Isbister Geoffrey K, Gray Michael R
Discipline of Clinical Pharmacology, University of Newcastle, Level 5, Clinical Sciences Building, Newcastle Mater Misericordiae Hospital, Waratah, NSW 2298, Australia.
Med J Aust. 2003 Aug 18;179(4):199-202. doi: 10.5694/j.1326-5377.2003.tb05499.x.
To investigate the circumstances and clinical effects of bites by white-tail spiders, including the two species Lampona cylindrata and L. murina commonly encountered by humans, and the incidence of necrotic lesions.
Prospective cohort study of definite white-tail spider bites. Cases were only included if there was a clear history of bite, the spider was caught and was identified by an expert.
Calls to Australian poisons information centres and emergency departments.
130 patients with a definite bite by a white-tail spider from February 1999 to April 2002.
There were 79 bites by L. cylindrata and 51 by L. murina. Bites occurred in warmer months, 95% indoors and 75% between 16: 00 and 08: 00. The activity at the time of the bite was characteristic and the spider was encountered between bedclothes, towels or clothing. 25% of bites occurred on distal limbs. Pain/discomfort occurred in all cases, and was severe in 27%. Other effects included puncture marks (17%), redness/red mark (83%) and itchiness (44%). Systemic effects occurred in 9%. There were no cases of necrotic ulcers (97.5% CI, 0-2.8%) or confirmed infections. Median duration of effects was 24 hours (interquartile range, 1-168 hours). There were three distinct clinical patterns: pain only (21%), pain and red mark for < 24 hours (35%), and a persistent painful or irritating red lesion (44%).
Bites by Lampona spp. cause minor effects in most cases, or a persistent painful red lesion in almost half the cases. White-tail spider bites are very unlikely to cause necrotic ulcers, and other diagnoses must be sought.
调查白尾蛛咬伤的情况及临床效果，包括人类常见的两种白尾蛛——圆柱扁蛛（Lampona cylindrata）和穆氏扁蛛（L. murina），以及坏死性损伤的发生率。
对白尾蛛明确咬伤情况进行前瞻性队列研究。仅当有明确的咬伤史、蜘蛛被捕获且由专家鉴定时，病例才被纳入。
澳大利亚毒物信息中心和急诊科接到的电话。
1999年2月至2002年4月期间130例被白尾蛛明确咬伤的患者。
圆柱扁蛛咬伤79例，穆氏扁蛛咬伤51例。咬伤发生在较温暖的月份，95%发生在室内，75%发生在16:00至08:00之间。咬伤时的活动情况具有特征性，蜘蛛多在床单、毛巾或衣物间被发现。25%的咬伤发生在四肢远端。所有病例均出现疼痛/不适，其中27%疼痛严重。其他症状包括穿刺痕迹（17%）、发红/红色印记（83%）和瘙痒（44%）。9%出现全身症状。未出现坏死性溃疡病例（97.5%可信区间，0 - 2.8%）或确诊感染。症状持续的中位时间为24小时（四分位间距，1 - 168小时）。有三种不同的临床模式：仅疼痛（21%）、疼痛和红色印记持续时间<24小时（35%），以及持续性疼痛或刺激性红色损伤（44%）。
多数情况下，扁蛛属咬伤造成的影响较小，近半数病例会出现持续性疼痛的红色损伤。白尾蛛咬伤极不可能导致坏死性溃疡，必须排查其他诊断。
