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Black and Brown Widow Spider Bites in South Africa

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Black and Brown Widow Spider Bites in South Africa \ , \, _----------------------------------- 399 REFERENCES 5. Van der Merwe PJ, Hundt HKL, Bekker M, Van der Merwe Je. Epidemiologiese studies van vergiftigings in Bloemfontein en 1. Litovitz TL, Bailey KM, Schmitz BF, Holm KC, Klein-Schwanz omge\ving, 1980 - 1985. S Afr Med] 1988; 74: 220-222. W. 1990 Annual Repon of rhe American Association of Poison 6. Hobson HE. Poison queries received during 1985 by the Regional Control Cenrers National Data Collection System. Am ] Emerg Drug and Poison Information Centre, Durban. S Afr Med] 1987; Med 1991; 9: 461-509. 71: 655-656. 2. Veltri JC, McElwee J\'E, Schumacher ML. Interpretation and uses 7. Weisman RS, Howland MA. The toxicology laboratory. In: of data collected in poison control centres in rhe United States. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Med TOxUo11987; 2: 389-397. Howland MA, Kurlberg AG, eds. Gold/ral/k's Toxicological 3. Volans GN, l\1.irchell GM, Proudfoor AT, Shanks RG, Woodstock Emergencies. Norwalk, Conn.: Appleron-Century-Crofts, 1986: JA. National Poisons Information Services: report and conunent. 28-37. BM] 1981; 282: 1613-1615. 8. Hepler BR, Surheimer CA, Sunshine I. Role of the toxicology labo­ 4. Roberrs JC, Leary PM, Mann MD, Glasstone M. The panern of ratory in rhe treatment of acme poisoning. A'led Toxieol 1986; 1: childhood poisoning in rhe western Cape. S Afr Med] 1990; 78: 61-75. 22-24. Black and brown widow spider bites in South Africa A series of45 cases G. J. MULLER Abstract Cases of black widow (Latrodectus indistinctus) the more venomous black widow is also addressed and and brown widow (L. geometricus) spider bites clarified. The morphology and habitat of the South referred to the Tygerberg Pharmacology and' African Latrodectus species are also described to assist Toxicology Consultation Centre from the SUIIlIIler the physician in identification. of 1987/88 to the SUIIlIIler of 1991/92 were entered Except for case reports involving 1 or 2 patiems/-' no into this series. Of a total of 45 patients, 30 had case series has been reported since Finlayson's 1937 been bitten by black and 15 by brown widow spi­ publication on 15 cases of 'knoppie-spider' bites" All ders. It was evident that black widow spider bites recent review articles and books on the subject of caused a Inore severe fOrIn of envenomation than latrodectism in southern Africa"" have either been brown widow bites, characterised by generalised based on the series of Finlayson' or on publications muscle pain and craInps, abdoIninal Inuscle rigid­ from Europe, North America and Australia. ity, profuse sweating, raised blood pressure and The term latrodectism is used to describe the sys­ tachycardia. The symptoms and signs of brown temic symptoms and signs of envenomation in humans widow bites were mild and tended to be restricted caused by the bite of the Latrodectus spider species. The to the bite site and surrounding tissues. widow spiders are also locally known as the black and Conditions which should be considered in the dif­ brown button spiders. ferential diagnosis include cytotoxic spider bite, scorpion sting, snakebite, acute abdoIninal condi­ tions, myocardial infarction, alcohol withdrawal Methods and organophospate poisoning. To prevent the development of cOInplications, the administration Black widow CL. indistinctus) and brown widow CL. geo­ ofblack widow spider antivenoIn is recomInended metricus) spider bites dealt with by the Tygerberg in severe cases because untreated latrodectism Pharmacology and Toxicology Consultation Centre could becoIne protracted, without improvement, from the summer of 1987/88 to the summer of 1991/9.2 for several days. were entered into this study. Criteria for admission include a positive identification of the spider species S AIr Med J 1993; 83: 399-405. involved and/or symptoms and signs of latrodectism severe enough to warrant administration of antivenom, which led to a positive response within 6 - 12 hours. On account of the general uncertainty regarding the toxicity wing to the lack of reliable information on the of brown widow spider venom, very strict admission clinical toxicology of the two southern African criteria were maintained in that only cases in which O widow spider species, Latrodectus indisrinctus L. geometricus was positively identified were included in O.P.-Cambridge, 1904 and L. geometricus C. L. Koch, the series. 