A chronical of an unfortunate spiderly event....

 

After a not so pleasant and unplanned hiatus in August, last Saturday was my first attempt in ten days to return to normal life. I invited my son to join me at the office for a spin and later we would enjoy a mother and son lunch.

We propped ourselves into the car and began to drive into Miami city (Florida). About five minutes on the road, we noticed a dime sized object crawling towards us steadily.  It took about three seconds before we belted out in unison inaudible sounds followed by the word - Spider!  I jerked the car into a parked position and my son proceeded to beat the life out of it.

 

Eureka and boom-boom-pow!!! We found the catalyst that launched my life into the unplanned, chaotic, hiatus days before!

 

The dreaded Brown Recluse!

 

Brown Recluse Spider

 

Bites and Bite Symptoms

'Brown recluse spiders usually bite only when they become trapped next to the victim's skin. Bites occur either when sleeping humans roll onto the spider or put on clothes into which the spider has crawled (Vetter and Visscher 1998). Typically bites occur under clothing, mostly on the thigh, upper arm, or lateral torso, less often on the neck (Anderson 1998) [Dr. Philip C. Anderson is a physician and medical researcher who has worked on brown recluse bites and venom for 40 years].'

Ten days earlier:
Day 1: Tuesday,: July 30th, 2013...

Enlightenment...having spent the weekend cleaning spaces long forgotten around the house, I must have invited a creepy creature with teeth from out of his/her dust bowl. 
 

The Tuesday that followed, I was gazing at the circular beauty below located an inch or so beneath my belly button.  My new tattoo.

Startled to discover this anomaly on my lower abdomen, I made an agitated phone call to my Doctor.  I couldn't tell if it was a blister or a tumor, initially. I really did not know how I had acquired this 'thing.'

Day 2: Wednesday, July 31st, 2013

I was kindly slipped into the appointment book for a perusal of my new acquisition. By the time I arrived at the appointment, what appeared to be an Araneae tattoo began to change in color and size. 

After a quick review and a grimaced expression by the physician assistant, I was referred to another Doctor the following day and told that if the wound deteriorated to go straight to the nearest hospital Emergency Room.

Just like a tattoo
I'll always have you
(I'll always have you)...says the spider...

Day 3: Thursday, August 1st, 2013...

The  next day, my good friend and health partner Patricia and I visited another Doctor.  This time, I was given strong antibiotics typically used in the treatment of MRSA.(Methicillin-resistant Staphylococcus aureus) No bueno! Again, I was told if the condition deteriorated to go the a hospital.  This was just the beginning...

Day 4: Friday, August 2nd, 2013...

The next morning, the wound appeared angrier and uglier.  I waited ..this was going to get better.

Day 5: Saturday, August 3rd, 2013...

Saturday morning arrived.  After several calls to Patricia and many IPhone text images, my dutiful Dr. companion and I decided to visit the Urgent Care unit at Baptist Hospital.  We were met with yet, another confused expression from a Doctor.  This time, a  secondary antibiotic was assigned every six hours.  A time to wait... 

Day 6: Sunday, August 4th, 2013...

...waiting some more...

Day 7: Monday, August 5th, 2013...

The antibiotics were taking a toll. I became chronically lethargic and decided to sleep until this ordeal came to an end.  I slept the entire day. 

When I woke up, I received a text message from my colleagues at the office.  They collectively decided that I was going to see an infectious disease specialist the following day and they made the appointment.  I was deeply moved by their attention and concern for my plight. I submit, that my inner circle of friends have been an amazing source of comfort and support - for this I am eternally grateful.

Day 8: Tuesday, August 6th, 2013...

Patricia and I once again marched ourselves to the final specialist. This time, the news was not so bad; it would seem that the event may be almost over.  My marking is still very unattractive, but the medicine seems to be working.

Day: 9, 10, 11, 12 : Wednesday,  Thursday, Friday, Saturday and Sunday...

I just finished the last dose of antibiotics and my spidery tattoo is still not a popular image to behold as you can see.

Day 15: Wednesday August 14, 2013...

Waiting to exhale..I understand that spiders love warmth and when female spiders bite they do so because she is trying to lay eggs.  I truly hope that is not the case. 

Today this is me...waiting for an alien uprising...

 

 Game not over ...yet! Bites!

Post Data: I am not crticial. I am still sleeping it off. 

