A brown recluse spider bite wound: a case report and literature review.

DECLARATION OF INTEREST: The authors have no conflicts of interest.

Utilization of dapsone and hemoglobin in the epithelial skin regeneration therapy of cutaneous loxoscelism: A case report and integrative literature review

ABSTRACT BACKGROUND: Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics. OBJECTIVE: This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite. DESIGN AND SETTING: This case report and literature review was conducted in a Mexican university. METHODS: A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: "loxoscelism" OR "spider bite," OR "loxosceles" OR "loxosceles species" OR "loxosceles venom" OR "loxoscelism case report" AND "cutaneous" OR "dermonecrotic arachnidism." RESULTS: A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species. CONCLUSIONS: The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422424).

Loxoscelism in an HIV patient. The complexity behind a spider bite / Loxoscelismo en un paciente VIH. La complejidad detrás de la mordedura de una araña

Abstract Loxoscelism is a relatively common toxinological event in tropical countries. Although most are self-limiting, some cases may have serious local or systemic consequences. Unfortunately, lack of knowledge and limited diagnostic and treatment strategies still result in adverse outcomes in susceptible patients. The aim of this paper is to present a clinical case of serious loxoscelism in an HIV patient, highlighting the correlation between the clinical presentation and the toxinological characteristics of the poison. This was a previously healthy 48-year-old male patient with risky sexual habits, who experienced a serious arachnid accident after being bitten by a spider of the Loxosceles genus. He subsequently experienced a difficult clinical course, with deep vein thrombosis, progressively increasing transaminases to the range of hepatitis, and a de novo diagnosis of HIV, confirmed by fourth generation ELISA. This is the first case report of arachnidism in the context of HIV infection, which opens a discussion on the possible differential response of this population to the effects of spider poison. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2025).

Resumen El loxoscelismo es un evento toxinológico relativamente frecuente en los países tropicales. A pesar de que la mayoría son autolimitados, hay casos que pueden tener consecuencias locales o sistémicas graves. Lamentablemente el desconocimiento y la limitación en estrategias diagnósticas y terapéuticas aún representan desenlaces adversos en pacientes susceptibles. El objetivo de este trabajo es presentar un caso clínico de loxoscelismo grave en un paciente VIH, destacando la correlación entre la presentación clínica con las características toxinológicas del veneno. Se trató de un paciente masculino de 48 años previamente sano y con hábitos sexuales de riesgo, quien presentó accidente arácnido grave, posterior a mordedura por araña de género Loxosceles; con posterior evolución tórpida, desarrollo de trombosis venosa profunda, aumento progresivo de las transaminasas hasta el rango de hepatitis y diagnóstico de novo de VIH confirmado con Elisa de cuarta generación. Es el primer reporte de caso de aracnidismo en contexto de infección por VIH que lleva a discutir sobre una posible respuesta diferencial de esta población al efecto del veneno de araña. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2025).

A rare cause of secondary hemophagocytic lymphohistiocytosis: systemic loxoscelism.

BACKGROUND: Loxoscelism is caused by the bite of a specific spider type called the Loxosceles genus. In Turkey, most cases are seen after L. rufescens bites. Clinical manifestation of the bites ranges from local cutaneous reaction to severe ulcerative necrosis. Systemic loxoscelism may also occur. CASE: Herein, we report a previously healthy five-year-old male patient who developed a secondary hemophagocytic lymphohistiocytosis after a presumed brown spider bite. He was treated with dexamethasone. Within the following 14 days, hemophagocytic syndrome resolved. Local hyperbaric oxygen therapy was applied to the necrotic areas. CONCLUSION: Secondary hemophagocytic lymphohistiocytosis may develop after systemic loxoscelism. In the presence of persistent fever, hepatosplenomegaly and laboratory findings this clinical entity should be kept in mind.

Latrodectism in Italy: First report of successful treatment of L. tredecimguttatus envenomation using L. mactans antivenom from North America.

