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Objective: Rare disease Background: Compartment syndrome of the forearm has been associated with a variety of etiologies, including fractures, snake bites, complications of certain infections, and, very rarely, spider bites. Loxoscelism is the venom-related clinical manifestation of the bite of spiders of the genus Loxosceles, also called brown or fiddler (violinist) spiders. It manifests locally/regionally with pain, erythema, and edema, with subsequent necrotic plaque formation at the site of the bite. This condition can threaten the function and integrity of the limbs and, in severe cases, can be life-threatening. The basis of treatment is surgical decompression of the affected compartments to restore limb perfusion and avoid irreversible sequelae. Case Report: A 62-year-old male patient, without comorbidities, had edematous cutaneous loxoscelism and secondary development of acute compartment syndrome of the right forearm. He promptly visited the Emergency Department and underwent surgical treatment, in addition to the application of pharmacological treatment, under a multi-disciplinary team. The evolution was favorable. The biochemical levels of rhabdomyolysis decreased, the compartment syndrome resolved, the fasciotomies were closed, and the patient was discharged without further complications. Conclusions: Although arachnid bites are relatively uncommon in urban hospitals, it is crucial that general, vascular, and plastic surgeons maintain a high index of clinical suspicion for acute compartment syndrome. It is important to make an accurate differential diagnosis, and equally important is the interdisciplinary approach to treating this condition, ensuring prompt medical treatment and, if necessary, early surgical intervention. [ABSTRACT FROM AUTHOR]

Objectives: Antivenoms are important emergency medications to be held within Australia, particularly in regional and remote locations. We audited current antivenom holdings in hospitals and health services across South Australia (SA) and compared to recommendations in the 'Snakebite and Spiderbite Management Guidelines' from the State's Toxinology service. The process also assessed the feasibility of 'real‐time' remote stock monitoring. Methods: Fifty‐three sites listed in the guideline were recommended to hold antivenom, though only 49 are currently operational. Interrogation of antivenom stock for 29 sites was possible using electronic reports generated from the State Pharmacy database. The 20 remaining centres had their stock levels confirmed by calling the centres directly. Data obtained were then compared to recommended levels of antivenom holdings in the guideline with discrepancies and associated costs documented. A separate report verification process was used to determine 'real‐time' accuracy of the electronic reports. Results: Thirty‐seven sites (75%) held more than the recommended number of antivenom vials, totalling 129 vials in excess with an approximate total cost of $110 000. Twelve sites (24%) held inadequate stock to deliver a treatment dose for 19 envenoming events. The report verification revealed variances in the electronic reports. Conclusions: This audit has demonstrated a significant disparity between recommended and actual antivenom holdings across most sites in SA and has also revealed that 'real‐time' remote monitoring of state antivenom holdings is not currently feasible. Correction of stock levels to that recommended may result in financial benefit for State Health while also addressing inequity in regional and remote healthcare provision. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Educación e Investigación en Emergencias is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this case report is to highlight an uncommon diagnosis for necrotic wounds. Brown recluse spider bites are a challenging clinical diagnosis and need to be considered as part of differential diagnoses, especially with the spider's natural distribution altering due to the effects of climate change. We present a case of a 44-year-old female patient who developed systemic symptoms and wound necrosis from a presumed brown recluse spider bite. The patient had multiple risk factors for poor wound healing and necrotic skin infections. It is important to be able to recognise unique manifestations of this rare diagnosis in order to avoid delay of timely and effective intervention and treatment. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 18-year-old Brazilian male who developed severe edema and necrosis of the lower lip due to a brown spider bite, known as loxoscelism. Topics discussed include the clinical progression of the condition, challenges in diagnosing loxoscelism, and the specific treatment with loxosceles antivenom.

