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Sneaky SF Dude
15 June 2003, 12:51
My offering for the first thread for Medical Question of the Week. This is one of my favorites from the Q Course.

The Brown Recluse spider, Loxosceles reclusus, living up to its name, is naturally nonaggressive toward humans and prefers to live in undisturbed areas. The brown recluse is about 1/4 to 1/2 inches (6-12 mm) in body length and have a leg span of over 1 inch (25 mm). Most adults are about the size of a United States dime to a U.S. quarter with legs extended. The spider can tolerate temperatures from 32 degrees Fahrenheit (0 degrees
Celsius) to over 100 degrees Fahrenheit (38 degrees Celsius). Coloration ranges from tan to dark brown, with the abdomen often darker than the rest of the body. Characteristic violin-shaped markings on their backs have led brown recluses to also be known as fiddleback spiders. The darker violin-shaped marking can be seen on top of the leg-bearing section of the
body. The neck of the violin "silhouette" points towards the rear (abdomen) of the spider. Brown recluse spiders also have six eyes, rather than eight for most other spiders. They are most active at night from spring to fall.

The brown recluse roams at night seeking its prey. During the day, it hides in dark niches and corners, where it may spin a poorly organized, irregular web. It is shy and will try to run from a threatening situation but will bite if cornered. People are sometimes bitten while putting on a shoe or piece of clothing which a spider has selected for its daytime hiding place. People are also bitten while they are asleep because they roll onto
a brown recluse spider in the bed.

The brown recluse may be found living indoors or outdoors. Thorough inspection of cracks, corners, and other dark, undisturbed areas with a bright flashlight will help determine the location and extent of infestation. Indoors, pay particular attention to basements, attics, crawl spaces, closets, under/behind beds and furniture, inside shoes, boxes of
stored items, and between hanging clothing. Brown recluse spiders also may be found living above suspended ceilings, behind baseboards, and inside ductwork or registers.

Medical Significance
The bite from a brown recluse spider rarely causes death. The bite of the brown recluse is usually painless. Over the next 3 to 8 hours, the poison begins to kill the tissues around the bite, which is very painful. The area around the bite site may become red, swollen, and tender, developing into an ulcerous sore from 1 to 10 inches in diameter. This reaction gives a whitish appearance immediately surrounding the bite with a large reddened area around the white area. Aside from the skin problems, the poison and skin breakdown can cause chills, fever, nausea, and other flu-like symptoms.
Symptoms of a brown recluse bite include a rash, fever, chills, nausea, vomiting, and joint pain. In severe case, patients may also have renal failure, seizures, or coma. Healing often requires a month or longer, and the victim may be left with a deep scar. The destruction of the skin surrounding the bite can be quite significant occasionally requiring skin grafts. Prompt medical attention can reduce the extent of ulceration and alleviate other complications that may develop. Not all brown recluse bites
result in ulcerations or scarring.

Spider bites are difficult to diagnose, even by physicians. If bitten, it is best to clean the bite with soap and water and then place an ice pack over the wound. If possible, capture the spider (safely) so that it can be positively identified. Then, seek medical assistance immediately.
Unfortunately, there isn't a tremendous amount that can be done to neutralize the poison. Medications to decrease the body's inflammatory reaction to the poison are the primary methods of treatment. Ultimately the best "treatment" for brown recluse spider bites is prevention and control.

Control
Eliminating an infestation of brown recluse spiders involves two basic principles:
*Altering the environment in and around a building to make it less
attractive to spiders; and
*Finding and destroying as many spiders as possible.

To Avoid being bitten:
*Shake clothing, blankets, and shoes that have been on the floor or not been worn in a while.
*Wear long sleeves and gloves when moving boxes or working in storage areas.
*Wash or check bed linens in beds that have not been slept in for a while.