INTRODUCTION: Latrodectism is a rare, but potentially severe, clinical syndrome caused by spider of the genus Latrodectus. L. tredecimguttatus is widespread in Italy and its bite cause the injection of α-latrotoxin that cause depletion of acetylcholine at motor nerve endings and release of catecholamines at adrenergic nerve endings. We describe the first clinical case of L. tredecimguttatus poisoning successfully treated with L. mactans antivenom from North America. CASE REPORT: A healthy 60-year-old patient was admitted to the emergency department after unknown insect sting or arachnid/snake bite. In the early morning, the patient was working in the countryside when he felt a sting-like pain in the medial area of the right lower leg, associated with an intense burning sensation. An hour later he developed agitation, hoarseness, sweating, abdominal distress and intense pain in his right leg. In the emergency room vital signs showed a hypertensive crisis, tachycardia and peripheral oxygen desaturation. ECG was normal and ABE showed mixed acid-base disorder. Blood tests showed leukocytosis with neutrophilia, high levels of myoglobin, with normal coagulation and normal plasmatic cholinesterase. Neck, thorax and abdomen CT scan, with and without contrast medium, was negative. Four hours after admission hypertension worsened with board like rigid abdomen and onset of fasciculations, tremors, miosis and intense regional sweating. The definitive diagnosis of poisoning by L tredecimguttatus was based on the clinical picture. Within short time the antidote was provided by the Poison Centre and administered. A marked improvement of the symptomatology was noted after 30 minutes, and 1 hour later all symptoms were under control. The patient was discharged after 2 days. CONCLUSIONS: The clinical presentation of a patient suffering from latrodectism places the clinician in front of a challenging differential diagnosis. Following the suspicion, the first-line doctor is invited to discuss the case with a toxicologist, in order to confirm or exclude the diagnosis and implement all therapeutic measures. In our clinical case, the absence of organic lesions, laboratory tests not suggestive for other causes, and the presence of typical clinical feature suggested the diagnosis of L tredecimguttatus poisoning. This hypothesis was then supported by the close temporal relation between antivenom administration and symptoms improvement. With this case, we report the first use of L mactans antivenom from North America to treat L.tredecimguttatus poisoning and we confirm its effectiveness in counteracting latrodectism caused by this spider.

Probable cutaneous loxoscelism with mild systemic symptoms: A case report from Spain.

We present a case from Valencia, Spain, of a 25-year-old woman who presented with a painful erythematous skin lesion, initially diagnosed as cellulitis. The lesion was unresponsive to antibiotic treatments and progressed into a hemorrhagic blister with necrotic ulcer formation. Posterior collection of a spider from the patient's home and expert identification of the spider as Loxosceles rufescens was achieved, establishing the diagnosis of probable cutaneous loxoscelism. Symptomatic treatment, general wound care and ultimately surgery, resulted in complete recovery with minor residual scarring. This case illustrates some of the difficulties encountered in the diagnosis and treatment of loxoscelism and adds to the increasing reports of loxoscelism in the Mediterranean Basin.

Black widow spider bites experience from tertiary care center in Saudi Arabia.

INTRODUCTION: Black widow spiders are one of the most poisonous species to humans; there are more than 30 species of widow spiders in the globe but good thing that not all of them are dangerous. Some of these spiders produce toxic venoms, which cause broad spectrum of clinical manifestations including skin lesions, neurotoxicity, cardiac toxicity and death in some occasions. In Saudi Arabia there were no much reports of black widow spider bites apart from the case series by BUCUR and his group in ALBAHA region. SETTINGS: In 2 years period a total of 8 patients were presented to the emergency departments diagnosed to have black widow spider bites based on description by the patients. RESULTS: 100 % of the cohort were males, aged between 25-58 years. The time between bite and presentation to emergency room was one hour in average (30 min to 4 hours). 75% occured during summer season. All of them 100% had one bite only and reported the bite to be at nighttime in 75% of the times. The average pain score at presentation was 4 /10.100% of the bites were in the lower extremities and almost all progressed to have lower back pain. Three patients had gastrointestinal tract manifestation in form of abdominal cramps and nausea. One had bilateral ptosis, none of them had cardiac or pulmonary complications. The outcome was excellent in all patients and the average of hospital stay was 2.5 days (1-5).

