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Envenoming from the Malaysian 'Black & Gold', Thelcticopis Sp. Spider

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Envenoming from the Malaysian 'Black & Gold', Thelcticopis Sp. Spider Med & Health Jun 2019; 14(1): 183-190 https://doi.org/10.17576/MH.2019.1401.15 CASE REPORT A Huntsman’s Bite: Envenoming from the Malaysian ‘Black & Gold’, Thelcticopis sp. Spider (Arachnida: Araneae: Sparassidae: Sparianthinae) ISMAIL AK1, COURT DJ2, ANTHONYSAMY C3 1Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. 2Lee Kong Chian Natural History Museum, National University of Singapore, 2 Conservatory Drive, Singapore 117337, Singapore. 3Emergency and Trauma Department, Hospital Serdang, Jalan Puchong, 43000 Kajang, Selangor, Malaysia. ABSTRAK Kebanyakan spesies labah-labah di Malaysia dianggap tidak berbahaya kepada manusia dan kes gigitan labah-labah jarang dilaporkan. Ini adalah disebabkan oleh kesan dari gigitan yang tidak serius dan mangsa tidak mendapatkan rawatan di hospital. Sehingga kini, hanya terdapat beberapa kes gigitan labah-labah yang didokumentasikan dari Malaysia. Di sini, kami melaporkan gejala gigitan, kaedah perawatan dan hasil perawatan dua pesakit yang digigit labah-labah pemburu ‘Hitam & Emas’ dari genus Thelcticopis di Malaysia yang masih belum dinamakan spesisnya. Kes pertama melibatkan seorang lelaki berusia 42 tahun yang telah digigit di hujung jari tengahnya, menyebabkan kesakitan dan bengkak setempat. Beliau dirawat secara simtomatik dan pulih tanpa sebarang komplikasi. Kes kedua melibatkan seorang wanita berusia 57 tahun, yang telah digigit pada jari kelingking, menyebabkan kesakitan berdenyut dan kebengkakan progresif. Dia dirawat secara simtomatik dan dibenarkan pulang selepas 24 jam di wad perubatan. Walau bagaimanapun, beliau mendapat sakit di leher dan sendi terutamanya pinggul dan lutut. Beliau telah dirawat dengan ubat tahan sakit dan semua gejala sembuh dalam tempoh dua hari. Katakunci: bisa, kecemasan, labah-labah Address for correspondence and reprint requests: Dr. Ahmad Khaldun Ismail. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455703 Email: [email protected] 183 Med & Health Jun 2019;14(1): 183-190 Ismail A.K. et al. ABSTRACT Most spider species in Malaysia are considered harmless and spider bites are rarely reported. This is partly due to the mild effects from the bite and victims do not seek medical treatment in the hospital. To date, there are few well-documented cases of medically significant bites from indigenous spider species in Malaysia. Here, we report the presentation, clinical management and outcome of two patients following a bite by the yet to be described ‘Black & Gold’ Huntsman spider from the genus Thelcticopis in Malaysia. The first case involved a 42-year-old man who was bitten on the tip of the distal phalanx of his right middle finger and presented with severe pain and local swelling. He was treated symptomatically and was discharged well. The second case involved a 57-year-old woman, who was bitten on the proximal phalanx of her right little finger and presented with severe throbbing pain and progressive swelling. She was treated symptomatically and was discharged after 24 hours observation in the medical ward. However, she noted moderate neck and generalized joints pains especially affecting the hips and knees, one day prior to discharge. She was treated with oral analgesia and symptoms resolved within two days. Keywords: emergency, envenomation, spider INTRODUCTION Ctenidae). Bites and envenomation by Missulena (Actinopodidae) and To date, there are greater than 42,000 Sicarius (Sicariidae) may be very described spider species worldwide serious but are less frequently reported. (Platnick 2011). Some species of Less serious effects may occur after spiders specialised in seeking and bites by brush-footed trap door spiders destroying mosquitoes are beneficial (Barychelidae), wolf spiders (Lycosidae), to humans (Muhammad Luqman et Chinese and Spanish funnel webs al. 2018; Ndava et al. 2018). However, spiders Macrothele (Hexathelidae), sac approximately 200 spider species from spiders Cheiracanthium (Miturgidae), 20 genera cause most of the serious or jumping spiders Mopsus (Salticidae), lethal envenomations of humans (Diaz the comb-footed spider Steatoda 2004; Kuhn-Nentwig et al. 2011). These (Theridiidae), huntsman spiders include the widows (Genus Latrodectus, (Sparassidae), true tarantulas or bird Family Theridiidae), the funnel webs spiders (Theraphosidae), and Uliodon (Genera Atrax and Hadronyche, both (Zoropsidae) (Diaz 2004; Isbister & Family Hexathelidae), fiddle backs or Gray 2002; Watt 1971). The medical recluse spiders (Genus Loxosceles, significance of white-tailed spiders Family Sicariidae) and the banana (Lamponidae) remains doubtful as the spiders of the genus Phoneutria (Family reputed necrotic effect of bites by this 184 Huntsman Spider Bite Envenoming Med & Health Jun 2019;14(1): 183-190 Figure 1: Acute presentation of the bitten area by a Thelcticopis sp. spider (A) The bite mark and swelling of the right middle