Due to its diverse manifestations, Lyme disease (caused by the bacterium Borrelia burgdorferi) can present as a diagnostic challenge. This article will help practitioners to recognise Lyme disease in all its formats, ensure that history-taking and assessment are appropriate, and to consider other differentials while considering Lyme disease as the most likely diagnosis. Additionally, clinicians need to be able to manage the presentation appropriately using up-to-date guidelines. There will also be some discussion about the sequelae of Lyme disease — treated or untreated — and the impact of global warming on arthropod disease generally, including Lyme disease [ABSTRACT FROM AUTHOR]

Black widows, one of the few spiders that can sting humans with poison, are members of the spider genus Latrodectus and are well-known for the extraordinary potency of their neurotoxic venom. Latrodectism, a symptom marked by excruciating muscular pain, stomach pain, and diaphoresis after envenomation, is very typical. We described a black widow envenomation case that produced a significant reaction, including diaphoresis and excruciating pain throughout the left thigh that later spread to the lower leg, lower back, belly, and chest. Because of the patient's description of the spider that bit him and his typical clinical state, it was assumed that Latrodectus envenomation was the cause of his symptoms. The patient received 3 days of observation in the ED while receiving opioid analgesic pain management and muscle relaxant treatment with diazepam. The patient's pain and symptoms were satisfactorily managed, and he was sent home. This case report will help further research be done in the area where it was reported to see if there are cases with similar presentations misdiagnosed as other illnesses. Finally, immediate pain relief is the most critical goal for all patients. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics. OBJECTIVE: This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite. DESIGN AND SETTING: This case report and literature review was conducted in a Mexican university. METHODS: A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: “loxoscelism” OR “spider bite,” OR “loxosceles” OR “loxosceles species” OR “loxosceles venom” OR “loxoscelism case report” AND “cutaneous” OR “dermonecrotic arachnidism.” RESULTS: A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species. CONCLUSIONS: The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422424).

Erythema multiforme (EP) is an immune-mediated mucocutaneous eruption characterised by targeted lesions consisting of generally symmetrical acral cocoons. It occurs most often in the setting of herpes simplex virus (HSV) or mycoplasma infection in certain predisposed individuals, but also in other less frequent causative agents and pathologies. We report the case of a 36-year-old woman with no history of herpetic or pulmonary infection and a rash consisting of cocardes and pseudo-cocardes mimicking erythema multiforme with an atypical clinical presentation following a spider bite. The diagnosis was made on clinical and biological grounds. The course was favourable with symptomatic treatment. To our knowledge, this is the third reported case of PE induced by a spider bite. [ABSTRACT FROM AUTHOR]

The article offers information on a 9-year-old girl initially presenting to the emergency department with painful "spider bites," leading to a diagnosis of insect bites and discharge. Topics include the patient's subsequent re-presentation with worsening symptoms, including fever, abdominal pain, and lymphadenopathy, prompting a differential diagnosis that considered urinary tract infection, septic joint, and erythema nodosum.

Black widow spiders (BWSs) are poisonous spiders of the Arthropoda phylum that live in the Mediterranean region. The effects of BWS bites ranges from local damage to systemic manifestations including paresthesia, stiffness, abdominal cramps, nausea, vomiting, headache, anxiety, hypertension and tachycardia. However, cardiac involvement following a BWS bite is uncommon. We report a 35-year-old male patient who presented to a tertiary hospital in Menoufia, Egypt, in 2019 and developed acute pulmonary oedema with electrocardiogram (ECG) changes that showed ST elevation in leads I and aVL with reciprocal ST segment depression in infero-lateral leads with elevated cardiac biomarkers. Echocardiography showed regional wall motion abnormalities with an impaired ejection fraction of 42%. The condition was reversible after one week of supportive treatment and the patient was discharged from the hospital with normal electrocardiogram, ejection fraction and negative cardiac markers. A routine cardiac evaluation, serial ECG, serial cardiac markers and echocardiography should be considered for any patient exposed to a BWS bite for detection of any potentially fatal cardiac abnormalities. [ABSTRACT FROM AUTHOR]

The spider bite of the genus Loxosceles is a public health problem in regions of Latin America. In Peru, it occurs more frequently in homes in the coastal region and could have serious consequences, including death in the case of cutaneous and visceral loxoscelism (CVL). The case of a pediatric patient with a suspected spider bite is presented below. The clinical picture developed with marked edema of the face and neck, without developing respiratory distress and without evidence of systemic compromise. The slow resolution of the edema and the lack of response to the treatment of choice for angioedema allowed us to guide the diagnosis to predominantly edematous cutaneous loxoscelism (CLEP), which is an infrequent form of presentation.

