Nehemya Moshe
Kaplan Medical Center, Rehovot.
Harefuah. 2008 Aug-Sep;147(8-9):672-6, 752.
Spider bites are not uncommon in our warm climate. The most prevalent species of venomous spiders in Israel are the brown recluse and the black widow. Although the black widow is more notorious than the recluse, for every bite by a black widow there are hundreds of recluse bites reported. Despite the numerous bites, there is little awareness amongst physicians with regard to the clinical signs of recluse bites, and very often the wrong diagnosis is made, resulting in complex and unnecessary treatments. The basis of this error stems from the numerous clinical diagnoses which closely imitate a recluse bite, the relative scarceness of documented recluse bites and the fact that in most cases the spider is not witnessed by the victim. The following article describes three cases of children admitted to our department, presenting with high fever, a necrotic lesion and an extensive maculopapular rash. The children were eventually diagnosed with brown recluse bites. Furthermore, the article summarizes the literature regarding the clinical signs of recluse bites, possible complications and treatment options. The objective of this review is to increase awareness towards recluse bites, thereby preventing misdiagnoses and unnecessary treatments.
在我们温暖的气候中,蜘蛛叮咬并不罕见。以色列最常见的有毒蜘蛛种类是棕色遁蛛和黑寡妇蜘蛛。尽管黑寡妇蜘蛛比棕色遁蛛更臭名昭著,但每有一例黑寡妇蜘蛛叮咬的报告,就有数百例棕色遁蛛叮咬的报告。尽管叮咬事件众多,但医生对棕色遁蛛叮咬的临床症状了解甚少,而且经常会做出错误的诊断,导致复杂且不必要的治疗。这种错误的根源在于许多临床诊断与棕色遁蛛叮咬极为相似、有记录的棕色遁蛛叮咬相对较少,以及在大多数情况下受害者并未目睹蜘蛛。以下文章描述了三例入住我们科室的儿童病例,他们表现为高烧、坏死性病变和广泛的斑丘疹。这些儿童最终被诊断为棕色遁蛛叮咬。此外,本文总结了关于棕色遁蛛叮咬的临床症状、可能的并发症及治疗选择的文献。本综述的目的是提高对棕色遁蛛叮咬的认识,从而防止误诊和不必要的治疗。