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An article about Spiders

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  • Ida Lively
    This article from the Washington Post (http://www.washingtonpost.com) was written by a friend of my husband, Mark s, family and deals with spider bites. Very
    Message 1 of 1 , Feb 5, 2002
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      This article from the Washington Post (http://www.washingtonpost.com) was
      written by a friend of my husband, Mark's, family and deals with spider
      bites.

      Very informative.

      To view the entire article, go to
      http://www.washingtonpost.com/wp-dyn/articles/A22272-2002Feb4.html




      Crawling With Fear

      By Lindsay A. Reed


      It started on a regular Monday morning in October, as my mom and I puttered
      around the kitchen in the house my parents, my son and I share in
      Germantown. "Something bit my foot," she said. She pulled up her pant leg
      and showed me a reddish patch on the top of her foot. It was barely visible
      through her stocking.

      The next time I saw the foot, when my mother returned from the emergency
      room that evening, the patch had become a target: a one-inch red circle
      center, a ring of white skin, then a mean red circle around that. The ER
      doc's diagnosis: brown recluse spider bite. My mom was given an antibiotic,
      a tetanus shot and painkillers. Then she was told to put a cold compress on
      the spider bite (the inner red circle), apply a hot compress on the
      cellulitis (the outer angry circle) and keep the foot elevated.

      The next day the inner red spot doubled in size and turned purple, Mom's
      temperature hit 102 and a saddle of inflammation shot red streaks up from
      her swollen foot to her ankle.

      Back in the ER, my mother's wound was a hit. She sat in a wheelchair, her
      leg extended and the angry giant foot propped on a chair. "A spider did
      that?" was people's incredulous response, followed by a shiver.

      In fact, as much as we and others like the story, we still don't know
      whether a spider really was behind the wound. Despite the original
      diagnosis, we learned this whole brown recluse thing is a lot more
      complicated than most people might expect. Brown recluse spiders, though
      widely feared for their flesh-killing wounds and often reported as biting
      people throughout the mid-Atlantic region, are not believed by
      arachnologists to live anywhere near our area.

      Some scientists insist that all kinds of conditions are routinely
      misattributed to the brown recluse. Suzanne Doyon, medical director of the
      Maryland Poison Center, a service of the University of Maryland School of
      Pharmacy, declined to provide a count of suspected brown recluse bites in
      the state, explaining that it wouldn't be accurate.

      "We tend to think it's way over-diagnosed," she says. In cases involving a
      "necrotic" wound; where the skin surrounding the site of the initial injury
      dies; staff members generally avoid making assumptions about what caused the
      damage.

      Part of the ambiguity arises from the fact that the only way to confirm a
      bite from a brown recluse, or any spider for that matter, is to have the
      offending creature in hand. This is a rare occurrence; the bites are often
      painless and not noted in time to pursue and capture the perpetrator. Plus,
      there is no blood test to determine the species behind a specific bite. And
      so, even in areas the brown recluse is known to inhabit, the record of
      verified bites is very small.

      And in the end, accurate diagnosis may not actually be very important –
      since there's no consensus on how to treat a brown recluse spider bite.

      That night, my mom was admitted to the hospital. She would not return home
      for nearly a week.

      As I talked to doctors and arachnologists in the days after my mother's
      hospitalization, a complex picture began to evolve. Although brown recluse
      bites are diagnosed from coast to coast, the spiders are traditionally
      concentrated in the South and Midwest..

      Most brown recluse bite diagnoses are made based on clinical signs –
      the swelling and the wound. When lab tests have ruled out other ailments,
      and a necrotic sore exists, brown recluse bite is a common diagnosis even in
      areas not known to harbor the spiders.

      Which brings us back to my mom and her inflamed foot.

      "It's a classic story," says Gregory Dick, head of surgery at Shady Grove
      Adventist Hospital in Rockville and my mom's plastic surgeon. "Someone's in
      the basement or the woods – they feel a little sting, and then later
      there's a punched-out circular area." He says he has treated about three
      dozen wounds he attributes to brown recluse bites in the last 10 years at
      Shady Grove. While he acknowledges the controversy about over-diagnosis and
      the difficulty of conclusive diagnosis, his repeated encounters with the
      wounds and the stories associated with them convince him the bites are from
      the accused creature. "Until proven otherwise," he says, "I will assume it's
      due to the [brown recluse] spider."