Tularemia presenting as suspected necrotic arachnidism.

The true danger of the spider bite stems from misdiagnosis and resultant delay in proper treatment of entities that, unlike spider bites, are not self-limited. Obtaining a complete exposure and travel history is central to the development of an accurate and appropriate differential diagnosis.

Arachnidism, scorpionism and ophidism in Ouro Preto Municipality, Minas Gerais State, Brazil

Abstract: INTRODUCTION This retrospective study shows the profile of arachnidism, ophidism, and scorpionism in the Ouro Preto Municipality, Brazil, from January 2007 to December 2013. METHODS The data were gathered from forms of the Epidemiological Surveillance Sector of the town's Health's Municipal Secretary. RESULTS Of the 412 envenomations, 308 were caused by spiders, 78 by scorpions, and 26 by snakes. The highest number of incidents involved people aged 20-34 years. Females were more affected than males. There were no reports of death. CONCLUSIONS The results show that envenomations caused by spiders, scorpions and snakes have decreased in recent years.

Conhecimento de puérperas sobre identificação e prevenção do acidente loxoscélico / Puerperal women's knowledge on the identification and prevention of loxoscelic acidentes / Conocimiento de las puérperas sobre la identificación y prevención de accidentes loxoscélicos

Objetivos: este estudo teve como objetivo identificar o grau de conhecimento que puérperas possuíam a respeito da aranha Loxosceles, sua picada e conduta no caso de acidente com elas ou seus filhos. Métodos: estudo transversal quantitativo, que utilizou um questionário estruturado abrangendo perfil socioeconômico, conhecimento sobre aranha-marrom e o loxoscelismo. Foram incluídas pacientes em puerpério imediato, considerado entre o primeiro e décimo dia do parto, internadas na maternidade do Hospital do Trabalhador em Curitiba-PR, entre julho e outubro de 2011. Participaram 208 puérperas, das quais oito foram excluídas porque os questionários foram preenchidos de forma incorreta. Os dados obtidos foram tabulados no programa Microsoft Excel 2007® e analisados pelos testes χ2 e Exato de Fisher. Resultados: sobre o conhecimento da aranha, 61% das puérperas afirmaram reconhecer a aranha e apontaram a imagem correta. Sobre a conduta em caso de acidente, 87,5% responderam a conduta correta, porém apenas 37% apontaram a sintomatologia correta. Hipóteses testadas mostraram que idade, escolaridade e acidente loxoscélico prévio são diretamente proporcionais ao conhecimento das participantes (p<0,05). Conclusão: a maioria das puérperas pesquisadas conhecia a aranha-marrom e grande parte reconhecia a lesão provocada pela picada, mas a gravidade da lesão foi superestimada. Contraditoriamente, o conhecimento dos sintomas foi pequeno, o que pode levar ao atraso do tratamento delas mesmas ou dos seus filhos. O conhecimento da aranha foi diretamente relacionado à idade, escolaridade e a acidente loxoscélico prévio.

Objectives: this study aimed to identify puerperal women's level of knowledge about the Loxosceles spider, its bite, and their own conduct in the event of a loxoscelic accident involving them or their children. Methods: this was a quantitative cross-sectional study using a structured questionnaire that included the socioeconomic profile of the participants, and knowledge about the brown spider and loxoscelism. Participants included postpartum women (between the first to tenth day of delivery), admitted to the maternity ward of the Hospital do Trabalhador, Curitiba-PR, between July and October 2011. From a total of 208 postpartum women, eight were excluded because the questionnaires were filled incorrectly. Data were tabulated using Microsoft Excel 2007® and analyzed using the χ2 test and Fisher's exact test. Results: regarding the knowledge about the spider, 61% of the participants said that they knew the spider and identified the correct picture. About their conduct in case of loxoscelic accidents, 87.5% gave appropriate responses, but only 37% identified the correct symptoms. Hypothesis testing revealed that age, education, and prior experience of loxoscelic accidents were directly proportional to the participants' knowledge (p<0.05). Conclusion: most of the women surveyed could identify the brown spider and largely recognized the spider's bite injury, but they overestimated its severity. On the contrary, they had little knowledge about the symptoms, which may lead to delayed treatment for them or their children. The participants' knowledge about the spider was directly related to age, education, and prior experience of a loxoscelic accident.

