Redback Spider Envenomation Clinical Presentation

  • Author: Rebecca L Rubin, MD; Chief Editor: Joe Alcock, MD, MS   more...
 
Updated: Apr 16, 2012
 

History

  • In Australia, most bites occur during the warmer months between December and April. Bites to the limbs comprise approximately three quarters of cases, and bites to the distal limbs are twice as common as to the proximal limbs; 46% in distal extremity and 26% in proximal limb.[8]
  • The cardinal symptoms of redback spider envenomation include immediate pain at the site of the bite with or without erythema, which usually progresses over hours to involve the entire limb and draining lymph nodes in the axilla or groin. The pain may persist longer than 24 hours, with a median duration of 36 hours. Other common complaints include nausea, vomiting, abdominal pain, headache, and migratory arthralgias.[3]
  • In infants, nonspecific symptoms may be present, including inconsolable crying and refusal to eat.
  • Most cases are mild or unrecognized and do not receive antivenom. The only way to accurately diagnose a redback spider bite is for the patient to recognize the typical markings on the spider's abdomen or bring the spider in with the patient for proper identification.[8]
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Physical

  • Common physical findings in a patient with redback spider envenomation include tenderness and erythema at the bite site. Occasionally, one can see localized or generalized sweating, which may be unrelated to the bite site. Local piloerection may also be present.[8]
  • Systemic findings in redback spider envenomation, seen in approximately 35% of all bites, include fever, hypertension, and tachycardia.[8]
  • Neurological symptoms may include restlessness and insomnia, muscle weakness and twitching, and paralysis. The median duration of all effects is 48 hours.
  • Rare complications include myocarditis, rhabdomyolysis, and death.
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Contributor Information and Disclosures
Author

Rebecca L Rubin, MD  Clinical Assistant Instructor and Resident Physician, Department of Emergency Medicine, State University of New York Downstate/Kings County Hospital Center

Rebecca L Rubin, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD  Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Assistant Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic 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 eMedicine gratefully acknowledge the contributions of previous authors, Alexandr Rafailov, MD, and Mark A Silverberg, MD, to the development and writing of this article.

References

  1. White J. CSL Antivenom Handbook. 2nd ed. 2001. Available at http://www.toxinology.com/generic_static_files/cslb_index.html.

  2. Nimorakiotakis B, Winkel KD. Spider bite--the redback spider and its relatives. Aust Fam Physician. Mar 2004;33(3):153-7. [Medline]. [Full Text].

  3. Graudins A. Widow spider envenomation: Lactrodectism. In: Dart RC, ed. Medical Toxicology. 3rd ed. Lippincott Williams & Wilkins; 2003:1592-1595/248. [Full Text].

  4. Nicholson GM, Graudins A. Spiders of medical importance in the Asia-Pacific: atracotoxin, latrotoxin and related spider neurotoxins. Clin Exp Pharmacol Physiol. Sep 2002;29(9):785-94. [Medline].

  5. Ushkaryov YA, Volynski KE, Ashton AC. The multiple actions of black widow spider toxins and their selective use in neurosecretion studies. Toxicon. Apr 2004;43(5):527-42. [Medline].

  6. Australian Museum. Available at http://australianmuseum.net.au/Redback-Spiders.

  7. Mollison L, Liew D, McDermott R, Hatch F. Red-back spider envenomation in the red centre of Australia. Med J Aust. Dec 5-19 1994;161(11-12):701, 704-5. [Medline].

  8. Isbister GK, Gray MR. Latrodectism: a prospective cohort study of bites by formally identified redback spiders. Med J Aust. Oct 20 2003;179(8):455; author 455-6. [Medline].

  9. Isbister GK, Brown SG, Miller M, Tankel A, Macdonald E, Stokes B, et al. A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism--the RAVE study. QJM. Jul 2008;101(7):557-65. [Medline].

  10. Hahn IH, Lewin N. Chapter 115: Arthropods. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006.

  11. Isbister GK. Failure of intramuscular antivenom in Red-back spider envenoming. Emerg Med (Fremantle). Dec 2002;14(4):436-9. [Medline].

  12. Isbister GK, Sibbritt D. Developing a decision tree algorithm for the diagnosis of suspected spider bites. Emerg Med Australas. Apr 2004;16(2):161-6. [Medline].

 
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Female redback spider showing a distinctive red stripe over the abdomen. Image courtesy of John Paterson.
Female redback spider with egg sacs. Image courtesy of John Paterson.
Female redback spider. Image courtesy of John Paterson.
Female redback spider. Image courtesy of John Paterson.
 
 
 
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