Spider bite in Child
Alerts and Notices
Synopsis
There are over 34,000 named species of spiders in the world. Almost all species are venomous, but only a few dozen can harm humans. Most spiders either do not have an adequate amount of venom to cause harm, the venom is not toxic to humans, or the fangs cannot penetrate human skin. Of the few spiders that are of medical importance, envenomation can cause a range of clinical manifestations from skin lesions to systemic illness and even death. Tarantulas have venom but usually cause illness from their urticating hairs.
Spiders with cytotoxic venoms cause local tissue injury. The bite is often painless at first, and then symptoms of pain and swelling at the bite site develop minutes to hours later. Some lesions resolve spontaneously while others go on to ulcerate and, at times, develop significant necrosis requiring medical attention. The recluse spiders (eg, Loxosceles reclusa and Loxosceles laeta) have cytotoxic venoms.
Bites from spiders with neurotoxic venoms affect the neuromuscular junctions, causing systemic symptoms from cholinergic and catecholamine excess. Often, the bite is very painful, and systemic symptoms include hypertension, tachycardia, palpitations, diaphoresis, anxiety, shortness of breath, hyperthermia or hypothermia, excessive salivation, nausea, vomiting, and severe pain. The widow spiders, Latrodectus species, have neurotoxic venoms.
The severity of a spider bite depends on the type and amount of venom injected, the site of the bite, and the health and age of the patient. Classically, spider bites are asymptomatic in children. However, when symptomatic (because of the large quantity of venom per kilogram), children are more likely to have systemic reactions than adults.
While there are no spiders that can be described as "truly deadly" (ie, lack of treatment can be expected to result in death), spiders of medical importance include:
Widow spiders
Spiders of the Latrodectus genus are found worldwide and have neurotoxic venoms, with alpha-latrotoxin as the major component that can cause severe systemic symptoms from massive neurotransmitter release. The bite is sharp and painful, and fang marks, diaphoresis, and a halo-like lesion may be seen.
In children, most black widow spider bites become asymptomatic within 48 hours. In more severe black widow bites, however, children can also experience diaphoresis, emesis, and abdominal pain. The abdominal pain can often be confused with peritonitis, and thus a careful history is necessary. Of note, those with peritonitis have pain with movement, while those with a spider bite are hypertensive and agitated, and move frequently to find a comfortable position.
Special Considerations in Infants:
Infants bitten by black widow spiders may present differently from toddlers or children, with non-specific signs and symptoms including poor feeding, irritability, and occasionally full body erythema. Often there is a history of sleeping in a bed that was stored in an outdoor shed.
False black widow spiders
Steatoda spiders are found worldwide and have venom capable of producing symptoms similar to Latrodectus but milder.
Recluse spiders
Spiders of the Loxosceles genus are found worldwide in temperate and tropical regions. Envenomation can cause local necrosis and, rarely, severe systemic symptoms. The brown recluse spider is regularly and erroneously blamed as the cause of necrotic lesions throughout the United States, although this spider is only endemic to the southeastern states.
In severe cases of Loxosceles envenomation in children, patients may present with hemolytic anemia, rhabdomyolysis, acute renal failure, or cellulitis. The most common admission diagnoses for spider bites include hemolytic anemia, cellulitis, and acute renal failure.
Hobo spiders
In the Pacific Northwest, the hobo spider (Tegenaria agrestis) is often blamed as the cause of necrotic skin lesions. However, there is only one documented case of hobo spider envenomation causing dermonecrosis. Other presumed cases are based on anecdotal reports and circumstantial evidence.
Yellow sac spiders
Yellow sac spiders, Cheiracanthium species, are found in North America, Europe, Africa, Asia, Australia, and the Pacific Islands. Envenomation is believed to cause dermonecrosis, but like the hobo spider, T. agrestis, and wolf spider, Lycosa species, the data do not support this association.
Wolf spiders
The wolf spiders, Lycosa species, are common spiders found worldwide. The bite from a wolf spider is typically transiently painful, generally lasting only several minutes. A local reaction might be evident; systemic symptoms are rare. There are no data to support the belief that envenomation causes necrotic lesions.
Banana spiders
Phoneutria species, of Central and South America, have extremely potent venom that is neurotoxic and can be lethal.
Australian funnel-web spiders
Atrax/Hadronyche species in Australia include the most dangerous spider, the Sydney funnel-web spider (Atrax robustus). The venom of this spider is neurotoxic, capable of producing severe pain at the bite site and systemic symptoms that can, rarely, be fatal within minutes.
