A review of the literature on brown recluse spider bite is presented, including clinical presentation and treatment. Emphasis is placed on the treatment of local tissue necrosis. [ncbi.nlm.nih.gov]

• Pain

  Those who are bitten can often feel a sharp, stinging pain—as Linsey did—or no pain at all, according to the NIH. Then, within a few hours, the pain can increase and become severe. [self.com]

  The mean (SD) pain score at the time of the bite on the 0 to 10 scale was 2.37 (2.84); after 24 hours, it was 6.74 (2.75). Of the 23 patients with recorded pain scores at the time of the bite, 12 (52%) had pain; 11 (48%) had no pain. [jamanetwork.com]

  Home care You may use acetaminophen or ibuprofen to relieve pain, unless another pain medication was prescribed. [mountnittany.org]

  Pain/Itching: Following the bite, you might experience mild to intense pain for 2 to 8 hours. Since most brown recluse spider bites go unnoticed at the beginning because of no or little pain, you might only begin to feel it several hours later. [associatedderm.net]

  Some may not be aware of the bite for 2 to 8 hours, whereas others feel a stinging sensation usually followed by intense pain if there is a severe reaction. [cancertutor.com]

• Fever

  Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal [ncbi.nlm.nih.gov]

  "If the urine is positive for blood and/or the child has other signs of systemic loxsoscelism (rash, fever), the child should be admitted and observed for hemolysis. [techtimes.com]

  The syndrome known as systemic loxsoscelism consists of brown recluse spider bites accompanied by a fever, rash and muscle pain, with or without hemolysis. [phys.org]

  If fever and nausea develop, treatment may be required to alleviate these symptoms. Home Care and Prevention The initial home care is to clean the skin wound with hydrogen peroxide, chlorhexidine or povidone iodine. [petplace.com]

• Swelling

  Swelling may worsen in the down position. Check the bite site daily for signs of infection (see below). Follow-up care Follow up with your health care provider or as advised. [mountnittany.org]

  "The swelling was the first thing, and then I ended up just having crazy, crazy symptoms," Linsey told PEOPLE. "I had muscle spasms, and I had a body rash all over." [health.com]

  Untreated spider bites may lead to more serious problems, such as swelling and infections. Severe swelling may cause blood supply problems in the area. Infection may spread to other parts of your body and become life-threatening. [drugs.com]

  Elevate the site if the bite happened on an arm or leg (to help prevent swelling). Get emergency care right away for further treatment. [ucihealth.org]

• Chills

  Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal [ncbi.nlm.nih.gov]

  Also, unlike other spiders that have 4 pairs of eyes, the brown recluse has 3 pairs, which is a distinguishing factor Brown Recluse Spider Bites can result in itching, fever, chills, and fatigue. [dovemed.com]

  He also wrote that he went to the ER about six hours after the bite because he was vomiting and experiencing chills. Eventually, a doctor suspected that it was likely a brown recluse bite based on the symptoms, KilledTheCar wrote. [businessinsider.com]

  Symptoms of a brown recluse spider bite include chills, itching, fever, nausea, sweating, and a large sore where the bite occurred. A brown recluse spider with its characteristic violin-shaped marking on its back. [self.com]

• Malaise

  Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal [ncbi.nlm.nih.gov]

  Systemic Effects Reported systemic effects of brown recluse spider bites include fever to 40C, nausea, vomiting, chills, arthralgias, myalgias, weakness, malaise and headache. [medicine.mc.vanderbilt.edu]

  Other symptoms can include a general feeling of discomfort (malaise), fever, nausea, and vomiting. In most cases, the bite site heals on its own within a week. But in some cases, the skin at the bite site may break down. [mountnittany.org]

  Systemic manifestations may include fever, chills, nausea and vomiting, diarrhea, myalgias, arthralgias, malaise, rash, and headache. History of present illness Symptoms (if noted) typically develop two to six hours after bite. [clinicaladvisor.com]

• Nausea

  Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal [ncbi.nlm.nih.gov]