      The diagnosis is complicated by the fact that roughly 30 other ailments can
      closely resemble the effects of a brown recluse spider bite. These include
      Lyme disease, lymphoma, chemical burns, cutaneous anthrax(!), diabetic
      sores, staph infection, fungal infection or bacterial infection.

      Richard Vetter, an entomology staff research associate at the University of
      California, Riverside, tells a story about a man in Connecticut diagnosed
      with a brown recluse bite who contacted Vetter. "To have a brown recluse
      bite, you have to have a brown recluse," Vetter told him. The man encouraged
      his doctor to look beyond the spider bite idea; and the diagnosis was
      changed to Lyme disease, for which the patient was quickly treated with
      antibiotics. As Vetter wrote in a Western Journal of Medicine article:
      "Because it can lead to irreversible neural and cardiac complications, [Lyme
      disease] misdiagnosis as a brown recluse bite could have grave
      consequences."

      Hernan Gomez, director of emergency medicine at the University of Michigan
      Medical School in Ann Arbor, is developing a test that could aid in
      diagnosis of the bites by measuring antibodies found in the blood when the
      body is responding to the spider's venom.

      According to Gomez, the fearsome necrosis is caused not by the spider's
      venom, but by the reaction of the victim's immune system; a reaction like
      one that could be triggered by "other creatures or arthropods with venom
      components." Other experts disagree, convinced the bull's-eye wound with
      localized necrosis is the singular mark of the brown recluse.




      The Treatment



      If diagnosis of a brown recluse bite is tricky, wait until you get to the
      treatment.

      Ronald Swinfard is chairman of the Department of Internal Medicine at the
      University of Missouri-Columbia Health Sciences Center, one of the nation's
      foremost hospitals for dealing with brown recluse bites. There is "no proven
      or demonstrated therapy for brown recluse bites," he says.

      Swinfard, who says he sees about 12 confirmed bites (meaning the spider has
      been captured) a year, calls the best therapy "watchful waiting." The vast
      majority of brown recluse bites, he says, do not cause necrosis, and their
      wounds heal on their own.

      More aggressive treatments; sometimes initiated immediately, sometimes after
      lesser measures fail; include:

      Dapsone, a potent drug formerly used to treat leprosy. The theory is that it
      draws white blood cells away from the site, essentially preventing the
      victim's immune system from attacking the bitten flesh. The drug can harm
      kidneys and, more rarely, the liver. Close monitoring of complete blood
      counts is recommended.

      Hyperbaric oxygen treatment, in which patients are placed in a pressurized
      chamber (a long enclosed cylinder) for several hours, sometimes twice a day
      for several weeks. In theory, the concentrated oxygen helps eliminate
      anaerobic bacteria and free radicals at the wound site, speeding healing and
      preventing infections.

      A nitroglycerin patch. Placed directly on the wound, the patch is thought to
      help draw the venom out of the body.

      None of the therapies has been shown to make much of a difference in
      clinical studies involving humans. Swinfard says the variability of
      responses makes a single recommendation difficult. "One's own immune system
      is just as important as anything else," he says.

      My mom's doctor initially treated her for both Lyme disease and the skin
      infection that can be a complication of a brown recluse bite. Daily
      intravenous antibiotics covered both possibilities. After a few days, the
      similarities to symptoms of subcutaneous anthrax also became apparent.
      Because she works for a defense contractor and because the Washington area
      is so sensitive to the possibility of bioterrorism, she was started on a
      course of Cipro while awaiting lab results. My mom was lucky to have a
      doctor willing to consider a variety of causes, Swinfard says. "People latch
      on to the uniqueness of the [brown recluse bite] diagnosis, and they . . .
      are unwilling to look at anything else."

      After several days at Shady Grove, my mom's wound slowly got better. The
      swelling was retreating, and some of the fluid was drawn from the purple
      blisters. The dead patch on her foot was about two inches in diameter. Dick,
      her plastic surgeon, says most necrotic wounds he sees are the size of a
      nickel or dime. Hers was a 50-cent piece. She was started on dapsone, to try
      to keep the immune system response from making her wound worse.

      Dick compared the function of dapsone with overkill in a military maneuver.
      "If you bring in a million troops [in this case, white blood cells],
      something bad happens. If you remove some of the troops and calm them down,
      it's okay."

      Despite her improvement, we still weren't sure exactly what had happened to
      my mom. The only certainties, ruled out by lab tests: It wasn't anthrax,
      Lyme disease or a bacterial infection.