The following measures can be used to control all spiders, including the brown recluse.
*Routine, thorough house cleaning is the best way to eliminate spiders and discourage their return. A vacuum cleaner or broom effectively removes spiders, webs, and egg sacs.
*Spiders prefer quiet, undisturbed areas such as closets, garages, basements, and attics. Reducing clutter in these areas makes them less attractive to spiders. Try not to make piles of objects in the closet, attics, and basements that are not cleaned regularly.
*Large numbers of spiders often congregate outdoors around the perimeter of structures. Moving firewood, building materials, and debris away from the foundation indoors can reduce migration. Shrubs, vines and tree limbs should be clipped back from the side of buildings. Removal of unnecessary clutter is especially helpful in making areas unattractive to these pests.
*Install tight-fitting window screens and door sweeps to exclude spiders and other insects. Inspect and clean behind outdoor window shutters.
*Consider installing yellow or sodium vapor light bulbs at outside
entrances. These lights are less attractive than mercury vapor,
fluorescent, or incandescent bulbs to night-flying insects, which in turn, attract spiders.
*Use glueboards or sticky traps to detect infestations. These devices, designed to capture mice and cockroaches, can be purchased at grocery or hardware stores. Place flush along walls and in corners. Glueboards and sticky traps are useful monitoring tools and will also capture large numbers
of spiders.

Sdiver
15 June 2003, 13:35
Question: Given the temperature range (32 degrees F to 100 degrees F) that the spider can survive in, what areas of the country/world does the spider live in? Excluding of course, the N & S poles. Is there an area that the spider is most common?

Sneaky SF Dude
15 June 2003, 13:42
Brown recluse spiders are most commonly found in Midwestern and Southern states of the U.S.

Polar Bear
15 June 2003, 13:55
Here is where the spider is most prevalent

Polar Bear
15 June 2003, 14:35
WARNING: Some of these pictures are somewhat graphic.


Pictures of Brown Reclus Bites (http://brownreclusespider.net/BitePhotos.htm)

Polar Bear
15 June 2003, 14:53
Found this on the WWW. Can anyone tell me what these drugs do to the body in layman terms to help with healing.

"An effective antivenom is not generally available. The physician will usually administer high doses of cortisone-type hormones to combat hemolysis and other systemic complications. A report suggests that treatment with dapsone (a drug used mainly for leprosy) may reduce the degree of tissue damage. "

ballsofsolidrock
15 June 2003, 15:11
Excellent information gents!

In addition to the areas mentioned previously, Brown Recluse spiders are also prevalent in Hawaii. Particulary Scholfield Barracks on Oahu. Those little buggers are all over the MOUT town there. (I have treated a fair number of Marines that were careless and forgot to shake out their boots and sleeping bags).

Sneaky SF Dude
15 June 2003, 15:18
We have also seen them in Ecuador.

ussfpa
15 June 2003, 16:17
Originally posted by Lance Serge
Found this on the WWW. Can anyone tell me what these drugs do to the body in layman terms to help with healing.

"An effective antivenom is not generally available. The physician will usually administer high doses of cortisone-type hormones to combat hemolysis and other systemic complications. A report suggests that treatment with dapsone (a drug used mainly for leprosy) may reduce the degree of tissue damage. "
Lance, The "cortisone-type hormones" I would venture to say are the steroids that Sneaky referred to in his initial post (well done might I add)...To break it down just a little further...look at Motrin, a NON STEROIDAL anti-inflammatory...Cortisone based medications are STEROID anti-inflammatory drugs.
The Dapsone "spin", though not recommended currently by OUR FDA :rolleyes:, could be for the treatment of cutaneous vasculitis (inflammation of blod vessels and capilaries)
Dapsone is routinely used in AIDS pts here in the US for it's anti-parasitic / antibiotic action against pneumocystis carinii pneumonia (PCP), toxoplasmosis, and again for the anti-inflammatory augment with Herpetiform Dermatitis (painful herpes blisters on immunodepressed patients)
Anti-venom with the recluse is lees significant in the big picture due to it's non lethality. The key is to de-nature the poison. Scraping out the bite (curretage) is widely accepted and the poison is relatively local acting in nature. KEY POINT< catch it early. Some areas with high bite rates have experimented over the past few years with injections of 1% Calcium Chloride as an infiltrate around the bite site...mixed results.
TO sum it up...
Steroids...STRONG anti-inflammatories, perhaps the pills or shot you got when you played RAMBO in poison ivy in the field.
Dapsone, some approved and some experimental uses...mainly dealing with base inflammation within the blood vessels themselves.

