ORDER ARANEA

All spiders, with the exception of two small groups, are venomous.
There are over 100,000 species of spiders.
only about 20 species cause serious envenoming in humans,
while about 150 to 180 can cause significant toxicity.
The common Indian species that cause serious envenoma- tion include
Brown Recluse, Black Widow, Wolf Spider, and Tarantula.
General Anatomy
Anatomically, a spider has a cephalothorax and an abdomen
with 4 pairs of legs fanning out from the thorax. Two claw-like
fangs called celicera protrude from the head and are connected
to venom glands which are under voluntary control.
Although the venom is quite potent in many species, serious
envenomation is rare because of inadequate injec- tion
mechanism, and small quantity injected with each bite.
Spiders are extremely shortsighted, and depend mainly on
sense of touch and vibration. The eyes are on the front part of
the cephalothorax. Most spiders have 8 eyes. Their size and
position varies by spider type.
Some large spiders (e.g. huntsman spider, wolf spider, orb
weaving spider), possess large spines on their legs. The spines
are raised from a prostrate to a vertical position when the spider
is irritated. If the spider is grabbed, picked up, or brushed off,
injuries (severe pain, erythema, pruritus) from the spines may
occur. These injuries often occur in conjunction with a bite by the
same spider, and splinters are usually found at bite sites.

Brown Recluse
Other Common Names
Fiddleback, Violin, or Brown Spider.
Species
Loxosceles reclusa, L. laeta, L. deserta, L. unicolor, L. arizonica, L.
rufescens.
Physical Appearance
It is a small (6 to 20 mm long), orange or reddish brown or grey
spider, with a brown violin shaped mark on its back.
The female is more aggressive than the male and bites when
provoked.

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Loxosceles spiders can be differentiated from most other

“garden” brown spiders, of which there are many, by its set of
six eyes (three pairs), rather than eight. Their webs are
distinguished by a bluish hue.

Venom
The venom is cytotoxic and consists of several toxic compo-
nents including hyaluronidase, ribonuclease, deoxyribonu-
clease, alkaline phosphatase, lipase, and sphingomyelinase D.
The last mentioned is the main constituent which is responsible
for tissue destruction. It reacts with sphingomy- elin in the RBC
membrane causing the release of choline and N-
acylsphingosine phosphate. This causes severe intra- vascular
occlusion of micro-circulation leading to necrosis.
Venom toxins may act as proteases upon molecular constitu-
ents of plasma extracellular matrix (fibronectin and fibrin- ogen),
and basement membrane constituents (entactin and heparin
sulfate proteoglycan). All of these degrading activi- ties may be
responsible for producing haemorrhage, delayed wound
healing, and renal failure, as well as the spreading of other
noxious toxins (e.g. dermonecrotic protein). By disrupting the
subendothelial basement membrane, blood vessel wall
instability and increased permeability can occur.

Clinical Features
1. Local
a. The bite itself is usually painless, but later begins to bleed
and ulcerate in 2 to 8 hours. The initial reaction often consists of
erythema and pain or pruritus. A small vesicle may form at the
bite area, and the lesion may take on a “bullseye” or “halo”
appearance, having a central vesicle surrounded by an
erythematous and ecchymotic area.
b. Ulcerated lesions if untreated, usually enlarge until about a
week when eschar formation takes place. Granulation and
healing takes up to 2 months to be completed.
c. In severe cases, cutaneous necrosis may occur and may
extend to involve subcutaneous fat and muscle.
2. Systemic
a.Systemic features (“loxoscelism”) include fever,chills, nausea,
skin rash, myalgia, arthralgia, headache, vomiting, haemolysis,
DIC, shock, renal failure, jaundice, convulsions and coma.
b.Acute tubular necrosis with resulting oliguria or anuria may
develop in patients with severe haemolysis.
c.Fever is common in patients with systemic effects and may
develop more often in children. Fever may be associated with
chills and night sweats.

Diagnosis
1. Leucocytosis (20,000 to 30,000 per cubic mm).
2. Evidence of haemolysis and DIC: Decreased levels of
fibrinogen, clotting factors, and platelets; increased levels of
fibrin degradation products; prolonged PT and PTT;
spherocytosis, positive D-dimer assay, and Coombs-positive
haemolytic anaemia.
3. Abnormal renal and liver function tests.