finger; (B & C) The bite mark with surrounding hyperemia and swelling of the hand prior to the administration of medication in the emergency department. species is unsupported by available described in the nineteenth century, evidence (Isbister & Hirst 2003). Most and since then, they have not been other spiders are considered harmless subjected to recent study or review to humans even if bites from many of (Murphy & Murphy 2000; Jäger 1998; these species could penetrate human Morandmand 2014). skin (Kuhn-Nentwig et al. 2011; We present here the clinical Nentwig 2013). manifestations of envenoming by a Most spiders of the family Sparassidae possibly undescribed Thelcticopis sp. are large and fast moving free ranging in Malaysia hunters. The genus Heteropoda Latreille, 1804 consists currently of CASE REPORT almost 200 species distributed mainly in Asia and Australia and tend to enter Case 1 human domiciles. Hence, they are generally well-known (World Spider While tapping a rubber tree in a Catalog 2018). Sparassids of the genus plantation area, a 42-year-old man with Thelcticopis are quite common and no relevant past medical history, was are also distributed worldwide within bitten on the tip of the distal phalanx the tropical belt, occurring throughout of his right middle finger (Figure 1) by a much of South East Asia and possibly black and golden coloured spider. He in northern Australia (Jäger 2001; Jäger then knocked the spider off the rubber 2005; Jäger & Praxaysombath 2009; tree and killed it. There was an almost Liu et al. 2010; Moradmand et al. immediate severe throbbing pain at 2014). Currently, there are 47 known the bite site. He sought medical care at Thelcticopis species and to date, there the Emergency Department (ED) of a are no revision of the genus (Jager nearby hospital and brought along the 2005). The literature on Thelcticopis is dead spider for identification (Figure 2). scanty with most species having been He arrived 20 minutes after the bite 185 Med & Health Jun 2019;14(1): 183-190 Ismail A.K. et al. Figure 3: Fangs and morphology of female Thelcticopis sp. copulatory organ. (A) Ventral Figure 2. Specimens of the Thelcticopis sp. (A) view of fangs and cheliceral teeth (note: The dead adult female specimen of Case 1; (B) posterior row has significantly smaller teeth). The eight eyes arrangement (enhanced); (C &D) Chelicerae (fang base) length 6.3 mm and The live adult male spider of Case 2; (E & F) The fang length 4.1 mm; (B) External copulatory intricate webs spun by the male spider while in organ (Epigyne); (C) Internal duct system with captivity. spermathecae. and reported a verbal numerical rating ECG was normal. The swelling and pain score (VNRS) of 8/10. The bitten pain resolved completely without any finger had mild-moderate oedema compromise in the dexterity/range of and a small amount of dried blood motion of the affected finger. He was was observed at the bite site. Initial discharged following an uneventful 12- vital signs were normal with heart rate hour observation. A follow-up phone of 78/min, blood pressure of 140/80 call 48 hours later, confirmed full mmHg and oxygen saturation (SpO2) recovery, and his return to work. 98% on room air. The VNRS reduced The spider specimen was identified to 5/10 and the swelling began to as an adult female Thelcticopis sp. with subside approximately 30 minutes overall body length 27.2 mm, carapace after the administration of intravenous length 14.3 mm (width 8.5 mm), (IV) morphine 2 mg, oral Tab abdomen length 13.6 mm (width 10.1 chlorpheniramine maleate 4 mg and IV mm), and maximum leg span (left leg hydrocortisone 100 mg. The baseline 2 claw tip to right leg 2 claw tip) 79.7 blood investigations (full blood count, mm. It was preserved in 70% alcohol urea and electrolyte, and coagulation and deposited at the Lee Kong Chian profile) were unremarkable and the Natural History Museum for analysis 186 Huntsman Spider Bite Envenoming Med & Health Jun 2019;14(1): 183-190 and future reference. subsequent follow-up via phone call. The spider was identified as an Case 2 adult male Thelcticopis sp. with overall body length 22.5 mm, carapace length A 57-year-old woman, with underlying 8.5 mm (width 9.5 mm), and abdomen controlled mild hypertension, was length 14.0 mm (width 9.0 mm). bitten on the proximal phalanx of her The spider was kept alive for several right little finger by a large black and months for observational purposes. It yellow coloured spider while putting was subsequently preserved in 70% on a shirt in her house in a village. The alcohol and deposited at the Lee Kong bite produced an almost immediate Chian Natural History Museum for severe throbbing pain (VNRS 7/10) analysis and future reference. Tissue which she described as “worse than samples were obtained for genetic a wasp sting”. Within a few minutes, analysis. the hand progressively became oedematous (Figure 1). She caught the DISCUSSION spider using a plastic container and brought it to the ED for identification The spiders responsible for the bites (Figure 2).
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