Hope this helps a little...
Primum non Nocere

NewportBarGuy
15 June 2003, 16:25
Any medical history on the accidental consumption of a Brown Recluse?

What are the steps to follow once bitten?

NewportBarGuy
15 June 2003, 16:29
Originally posted by ussfpa

Anti-venom with the recluse is lees significant in the big picture due to it's non lethality. The key is to de-nature the poison. Scraping out the bite (curretage) is widely accepted and the poison is relatively local acting in nature. KEY POINT< catch it early. Some areas with high bite rates have experimented over the past few years with injections of 1% Calcium Chloride as an infiltrate around the bite site...mixed results.

Hope this helps a little...
Primum non Nocere

Actually just a clarification on this is probably all I'd need to know. You're talking about going in with an edged tool of some sort and scraping out the "bad" area? To minimise the damage done?

Before I attack myself with any edged weapons, is that what you mean by scraping out the bite?

ussfpa
15 June 2003, 17:01
A currett is like a small "melonballer". A core currette takes a cylendrical "punch" out of the central bite area (similiar to a punch biopsy) then the "currettage" takes place until healthy tissue is revealed. Wound is dressed and allowed to heal from the bottom up...no suturing allowed.
This should be done in as controlled and clean an environment as the situation alllows. Antibiotics should also be administered to preclude secondary wound infection. Close follow up is strongly recommended...

Primum non Nocere

tryxter
15 June 2003, 17:05
I experienced one of these in North Carolina. I did feel the bite even though I'd been sleeping and the next morning there was a small red warm area top right thigh but no real pain. The next day though the area was bigger and I dropped out of the PT run near the med clinic and had it checked there. I'd seen the brown spider in my room but hadn't known at the time what a brown recluse was and because I wasn't sure it was that spider that bit me the clinic just gave me an antibiotic. The bite does as advertised it becomes red very warm and swollen. The venom did eat away at the surrounding tissue and it became a whitish puss. The next day the center of the bite had a small white hole so I took a key and matched the hole in the key with the hole of the bite and pressed it down and pushed all the white gunk out. That left a cleaner pink color and a small depression in my leg. But after doing that it healed quickly and eventually healthy tissue filled in the depression. The largest area affected was circular and about 2 1/2-3" across not as bad looking as your pics. I'm thinking because I'd had some treatment and cleaned out the puss and venom from the area fairly quickly it lessened the damage.

NewportBarGuy
15 June 2003, 17:08
Thank you, Sir!

This idea, topic of the week, is great.

ussfpa
15 June 2003, 18:16
But Sneaky deserves the credit...

Primum non Nocere

Doc
15 June 2003, 18:23
Originally posted by ussfpa
But Sneaky deserves the credit...

Primum non Nocere

Yes he does.

Good job.

Polar Bear
15 June 2003, 21:19
Originally posted by ussfpa
Lance, The "cortisone-type hormones" I would venture to say are the steroids that Sneaky referred to in his initial post (well done might I add)...To break it down just a little further...look at Motrin, a NON STEROIDAL anti-inflammatory...Cortisone based medications are STEROID anti-inflammatory drugs.

Would Ibuprofen also be a substitute for Motrin? Or does it not work in the same way. Reason I ask, after Sneaky brought this up I decided to go through my aid bag and see what I should keep and what I should DX and I had some old 800mg of IB in there and have no idea what the shelf life is.

Sdiver
15 June 2003, 22:06
Originally posted by Lance Serge
........I decided to go through my aid bag and see what I should keep and what I should DX and I had some old 800mg of IB in there and have no idea what the shelf life is.

Funny you should post that Lance, I too came across some old IB 800mg and also wanted to know what the shelf life was. I went down to the nearest F.D. station house (4 blocks up the street from me) and asked to see if their P.D.R. had any info. The Paramedics were more than happy to oblidge and after looking in their P.D.R., I'm sorry to say that there was no info on shelf life for it.