Six-eyed crab spiders
Spiders of the Sicarius genus are found in Africa and South America and are considered to be extremely venomous but, fortunately, live in remote areas. Their venom is proteolytic.
Tarantulas
Tarantulas, found in the family Theraphosidae, have relatively harmless bites, but they can disperse urticating hairs from their abdomens resulting in local skin reactions, ocular problems, and allergic rhinitis.
Codes
ICD10CM:T63.391A – Toxic effect of venom of other spider, accidental, initial encounter
SNOMEDCT:
403149008 – Spider bite wound
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- CA-MRSA skin infection (presenting as an abscess, abscesses, or furunculosis) is often mistaken for spider bites. Have a very high suspicion for CA-MRSA and discount the patient history of a spider bite if there is any clinical suspicion of CA-MRSA.
- Caterpillar envenomation
- Cellulitis
- Centipede envenomation
- Contact dermatitis
- Ecthyma
- Factitial ulcer
- Hymenoptera stings (bee sting, wasp sting)
- Insect bites
- Lyme disease
- Medication-induced drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis
- Necrotizing fasciitis
- Pyoderma gangrenosum
- Skin infections caused by cutaneous anthrax, Streptococcus, sporotrichosis, herpes zoster (shingles), and herpes simplex virus (HSV)
- Tetanus
- Tularemia
- Ergotism
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:11/15/2016
Last Updated:12/05/2021
Last Updated:12/05/2021
Patient Information for Spider bite in Child
Overview
Spiders are a member of the family Arachnida, and although greatly feared, spider bites are rather rare. Only a few species of spiders are able to puncture the skin to harm humans. People often mistake insect bites or skin infections for spider bites.Who’s At Risk
The risk of being bitten by a dangerous spider is increased if you live or travel in the same area as venomous spiders and you disturb their habitat:- Although widow spiders are found worldwide, the black widow spider is the most common of the widow spiders throughout the United States. They are usually found outdoors in wood piles, garages, sheds, gardening pots; rarely indoors.
- Recluse spiders are found worldwide in tropical and temperate climates, mostly in North and South America. In the US, the brown recluse spider is most common in southern and midwestern states, hiding in undisturbed quiet spots like closets, basements, cupboards, behind or under furniture, or outdoors in tree stumps or under rocks.
- Funnel-Web spiders include the hobo spider (aggressive house spider) in the Pacific Northwest and southwestern Canada. The most dangerous, the Sydney funnel-web spider, is found in Australia.
- Tarantulas are found worldwide, but in the US are predominant in the southwestern states. Pet tarantulas, mostly imported, have become popular throughout the United States.
Signs & Symptoms
A spider bite is typically red, inflamed, and itchy on your skin. The severity of a spider bite depends on the type of spider, your body's sensitivity to the venom, your age and health, and the amount of venom injected into your body. Spider bites have varying symptoms so it is important to identify the type of spider that bit you.Common symptoms of widow spiders are:
- Pain at site of bite
- Shortness of breath
- Rapid heart rate
- Abdominal pain
- Nausea
- Vomiting
- Salivation
- Pain increasing during first 8 hours after bite
- Chills
- Fever
- Body aches
- Rarely, the skin can become dark blue or purple and develop into an ulcer
- Pain at site of the bite
- Redness
- Australian species – neurotoxic effects such as trouble breathing, high blood pressure, rapid heart rate, sweating, salivating, nausea and vomiting, muscle twitches, and agitation
- Less common, red and painful bite
- More common, itching red sting from tarantula hairs
- Sometimes, tarantula hairs in the eye, causing eye irritation
- Allergic reaction such as runny nose
Self-Care Guidelines
If you were bitten by a spider follow these guidelines:- Gently wash the bite with soap and water
- Cool the bite with ice to reduce inflammation and pain
- Elevate the bite if it is on a hand or arm
- Over-the-counter medications such as acetaminophen (Tylenol) and ibuprofen (Advil) can be used as pain relievers
When to Seek Medical Care
Seek medical care if you are unsure if you were bitten by a poisonous spider. If you were bitten and have severe pain, abdominal cramps, difficulty breathing, or a growing ulcer seek medical attention immediately.NOTE: if you were able to capture the spider, bring it with you for identification.
Treatments
Your health care provider will identify the type of spider bite and treat the symptoms of the bite. Your health care provider may also give you a tetanus shot if you have not had one in the past 5 years.For more severe reactions, and especially for children, your health care provider may place you in observation until the reactions seem to be under control.
Spider bite in Child