Latrodectism from black widow spider (BWS) bites is rare in the United States. Latrodectism is a severe systemic manifestation of the envenomation that includes severe abdominal pain mimicking acute surgical abdomen and, in rare cases, could lead to acute myocarditis and rhabdomyolysis. The BWS typically inhabits dark, low-lying areas such as woodpiles, tree stumps, outdoor storage, outdoor furniture, outdoor toilets, and rock piles and is most active during warm weather months. Military service members often participate in field training exercises during warm weather in wooded areas littered with woodpiles and tree stumps; therefore, they are at an increased risk for bites by arachnids. We report the case of a 26-year-old active duty male soldier evacuated from field training with latrodectism and possible envenomation-induced myocarditis after a suspected BWS bite. [ABSTRACT FROM AUTHOR]

Abstract Objective: to describe the completeness of notifications of accidents involving venomous animals held on the Notifiable Health Conditions Information System (SINAN), in Brazil and its macro-regions, from 2007 to 2019. Methods: we analyzed essential and non-mandatory fields for snakebite, spider bite and scorpion sting notifications, considering the following completeness categories: Excellent (≤5.0% incompleteness), Good (5.0% to 10.0%), Regular (10.0% to 20.0%), Poor (20.0% to ≤50.0%) and Very Poor (>50.0%). Proportional change in completeness between 2007 and 2019 was estimated. Results: 1,871,462 notifications were investigated. The “localized manifestations”, “systemic manifestations”, “case classification”, “case progression” and “zone of occurrence” fields had excellent or good completeness. Completeness was regular or poor for the “schooling” and “race/color” fields. The “occupation” field was predominantly poorly or very poorly filled in. There was a proportional worsening in completeness (PC

The article describes the role of nurses in determining symptoms of brown recluse spider bite with presentation of non-healing cellulitis. It cautions against complications of loxoscelism such as hemolytic anemia, acute kidney injury, rhabdomyolysis and disseminated intravascular coagulation, and describes its clinical presentation. It outlines nursing interventions for treatment of loxoscelism that may include intravenous fluids, antibiotics, plasmapheresis, wound care and possible dialysis.

Snakes and spiders are two of the most commonly feared animals worldwide, yet we know very little about the mechanisms by which such fears are acquired. We explored whether negative information about snakes and spiders from parents shapes children's fear beliefs. Study 1 included 27 parents (22 mothers, five fathers) and children (12 female, 15 male, Mage = 5.33 years, 18 White, one Hispanic, eight more than one race). Most parents reported having an advanced degree (78%) and an annual household income of above $100,000 (74%). Participants read an animal picture book and then rated their fear toward each animal. Study 2 included 54 parents (44 mothers, eight fathers, two legal guardians) and children (27 female, 27 male, Mage = 5.52 years, 30 White, one Hispanic, seven Asian/Pacific Islander, four South Asian/Indian, 12 more than one race). Most parents reported holding an AA/BA degree (28%) or an advanced degree (59%) and reported an annual household income of $60,000-$100,000 (28%) or above $100,000 (59%). In Study 2, half of the parents were primed about how their conversations might shape children's fear prior to reading the book. Across both studies, we found that participants provided more negative than positive information about snakes and spiders and provided less positive (Study 1) and more negative (Study 2) information compared to other animals. Our results highlight the prominence of negative information in conversations about snakes and spiders and suggest that the way parents talk about these animals may shape the development of children's fears. [ABSTRACT FROM AUTHOR]