Their recomondation was to go to a pharmacist and have them check into it. (still haven't gone down to one yet, as I hold my head in shame)

This post has really peaked my intrest. I've had something bothering my R shoulder for the past 4-6 weeks now. At first I thought it was I had just slept on it funny one night and that it was just a muscle strain, but heating it did nothing for it. At one point it had gotten so bad, the smallest movement from my arm or shoulder and I was putting a hole in the wall with my fist. The only way I could get any relief was icing it down and taking Advil. I did take a couple of the IB's and did get some relief, but not the same as the Advils.

After I ruled out a muscle strain or sprain I then thought about getting bit by some type of creepy crawly during the night. I did notice a small "boil" on the top my shoulder, but it didn't resemble any type of bite. It looked like just any type of normal "zit". I also thought it might be some type of roomatoide (sp) arthritis.

It's more or less has gotten better. There are twinges now and then, but for the most part I've regained about 90% mobility.

Thanks Sneaky....for posting a GREAT topic.

Gooch
15 June 2003, 22:40
Whats the history on the photo's in the slide show?

How long did those bites go untreated?

I had no idea the little bastards bite could be so bad! I've lived in the things AO for years and knew they were bad but.... jeeze!

Out

CPTAUSRET
15 June 2003, 22:41
Originally posted by ussfpa
But Sneaky deserves the credit...

Primum non Nocere

Sure does, excellent post Sneaky:

Terry

NewportBarGuy
15 June 2003, 22:53
Thank you Senor Sneaky!

frogstyle
15 June 2003, 23:05
Ian,
Post more frquently.

NewportBarGuy
15 June 2003, 23:35
I've been hanging out here...

Interesting perspective... They like us, as people I mean.

Sneaky SF Dude
16 June 2003, 00:20
I didn't write it. The guy that did deserves all the credit. Thanks.

ussfpa
16 June 2003, 01:12
Dude,
The kudos were for the thread, not the boring ass pocket protector text you put into it :D LOL

Now stop being so modest, tell us all to go pound our personal puds, and grin with your beer knowing you started a good thing here ;)

Seriously, top shelf idea...I got next weeks...

Primum non Nocere

Doc
16 June 2003, 06:05
Originally posted by Lance Serge
Would Ibuprofen also be a substitute for Motrin? Or does it not work in the same way. Reason I ask, after Sneaky brought this up I decided to go through my aid bag and see what I should keep and what I should DX and I had some old 800mg of IB in there and have no idea what the shelf life is.

The active ingredient in Motrin is ibuprofen.

The expiration date is on the bottle the medicine is packaged in when it's manufactured.

When in doubt, throw it out. Get some new stuff that you know is good.

Doc

TerribleTed
17 June 2003, 01:09
In the ER and at sick call, every type of insect bite gets called a "brown recluse bite" by the bearer. The person usually follows up with "it was huge, about 4 inches across and hairy".

Out of the 8 jillion insect and spider bites I've seen, I could only definately call two as brown recluse bites.


To follow up on what Doc said: Ibuprofen = Motrin = Advil = Nuprin = Rufen. Just different brand names for the same medication - ibuprofen.

DFC5343
17 June 2003, 01:45
Originally posted by Doc
The active ingredient in Motrin is ibuprofen.

The expiration date is on the bottle the medicine is packaged in when it's manufactured.

When in doubt, throw it out. Get some new stuff that you know is good.

Doc

Are you in the employ of a pharmacutical manufactuer already? Ya sound so...OFFICAL!

Doc
17 June 2003, 06:39
Originally posted by DFC5343
Are you in the employ of a pharmacutical manufactuer already? Ya sound so...OFFICAL!

LMAO!

Hoepoe
22 June 2003, 03:00
Some more pics....

http://images.ogrish.com/2003/94/

Hoepoe

sta marine
22 June 2003, 03:08
OOOOOOO Thanks bro I'm good...

themadmedic
23 June 2003, 21:02
Originally posted by NewportBarGuy
What are the steps to follow once bitten?