Objetivos: este estudio tuvo como objetivo identificar el grado de conocimiento que las puérperas tenían respeto la araña Loxosceles, su picadura y la conducta en el caso de un accidente con ellas o sus hijos. Métodos: estudio transversal cuantitativo en que se utilizó un cuestionario estructurado con el perfil socio-económico, el conocimiento sobre la araña marrón y el Loxoscelismo. Las pacientes incluidas fueron aquellas en el período inmediatamente posterior al parto, del primero hasta el décimo día puerperal, admitidas en la Maternidad y Hospital del Trabajador en Curitiba- PR, entre julio y octubre del 2011. Participaron 208 puérperas, de las cuales ocho fueron prohibidas debido a que sus cuestionarios fueron completados incorrectamente. Los datos fueron tabulados en Microsoft® Excel 2007 y analizados mediante el Test de χ2 y Exacto de Fisher. Resultados: respeto al conocimiento de la araña, el 61% de las madres dijeron reconocer la araña y apuntaron a la imagen correcta. Acerca de la conducta en caso de accidentes, el 87,5% respondieron la conducta correcta, pero sólo el 37% identificaron los síntomas correctos. Las hipótesis testadas mostraron que la edad, la educación y el accidente loxoscélico anterior son directamente proporcionales a los conocimientos de las participantes (p<0,05). Conclusión: la mayoría de las mujeres encuestadas conocía la araña marrón y en gran parte reconoció el daño causado por la picadura, pero sobrestimaran la gravedad de las lesiones. Paradójicamente, el conocimiento de los síntomas fue pequeño, lo que puede llevar al retraso del tratamiento para sí mismas o para sus hijos. El conocimiento sobre la araña estuvo directamente relacionado con la edad, la educación y el accidente loxoscélico anterior

Perfil dos acidentes com aranhas no estado de Goiásno período de 2007 a 2011 / Profile of arachnid accidents in the State of Goias, Brazil, between 2007 and 2011

Objetivos: Descrever os aspectos epidemiológicos e clínicos dos acidentes com aranhas reportados ao Centro de Informações Toxicológicasdo Estado de Goiás. Comparar e contrastar os dados de descrição e avaliação do quadro clínico e uso do soro específico com as recomendaçõesdo Ministério da Saúde e da literatura médica.Métodos: Para a coleta de dados foram utilizadas as fichas de notificação do Centro de Informações Toxicológicas de Goiás. Os dados sobrea expansão urbana foram obtidos no Instituto Brasileiro de Geografia e Estatística e através de imagens de satélite Landsat.Resultados: No período estudado, o araneísmo no estado de Goiás correspondeu a 15,91% dos acidentes com artrópodes peçonhentos,totalizando 659 casos. As duas microrregiões com maior ocorrência foram Goiânia, com 305 casos (46,28%) e Entorno de Brasília, com 69(10,47%). Houve um acometimento maior dentro da faixa etária de 20 a 39 anos. A região mais comum da picada foi o pé. O intervalo entreacidente e atendimento, na maioria dos casos, foi de uma a três horas. A dor foi o sintoma mais prevalente, podendo estar associada a edema,hiperemia e parestesia que, juntamente com sintomas vagais, determinaram a gravidade do acidente. Em 214 casos foi usada soroterapia, sendoinformado o tipo de soro em 83,17% dos mesmos. Houve uso de número excessivo de ampolas de soro de acordo com as recomendações doMinistério da Saúde em 98,87% dos casos em que o dado pôde ser levantado. Dos casos informados, 89,37% evoluíram para a cura. Os dadosnão indicam o gênero da aranha que foi agente causal dos acidentes.Conclusões: Os resultados indicam que a prevalência do araneísmo está ligada ao processo de expansão urbana. O tratamento foi em geralsatisfatório, com alto índice de cura e inexistência de óbitos. Houve uso desnecessário de soro e de um número incorreto de ampolas em muitoscasos. Os dados sugerem um distanciamento das recomendações do Ministério da Saúde, que possui protocolos claros, desde a identificaçãoda aranha até o uso de soro conforme a gravidade do caso.

