Q J Med 2002; 95: 723-731
© 2002 Association of Physicians
A prospective study of 750 definite spider bites, with expert spider identification
From the 1 Discipline of Clinical Pharmacology, University of Newcastle, and Newcastle Mater Misericordiae Hospital, and 2 Division of Invertebrate Zoology, Australian Museum, Sydney, Australia
Received 3 July 2002 and in revised form 29 July 2002
Background: Spider bite is a subject of much medical mythology with prevalent fears that spiders cause severe envenoming, with neurotoxic effects or necrotic ulcers. Clinical experience and small studies suggest otherwise, but this has not been confirmed by prospective studies of bites by identified spiders.
Aim: To describe the clinical effects of bites by accurately identified spiders, and determine whether early clinical features and circumstances can predict spider type.
Design: Prospective follow-up study.
Methods: Patients were recruited from admissions to two emergency departments (n=48) and referrals from three state poison information centres (n=1426), over 27 months. Overall, there were 750 people with definite spider bites where the spiders were immediately collected and expertly identified.
Results: Significant effects occurred in 44 bites (6%), including 37 (of 56) redback spider bites (Latrodectus hasselti) with significant pain lasting >24 h. Of these, only 6 (11%) received antivenom. One severe neurotoxic envenoming by an Australian funnelweb spider required antivenom. No definite spider bites resulted in necrotic ulcers (0%, 99%CI 0–0.7%). There were no early allergic reactions and secondary infection occurred in seven cases (0.9%, 95%CI 0.4–1.9%). Circumstances and early clinical effects were strongly associated with taxonomic spider identification, with positive predictive values >0.95 for common groups of spiders.
Conclusions: Australian spider bite caused minor effects in most cases and is unlikely to cause necrotic ulcers, allergic reactions or infection. Redback spider bite (widow spider) caused prolonged pain, and antivenom could have been used more frequently. The circumstances and early clinical features of spider bites may allow early appropriate advice and treatment of spider bite without taxonomic identification.
Address correspondence to Dr G.K. Isbister, Discipline of Clinical Pharmacology, Level 5, Clinical Sciences Building, Newcastle Mater Misericordiae Hospital, Waratah NSW 2298, Australia. e-mail: gsbite{at}bigpond.com
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