  Nausea or vomiting: Besides affecting the rest of the body, some symptoms of a brown recluse spider include nausea. You may feel mildly ill with nausea and feverish until your body can process the spider venom. [associatedderm.net]

  If lethargy, vomiting or nausea occur, there is no home care and seeking veterinary assistance is strongly recommended. The primary prevention is to limit your dog’s access to brown recluse spiders. [petplace.com]

  Symptoms of a brown recluse spider bite include chills, itching, fever, nausea, sweating, and a large sore where the bite occurred. A brown recluse spider with its characteristic violin-shaped marking on its back. [self.com]

  Symptoms of a Brown Recluse Bite Nausea Vomiting Fever Rashes Muscle and joint pain Over the next few days necrosis (the skin and other tissue dies) at the site of the bite may develop. [firstaidanywhere.com]

• Vomiting

  Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal [ncbi.nlm.nih.gov]

  He also wrote that he went to the ER about six hours after the bite because he was vomiting and experiencing chills. Eventually, a doctor suspected that it was likely a brown recluse bite based on the symptoms, KilledTheCar wrote. [businessinsider.com]

  Symptoms of a Brown Recluse Bite Nausea Vomiting Fever Rashes Muscle and joint pain Over the next few days necrosis (the skin and other tissue dies) at the site of the bite may develop. [firstaidanywhere.com]

  Medicines may cause nausea or vomiting. You may have sore throat, or your skin may become pale or yellowish. You may develop soreness, redness, or swelling in the muscle where the tetanus shot was given. [drugs.com]

• Cyanosis

  The bite site may develop a blue macule or a characteristic erythematous lesion with surrounding pallor encircled by an area of cyanosis. Over the next week an eschar may develop and slough. [cancertherapyadvisor.com]

• Blister

  The next morning, the red spot began to blister and hurt even more. Greenwald did not hesitate anymore and went to her family doctor. Doctors determined that Greenwald suffered a spider bite. [mlive.com]

  You may notice a red mark which looks similar to a bee sting or a pin prick that may be followed by a blister that forms at the bite site. The bites that develop blisters and a blue tinge may take longer than usual to heal. [associatedderm.net]

  "The blistering and infection got worse," Greenwald said. "I was having flu-like symptoms such as nausea, fever, loss of appetite." [cbsnews.com]

  What began with slight blistering quickly developed into this - a huge fluid filled blister on her arm. [abc12.com]

  But about 10% of them cause ulcers or blisters that damage your skin so badly that you need a doctor’s care. If your symptoms are mild, try these simple home remedies: Clean it with soap and water. Apply antibiotic cream. [webmd.com]

• Erythema

  A generalized pruritic macular eruption (toxic erythema) occurs approximately 48 hours after the initial bite. Mild leukocytosis is a common laboratory abnormality. [medicine.mc.vanderbilt.edu]

  […] nodosum, erythema multiforme, drug reactions Infections (staphylococci and/or streptococci, cutaneous anthrax, erythema migrans [Lyme disease], fungal infections, leishmaniasis, atypical mycobacterial infection [e.g., scrofula], herpes simplex/zoster [clinicaladvisor.com]

  In all but one case, the erythema, edema, and pain resolved significantly in 24 to 48 hours, and the wounds healed primarily with minimal scarring. [ncbi.nlm.nih.gov]

  Infarction at the site presents as a sinking blue macule; surrounding erythema develops two to eight hours later. [aafp.org]

• Skin Rash

  Skin rash: Symptoms of a brown recluse bite include skin rash all over the body with many tiny, flat purple and red spots. Nausea or vomiting: Besides affecting the rest of the body, some symptoms of a brown recluse spider include nausea. [associatedderm.net]

  Skin rash all over the body with many tiny, flat purple and red spots. Nausea or vomiting. Joint pain. What should I do if a brown recluse spider bites me? If you think you have been bitten by a brown recluse spider: Remain calm. [cigna.com]

