Funnel Web Spider Envenomation Clinical Presentation

  • Author: Joe Alcock, MD, MS; Chief Editor: Joe Alcock, MD, MS   more...
 
Updated: Apr 17, 2012
 

History

  • The spider usually is seen, and its bite is extremely painful for hours to days (the fangs are large and enter with considerable force).
  • Early symptoms of systemic envenomation may occur rapidly, with a 28-minute median onset. A pressure-immobilization dressing can delay onset of symptoms.
  • The following are symptoms of a serious envenomation:
    • Perioral tingling
    • Lacrimation
    • Salivation
    • Abdominal pain
    • Nausea
    • Vomiting
    • Diaphoresis
    • Severe dyspnea
  • Muscle fasciculations and spasms are common.
  • Agitation and confusion can occur.
  • Unconsciousness occurs in a minority of patients.
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Physical

  • Erythema, piloerection, diaphoresis, and muscle fasciculation may be seen at and around the bite site.
  • Generalized diaphoresis, lacrimation, and salivation may be noted.
  • Fasciculations and muscle spasms are frequent findings in severe envenomation; however, paralysis does not appear to occur.
  • A brief period of hypotension and tachycardia is followed by severe hypertension.
  • Cardiac arrhythmias and cardiac arrest may occur.
  • Severe pulmonary edema that is poorly responsive to loop diuretics occurs early and may be fatal.
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Contributor Information and Disclosures
Author

Joe Alcock, MD, MS  Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; Chief, Emergency Medicine Service, New Mexico Veterans Affairs Health Care System

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Matthew M Rice, MD, JD, FACEP  Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS  Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; Chief, Emergency Medicine Service, New Mexico Veterans Affairs Health Care System

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Simon G A Brown, MBBS, PhD, FACEM, to the development and writing of this article.

References

  1. Isbister GK, Gray MR, Balit CR, Raven RJ, Stokes BJ, Porges K, et al. Funnel-web spider bite: a systematic review of recorded clinical cases. Med J Aust. Apr 18 2005;182(8):407-411. [Medline]. [Full Text].

  2. Isbister GK, Fan HW. Spider bite. Lancet. Dec 10 2011;378(9808):2039-47. [Medline].

  3. Isbister GK, Gray MR. Bites by Australian mygalomorph spiders (Araneae, Mygalomorphae), including funnel-web spiders (Atracinae) and mouse spiders (Actinopodidae: Missulena spp). Toxicon. 2004;43(2):133-40. [Medline].

  4. Graudins A, Wilson D, Alewood PF, Broady KW, Nicholson GM. Cross-reactivity of Sydney funnel-web spider antivenom: neutralization of the in vitro toxicity of other Australian funnel-web (Atrax and Hadronyche) spider venoms. Toxicon. Mar 2002;40(3):259-66. [Medline].

  5. Isbister GK, Gray MR. A prospective study of 750 definite spider bites, with expert spider identification. QJM. Nov 2002;95(11):723-31. [Medline].

  6. Fisher MM, Carr GA, McGuinness R, Warden JC. Atrax robustus envenomation. Anaesth Intensive Care. Nov 1980;8(4):410-20. [Medline].

  7. Sutherland SK, Duncan AW. New first-aid measures for envenomation: with special reference to bites by the Sydney funnel-web spider (Atrax robustus). Med J Aust. Apr 19 1980;1(8):378-9. [Medline].

  8. Dieckmann J, Prebble J, McDonogh A, Sara A, Fisher M. Efficacy of funnel-web spider antivenom in human envenomation by Hadronyche species. Med J Aust. Dec 4-18 1989;151(11-12):706-7. [Medline].

  9. Harrington AP, Raven RJ, Bowe PC, Hawdon GM, Winkel KD. Funnel-web spider (Hadronyche infensa) envenomations in coastal south-east Queensland. Med J Aust Med J Aust. Dec 6-20 1999;171(11-12):651-3. [Medline]. [Full Text].

  10. Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. Dec 5-19 1994;161(11-12):695-700. [Medline].

  11. Sutherland SK. The Sydney funnel-web spider (Atrax robustus). 3. A review of some clinical records of human envenomation. Med J Aust. 1972;2:642-6.

  12. Sutherland SK, Duncan AW, Tibballs J. Local inactivation of funnel-web spider (Atrax robustus) venom by first- aid measures: potentially lifesaving part of treatment. Med J Aust. Oct 18 1980;2(8):435-7. [Medline].

  13. White J, Cardoso JL, Fan HW. Clinical toxicology of spider bites. In: Handbook of Clinical Toxicology of Animal Venoms and Poisons. CRC Press; 1995:272-83.

 
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The Sydney funnel-web spider, Atrax robustus. Male (left) and female (right). Photograph courtesy of the Australian Venom Research Unit, Department of Pharmacology, University of Melbourne, Australia.
Female funnel-web spider. Image courtesy of Glenn DuBois, CEO, http://www.termite.com/spider-identification.html.
Male funnel-web spider. Image courtesy of Glenn DuBois, CEO, http://www.termite.com/spider-identification.html.
 
 
 
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