Treatment
Local
a. Wound cleansing.
b. Immobilisation of bitten extremity.
c. Tetanus prophylaxis.
d. Analgesics: Persistent pain may necessitate lumbar sympa-
thetic blocks. Application of cold compresses may help. e.
Antipruritics: Diphenhydramine 5 mg/kg/day orally, with a
maximum dose of 25 to 50 mg four times a day. Hydroxyzine
may also be used: 25 to 50 mg every 6 to8 hours; maximum
dose 400 mg/day. f. Antibiotics, if wound gets infected.
Systemic
1.Admit patient to hospital and monitor for evidence of
haemolysis, coagulopathy and renal failure.
2.If haemoglobinuria occurs, renal failure may be prevented by
increasing IV fluids, and alkalinising urine.
3.Significant haemolysis should be treated with transfu-sions.

Black Widow*
Widow (or hour-glass) spiders belong to the Latrodectus
species of phylum Arthropoda.
Other Common Names
Hourglass Spider.
Species
Latrodectus mactans.
Physical Appearance
The female is much larger than the male with a leg span of 5 cm
and body length of 1.5 cm. It has a characteristic red hourglass
spot on the back of its shiny black body
The male has more colourful white markings and is less
aggressive than the female. In fact, the popular name “Black
Widow” is due to the female’s practice of killing its partner after
insemination.
Venom
The venom of black widow is neurotoxic, with six active
components of molecular weight ranging from 5000– 130,000
D. The main component is alpha latrotoxin which binds avidly to
a specific presynaptic receptor.
The venom affects the motor endplates of neuromuscular
synaptic membranes by the binding of gangliosides and
glycoproteins at the synapses. This causes the channels for
sodium influx into neurons to remain open, as a result of which
there is extensive release of acetylcholine and noradrenaline
into the synapses, thereby inhibiting reuptake. The end result is
massive stimulation of motor endplates as the venom travels
through the lymphatic system.

Clinical Features (Latrodectism )

Grade 1
1. Sharp pain at bitesite, which may have one or two small
puncture wounds, 1 to 2 mm apart. The immediate area may be
warm, mildly indurated, and slightly reddened. Swelling of the
affected part may occur after red-back spider bites.
2. No systemic features.

Grade 2
1. Muscular pain in bitten extremity.
2. Extension of pain to the trunk.
3. Local diaphoresis of bitten extremity.
4. Tender regional lymphadenopathy may be present. 5. No
systemic features.
Grade 3
1. Generalised muscle pain and weakness, with difficulty in
walking.
2. Generalised sweating.
3. Tachycardia and hypertension are quite common.
4. ECG changes have been reported in a few victims: slur-ring
of the QRS with ST and T segments depression, prolonged QT
interval, and changes consistent with inferolateral ischaemia.
5. Leucocytosis is a common finding.
6. Nausea, vomiting, and headache are also very common.
7. Priapism, urinary retention, pyuria, proteinuria,microscopic
haematuria, and testicular pain have been reported in a few
cases.
8. During this period the victim often displays a
contorted,grimacing, sweating facial appearance, referred to
as“facies latrodectismica”.
9. In severe cases, the following manifestations occur: ptosis,
salivation, hyperreflexia, tremor, convulsions, tachypnoea, and
respiratory compromise. Board-like rigidity of the abdomen,
shoulders, and back may develop. Although uncommon, acute
renal failure has been reported following envenomation. Death
is uncommon, but is more likely in the case of infants, old
individuals, pregnant women, and chronic inva- lids.
Diagnosis
1.Leucocytosis
2.Elevated creatine kinase
3.Albuminuria.

Treatment
1.Calcium gluconate IV (10 ml of 10%) has been traditionally
advocated for pain relief, but its actual efficacy is doubtful.
2.Pain is usually better controlled with a combination of IV
morphine or pethidine and benzodiazepines (diazepam or
lorazepam). Milder cases may be treated with
aspirin,paracetamol, and/or codeine.
3.Application of cold or warm compresses (as guided by patient
comfort) to bitten site is usually helpful.
4.Swelling responds to non-steroidal anti-inflammatory drugs.
5.Muscle relaxants such as diazepam, methocarbamol, or
dantrolene may help relieve muscle spasm.
6.Tetanus prophylaxis is essential.
7.Wound care:
a.Cleansing with antiseptics.
b. Immobilisation, elevation, and serial observation.
c. If infection sets in, antibiotics must be administered. d.
Surgical intervention (excision) may be necessary if lesion
exceeds 4 cm at 12 hours post-envenomation.

Wolf Spider
The bite of the wolf spider is generally not associated with
serious manifestations. Occasionally it causes moderate pain,
erythema, oedema, or pruritis. Rarely there is necrosis.
Systemic manifestations may develop after 1 to 2 days,
characterised by fever, chills, myalgia, and arthralgia. Very
rarely there may be features of haemolysis, renal failure, and
shock.
Treatment involves supportive and symptomatic measures.
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