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Spider Envenomation, Funnel Web

Author: Joe Alcock, MD, MS, Assistant Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center; Acting Chief, Emergency Medicine Service, New Mexico Veterans Affairs Health Care System
Contributor Information and Disclosures

Updated: Dec 4, 2008

Introduction

Background

Australian funnel-web spiders (family Hexathelidae, subfamily Atracinae, genera Atrax and Hadronyche) are the most venomous spiders in the world based on clinical experience in Australia and animal lethal dose studies. Funnel-web spiders belong to the suborder Mygalomorphae, a primitive group of spiders that also includes tarantulas. Funnel-web spiders of medical importance comprise 40 species within 2 genera, Atrax and Hadronyche, in the family Hexathelidae, subfamily Atracinae. The Atrax genus contains 3 species, including Atrax robustus, the Sydney funnel-web spider. The remaining 37 species are members of the genus Hadronyche. Funnel-web spiders are primarily found on the eastern coast of Australia. Related funnel-web spiders can also be found in New Guinea and the Solomon Islands.

Funnel-web spiders are medium-to-large robust spiders that tend to be dark or black in color. These spiders measure up to 5 cm. They have stout legs and prominent fang-bearing chelicerae that deliver a neurotoxic venom. The common name derives from the funnel-like entrance to silk-lined subterranean burrows built by both males and females. The Sydney funnel-web spider (A robustus) is responsible for most reported envenomations and the only confirmed deaths in humans.

In Australia, there have been 138 confirmed funnel-web spider bites since 1926 to 2004.¹ A prospective study revealed 16 envenomations between 1999 and 2003;² 10-20% of bites produce toxicity. Male spiders are responsible for most bites. Unfortunately, the venom of male spiders is also more toxic than that of female spiders. Male funnel-web spiders exhibit a seasonal wandering behavior in search of female mates, which often brings them into houses and in contact with humans. Humans and other primates suffer severe life-threatening toxicity from the venom, while other vertebrates, such as rabbits and cats, are almost unaffected. Since 1981 when an antivenom was first used clinically, no fatalities have occurred.

Pathophysiology

The venom components responsible for mortality and morbidity are labeled delta-atracotoxins (formerly robustotoxin in A robustus and versutoxin in Hadronyche versuta). While the amino acid structure of delta-atracotoxins differs slightly between species of funnel-web spiders, strong antigenic cross-reactivity exists between their venoms. Funnel-web spider antivenom, derived from purified immunoglobulin G (IgG) of rabbits hyperimmunized with A robustus venom , is also effective against venom of Hadronyche species. Delta-atracotoxins are polypeptide neurotoxins that induce spontaneous, repetitive firing and prolongation of action potentials in presynaptic autonomic and motor neurons. 

Delta-atracotoxins bind to the outer surface of tetrodotoxin-sensitive sodium channels. After binding, they induce excitability of these voltage-dependent sodium channels. The toxins also interfere with the conformational changes necessary for gating and inactivation of the channel. The ensuing massive neurotransmitter release results in an autonomic storm. The excessive release of endogenous acetylcholine, norepinephrine, and epinephrine is responsible for many of the clinical findings of funnel-web spider envenomation.

Envenomation is heralded by substantial pain at the bite site. Most funnel-web spider bites do not proceed to severe systemic symptoms, causing only mild or local neurotoxic effects. In severe cases, the onset of symptoms is rapid, with a median onset of 28 minutes. Agitation and vomiting are common. Autonomic effects include diaphoresis, salivation, piloerection, lacrimation, and pupillary changes. Cardiovascular changes commonly include hypertension and tachycardia. Hypotension and bradycardia occur more rarely. Pulmonary edema occurs in more than half of severe envenomations, with dyspnea and pink, frothy sputum often accompanied by respiratory failure. Skeletal muscle fasciculation, muscle spasms, and oral paresthesias are frequent neurologic findings. Coma or loss of consciousness occurs in about 10% of patients who experience severe envenomation.

Rhabdomyolysis is common in serious envenomation with massive increases in serum creatine kinase (CK) levels and risk of renal failure.

Frequency

International

Funnel-web spiders of medical importance are found in eastern and southern Australia. The Sydney funnel-web spider (A robustus) is distributed in a roughly 75-mile radius around the city of Sydney. Hadronyche species have a much wider distribution, from southeast Queensland to Victoria, Tasmania, and parts of South Australia.

Sixteen confirmed cases of funnel-web spider bites were reported to poison control centers or hospitals in Australia from 1999-2003. A minority of patients (10-20%) require treatment with antivenom.²

Mortality/Morbidity

• The mortality rate is difficult to determine from data from the era before antivenom. From 1927-1980, 13 deaths attributed to A robustus were reported in the medical literature and news media. No deaths have occurred since the introduction of antivenom.¹
• Deaths occurred in children and adult females with bites. In all cases where the spider was identified, the culprit was the Sydney funnel-web spider, A robustus. Severe envenomation, but not death, has been reported following bites by Hadronyche species.
• Death occurs between 15 minutes and 3 days following the bite. In children, death is usually early and caused by pulmonary edema. In adults, death usually occurs later and is caused by persistent hypotension and cardiovascular collapse. In the late 1970s, two deaths occurred despite modern intensive care units. Death in these cases occurred from multisystem organ failure days after the bite.³

Age

Bites are equally common in adults and children. However, envenomation in children is more severe because of the greater venom load per kilogram of body mass. Children may experience life-threatening envenomation within an hour of the bite and require immediate treatment.

Clinical

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.

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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