Aims: To describe the epidemiological and clinical aspects of the spider accidents reported at the Center for Toxicological Information ofthe State of Goiás. To compare and contrast the data of description and evaluation of the clinical picture and use of specific serum with therecommendations of the Ministry of Health and the medical literature.Methods: The data were collected using the report notes of the Center for Toxicological Information of the State of Goiás. The data on theurban expansion were obtained at the Brazilian Institute of Geography and Statistics and through Landsat satellite images.Results: In the period of this study the spider accidents in the State of Goiás represented 15,91% of the accidents with venomous arthropods, witha total of 659 cases. The two micro regions with the highest occurrence of cases were Goiânia, with 305 cases (46,28%) and the surroundingsof Brasília, with 69 cases (10,47%). There was a higher incidence in the 20 to 39 years age group. The most common region of accident wasthe foot. The time interval between accident and first medical care, in the majority of the cases, was between one and three hours. Pain wasthe prevailing symptom, which might be associated with edema, hyperemia and paresthesia, which together with vagal symptoms determinethe gravity of the accident. In 214 cases serum therapy was used, and the type of serum was informed in 83.17%. There was use of excessivenumber of serum ampoules according to the Ministry of Health recommendations in 98,87% of the cases in which these data could be recovered.Among the notified cases, 89,37% evolved to cure. The data did not indicate the spider genus that caused the accidents.Conclusions: These results indicate that the prevalence of spider accidents is linked to the urban expansion. In general the treatment wassatisfactory, with high rate of cure and absence of deaths. There was an unnecessary use of serum and an incorrect number of ampoules inmany cases. These data suggest a detachment from the recommendations of the Ministry of Health, which possess clear protocols, fromidentification of the spider to use of serum according to the gravity of the case.

[Systemic loxoscelism presented in a pregnant patient]. / Loxoscelismo sistémico en una mujer embarazada.

BACKGROUND: Loxoscelism is a condition caused by the inoculation of a series of proteolytic enzymes through the loxosceles spider bite (violinist). Morbidity and mortality is unknown in our country. The loxoscelism toxi-syndrome of local expression may have a good prognosis; however, viscera-cutaneus or systemic form has a serious and often fatal evolution. We report a case of a systemic variant developed in a pregnant patient. CLINICAL CASE: We present the first reported case of systemic loxoscelism in a pregnant patient, highlighting the survival of the mother-son, in the presence of viscera-cutaneus behavior. We describe the natural history of clinical expression, highlighting the benefit of current therapeutic antivenom fourth generation and immunoregulation role in supporting the therapeutic approach and the guideline of the surgical approach. CONCLUSIONS: The appropriate multidisciplinary management coupled with an early use of antivenom limits the severity and the potential development of complications. Clinical suspicion is the cornerstone of therapeutic management of these patients.

INTRODUCCIÓN: el loxoscelismo se debe a la inoculación de un conjunto de enzimas proteolíticas por la mordedura de la araña Loxosceles. Puede tener una expresión local, sin embargo, la forma viscerocutánea o sistémica tiene una evolución grave. Se presenta el primer caso de la variante sistémica en una mujer embarazada. CASO CLÍNICO: mujer con embarazo normoevolutivo de 28 semanas. Después de estar expuesta a un ambiente semirrural, presentó placa plana eritematosa en el glúteo derecho, con aumento de la temperatura e hiperestesia local. Fue hospitalizada para administrarle antibióticos parenterales, por considerarse que se trataba de la picadura de un insecto. A las cuatro horas se incrementó el dolor y la paciente desarrolló deshidratación e hipotensión severas hasta llegar al choque, por lo que se inició tratamiento con cristaloides, aminas vasopresoras y protección de la vía aérea. Se realizó operación cesárea, de la que se obtuvo un niño, y se efectuó desbridación en el glúteo derecho. El diagnóstico fue loxoscelismo sistémico, por lo que se administró el antiveneno específico. La paciente fue egresada a los dos meses. CONCLUSIONES: el manejo multidisciplinario oportuno, aunado al empleo del antiveneno, limitó la severidad y el desarrollo potencial de complicaciones. La sospecha clínica es la piedra angular del tratamiento en estos pacientes.

