant necrotic lesion from a recluse bite (though another reference I looked up mentions someting about a 20% rate for some kind of necrosis for all affecteds). Something to check if your flulike symptoms don't get better would be general blood tests to make sure you're not undergoing secondary systemic reactions to the bite. Though pretty rare, these can potentially be somewhat serious, so keep an eye on how you're feeling (and how much you're peeing, since kidneys can be affected) without getting too fussed about the whole thing. If you're not getting any better, a return visit to the ER might be in order.

You'll prolly be fine, just keep the heads up on the lesion and your symptoms.

Good luck and take it easy.