Arachnid Envenomation in Taiwan

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S15 Arachnid Envenomation in Taiwanutes followed by tongue spasms, lacrimation,salivation, abdominal pain, nausea, vomiting,diaphoresis or severe dyspnea. Muscle fasciculationsand spasms are also common. Cardiacarrythmias and cardiac arrest may occur. Severepulmonary edema may occurs early andbe fatal. 9,17TaruntulaMild pain similar to a pinprick is the most complaintof Taruntula bite. However, some bitesmay cause severe pain, local swelling andnumbness. If the bite is near the joint, arthriticstiffness may last for several weeks. 12 Ocularexposure to tarantula hairs may lead to ocularinjury and the patient may have a red eye andassociated keratoconjunctivitis. Significant allergicrhinitis may be present in patients whohave inhaled hairs. Anaphylaxis is a rare complicationof Taruntula hair exposure. 12,18TreatmentRedback spiderDuring prehospital period, pressure-immobilizationbandaging is not recommended becausethe progression of envenomation is usually slow.Ice packing is an effective analgesic. Supportivetreatment with ACLS protocols is required.Tetenus prophylaxis should be done. The goalof therapy is to neutralize the toxin of the spiderbite with the antivenom. However, there is noantivenom available in Taiwan. Fortunately, theoutcome of Latrodectus species bite, even themost venomous black widow spider, is good.Most patients do not need hospitalization andneed only supportive treatments. The supportivetreatments focus on alleviating pain andmuscle cramping. The three main treatments arepain relievers such as narcotics, musclerelaxants, and intravenous calcium gluconate.The effect of calcium gluconate is not clear butit seems to reduce the mortality and morbidity.The dose of calcium gluconate is 1-2ml/Kg with10% solution as slowly intravenous route, notexceed 10 ml/dose. Antihistamine may be prescribedfor skin itching and antibiotics are nothelpful. Most patients will recover fully. 5,15,16,19Macrothele sp.The prehospital care is mainly supportive treatmentswith ACLS protocols. Most bites do notresult in envenomation and pain is the most commoncomplaint. When envenomation occurs,standard life support measures and antivenintherapy are necessary. However, there is noantivenum available in Taiwan and supportivetreatment is the main way. Tetanus immunizationmust be prescribed. Victims may be dischargedsafely in one day or so if they responsewell to antivenin. If antivenum is unavailable,the patient may need to stay more days in intensivecare unit. Hypertension may be treatedwith alpha-blocker. Ventilator is indicated if respiratoryfailure is noted. 9,17,19,20TarantulaSupportive care is needed in prehospital stage.Eye protective shield may be needed followingocular exposure to prevent the patient from rubbingthe eyes and driving the hairs deeper. Inhospital, it is most important to relieve thesymptoms. Antihistamine and analgesics may beused to relieve itching sensation and pain. Tetanusimmunization is indicated. The ophthalmologistshould be consulted for orbital involvementsand topical broad-spectrum antibiotic may behelpful. Following up in ophthalmologist departmentis recommended. If anaphylaxis occurs,Ann Disaster Med Vol 3 Suppl 1 2004
Arachnid Envenomation in Taiwan S16admission is indicated. Chronic local dermatitiscaused by urticating hair could be controlledby oral steroid and antihistamine. 12,18,22,23Education, prevention and supportive care arethe main management strategies for such kindof animal injury.Case report in Taiwan 4There is only one case report about spider envenomationin Taiwan. In May 2000, a fouryear-oldboy was bitten over left middle toe bya hidden spider in his shoes when he was wearingthem. About 10 minutes later, severe painover left foot and muscle cramping over leftlower leg with mild claudication were noted.There was an obvious red line extended fromthe wound to inguinal area and abdominal painwas also noted. Two hours later, generalweakness, poor appetite, drowsiness, drooling,vomiting and chills happened. He was sent toemergency department ten hours later. Physicalexamination showed tachycardia ,a targetlesion over left middle toe and rigidity over leftlower leg. Bilateral inguinal lymph nodes enlargementand mild abdominal tenderness werenoted. Lab data showed leukocytosis and mildhypoglycemia. 10% Calcium gluconate, glucose-containingfluid, antihistamine and prophylacticantibiotics were prescribed. Patient wasdischarged under stable condition 48 hours later.The spider was finally confirmed as Macrothelesp.ConclusionOf 300 species in Taiwan, only two kinds ofspiders are reported to do serious harm topeople. They are Latrodectus hasselti (redback spider) and Macrothele species (includeM. gigas, M. holsti and M. taiwanensis). Tarantulawhich is mainly imported for pettingwould have the same effects. There is still nomortality case after spider bite in Taiwan.References1. Chen SH. A guide to common spiders ofTaiwan:64-672. Allen C. Arachnid envenomations. EmergMed Clin North Am 1992;10:269-983. Saucier JR. Arachnid envenomation. EmergMed Clin North Am 2004;22:405-224.Medical digest 2000;31:244-495. Hampton Roy, Sr, MD. spider bites. Availableat: URL: http://www.emedicine.comassessed at June 6 th , 20046. Wilson DC, King LE. Spiders and spiderbites. Dermatol Clin 1990;8:277-867. Simon GA Brown, MD. SpiderEnvenomations, Redback. Available at:URL:http://www.emedicine.com assessedat June 6 th , 20048. Jelinek GA, Banham ND, Dunjey SJ. Redbackspider-bites at Fremantle Hospital,1982-1987. Med J Aust 1989;150:693-59. Simon GA Brown, MD: SpiderEnvenomations, Funnel Web. Available at:URL:http://www.emedicine.com assessedat June 6 th , 200410. Dieckmann J, Prebble J, McDonogh A, etal. Efficacy of funnel-web spider antivenomin human envenomation by Hadronychespecies. Med J Aust 1989;151:706-711.2003:239-4112.Fell SD, Kukula CL. SpiderEnvenomations, Tarantula. URL:http://www.emedicine.comAnn Disaster Med Vol 3 Suppl 1 2004
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