Surgical treatment of a brown recluse spider bite: a case study and literature review.

Spider bite envenomation can cause local, constitutional, and/or systemic symptoms. The present case study reports on 5 years of follow-up for a "probable" brown recluse spider bite of the foot and ankle that was refractory to conservative treatment and was subsequently treated with surgery. The present case study reports the atypical occurrence of long-term peripheral neuropathy after necrotic arachnidism induced by "probable" brown recluse (Loxosceles recluse) envenomation, in a 46-year-old male. The state of published data suggests to minimize inflammation and tissue necrosis, prevent bacterial superinfection, and control pain levels. For patients with long-term peripheral neuropathy refractory to conservative therapy, surgical intervention may further improve their symptoms.

First Record of the Mediterranean Recluse Spider Loxosceles rufescens (Araneae: Sicariidae) from Iran.

Loxosceles rufescens, commonly known as the Mediterranean Recluse or Mediterranean Fiddle-Back Spider is recorded from Iran for the first time. The genus Loxosceles contains 103 accepted species, two of them (including L. rufescens) are cosmopolitan. All Loxosceles species tested so far possess necrotic venoms, which is a unique characteristic among the Order Araneae. Considering this characteristic, it is of medical importance to determine a specific geographical distribution of these spiders. Collecting methods include visual inspection and direct hand collecting. All of the specimens were collected in Tehran. Six specimens of both sexes were collected from parks, houses and apartments. The characteristics of the genus, which are the unique arrangement of six eyes in three diads, the violin shaped mark on the cephalothorax, and the short tibia of adult male palpi with narrow base and it's embolus which is about as long as the width of the globular bulb were observed and recorded. Having the cytotoxicity of the venom and its urban distribution in mind, L. rufescens is probably among the more important spider species of Iran. Since there are no reports of loxoscelism from Iran, we assume that the bites are either infrequent or misdiagnosed. Therefore further studies are needed to clarify the medical importance degree of this species.

Accidents caused by Phoneutria nigriventer: diagnosis and nursing interventions / Acidentes causados por Phoneutria nigriventer: diagnósticos e intervenções de enfermagem / Accidentes causados por Phoneutria nigriventer: diagnósticos e intervenciones de enfermería

Objetivo: Identificar os principais rótulos diagnósticos de enfermagem e suas respectivas intervenções de enfermagem, através das principais manifestações clínicas apresentadas pelos indivíduos intoxicados pelo veneno da aranha Phoneutria ningriventer encontradas na literatura. Método: Revisão integrativa da literatura consultada nas bases de dados PubMed e BVS, publicações impressas e sites oficiais relacionados à temática. Os rótulos diagnósticos de enfermagem foram elaborados com base na taxonomia II da North American Nursing Diagnosis Association International e o planejamento das intervenções de enfermagem de acordo com a Classificação das Intervenções de Enfermagem. Resultados: A partir dos achados, foi possível identificar oito rótulos diagnósticos e suas respectivas intervenções de enfermagem. Conclusão: Foram encontrados poucos estudos na literatura abordando as manifestações clínicas apresentadas pelos indivíduos intoxicados pelo veneno da aranha Phoneutria nigriventer e da atuação da enfermagem frente a esses casos.

Objective: To identify the main nursing diagnostic labels and the respective interventions through the main clinical manifestations presented by individuals poisoned by the venom of the spider Phoneutria nigriventer found in the literature. Method: Integrative review of literature consulted in PubMed and BVS databases, printed publications and official websites related to the theme. The nursing diagnostic labels were developed based on taxonomy II from the American Nursing Diagnosis Association International and the planning of nursing interventions in accordance with the Nursing Interventions Classification. Results: From the findings, it was possible to identify eight diagnostic labels and the respective nursing interventions. Conclusion: We found few studies addressing the clinical manifestations presented by individuals poisoned by the venom of the spider Phoneutria nigriventer and nursing performance in these cases.

