When parents bring their children to the emergency department with concern for a spider bite, it usually isn’t a spider bite. Most of these cases are skin and soft tissue infections such as cellulitis or abscesses. However, in Missouri, there is a venomous spider known as a brown recluse (Loxosceles reclusa), according to the Missouri Department of Conservation. Children do come into our emergency departments with complications from brown recluse bites and sometimes need admission to the hospital.
Brown Recluse Spiders
These spiders have been described as yellow-brown in color, with a violin shaped mark on their head. They prefer to hang out in dark, quiet areas like the basement or attic. They are not aggressive but bite when they think they are being attacked. Often, people will unknowingly put on clothes or shoes with a brown recluse hiding inside. They also may accidentally roll over a brown recluse that is climbing onto the bed sheets. The brown recluse will bite as it is crushed against a person’s skin.
Common Symptoms of Brown Recluse Spider Bites
People who have been bitten can initially report mild pain and itching. This pain may become worse over the next several hours. The “classic” brown recluse bite presents itself as an area of central necrosis (or tissue breakdown), surrounded by a pale ring, followed by an outer red ring. The central area can have tiny clear bumps before the tissue break down begins. It’s thought that the area of tissue break down is related to the amount of venom injected into the skin. Most of the time, these bites will heal on their own. Although sometimes patients with large, deep wounds need referral to wound care specialists or dermatologists. How quickly the wound heals depends on the size of the wound, but most people do not become seriously ill.
Concerning Symptoms of Brown Recluse Spider Bites
Rarely, children bitten by a brown recluse can become very ill if they develop “loxoscelism,” which is when the venom effects several systems in the body. This can present itself as fever, chills, abdominal pain, nausea, vomiting, joint pain, jaundiced (yellow) eyes, and change of color of urine. In addition, it can cause kidney damage and red blood cell breakdown, leading to severe anemia. The good news is that this is rare. The bad news is that younger children are more likely to develop these severe effects.
Treatment for a Brown Recluse Spider Bite
Any patient, particularly children, with a suspected brown recluse bite need to be assessed to ensure their vital signs are normal and that they have no concerning signs (such as fever, nausea, abdominal pain, yellow eyes, or dark urine). A child with a brown recluse bite with some of the concerning signs described above needs to be hospitalized. Children who have the symptoms of a “classic” bite, who are otherwise well, are usually able to be discharged home from the ED after careful examination. If discharged home, patients should follow up with their doctor to make sure the wound is healing well. However, they should return to the emergency room immediately if they develop any of the concerning symptoms described above.
Preventing Spider Bites
The best way to prevent a brown recluse bite is to avoid contact with them. Always shake any shoes or clothes that have been on the floor before putting them on, to confirm no creature is tucked inside.