Jelinek G A
Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, West Australia.
Wilderness Environ Med. 1997 Nov;8(4):226-31. doi: 10.1580/1080-6032(1997)008[0226:wselaw]2.3.co;2.
The objective of this study was to review widow spider envenomation on a worldwide basis, with an emphasis on regional variability in management, particularly between the United States and Australia. Data sources were the Medline database (1966-1997) for English language references using as key words widow spider, latrodectism, and red back spider, and Mesh headings. Textbooks of toxinology were also used. Studies involving clinical reports and series were selected. The data indicated that envenomation by widow spiders (latrodectism) is common worldwide. Local pain and sweating predominate, in about 25% of cases becoming generalized or developing in remote sites. The mortality in published series varies from 5% to 10%, although these may be overestimates. Australia may have the highest rate of latrodectism in the world. The literature reveals regional disparities in the treatment and outcome of latrodectism. In Australia, intramuscular antivenin has been used liberally for more than 40 years with a very low rate (0.5% to 0.8%) of allergic reactions and no deaths recorded since its introduction. Antivenin is routinely successful in relieving the effects of latrodectism. In the United States, the antivenin is given intravenously, is usually reserved for very severe cases, and the rate of allergic reaction is high (from 9% up to 80% in those skin testing positive). Deaths have been recorded after antivenin. The literature suggests that antivenin to one species of Latrodectus is likely to be effective against other species. The conclusion drawn was that latrodectism is a common envenomation worldwide. There is a strong case for a comparative trial of Australian vs US antivenin in treating latrodectism due to the black widow spider in the United States.
本研究的目的是在全球范围内回顾寡妇蜘蛛咬伤情况，重点关注治疗方面的地区差异，尤其是美国和澳大利亚之间的差异。数据来源为Medline数据库（1966 - 1997年），以寡妇蜘蛛、红斑蛛中毒和红背蜘蛛作为关键词检索英文参考文献，并使用医学主题词表。还查阅了毒理学教科书。选取了涉及临床报告和系列病例的研究。数据表明，寡妇蜘蛛咬伤（红斑蛛中毒）在全球很常见。局部疼痛和出汗为主，约25%的病例会发展为全身症状或在远离咬伤部位出现症状。已发表系列病例中的死亡率在5%至10%之间，不过这些数字可能有所高估。澳大利亚可能是世界上红斑蛛中毒发生率最高的国家。文献揭示了红斑蛛中毒在治疗和预后方面的地区差异。在澳大利亚，肌肉注射抗蛇毒血清已广泛使用40多年，过敏反应发生率极低（0.5%至0.8%），自引入以来未记录到死亡病例。抗蛇毒血清通常能成功缓解红斑蛛中毒的症状。在美国，抗蛇毒血清通过静脉注射给药，通常仅用于非常严重的病例，过敏反应发生率很高（皮肤试验阳性者中从9%到80%不等）。使用抗蛇毒血清后有死亡记录。文献表明，一种红斑蛛属蜘蛛的抗蛇毒血清可能对其他种类也有效。得出的结论是，红斑蛛中毒在全球是一种常见的中毒情况。鉴于美国黑寡妇蜘蛛咬伤导致的红斑蛛中毒，很有必要对澳大利亚和美国的抗蛇毒血清进行比较试验。