• Pruritus

  FACT: Typically, bites cause pain, erythema, and sometimes pruritus; tissue necrosis involving underlying tissue or muscle, a serious complication, is fortunately rare. A bulla resembling a bull's eye may form at the site. Deborah H. [journals.lww.com]

  The most common symptoms were pain, pruritus, malaise, chills, sweats, and rash. Patients were randomized into three treatment groups: dapsone, brown recluse spider antivenom, or combination therapy. All patients were treated with erythromycin. [ncbi.nlm.nih.gov]

  A more intense, local pain, often with pruritus occurs after 6-8 hours. As the lesion progresses, the erythema with central mottling may develop a bleb or blister. [medicine.mc.vanderbilt.edu]

  Symptoms range from asymptomatic patients, local signs around the bite area, to systemic repercussion with kidney failure. 1,2 Pain presents within the first few hours and progressively increases in intensity, with associated pruritus and erythema. 24 [elsevier.es]

  Chief concern Sensation at site of bite may range from pruritus to severe, burning pain. Systemic manifestations may include fever, chills, nausea and vomiting, diarrhea, myalgias, arthralgias, malaise, rash, and headache. [clinicaladvisor.com]

• Skin Ulcer

  Most spider bites are asymptomatic but what makes this bite so devastating is the toxin injected by the brown recluse spider, which can cause considerable systemic symptoms as well as necrotic skin ulcers (necrotic arachnidism). [ncbi.nlm.nih.gov]

  ulceration in about 20% of cases (only North American spider bite frequently associated with necrotic skin lesions) —No deaths Pyoderma gangrenosum as a result of bite has been reported. [clinicaladvisor.com]

  Chronic Recluse bites usually heal within a few months, so if that skin ulcer is just not going away it could be something even more concerning — like a rare autoinflammatory disease, or a type of skin cancer. [theverge.com]

  Because ulceration can spread and tissue death can occur, skin that becomes necrotized in response to brown recluse venom may need to be removed through surgery. [livestrong.com]

  A necrotic ulcer forms when the eschar separates. Ulceration may occur within several hours or up to 2 weeks after envenomation. The ulcers may take weeks to months to heal. [calpoison.org]

• Suggestibility

  The identification of the spider as a brown recluse and the location of the bite over the nerve's usual pathway strongly suggest that the venom was responsible for this complication. [ncbi.nlm.nih.gov]

  Since haptoglobin binds free hemoglobin in the blood, decreased levels of haptoglobin suggest intravascular hemolysis, whereas normal levels of haptoglobin suggest extravascular hemolysis. 3, 7, 9 The Direct Coombs’ Test (direct antiglobulin test or DAT [academic.oup.com]

  […] away, so most patients dismiss the incident. 5 Soon, however, pain from the envenomation begins and, importantly, becomes disproportionate to physical findings—the patient shows you where it hurts, but there is nothing visible to support a diagnosis or suggest [mdedge.com]

  Betts suggests a professional if a home is having issues with brown recluse spiders. [kake.com]

• Seizure

  Rare complications can occur, including kidney damage, seizures, coma, and blood clots. What to Do About a Brown Recluse Bite You should see a doctor if you believe you have been bitten by a brown recluse spider. [budgetbrotherstermite.com]

  Within the first day or two after you’ve been bitten, you may notice: Pain or redness at the site of the bite A deep sore (ulcer) that forms where you were bitten, with the skin at the center turning purple Fever Chills Nausea Joint pain Feeling weak Seizures [webmd.com]

• Confusion

  Here’s to hoping you don’t get bit by a spider, or worse, get anthrax that your doctor confuses for a spider bite. [ JAMA Dermatology ] [gizmodo.com]

  Early findings can be confusing. Brown recluse bites typically feel like a pin prick. A vasoconstrictive halo may surround the bite, but this sign is inconsistent. [mdedge.com]

  This can lead to tragedy because about 40 medical conditions, including several deadly bacterial infections, can be confused with brown recluse bites. [sciencedaily.com]