A previously healthy 14-year-old boy developed right-sided neck pain, tachycardia, a diffuse erythematous rash, and subjective fevers over 2 days. He sought medical attention in a local urgent care clinic, where he had a negative Sars-CoV-2 antigen test and was referred to the local emergency department (ED) for persistent tachycardia and further workup. After fluid resuscitation, his tachycardia was not improved, so he was admitted to the Pediatric Hospital Medicine Service. Physical examination showed large areas of erythema and erythroderma of multiple body sites, perioral sparing, increased erythema in flexor skin folds, posterior soft palate petechiae, and a white strawberry tongue. There was a small, tender lesion with surrounding erythema without discharge on his right neck thought to be a possible entry point for infection. Laboratory results showed thrombocytopenia, normal white blood cell count, normal hemoglobin concentration, absolute lymphopenia, and an elevated C-reactive protein (CRP) to 130 mg/L. He was started on intravenous fluids and antibiotics for a presumed infectious cause of the rash and laboratory findings. The next morning, an expanded diagnostic workup was undertaken including electrocardiogram, echocardiogram, ferritin, triglycerides, liver enzymes, lactate dehydrogenase (LDH), brain natriuretic peptide, coagulation studies, and fibrinogen. With treatment and supportive care, his tachycardia and energy improved, so he was discharged with oral antibiotics and follow-up with the Infectious Disease Clinic in 2 days. When seen in follow-up, he was immediately admitted to the hospital for worsening fatigue, tachycardia, and new findings that prompted multiple consultations, and transfer to pediatric critical care services. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Spiders are often wrongly designated as responsible for cutaneous eruptions. We aim to describe spider bites and the spider species implicated in metropolitan France. A retrospective observational study was conducted for all reported cases of spider bites from 2007 to 2018 extracted from the French Poison Control Centers (PCCs) information system, after exclusion of non‐native spiders. We described identification of the spider, level of certainty of the bite, symptoms and severity of cases. 1194 cases of spider bites met the inclusion criteria. The average age of the patients was 36.9 ± 19.8 years. Identification of the species or at least that a spider was implicated was only possible in 346 cases (29.0%). Loxosceles were involved in 53 cases (4.4%), Latrodectus in 46 cases (3.9%) and Cheiracanthium in 35 cases (2.9%). In one third of cases, the involved spider was not known to be present where the bite occurred. Where most of the patients (n = 1111, 93%) reported at least one cutaneous symptom, most of the symptoms were neurological. The bite was considered proven in only 242 cases (20%). Despite the efforts of arachnologists to educate the public, the fear of spiders is still alive in France, where spider bite is rare with low severity and often unproven. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We report an interesting clinical case of Acquired Haemophilia A (AHA) after a probable Loxosceles rufescens spider bite in a 73-year-old woman, admitted to an Emergency Department (ED) of Central Italy during April 2019. AHA is a rare disease, whose acute clinical manifestations are not widely known by most ED physicians; its prompt recognition and treatment are crucial to avoid fatal bleeding. In particular, the development of AHA after a violin spider bite (another rare and poorly characterized clinical condition) has never been described. Therefore, our case report could provide useful insight into the understanding and treatment of such unusual and possibly life-threatening conditions. [ABSTRACT FROM AUTHOR]

Acute wounds and injuries are a common daily occurrence, and their appropriate care is critical to healing. In South Africa, community pharmacists are often the first to encounter acute wounds and injuries such as cuts, bites, bruises and sprains, due to the accessibility and cost constraints associated with primary healthcare facilities. Since pharmacists assist with first aid, refer the patient for further management if necessary, and provide the appropriate dressings during the later healing phase, it is imperative for pharmacists to stay informed on developments in wound care. This review aims to highlight some of the more common acute wounds and injuries encountered by pharmacists, such as cuts, bites, bruises and sprains, and the associated therapeutic strategies. [ABSTRACT FROM AUTHOR]

Background: Acute generalized exanthematous pustulosis (AGEP) is a type of severe cutaneous adverse reaction that is characterized by the rapid development of nonfollicular, sterile pustules on an erythematous base. Objectives: The aim of our study was to enroll all cases of AGEP reporting to our department over a period of one year and to find out the clinical and etiological profile of the patients. Materials and Methods: All the patients reporting to our department with clinical features suggestive of AGEP were enrolled for the study. Careful history and examination were done to rule out other causes of pustular eruptions, which can resemble AGEP. AGEP validation score of the EuroSCAR study group was used to establish the diagnosis. Results: A total of 16 patients were enrolled during the study period of one year. The majority of the patients were females with a mean age of 28.41 ± 12.2 years. Twelve (75%) of the patients had a history of drug intake while 4 (25%) had developed AGEP following an insect bite. Penicillins were the causative factor in five patients followed by cephalosporins in three patients, nonsteroidal anti-inflammatory drugs (NSAIDs) in 2 patients, and terbinafine in 1 patient. Tetanus toxoid was responsible for the development of AGEP in one patient. The insect bites were all spider bites. Conclusion: AGEP is a rare type of severe cutaneous adverse drug reaction.We encountered 16 patients of AGEP over a period of one year. An important cause of AGEP was spider bite in our study group.

The article presents a case study of a 45-year-old woman from Kolhapur, Maharashtra, India, who developed a painful necrotic ulcer on her left groin, potentially due to a spider bite, specifically from a Loxosceles spider, causing cutaneous loxoscelism. It states that despite initial treatment with antibiotics and steroids, her condition worsened, leading to a severe necrotic ulcer with central black tissue and a violaceous border.

