Young Adult Institute and Premier HealthCare, 220 East 42nd St, 8th Floor, New York, NY, 10017, USA.
Toxicon. 2024 Oct;249:108077. doi: 10.1016/j.toxicon.2024.108077. Epub 2024 Aug 23.
The genus Latrodectus (Araneae: Theridiidae) consists of 35 widow spider species with global distribution. Envenoming by medically important species, latrodectism, commonly features bite site erythema and diaphoresis, variably severe pain that may be persistent, myalgia/cramping and/or myoclonus, autonomic symptoms, abdominal distress; severe envenoming can be prolonged and include serious effects such as oliguria, hypertension and, rarely, myocarditis/myocardial injury. Red-back spiders (Latrodectus hasselti) are the most common cause of envenoming in Australia and can cause the spectrum of effects noted for other medically important widow spiders. A 34-yr-old woman with a history of previous L. hasselti envenoming and treatment with antivenom was envenomed in her left ankle by a verified L. hasselti (hiding in her boot) while attending an appointment with her primary care physician. She reported some of the common effects of latrodectism including severe, prolonged pain, bite site diaphoresis, and malaise; however, she also developed marked edema that involved the entire left foot. She also exhibited mild hypertension and autonomic/non-specific effects limited to nausea, headache, and anxiety. She was effectively treated with red-back spider antivenom (a total of 4 ampoules) and supportive care; full resolution of the edema required almost 5 days. The uncommon clinical evolution of L. hasselti local envenoming observed in this patient may have been caused by a mixed picture of venom-induced effects and Type I hypersensitivity, but alternatively could be a rare, solely venom-induced manifestation. While provision of patient-centred care for anyone envenomed by Latrodectus spp. requires careful history collection and assessment of comorbidities, differentiation of atopic and direct venom effects may be challenging in some envenomed patients with established complex allergy history.
Latrodectus 属（蜘蛛目：Theridiidae）由 35 种具有全球分布的寡妇蛛组成。由具有医学重要性的物种（Latrodectism）引起的中毒通常表现为咬伤部位红斑和出汗、程度不同的剧烈疼痛，可能持续存在、肌肉痛/痉挛和/或肌阵挛、自主症状、腹部不适；严重中毒可能持续时间延长，并包括少尿、高血压和罕见的心肌炎/心肌损伤等严重影响。红背蜘蛛（Latrodectus hasselti）是澳大利亚最常见的中毒原因，可引起其他具有医学重要性的寡妇蛛所引起的一系列影响。一名 34 岁的妇女，既往有 L. hasselti 中毒和抗蛇毒血清治疗史，在接受初级保健医生预约时，她左脚踝被一只经过验证的 L. hasselti（藏在她的靴子中）咬伤。她报告了一些 Latrodectism 的常见影响，包括剧烈、持久的疼痛、咬伤部位出汗和不适；然而，她还出现了明显的水肿，累及整个左脚。她还出现了轻度高血压和自主/非特异性影响，仅限于恶心、头痛和焦虑。她接受了红背蜘蛛抗蛇毒血清（共 4 安瓿）和支持性治疗，有效治疗；水肿完全消退需要近 5 天。该患者观察到的 L. hasselti 局部中毒的罕见临床演变可能是由毒液引起的效应和 I 型超敏反应的混合表现引起的，但也可能是一种罕见的、仅由毒液引起的表现。虽然为任何被 Latrodectus spp. 咬伤的患者提供以患者为中心的护理需要仔细收集病史和评估合并症，但在一些具有既定复杂过敏史的中毒患者中，区分特应性和直接毒液效应可能具有挑战性。
