eMedicine Specialties > Emergency Medicine > Environmental

Spider Envenomation, Redback: Follow-up

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
Coauthor(s): Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Sep 23, 2009

Follow-up

Further Inpatient Care

  • Hospitalization is generally not required, after a period of observation, for patients whose symptoms have been alleviated with antivenom. Patients who have contraindications to antivenom and those requiring large doses of opioid analgesics and sedatives for symptomatic control should be hospitalized.8 Hospitalization should be considered in the following situations:
    • Pregnant women
    • Severely symptomatic children
    • Elderly patients with significant comorbidities
    • Patients who develop anaphylaxis to antivenom
    • Patients with complications of envenomation
    • Patients with hemodynamic instability

Further Outpatient Care

  • Patients should be given thorough instructions listing the symptoms of serum sickness (fever, pruritus, and arthropathy) and cellulitis and advised to seek medical care if such symptoms occur.1

Inpatient & Outpatient Medications

  • Patients may need to undergo a short course of steroid treatment should serum sickness occur.

Deterrence/Prevention

  • Use of pesticides may prevent exposure to spiders in the home. In endemic areas, patients should be advised to inspect their clothes and shoes for spiders before wearing them.

Complications

  • Hypertensive emergency
  • Acute myocardial infarction
  • Myocarditis
  • Rhabdomyolysis
  • Paralysis
  • Death
  • Antivenom-associated complications
    • Anaphylaxis (type I hypersensitivity reaction) is characterized by urticaria, wheezing, and circulatory collapse. The risk of allergic reaction in patients receiving redback antivenom is 0.5% and is higher in patients with prior exposure to horse serum proteins or history of reactive airway disease. Anaphylaxis is treated with epinephrine, corticosteroids, antihistamines, intravenous fluids, and ventilatory support in the usual medical fashion.
    • Serum sickness (type III hypersensitivity reaction) is characterized by fever, urticaria, pruritus, nephritis, and arthritis. This condition occurs in 1.4% of patients receiving antivenom and is self-limiting. Treatment is usually conservative. Antihistamines and topical steroids may be used for dermatitis and aspirin for arthralgia. In severe reactions, including glomerulonephritis, corticosteroid therapy may be necessary.

Prognosis

  • Most patients with redback spider envenomation recover fully.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Administration of antivenom may require informed consent.
  • Discharging a patient who subsequently returns with persistent symptoms requiring antivenom treatment and/or admission may constitute a legal pitfall.
  • Administration of antivenom to a patient with a documented prior hypersensitivity to horse serum or history of asthma and multiple medication allergies, who subsequently develops anaphylaxis may serve as grounds for malpractice.
 
Acknowledgments

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.



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Multimedia: Spider Envenomation, Redback
References
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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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Further Reading

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Keywords

spider bite, redback spider, spider envenomation, Jockey spider, latrodectism, latrotoxin, aLTX, neurotoxin, redback spider bite, spider bite treatment

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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, 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.

Medical Editor

Robert L Norris, MD, Associate 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.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

Matthew M Rice, MD, JD, FACEP, Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians; Assistant Clinical Professor of Medicine, University of Washington at Seattle
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: Team Health  Salary Employment

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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