Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine at Anschutz Medical Center, Aurora, CO, USA; Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv, Israel; Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Israel.
Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv, Israel.
Am J Emerg Med. 2018 Jun;36(6):998-1002. doi: 10.1016/j.ajem.2017.11.011. Epub 2017 Nov 6.
Black widow species (Latrodectus species) envenomation can produce a syndrome characterized by painful muscle rigidity and autonomic disturbances. Symptoms tend to be more severe in young children and adults. We describe black widow spider exposures and treatment in the pediatric age group, and investigate reasons for not using antivenom in severe cases.
All black widow exposures reported to the Rocky Mountain Poison Center between January 1, 2012, and December 31, 2015, were reviewed. Demographic data were recorded. Patients were divided into 2 groups. Group 1: contact through families from their place of residence, public schools and/or cases where patients were not referred to healthcare facilities. Group 2: patient contact through healthcare facilities.
93 patients were included. Forty (43%) calls were in Group 1 and 53 (57%) in Group 2. Symptoms were evident in all victims; 43 (46.2%) were grade 1, 16 (17.2%) grade 2 and 34 (36.5%) grade 3, but only 14 patients (41.1%) of this group received antivenom. Antivenom use was associated with improvement of symptoms within minutes, and all treated patients were discharged within hours, without an analgesic requirement or any complications. Reasons for not receiving antivenom included: skin test positive (2/20), strong history of asthma or allergies (2/20), physician preference (2/20), non-availability of the antivenom at the health care facility (14/20).
In our study, most symptomatic black widow envenomations were minor. Relatively few patients received antivenom, but antivenom use was associated with shorter symptom duration among moderate and major outcome groups.
黑寡妇蜘蛛（Latrodectus 属）咬伤可导致以肌肉疼痛性僵硬和自主神经功能紊乱为特征的综合征。该综合征在幼儿和成人中更为严重。我们描述了儿科年龄组的黑寡妇蜘蛛咬伤和治疗情况，并调查了严重病例未使用抗蛇毒血清的原因。
回顾了 2012 年 1 月 1 日至 2015 年 12 月 31 日期间向落基山毒物中心报告的所有黑寡妇蜘蛛咬伤事件。记录了人口统计学数据。患者分为两组。第 1 组：通过居住家庭、公立学校和/或未转至医疗机构的病例与患者接触。第 2 组：通过医疗机构与患者接触。
共纳入 93 例患者。第 1 组有 40 例（43%），第 2 组有 53 例（57%）。所有患者均出现症状；43 例（46.2%）为 1 级，16 例（17.2%）为 2 级，34 例（36.5%）为 3 级，但该组仅 14 例（41.1%）患者接受了抗蛇毒血清治疗。抗蛇毒血清治疗后症状迅速改善，所有接受治疗的患者均在数小时内出院，无需使用镇痛药，也无任何并发症。未使用抗蛇毒血清的原因包括：皮肤试验阳性（2/20）、哮喘或过敏病史强（2/20）、医生偏好（2/20）、医疗机构无抗蛇毒血清（14/20）。
在我们的研究中，大多数有症状的黑寡妇蜘蛛咬伤为轻度。接受抗蛇毒血清治疗的患者相对较少，但在中重度症状患者中，抗蛇毒血清的使用与症状持续时间缩短有关。