  SPIDERS COMMONLY CONFUSED WITH RECLUSES Because of the misinformation surrounding the brown recluse's presence in California, many spiders that are virtually harmless are submitted by the public to arachnologists for identification. [ipm.ucanr.edu]

  Most false sightings are due to confusion with one of the 13 other species found in the same family. The most common non-brown recluse spiders are the desert recluse found in Texas, Arizona, and California and the Arizona recluse. [emedicinehealth.com]

• Stroke

  I was seconds from a stroke," Wright told CBS News. Wright notified the management company in charge of the "Views of Brentwood" complex, where she lives, that her home was crawling with spiders, and she was bitten by them. [cbsnews.com]

  "I couldn't walk, I couldn't move and I could barely swallow," Wright told the news station, adding that doctors told her that she could have suffered a stroke had she waited to go to the emergency room. [foxnews.com]

  Victoria Owen "They come back in and they’re like, you’re seconds away from a stroke," she said. "I couldn’t comprehend it." Blood clots can end up in various parts of the body, including the legs and lungs. [buzzfeednews.com]

  Wright told CBS that the spider bites nearly caused a stroke when blood clots formed in her lungs. Metro reports that Wright was bitten by brown recluse spiders at least three times, and that about 50 of them were later found in her bedroom. [bustle.com]

  "I didn't know it, but I was seconds away from a stroke," she said. Wright had been dealing with a brown recluse spider infestation in her apartment, which was first reported by WSMV. She estimated she had found at least four dozen spiders. [eu.tennessean.com]

• Kidney Failure

  In case of systemic toxicity, they have been used to prevent kidney failure 8 and haemolysis. [elsevier.es]

  In more severe cases, hemolysis (rupturing of red blood cells) or kidney failure can occur, says Dr. Freeman. Depending on the severity of the bite and where it's located, it can take weeks or even months to heal. [health.com]

  These can include muscle damage, kidney failure, problems with blood clotting, and coma. The bite site will be cleaned. Medications may be given to relieve pain, if needed. Antibiotics may also be given to treat infection. [mountnittany.org]

  And the brown recluse's venom can cause serious wounds or kidney failure, so isn't to be trifled with, either. The aptly named mnemonic NOT RECLUSE could help limit misdiagnoses and make sure people get the right treatment. [npr.org]

• Hematuria

  Elevated lactate dehydrogenase (LDH) is consistent with hemolysis. 7 Urinalysis may reveal hemoglobinuria, but not hematuria, as a result of hemolysis. 2, 9 Urine may be dark and high levels of urobilinogen may be present, suggesting extravascular hemolysis [academic.oup.com]

  In order to be considered a confirmed case of BRSB hemolysis, cases had to have clinical documentation of a recent insect bite, signs (hematuria, fever, or jaundice) or symptoms (abdominal pain) supportive of hemolysis, as well as a hematocrit of less [journals.plos.org]

  There are also cases of hemolytic anemia and hematuria which are associated with sensory disorders. The body temperature can rise up to 41 degrees Celsius, with can also set a coma in severe cases. [google.nl]

Lab workup showed: 29 720 leukocytes/μl (85% polymorphonuclear); PCR 14.7; lactate 1.1; CPK 138; urea 32; creatinine 0.98; other parameters were normal. Chest radiograph was normal. Doppler ultrasound of the lower extremities was normal. [elsevier.es]

Patients with significant wounds and/or systemic symptoms require an extensive workup. The wound should be cleaned and dressed; an ice pack should be applied. 13,14 As with any insect bite, tetanus toxoid should be given, along with analgesics. [o-wm.com]

You might be wise to use a combination of the above two treatments. Noni Juice Another possible major treatment for brown recluse spider bites is Tahitian Noni Juice. [cancertutor.com]

Even with early treatment, prognosis often is poor. Future studies might help establish better treatment regimens. [ncbi.nlm.nih.gov]

If you need emergency care, the poison specialist will contact the emergency room staff with treatment advice. [poison.org]