1841, we recently studied the relative toxicity and polypeptide composition of the venoms of the two species.' As a sequel, this report, based on data collected Results from 45 cases, focuses on the medical aspects of black and brown widow spider bites. The controversy regard­ Of a total of 45 cases entered into the series, 30 were ing the toxicity of the brown widow relative to that of black widow CL. indistinctus) and 15 brown widow CL. geomemcus) spider bites. The majority ofbites took place in the summer, 65% occurring during the peak months Department ofPhannacology, University ofStellenbosch, ofJanuary, February and March. No bites were record­ Parowvallei, CP ed in the winter months ofJune, July and August. G. J. MUllER, B.Se., M.B. CH.B., B.Se. HONS The most prominent symptoms and signs of black (PHAR.M.ACOLOGY), M.MED. (A.."IAESTH.) and brown widow spider bites documented in this series Accepred 25 Aug 1992. are summarised in Fig. 1. Thirty-two ofthe patients bit- 400 SAMJ VOl83 JUNIE 1993 ten were adults, 2 were aged 13 - 19 years and 11 were .and in 7 the response was described as dramatic, with children; 26 were male and 19 female. Of the 11 child­ marked improvement within 30 - 60 minutes. Two ren, 9 were in the black widow and 2 in the brown patients received a follow-up dose of 5 rnl antivenom widow spider group. Half the black widow bites took within 6 hours after the first dose. Three patients in the place in the home environment, 8 inside the house and brown widow spider bite group (2 children and 1 adult) 7 outside. The other half occurred in the veld, and of received antivenom, 2 within 6 hours of the bite and 1 these 9 were associated with farming activities. Most of on day 5. Four patients, 3 ofwhom had been birren by a the brown widow bites, with the exception of 1 which black and 1 by a brown widow spider, remained ill until occurred in a vineyard, took place inside the house (9) antivenom was administered on days 3 - 5. No allergic or or in its immediate environs (5). Seventeen of the black other adverse reactions to the antivenom were reponed. widow bites were inflicted below the waist (lower Other drugs given, either to relieve symptoms or to abdomen and burrocks 5, legs 12) and 13 above the minimise the effects of a possible allergic reaction to the waist (arms and shoulder 8, neck 3, upper abdomen 1, antivenom, included calcium gluconate, neuroleptics back 1). In contrast, 10 of the brown widow bites were (promethazine and hydroxyzine), benzodiazepines on the upper part and 5 on the lower part of the body (diazepam), antispasmodics (hyoscine), opioids (pethi­ (arms 4, chest 3, upper abdomen 1, head 1, lip 1, but­ dine, morphine and tilidine), glucocorticosteroids and tocks and legs 5). The exact time of 22 of the 30 black non-steroidal anti-inflammatory agents. Laboratory widow bites was known; in these cases symptoms and and/or radiographic evaluations were performed op 10 signs of latrodectism developed within 15 - 60 minutes patients. The only consistent or positive finding was a ofthe bite. moderately raised white cell count in 6 patients, ranging A high degree of restlessness was evident in children from 11 to 18 x 109/1. In 1 of 2 cases in which creatine in both the brown and black widow spider groups kinase assays were performed the value was raised (73%). The two children (aged 4 and 10) in the brown to 1 901 VII. All the patients made a complete and widow spider group both had generalised muscle uneventful recovery. cramps and difficulty in walking. One presented with L. indistinctus was positively identified in 6 cases of abdominal rigidity and the other with extreme restless­ black \vidow spider bite (20%). In 10 cases of brown ness and diaphoresis. widow spider bite the spider was brought in and identi­ In all but 1 case, in which envenomation had been fied by an expen as L. geomemcus, and in the remaining mild, patients binen by black widow spiders received 5 identification was based on a satisfactory description antivenom. The standard dose was 5 rnl intramuscular­ ofthe spider and its egg sac. ly. Twenty patients received antivenom within 12 hours after the bite, 3 between 12 and 24 hours and 3 after 3 - 5 days. In 3 cases the exact time of antivenom Discussion administration was not documented. All the patients responded within 6 - 12 hours. In 19 cases the symp­ Three species of the genus Latrodectus are found in I toms and signs cleared up completely within 6 hours South Africa. ,9,10 Latrodectus indistinctus (black widow or SYMPTOMS Latrodectus indistinctus (n =30) L. geometricus (n =15) Generalized muscle pain and cramps· (80%) • (13,3%) Burning pain at bite site (66,6%) (93,3%) Abdominal pain and cramps - (66,6%) _ (26,6%) limb pain, especially legs (56,6%) • (6,6%) Cramp and pain in back muscles (46,6%) • (6,6%) Weakness in legs, difficulty in walking· (46,6%) • (13,3%) Constriction of chest muscles· (30%) 0 Pain in regional lymph nodes (23,3%) (23,3%) Headache - --- (20,8%) 0 Nausea and vomiting --------------- _(16,6%) 0 Paresthesia in hands and feet ---------- - _(13,3%) 0 SIGNS Profuse sweating (70%) • (6,6%) Abdominal muscle rigidity - (70%) • (6,6%) Bite site evident (66,6%) (80%) Raised blood pressure, tachycardia (60%) 0 Restlessness, agitation - (50%) • (13,3%) Swelling of face, especially eyelids.
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