Objetivo: Identificar las principales etiquetas diagnósticas de enfermería y sus respectivas intervenciones a través de las principales manifestaciones clínicas que presentan las personas intoxicadas por el veneno de la araña Phoneutria nigriventer encontradas en la literatura. Método: Revisión Integral de la literatura consultada en los bancos de datos PubMEed y BVS, publicaciones impresas y sitios web oficiales sobre el tema. Las etiquetas diagnósticas de enfermería fueron elaboradas con base en la taxonomía II de la North American Nursing Diagnosis Association International y planeamiento de las intervenciones de enfermería de acuerdo con la Clasificación de Intervenciones de Enfermería. Resultados: A través de los resultados fue posible identificar ocho etiquetas de diagnóstico y las respectivas intervenciones de enfermería. Conclusión: Se encontraron pocos los estudios de las manifestaciones clínicas que presentan las personas envenenadas por el veneno de la araña Phoneutria nigriventer y la actuación de enfermería en estos casos.

Loxoscelismo cutáneo: revisión narrativa de un problema actual / Cutaneous loxoscelism: narrative review of a current problem

The endemic presence of Loxosceles laeta species in Chile determines a constant validity of loxoscelism in clinical practice. Among their clinical scope, cutaneous loxoscelismis the most common presentation and it usually requires surgical management. The objective of this article is to review basic knowledge, epidemiologic data, clinical and therapeutic knowledge and advances in this disease based on the available evidence. Evidence does not support the routinary use of any pharmacological agent in cutaneous loxoscelism. General therapeutic measures, adequate analgesia, the delimitation of thedermonecrotic area and in cases if needed a conservative surgical approach are recommended. The use of antibiotics should be restricted to cases of concomitant infection. Emphasis should be on prevention of these injuries, stressing the importance of early consultation in the emergency service, and monitoring for signs and symptoms of the systemic compromise. A conservative surgical approach minimizes unnecessary morbidity.

Documented bites by a yellow sac spider (Cheiracanthium punctorium) in Italy: a case report

In Italy reports of human envenomations by yellow sac spiders have been sporadic. Since increasing clinical information would improve understanding of the danger of yellow sac spiders to humans, we report the case of a 7-year-old child and her father bitten by a documented Cheiracanthium punctorium. They developed acute persistent pain with local skin signs and numbness, and required emergency treatment. The father recovered completely within 1 to 2 hours and the child within 3 to 4 days after treatment, probably as a result of spontaneous evolution. Clinicians should be aware of the risks and immediate management of spider bites.(AU)

Perfil dos acidentes causados por aranhas na área de abrangência sanitáriado município de juiz de fora - MG / Parachnidism epidemiology in Juiz de Fora, Minas Gerais, Brazil

= 348), com evolução para a cura em 82,3% (n = 357) doscasos. Os indivíduos acometidos eram, frequentemente,O araneísmo constitui um problema de saúde pública. Osgêneros Phoneutria, Loxosceles e Latrodectus são referenciadosna literatura como responsáveis por cerca de 81,0% dosacidentes causados por animais peçonhentos que ocorremem nosso país, representando cerca de 5000 acidentes/ano. O município de Juiz de Fora/MG situa-se em áreaendêmica para estes animais. Assim, o objetivo deste estudofoi verificar o perfil dos acidentes causados por aranhasna área de abrangência sanitária do município de Juiz deFora. Tratou-se de um estudo descritivo e retrospectivodo araneísmo entre janeiro de 2002 e dezembro de 2007.Os dados foram obtidos a partir do Sistema de Informaçãode Agravos de Notificação (SINAN), disponíveis noDepartamento de Vigilância Epidemiológica de Juiz deFora e analisados com o auxílio do Programa StatisticalPackage for the Social Sciences, versão 14.0. Foram registradas1500 notificações de acidentes causados por animaispeçonhentos, dos quais 28,9% (n = 434) foram provocadospor aranhas. O gênero Phoneutria foi responsável por 45,4%(n = 197) dos casos e Loxosceles, por 5,1% (n = 22) e, em39,2% dos casos, o gênero do animal foi ignorado. A maioriados acidentes (80,2%) ocorreu no município sede, compredominância da zona urbana (50,0%, n = 217) sobre arural (46,5%; n = 202). A maior parte das vítimas (52,1%;n = 226) foi atendida em até 3 horas após o acidente. Osmembros superiores foram os mais atingidos (44,6%; n =193), com destaque para os dedos da mão (24,7%; n = 107).A soroterapia foi realizada em apenas 3,2% (n = 14) doscasos. Os acidentes leves foram mais frequentes (80,2%, ndo sexo masculino (66,6%; n = 289), raça branca (23,7%;n = 103) e possuíam de 4 a 7 anos de estudo em 8,1% (n= 348), com evolução para a cura em 82,3% (n = 357) doscasos. Os indivíduos acometidos eram, frequentemente,= 35) das notificações. Indivíduos com idades entre 16 e60 anos foram acometidos em 72,6% (n = 315) dos envenenamentos.O número de acidentes por aracnídeos naregião indica a necessidade de elaboração de estratégias decontrole e programas de prevenção de acidentes.