Loxoscelism is produced by the bite of Loxosceles spiders. There is in the literature a rare variant of cutaneous loxoscelism, mainly edematous, which is called edematous cutaneous loxoscelism (ECL). Here is reported the case of a 12-year-old girl, who presented ECLwith upper airway obstruction. [ABSTRACT FROM AUTHOR]

Introduction. Spider bites are often overestimated because there are no specific clinical or histopathological aspects that characterize them, and skin lesions that resemble a spider bite are often wrongly considered to be a "true spider bite". However, even in case of a true spider bite, it is almost impossible to confirm the biting species, since very often neither physicians nor patients are trained in spider identification. Objective. The aim of this report is to provide clinicians with a rapid and simple recognition of the few Italian medically relevant spiders, in order to take relative medical measures in case of spider bites. Materials and methods. We defined spiders of considerable medical relevance the ones that cause local symptoms with possible systemic involvement, while we defined spiders with mild medical relevance the ones whose bite is not a medical emergency but is particularly painful or can cause lasting symptoms. We focused on the identification of the four spider taxa of major clinical interest through a brief descriptive, photographic and graphic guide, in association to dermatological manifestations. Results. Spiders of considerable medical relevance are Loxosceles rufescens and Latrodectus tredecimguttatus, while spiders of less severe medical relevance are Steatoda paykulliana, S. nobilis, S. grossa, Cheiracanthium punctorium, Amblyocarenum spp. and Macrothele calpeiana (the presence of the latter in Italy is only accidental and very sporadic). The only species capable of causing necrosis is Loxosceles rufescens, while Latrodectus tredecimguttatus can cause more systemic symptoms. Discussion and Conclusion. With the aim of promoting a first and rapid recognition of the species, we performed a morphological usable aspect for an initial and quick recognition according to an identification key. [ABSTRACT FROM AUTHOR]

The impact of Covid-19 on envenomations by venomous animals in countries heavily affected by both conditions has not been quantified yet. Brazil shows high incidence of envenomations by scorpions, spiders and snakes and was heavily affected by waves of Covid-19. To determine how the pandemic impacted the epidemiology of envenomations by those three groups of venomous animals, we used online databases from two surveillance sources on number of cases and mortality. During the years before and during the pandemic, scorpion stings typically occurred in adults of both sexes in urban zones in the Southeast and Northeast regions. Spider bites occurred mainly in the South region, in adults of both sexes in urban zone. Snakebites affected mainly rural adult men in the Amazon. Between 2007 and 2021, overall incidence of cases by scorpions, spiders and snakes decreased after the beginning of the pandemic, snakebites did not show changes after the pandemic started in Brazil, but cases by scorpions and spiders decreased. No changes in the incidence of deaths were observed. On national level, Covid-19 affected some demographic, clinical and epidemiological aspects in cases by scorpions, spiders and snakes. [Display omitted] • Epidemiology of snakebites, scorpion stings and spider bites did not change with the Covid-19 pandemic in Brazil. • Incidence of snakebites did not change among both periods. • Incidence of scorpion stings and spider bites decreased after the beginning of the pandemic. • Mortality of cases did not change in any of the three groups of animals. [ABSTRACT FROM AUTHOR]

• This work reports for the first time the presence of adult black widow spiders in winter in northeastern Patagonia. • Some of them even survived the winter, arriving alive the following spring. • All overwintering specimens inhabited abandoned anthropic materials (urban waste) in peri‑urban areas near the city of Puerto Madryn. Cases of araneism reported in the province of Chubut (Argentina) have tripled in the last two decades, and almost 80 % of them involve Latrodectus mirabilis (Holmberg) (Araneae: Theridiidae). According to descriptions of the life cycle of this species in Argentina, the low temperatures typical of autumn-winter cause the death of all adult spiders, so that no adult specimens of L. mirabilis are observed in winter. Field samplings, observations by the Grupo de Entomología Patagónica (GENTPAT, IPEEC CCT CENPAT CONICET), and citizen reports for more than 15 years suggested a similar cycle in northeastern Patagonia. However, for the last three consecutive years, we have recorded adult females in the field throughout the Patagonian winter. Some of these individuals even survived the winter and were alive the following spring. The purpose of this note is to report the field presence of adult female specimens of L. mirabilis in the outskirts of the city of Puerto Madryn (Chubut, Argentina) during the last three consecutive winters corresponding to the years 2021, 2022 and 2023; and to note that at least two of them survived the winter, arriving alive (and in good condition) the following spring. Given the medical importance of this spider, the publication of this information, the context of the findings, and their ecological implications will help to prevent its spread and reduce the likelihood of accidents. [Display omitted] [ABSTRACT FROM AUTHOR]