      Enter, the Spider



      It was into this uncertain and hostile climate that the brown spider
      emerged. I had been worried about my 5-year-old son's safety all week, in
      case we did have a brown recluse in the house. I drummed it into him: "If
      you see a spider, call for help." "Wear your shoes, in case of spiders,"
      etc. I've probably given him arachnophobia.

      But it all paid off, when, on a Sunday morning, I heard him yelling, "Mommy!
      Spider! Spider!" I raced to the bathroom, where he stood on top of the
      toilet. The spider, brown and about a half-inch in diameter, was crawling
      from a pair of abandoned jeans. I smashed first, conducted my investigation
      second.

      The dead spider was too small to explore with the naked eye, so I whipped
      out the video camera to capture the details via the zoom lens. It had a
      clearly defined darker patch on its back, but I couldn't tell if it was a
      violin. When I compared it to a picture of a female recluse on the Web, the
      similarities were striking.

      Jeffrey Shultz, an arachnologist at the University of Maryland, College
      Park, took a look at my prize. It was not a brown recluse. It was a spider
      common to this area, called an ariadne bicolor. Although I was relieved, the
      pronouncement deepened the mystery of my mom's ailment. I thought we had
      captured her assailant.

      "Well, maybe you did," Shultz said. All spiders have venomous sacs, he
      explained, and there have not been extensive studies to show exactly which
      spiders are harmful to humans. Perhaps my mom had had a unique response to
      this spider's venom. Or maybe I'd summarily executed an innocent.

      So I asked Shultz if he thought there were brown recluse spiders in
      Maryland. He was cautious. "Blanket statements are not appropriate," he
      said. "I can't say it would be impossible for Loxosceles to be here, but it
      would be unusual."

      Thomas Arnold, medical director of clinical toxicology at Louisiana State
      University Medical Center in Baton Rouge, who sees several brown recluse
      bites a year, doesn't rule out the possibility that the creatures could turn
      up in the Washington D.C. area. "That's not their normal habitat," he says,
      "but they certainly can turn up there. They can be anywhere; they just get
      on a truck pallet somewhere and show up."

      This migration theory; spiders' hitchhiking into nonnative areas; is "the
      erroneous extrapolation that doctors around the country have been putting
      forth for years to justify this diagnosis," says the University of
      California's Vetter. "They say brown recluses can be transported, but they
      never take it any further. If you can find one brown recluse in an area, you
      should be able to find dozens."

      So far, that hasn't happened here. Shultz says that all of the calls he gets
      about spiders are about brown recluses. My spider was far from the first
      suspected recluse he's examined.

      The number that have turned out to be bona fide brown recluses?

      Zero.

      My mom has been home from the hospital for four months. Her foot still
      swells, itches and stings, but the big hole in the top of it is finally
      closed. The foot is still constantly bandaged, and the skin remains fragile
      and red. If the wound reopens for any reason, she'll likely need a skin
      graft.

      We may never know for sure what caused the problem. But, just to feel like
      we have done something useful, we have contracted with a pest control
      company. The bug guy says he is sure there are brown recluse spiders in
      Maryland; though he's never seen one. I told him about the map showing the
      limited range. He knew all about that. He's a strong proponent of the
      migration theory.

      I don't know what to think anymore. If they aren't here, why so many stories
      and such widespread fear? And if they are, why don't the spider experts know
      it? And what the heck happened to my mom?

      As Shultz says, "People want things to be simple, but they're not. It's
      biology."



      Meet the Fiddleback

      The brown recluse spider; Loxosceles Reclusa to scientists; earned its name
      for its tendency to avoid contact with humans, preferring undisturbed areas
      like attics, basements, clothes in storage and woodpiles. It's also called a
      "violin" or "fiddleback" spider for the pattern on its back that resembles
      the stringed instrument. The spider's body measures up to of an inch in
      diameter, with a leg span roughly the size of a quarter. Unlike most spiders
      common to the United States, which have eight eyes, the recluse has six, in
      rows of two. You have to get pretty close to see that.

      The spider's bite can cause a necrotic sore. After the dead skin falls off
      or is cut away, the resulting wound is often sharply defined and difficult
      to camouflage, even with skin grafts or plastic surgery. Usually the damage
      remains local. In rare instances people develop systemic illnesses and
      infections. Recovery can take several months. All of which contributes to
      the spider's image of menace.

      (A spider that is common throughout the United States, the yellow sac, can
      also cause necrotic wounds, but its bite is generally not believed to be as
      severe as a brown recluse bite.)
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