Lots of suggestion for application of a cold compress...it decreases the activity of the "toxin" as it is temperature dependant.

ussfpa
24 June 2003, 03:04
That the toxin may not be temoerature dependent, BUT, cooling the area will decrease the circulation and therefor decrease the amount of venom that circulate and is absorbed.
My thoughts...

Primum non Nocere

Doc
24 June 2003, 06:12
Originally posted by ussfpa
That the toxin may not be temoerature dependent, BUT, cooling the area will decrease the circulation and therefor decrease the amount of venom that circulate and is absorbed.
My thoughts...

Primum non Nocere


I've read where they've tried Eppy as well to control the infiltration of the toxin.

rheanna_92
24 June 2003, 07:36
Originally posted by Sneaky SF Dude

The brown recluse may be found living indoors or outdoors. Thorough inspection of cracks, corners, and other dark, undisturbed areas with a bright flashlight will help determine the location and extent of infestation. Indoors, pay particular attention to basements, attics, crawl spaces, closets, under/behind beds and furniture, inside shoes, boxes of
stored items, and between hanging clothing. Brown recluse spiders also may be found living above suspended ceilings, behind baseboards, and inside ductwork or registers.

Medical Significance
...., patients may also have renal failure, seizures, or coma. Healing often requires a month or longer, and the victim may be left with a deep scar. The destruction of the skin surrounding the bite can be quite significant occasionally requiring skin grafts. Prompt medical attention can reduce the extent of ulceration and alleviate other complications that may develop. Not all brown recluse bitesresult in ulcerations or scarring.

.

Don't forget that they can also be introduced into your area. My mom is a Texas nurseryperson (living in the natural area), but she got the bite unloading a shipment of plants. Bit her right dead between the eyes. By the time she realized it wasn't a normal spider bite and got to the doctor, it was down to the bone due to a lack of tissue in that area. With a history of diabetes and the infection, the doctor was much displeased that she had waited so long. I don't remember the protocol they used, but they were much concerned with the placement of the bite. Luckily the scar is not unsightly, but it ate a pretty good hole.

Haggis
24 June 2003, 10:32
Is there any kind of repellant that can be used around the house that may discourage these little critters from taking up residence?

ussfpa
24 June 2003, 12:31
Originally posted by Doc
I've read where they've tried Eppy as well to control the infiltration of the toxin.
Me too...

Primum non Nocere

TigerHooter
24 June 2003, 23:11
I got hit on my left calf while stationed in Kansas.

At first I thought it was a boil. On the nd day I iced it and lanced the top. cleaned it out and put a potato poutice (siq) on it (Granny's old cure).

The day after that I went on sick call, since it had grown 100% in size.

I'd heard of de-breding, but didn't realized they used melon ball scoops. Left a whole you could drop a golf ball 1/3 in.

That's one of those things you try not to remember while lying in a hide-site.

(Man, my spelling has gone to crap.)

Axe
25 June 2003, 00:04
Any experience or knowledge of efficacy rate of transderm nitro patches? All I can find is mixed results mentioned.

themadmedic
25 June 2003, 11:15
I would assume that it would only benefit the pain associated, and not change the course of lesion progression or wound healing...

Doc T
25 June 2003, 20:19
Originally posted by themadmedic
I would assume that it would only benefit the pain associated, and not change the course of lesion progression or wound healing...

Animal studies (mostly rabbits) showed no improvement... some studies have shown improvement in wound healing, size of necrotic area, scarring with both hyperbaric oxygen treatment and dapsone (separate studies)... I have used dapsone and not sure I could honestly say I noticed any less indolent a course. Remember a patient at the VA that had been bit while I was a resident....he caught and killed the spider and spent the next year having treatments on his leg from the bite.... told us if he had known the suffering the spider had caused he would have kept it and tortured it every day of its life rather than killing it instantly.

Bad bites... bad problem... no good solution.

Axe
26 June 2003, 09:39
The guy at the VA must have been former SF.