The most common treatment for brown recluse bites is an antibiotic called Dapsone. Hyperbaric chambers treatment may also be used to speed up wound healing. [health.com]

Even with early treatment, prognosis often is poor. Future studies might help establish better treatment regimens. [ncbi.nlm.nih.gov]

What is the Prognosis of Brown Recluse Spider Bite? The prognosis is dependent on the location of bite, the severity of reaction, and the overall health of the individual. [dovemed.com]

[…] to three days signals good prognosis) Fatty areas, such as proximal thigh and buttocks, may develop more cutaneous reaction/extensive necrosis. [clinicaladvisor.com]

Making the diagnosis No specific diagnostic test is available, and the condition may be overdiagnosed (used as a catch-all diagnosis for necrotic skin lesions of uncertain etiology). [clinicaladvisor.com]

Prevelance- The diagnosis of brown recluse spider bite is overused for dermonecrotic wounds of uncertain etiology. Check out this link discussing recluse spiders in Florida …state.fl.us/pi/enpp/ento/entcirc/ent406.pdf [tripadvisor.com]

(Etiology) Brown Recluse Spider Bites release a small amount of poisonous venom into the skin. [dovemed.com]

Clin Toxicol (Phila) 2012;50:911 ) Sites Any body site can be affected, especially exposed skin Cutaneous manifestations occur in around 80% cases around the site of bite, predominantly in the lower limbs ( Rev Inst Med Trop Sao Paulo 1989;31:403 ) Etiology [pathologyoutlines.com]

Misdiagnosing dermonecrotic wounds of unclear etiology as spider bites is a worldwide issue, and has been reported in other countries such as Australia, New Zealand and Brazil. 4,5 Finally, the “deadly” reputation of these spiders has been largely predicated [calpoison.org]

Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis. [ncbi.nlm.nih.gov]

Epidemiology Loxosceles reclusa, the brown recluse spider, is endemic to the south-central United States, ranging from Texas to Georgia and from Louisiana to Iowa. 1 Isolated specimens have been found in association with recent shipments of goods into [calpoison.org]

[…] eosinophils, but other histologic features vary: neutrophilic vasculitis with hemorrhage, arterial wall necrosis or eschar covered ulceration and subcutaneous necrosis Terminology Also called loxoscelism ( Loxosceles reclusa ), necrotizing arachnidism Epidemiology [pathologyoutlines.com]

Pathophysiological studies in laboratory animals yield conflicting results and therapeutic recommendations because of technical and species-specific differences. [ncbi.nlm.nih.gov]

Pathophysiology True envenomation by the brown recluse spider is associated with development of necrotic skin wounds. Loxosceles reclusa venom contains several cytotoxic enzymes. [calpoison.org]

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. [emedicine.medscape.com]

Abstract The objectives in the treatment of the brown recluse spider bite are to prevent skin necrosis and the need for reconstructive surgery. [ncbi.nlm.nih.gov]

Seal small openings, holes and cracks on the outside of your home to prevent entry by spiders, other insects or pests. A 30-year-old man went to his doctor's office because of a possible insect bite on his hip. [poison.org]

Medical News Today notes that preventative measures are pretty simple, and can go a long way in preventing brown recluse bites. [bustle.com]

Veterinary care is generally recommended to prevent additional tissue damage. [petplace.com]

Brown recluse spiders (loxosceles reclusa) are part of the loxosceles species of spiders in the United States of which there are 13 different species, 11 native and two nonnative. The brown recluse spider is the most common spider linked to brown spider bites. These bites were originally reported in the US in the 1800s and are still reported today. These bites are so prevalent and serious that the brown recluse spiders are thought to be a clinical concern [1].

Normally, these bites happen without any notice since they usually occur without any pain [2]. If an individual does feel something at the instance of a bite it is usually described as a similar feeling to a bee sting. When this spider bite happens, it causes skin and tissue injury in the affected area due to the venom of the spider. This localized or generalized symptoms following a bite are called loxocelism.