Hospital Vital Brazil, Instituto Butantan, São Paulo-SP, Brazil.
Toxicon. 2011 Dec 1;58(8):664-71. doi: 10.1016/j.toxicon.2011.09.011. Epub 2011 Oct 2.
Loxosceles spiders are found globally, especially in South and North America. In Brazil, approximately 10,000 cases of Loxosceles spp. spider bites are reported annually. Herein we analyzed 81 patients diagnosed as either cutaneous or cutaneous-hemolytic loxoscelism, in a geographical area where most accidents are caused by Loxosceles gaucho, and we report their clinical and laboratory data obtained during week 1 and 2 after the bite. Massive hemolysis was noticed in only 2 cases, but high serum bilirubin and LDH levels, suggestive of hemolysis, were noticed in 25 cases on admission. Anemia was not frequent (14.7%), and reticulocytosis was particularly noticed during week 2 (in 56% of patients). High D-dimer levels were suggestive of endothelial cell activation and intravascular thrombin generation, but thrombocytopenia was noticed in only 17.6% of patients in week 1. Acute kidney injury (AKI) only occurred in patients with massive hemolysis. The definitive diagnosis of overt disseminated intravascular coagulation (DIC) could not be established on admission. Fever was associated with the presence of hemolysis (p = 0.03). Altogether, these findings provide evidence that mild hemolysis is frequent in loxoscelism and suggest that AKI is uncommon, exclusively occurring in patients with massive hemolysis.
狼蛛在全球范围内都有发现，尤其在南美和北美更为常见。在巴西，每年报告约有 10000 例狼蛛咬伤病例。在此，我们分析了 81 例在地理区域内被诊断为皮肤型或皮肤-溶血型狼蛛咬伤的患者，该区域大多数咬伤事故都是由 Loxosceles gaucho 引起的，并报告了他们在咬伤后第 1 周和第 2 周的临床和实验室数据。只有 2 例出现了大量溶血，但入院时 25 例出现了高血清胆红素和 LDH 水平，提示存在溶血。贫血并不常见（14.7%），在第 2 周（56%的患者）特别注意到网织红细胞增多。高 D-二聚体水平提示内皮细胞激活和血管内凝血酶生成，但在第 1 周只有 17.6%的患者出现血小板减少症。只有在发生大量溶血的患者中才会出现急性肾损伤（AKI）。入院时不能确定显性弥散性血管内凝血（DIC）的明确诊断。发热与溶血的存在相关（p=0.03）。综上所述，这些发现表明轻度溶血在狼蛛咬伤中很常见，并提示 AKI 并不常见，仅发生在发生大量溶血的患者中。