About the Recluse:
Description of the symptoms is from Wingo (1960), Gorham (1968, 1970), Anderson (1982, 1998), and Vetter and Visscher (1998). Reactions to a bite vary from no noteworthy symptoms to severe necrosis or systemic effects. Discomfort may be felt immediately after the bite, or several hours may pass before any local reaction to the bite occurs. In one study, only 57% of the patients realized they had been bitten at the time of the bite. It must be realized that there are at least two significant variables affecting the outcome of a bite. The first is the amount of venom injected by the spider. Like some venomous snakes, spiders are known to sometimes give "dry" bites, with little or no venom injected. The second variable is the sensitivity of the victim. Some people are simply more prone to have a severe reaction in instances where another person might only have a slight reaction.
Typical symptoms are as follows: Symptoms start two to six hours after the bite. Blisters frequently appear at the bite site, accompanied by severe pain and pronounced swelling. A common expression is the formation of a reddish blister, surrounded by a bluish area, with a narrow whitish separation between the red and blue, giving a "bull's-eye" pattern. By 12 to 24 hours, it is usually apparent if a Loxosceles wound is going to become necrotic because it turns purple in color; if necrotic symptoms do not express by 48 to 96 hours, then they will not develop. If the skin turns purple, it will then turn black as cells die. Eventually the necrotic core falls away, leaving a deep pit that gradually fills with scar tissue.

Experimental antivenin (Rees et al. 1981; not commercially available) was very successful when administered within 24 hours, but many times a victim does not seek treatment until after necrosis is well underway (more than 24 hours), after which the antivenin is less effective. Systemic effects usually take two to three days to show symptoms. Bites that become systemic usually do not also become necrotic; it is thought that in necrotic wounds the venom is localized in the tissue whereas in systemic reactions the venom is distributed quickly into the body without necrotic local effects. The wound is usually free of bacterial infection for the first two to three days but may be contaminated by patients due to pruritis (itching) leading to scratching. Recluse venom can exhibit extended necrosis in adipose (fatty) tissue of thighs, buttocks and abdomen of obese patients; there is also a gravitational flow of the venom effects, at times leading to satellite pockets of necrosis. Healing can take weeks to months and may leave an unsightly scar, although scarring is minimal in most cases. Skin grafts may be required to complete healing in the worst cases, but should be considered a last resort.

Final Disclaimer and Medical Analysis:

The following technical analysis is condensed from the medical literature. Persons who suspect they have been victimized by a brown recluse spider bite are strongly encouraged to consult with a physician.

In medical terms (Vetter 1998), bites from Loxosceles can be unremarkable (requiring no care), localized (requiring some care but usually healing without intervention), dermonecrotic (a slow- healing, necrotic ulcerated lesion needing supportive care), or systemic (vascular and renal damage, sometimes life-threatening). Within 10 minutes of venom injection, there is a constriction of capillaries around the site of the bite. A major venom component is sphingomyelinase D which causes hemolysis (destruction of red blood cells). Recluse venom has a strong disruptive effect on endothelial tissue. Polymorphonucleocytes (PMN) are activated (by the patient.s immune system) and infiltrate the bite site; in test animals where PMN activity was suppressed, degree of necrosis was lessened. General symptoms are edema (swelling), erythema (redness caused by blood being brought to the surface to counteract the damage), pruritis (itching), pain at the site, and mild fever. A pruritic or painful eruption can occur within a few hours of the bite and persist for a week, ending with scaling and peeling of the hands, and a truncal papular rash, that recalls pictures of scarlet fever rashes; the pruritis may be worse for the patient than the painful focal necrosis. The skin may feel hot and tender to the patient. It may be advisable to treat the rash and pruritis symptoms with Prednisone (Anderson 1998). Treatment with corticosteroids does not appear to affect either the skin necrosis or the hemolysis (Anderson 1998).

Dermatologic expression varies. In mild self-healing wounds, the bite site may not progress past an edematous erythema; these wounds do not become necrotic and non-intrusive care is sufficient. In more serious wounds, a sinking blue-gray macule on the skin contains a "bull's- eye" pattern formation where a central erythematous bleb (blister) is separated from a peripheral cyanotic region by a white zone of induration (red-white-blue). If the bite becomes violaceous within the first few hours, this usually indicates that severe necrosis may occur and more supportive measures are necessary.

The initial bleb gives way to ischemia (localized temporary blood deficiency). A central eschar (hardened scab similar to that made after burns) forms, hardens, and within seven to 14 days the eschar falls out leaving behind an ulcerated depression. The necrosis may continue to spread from the bite site possibly due to an autoimmune response (see above). Normally, the wound limits begin to recede after one week as healing begins. Unnecessary removal of tissue often leads to greater scarring than would result from normal healing. Extirpation of damaged skin is only recommended in severe cases and only after the limits of the wound are strongly demarcated at six to eight weeks. Most wounds self-heal with excellent results.

Systemic conditions that might manifest in severe cases are hematoglobinuria (hemoglobin in the urine), hematoglobinemia (reduction of useful hemoglobin, resulting in anemia-like condition), thrombocytopenia (reduction of clotting platelets in the blood), and/or disseminated intravascular coagulation (DIC) (precipitation of platelets causing mini-clots all over the body). The presence of sustained coagulopathy with hemolysis indicates severe systemic loxoscelism. Fortunately, less than 1% of cases exhibit these symptoms. Although rare, if death occurs, it is most often from hemolysis, renal failure and DIC; children are most adversely affected due to their small body mass. Anderson (1998) noted, however, that none of the fatalities were proven to have been caused by a brown recluse spider.