Loxosceles reclusa (LR), commonly known as the brown recluse spider, is endemic to the south central United States. We present a case of LR envenomation in a healthy adult male outside the usual geographic range, with atypical dermatologic and delayed, prolonged systemic loxoscelism (LX). This case demonstrates the importance of expanding the depth of knowledge of LR envenomations. A previously healthy 27 year-old male presented to an emergency department (ED) in central Virginia two hours after a LR envenomation to his left proximal arm. He was treated with diphenhydramine and discharged on oral methylprednisolone for a 5-day taper. On post-bite Days 1 and 2, the patient developed subjective fevers, chills, arthralgias, and myalgias, followed by a blanching, pruritic, morbilliform rash throughout his trunk and lower extremities. Post-bite Day 3, the patient presented to the ED again because of marked erythema of face and the right lateral thigh, and posterior and anterior trunk. Vital signs and laboratory analysis were generally unremarkable. The patient was observed overnight, and discharged with a prescription for prednisone 60 mg per day. On post-bite Day 7, the patient noted a petechial rash on the palms and soles and returned to the ED with a fever of 102.6 °F, a heart rate of 130 beats per minutes, and systolic blood pressure ranging 80–90 mmHg. After considering this may be an atypical presentation of LX, corticosteroids were increased to methylprednisolone 1 mg/kg IV every 6 h. The patient's condition slowly improved and he was discharged on post-bite Day 10. On post-bite Day 24, he had nearly complete resolution of skin findings. LR envenomation can cause a variety of dermatological and systemic manifestations of toxicity. It is critical for toxicologists to be aware of the variety of presentations and findings to appropriately assess and treat LX. [ABSTRACT FROM AUTHOR]

Envenomation by Loxosceles spiders can result in local and systemic pathologies. Systemic loxoscelism, which can lead to death, is characterized by intravascular hemolysis, platelet aggregation, and acute kidney injury. Sphingomyelinase D (SMase D) in Loxosceles spider venom is responsible for both local and systemic pathologies, and has been shown to induce metalloprotease activity. As the complement system is involved in many renal pathologies and is involved in hemolysis in systemic loxoscelism, the aim of this study was to investigate its role and the role of complement regulators and metalloproteases in an in vitro model of Loxosceles venom induced renal pathology. We investigated the effects of the venom/SMase D and the complement system on the HK-2 kidney cell line. Using cell viability assays, western blotting, and flow cytometry, we show that human serum, as a source of complement, enhanced the venom/SMase D induced cell death and the deposition of complement components and properdin. Inhibitors for ADAM-10 and ADAM-17 prevented the venom induced release of the of the complement regulator MCP/CD46 and reduced the venom/SMase D induced cell death. Our results show that the complement system can contribute to Loxosceles venom induced renal pathology. We therefore suggest that patients experiencing systemic loxoscelism may benefit from treatment with metalloproteinase inhibitors and complement inhibitors, but this proposition should be further analyzed in future pre-clinical and clinical assays., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Acute generalized exanthematous pustulosis (AGEP) is a toxic cutaneous reaction pattern that is mostly caused by drug intake and rarely associated with spider bites. We report a case of a female patient, 47 years old, with febrile pustular lesions on an erythematous base at the abdominal region. She had three violaceous erythematous and edematous plaques on the interscapular region, one of which had a necrotic crust at its center. The lesions were compatible with spider bites. By considering histopathological and clinical findings, the patient was diagnosed with AGEP. Since she had no history of drug intake, viral infection or other triggers, a spider bite was thought to have caused the AGEP. [ABSTRACT FROM AUTHOR]

