Widow Spider Envenomation Follow-up
- Author: Sean P Bush, MD, FACEP; Chief Editor: Rick Kulkarni, MD more...
Further Inpatient Care
Admission to the hospital is indicated to the following patients:
- Severely symptomatic children[10]
- Pregnant women
- Patients with a history of hypertension or heart disease
- Patients with intractable pain and contraindications to antivenom
- Patients with unusual complications of envenomation
- Patients who develop anaphylaxis to antivenom
Discharge patients who experience relief with opioid analgesics, sedative-hypnotics, and/or antivenom (after a period of observation). Antivenom administration may reduce the need for hospitalization.
Further Outpatient Care
Instruct patients to return if any of the following symptoms occur:
- Hematuria
- Rash
- Joint pain
- Swollen lymph nodes
- Difficulty breathing
- Signs of infection
Advise patients that if treated symptomatically with pain medications and benzodiazepines, pain may come and go for up to days to weeks after envenomation.
If patients have been treated with antivenom, discuss signs of serum sickness (as noted above) and warn them of its possible occurrence in 3-14 days.
Inpatient & Outpatient Medications
Antihistamines and steroids should be given if serum sickness to antivenom develops. This is rare because treatment of widow spider envenomation usually requires only 1-2 vials of antivenom, and serum sickness usually occurs when more antivenom is given.
Deterrence/Prevention
Pesticides may prevent exposures to widow spiders at home.
Complications
Complications may include the following:
- Respiratory difficulty, reactive airway exacerbation
- Spontaneous abortion or preterm labor
- Hypertensive emergency with or without associated seizures (isolated normotensive seizures have not been described), acute myocardial infarction
- Rhabdomyolysis
- Priapism (rare)
- Compartment syndrome (rare)[13]
- Toxic myocarditis (rare)
- Antivenom-associated complication: Anaphylaxis, a type I (immediate) hypersensitivity reaction that may be life threatening, is characterized by urticaria, wheezing, and shock. It may occur to some degree in as many as 25% of patients given antivenom. Risk factors may include previous exposure to horse serum or antivenom or a history of reactive airways. It is treated with epinephrine, antihistamines, steroids, and ventilatory/circulatory support. One death has been reported from anaphylaxis to widow spider antivenom in the United States. The patient had a history of asthma and, after antivenom was administered, developed severe bronchospasm unresponsive to medical therapy.
- Antivenom-associated complication: Serum sickness, a type III (delayed) hypersensitivity reaction characterized by fever, urticaria, lymphadenopathy, and arthritis, may occur 5 days to 3 weeks after antivenom administration. It usually is benign, self-limited, and treated with antihistamines and steroids. Serum sickness is dose related and uncommon following administration of widow spider antivenom because of the small amounts generally needed (1 or 2 vials).
Prognosis
The vast majority of patients with widow spider envenomations recover fully.
Patient Education
For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education articles, Black Widow Spider Bite and Brown Recluse Spider Bite.
Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). Dec 2007;45(8):815-917. [Medline].
Langley RL, Morrow WE. Deaths resulting from animal attacks in the United States. Wild Environ Med. 1997;8:8-16.
Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, Youniss J, Reid N, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].
Gonzalez Valverde FM, Gomez Ramos MJ, Menarguez Pina F, Vazquez Rojas JL. [Fatal latrodectism in an elderly man]. Med Clin (Barc). Sep 22 2001;117(8):319. [Medline].
Pneumatikos IA, Galiatsou E, Goe D, Kitsakos A, Nakos G, Vougiouklakis TG. Acute fatal toxic myocarditis after black widow spider envenomation. Ann Emerg Med. Jan 2003;41(1):158. [Medline].
Hoxha R. Two Albanians die from black widow spider bites. BMJ. Aug 5 2006;333(7562):278. [Medline].
Boyer Hassen LV, McNally JT, Binford GJ. Spider bites. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis: Mosby-Year Book; 2001:807-838.
Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med. Jul 1992;21(7):782-7. [Medline].
Bush SP, Thomas TL, Chin ES. Envenomations in children. Pediatr Emerg Med Rep. 1997;2:1-12.
Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children?. Pediatr Emerg Care. Oct 1996;12(5):360-4. [Medline].
Bush SP. Black widow spider envenomation mimicking cholecystitis. Am J Emerg Med. May 1999;17(3):315. [Medline].
Allen RC, Norris RL. Delayed use of widow spider antivenin. Ann Emerg Med. Sep 1995;26(3):393-4. [Medline].
Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med. Apr 2005;45(4):414-6. [Medline].
Bush SP, Naftel J. Injection of a whole black widow spider. Ann Emerg Med. Apr 1996;27(4):532-3. [Medline].
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