Factores asociados a la presentación víscero-hemolítica de loxoscelismo en el Hospital Nacional Cayetano Heredia, entre el 2000 y 2008 / Factors associated with visceral-hemolytic loxoscelism in Hospital Nacional Cayetano Heredia between 2000 and 2008

Objetivos: Determinar los factores asociados a la forma víscero hemolítica de loxoscelismo en pacientes admitidos al Hospital Nacional Cayetano Heredia y describir las características clínico epidemiológicas de esta enfermedad. Material y método: Estudio de casos y controles que incluyó a los pacientes hospitalizados en la institución indicada entre el 2000 y 2008 por loxoscelismo víscero-hemolítico (casos) y loxoscelismo cutáneo (controles), de acuerdo a definiciones operativas. Las variables fueron analizadas en un modelo de regresión logística ajustado por potenciales factores de confusión. Resultados: Se incluyeron 48 casos y 89 controles; no se encontraron diferencias en la media de las edades (33 años +/- 18 vs. 31 años +/- 20, p=0,27). En el análisis multivariado, la presentación víscero-hemolítica se asoció con la presencia de mordedura en el tórax (ORa 6,6; IC95% 1,5 a 28,7) y de manifestaciones sistémicas en las primeras 24 horas de la admisión, incluyendo fiebre (ORa 3,2; IC95% 1,3 a 8,1) y mal estado general (ORa 3,3; IC95% 1,3 a 8,1). La mortalidad fue de 18% en los casos y 0% en los controles. Conclusiones: La mordedura en tórax y la presencia de fiebre y malestado general durante las primeras 24 horas están asociadas al desarrollo de la forma víscero-hemolítica de loxoscelismo en este escenario.

Objectives: To determine clinical factors associated with the occurrence of visceral-hemolytic loxoscelism in patients admitted to Hospital Nacional Cayetano Heredia, and to describe both clinical and epidemiological features of this condition. Material and method: We conducted a case-control study including patients admitted to Hospital Nacional Cayetano Heredia in Lima, Peru, with a diagnosis of visceral-hemolytic loxoscelism (cases) and cutaneous loxoscelism (controls), between years 2000 and 2008. Variable were analyzed using a logistic regression model adjusting for potential confounding factors. Results: Forty-nine cases and 89 controls were included. Age of patients was similar in both groups (33 +/- 18 years vs. 31 +/- 20 years, p= 0,27). Visceral-hemolytic loxoscelism was associated with spider bites located in the thorax (OR: 7.3; 95% CI: 1.3-41.0) and with systemic manifestations, including fever (OR: 3.2, 95% CI: 1.3-8,1) and a poor general condition (OR: 3.3; 95% CI: 1.3-8.1). Mortality rates were 18% in cases and 0% in controls. Conclusions: Spider bites located in the thoracic area and the presence of fever and a poor general condition during the first 24 hours of hospitalization are associated with the occurrence of visceral-hemolyticloxoscelism.