Background: Spiders are blamed for all kinds of things that turn out to be simple infections or some other bugs faults as most are harmless bite except two spiders, the black widow and brown recluse that might cause reaction locally as ulcers and systemic beyond the bite like abdominal pain, cramps or respiratory problems. Materials and Methods: Twenty-four patients with history of spider bite were recorded during the period from May 2012 to March 2020, their ages ranged from 25-35 years five females and 19 males. All cases were seen three-15 days after biting and no one examined at the time of bite. On careful questioning of patients, many had seen brown-black spider while others had felt a bite only. Results: On careful examination, the lesional bites could be divided into early and late presentations. Regarding the early presentation in six cases were observed and all had cellulitis like picture with small black necrosis at the center while the late cases showed gangrenous well defined ulcer that simulate pyoderma gangrenosum in (18) patients and these ulcers were characteristically polygonal in shapes at their margins. The sites of these bites were as follow: 14 (58.3%) thighs including groins, 3 (12.5%) legs, 3 (12.5%) fingers, 3 (12.5%) male genitalia and one (4.16%) was left axilla. Medical management including topical antiseptic together with topical and oral antibiotic cover with oral antihistamine and oral prednisolone. The duration of therapy depending on the size of ulcer but generally it took from two weeks to two months. No surgical debridement was carried out. Conclusion: Spider bites are commonly seen adult males and could be presented as early cellulitis like and late polygonal pyoderma gangrenosum like. The commonest sites affected were lower limbs, most commonly thighs and groins. Healing might take few weeks to few months depending on the size of necrotic ulcer. Wound debridement was not carried out but skin grafting might be suggested for large ulcer as to reduce the time of morbidity and recovery. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 11-year-old African American male with past medical history of attention deficit hyperactivity disorder on Vyvanse presented with one day of a diffuse erythematous rash. It notes the continuation of broad-spectrum antibiotics of vancomycin and ceftriaxone, along with diagnosis of systemic loxoscelism requires a high index of suspicion.

Background: Acute generalized exanthematous pustulosis (AGEP) is a type of severe cutaneous adverse reaction that is characterized by the rapid development of nonfollicular, sterile pustules on an erythematous base. Objectives: The aim of our study was to enroll all cases of AGEP reporting to our department over a period of one year and to find out the clinical and etiological profile of the patients. Materials and Methods: All the patients reporting to our department with clinical features suggestive of AGEP were enrolled for the study. Careful history and examination were done to rule out other causes of pustular eruptions, which can resemble AGEP. AGEP validation score of the EuroSCAR study group was used to establish the diagnosis. Results: A total of 16 patients were enrolled during the study period of one year. The majority of the patients were females with a mean age of 28.41 ± 12.2 years. Twelve (75%) of the patients had a history of drug intake while 4 (25%) had developed AGEP following an insect bite. Penicillins were the causative factor in five patients followed by cephalosporins in three patients, nonsteroidal anti-inflammatory drugs (NSAIDs) in 2 patients, and terbinafine in 1 patient. Tetanus toxoid was responsible for the development of AGEP in one patient. The insect bites were all spider bites. Conclusion: AGEP is a rare type of severe cutaneous adverse drug reaction.We encountered 16 patients of AGEP over a period of one year. An important cause of AGEP was spider bite in our study group. [ABSTRACT FROM AUTHOR]

Managing acute wounds with soft tissue loss can be very challenging for both patients and physicians. Successful wound healing depends on several factors including exudate control, prevention of infection, and moisture balance. In this case series, we describe a novel combination treatment method utilising small intestinal submucosa wound matrix (SISWM) with the bolster technique as a way of assisting the integration of collagen‐based wound treatment products into the base of complex wounds with the intent of restoring a dysfunctional extracellular matrix. In case 1, a 44‐year‐old female presented with an acute wound resulting from a spider bite to the posterior aspect of the right knee. In case 2, a 12‐year‐old male sustained multiple injuries to his right foot from an all‐terrain vehicle accident. In case 3, an 80‐year‐old female on anticoagulants sustained an avulsion injury to her left lower leg. In case 4, a 41‐year‐old female sustained a severe complex avulsion injury to the dorsal left forearm sustained from a dog bite. All patients were successfully treated with SISWM and the bolster technique, and their wounds healed completely within 6 weeks. The bolster technique, when combined with an SISWM, is a novel method designed to enable the SISWM to impart its wound healing properties to these complex traumatic wounds. This case series presents treating clinicians with a different treatment methodology to assist the patient in achieving a successful outcome. [ABSTRACT FROM AUTHOR]