Spider bite

Spider bite
Other names: Arachnidism
Fangs of a black wishbone spider
SpecialtyEmergency medicine
SymptomsWidow bite: Pain, sweating, muscle twitching, headache, vomiting[1]
Recluse bite: Pain, skin death and breakdown, red blood cell breakdown[1]
CausesSpiders[1]
Diagnostic methodBased on symptoms[1]
Differential diagnosisMRSA skin infections, insect bite, IVDU[2]
PreventionClearing clutter, pesticides[1][3]
TreatmentSupportive (NSAIDs, antihistamines)[4]
FrequencyUnclear[5]
DeathsRare[1][6]

A spider bite is an injury resulting from the bite of a spider.[2] Most spiders do not cause bites that are of importance as there fangs are unable to penetrate the skin.[1][2] Most of the time there is only mild symptoms around the area of the bite.[1] Onset of symptoms may occur 30 minutes to 7 days after the bite.[5] Deaths are rare, with in the United States less than 3 per year.[6][2]

The main exceptions are widow spiders and recluse spiders.[1] Widow bites may result in latrodectism, with pain that is localized or generalized, sweating, muscle twitching, headache, and vomiting.[1] Recluse bites may result in loxoscelism, which begins with mild pain and redness and can progress to skin death and breakdown.[1] Headaches, vomiting, fever, and red blood cell breakdown may occur.[1] Other significant bites include the Australian funnel-web spider and South American wandering spider.[1] Diagnosis is generally based on symptoms and seeing the spider.[1]

Prevention include clearing clutter and the use of pesticides.[1][3] Most bites are managed with supportive care such as NSAIDs for pain and antihistamines and steroid creams for itchiness.[4][2] Opioids may be used if the pain is severe.[4] While an antivenom exists for widow venom, it may result in anaphylaxis and therefore not commonly used in the United States.[4] Antivenom for funnel web spider venom improves outcomes.[1] Surgery may be required to repair the area of injured skin from some recluse bites.[4]

Spider bite reports are common.[6] They; however, may be overdiagnosed or misdiagnosed.[1] In many reports it is unclear if a bite actually occurred.[7] In the Middle Ages, a condition where people danced wildly, known as tarantism, was claimed to be from a spider bite.[8] While necrosis has been claims for a number of spiders, evidence only supports it in recluse bites.[1]

Signs and symptoms

A Brazilian man 31 hours after having been bitten on his face by a recluse spider
4 months after a brown recluse spider bite with scar remaining

Almost all spiders are venomous, but not all spider bites result in the injection of venom. Pain from non-venomous, so-called "dry bites" typically lasts for 5 to 60 minutes while pain from envenomating spider bites may last for longer than 24 hours.[9] Bleeding also may occur with a bite. Signs of a bacterial infection due to a spider bite occur infrequently (0.9%).[9]

A study of 750 definite spider bites in Australia indicated that 6% of spider bites cause significant effects, the vast majority of these being redback spider bites causing significant pain lasting more than 24 hours.[10] Activation of the sympathetic nervous system can lead to sweating, high blood pressure and gooseflesh.[11]

Most recluse spider bites are minor with little or no necrosis. However, a small number of bites produce necrotic skin lesions. First pain and tenderness at the site begin. The redness changes over two to three days to a bluish sinking patch of dead skin—the hallmark of necrosis. The wound heals slowly over months but usually completely.[12] Rarely, bites may cause widespread symptoms, with occasional fatalities.[13]

There are a few spiders that can bite human skin and cause a skin reaction, but spiders are blamed for many more reactions. In particular the misdiagnosis of infections and other skin ailments are commonly attributed to brown recluses.[14]

Spiders associated with skin reactions
Scientific nameCommon nameVenomReaction
Lampona spp[15][16] White-tailed Welt
Loxosceles spp[14]Brown recluseSphingomyelinase Necrosis
Cheiracanthium sppSacLipase Redness
Tegenaria agrestis[17]Hobo Redness
Lycosidae spp[18][19]Wolf Redness, itching
  • Spider bite-day 1
    Spider bite-day 1
  • Spider bite-day 2
    Spider bite-day 2
  • Spider bite-day 3
    Spider bite-day 3

Cause

Main article: List of medically significant spider bites

Spiders do not feed on humans and typically bites occur as a defense mechanism.[20] This can occur from unintentional contact or trapping of the spider.[20] Most spiders have fangs too small to penetrate human skin.[21] Most bites by species large enough for their bites to be noticeable will have no serious medical consequences.[22]

Medically significant spider venoms include various combinations and concentrations of necrotic agents, neurotoxins, and pharmacologically active compounds such as serotonin. Worldwide only two spider venoms have impact on humans—those of the widow and recluse spiders. Unlike snake and scorpion envenomation,[23] widow and recluse species bites rarely have fatal consequences. However, isolated spider families have a lethal neurotoxic venom: the wandering spider in Brazil and the funnel web in Australia. However, due to limited contact between these spiders and humans, deaths have always been rare, and since the introduction of anti-venom in Australia, there have been no funnel web related deaths.[24]

Pathophysiology

Main article: Pathophysiology of spider bites

A primary concern of the bite of a spider is the effect of its venom. A spider envenomation occurs whenever a spider injects venom into the skin. Not all spider bites involve injection of venom, and the amount of venom injected can vary based on the type of spider and the circumstances of the encounter. The mechanical injury from a spider bite is not a serious concern for humans. However, it is generally the toxicity of spider venom that poses the most risk to human beings; several spiders are known to have venom that can cause injury to humans in the amounts that a spider could inject when biting. While venoms are by definition toxic substances, most spiders do not have venom that is directly toxic (in the quantities delivered) to require medical attention and, of those that do, severity is typically mild.

Spider venoms work on one of two fundamental principles; they are either neurotoxic (attacking the nervous system) or necrotic (attacking tissues surrounding the bite). In some cases, the venom affects vital organs and systems. The venoms of the widow spiders, Brazilian wandering spider and Australian funnel-web are neurotoxic. Heart muscle damage is an unusual complication of widow venom that may lead to death.[25] Pulmonary edema, which is fluid accumulation in the lungs, is a feared and potentially serious but uncommon complication of funnel-web venom.[24] Recluse and South African sand spider venoms are necrotic. Recluse venom may also cause severe hemolysis (destruction of red blood cells), though this is typically uncommon.[26]

Diagnosis

Reliable diagnoses of spider bites require three conditions: first, there should be clinical effects of the bite at the time or soon afterwards, although there are no symptoms universally diagnostic of a spider bite, and bites by some spiders, e.g. Loxosceles species, may initially be painless; second, the spider should be collected, either at the time of the bite or immediately afterwards; and third, the spider should be identified by an expert arachnologist.[27][7]

Spider bites are commonly misdiagnosed. A review published in 2016 showed that 78% of 134 published medical case studies of supposed spider bites did not meet the necessary criteria for a spider bite to be verified. In the case of the two genera with the highest reported number of bites, Loxosceles and Latrodectus, spider bites were not verified in over 90% of the reports. Even when verification had occurred, details of the treatment and its effects were often lacking.[7] Unverified bite reports likely represent many other conditions, both infectious and non-infectious, which can be confused with spider bites.[28] Many of these conditions are far more common and more likely to be the source of necrotic wounds.[29] An affected person may think that a wound is a spider bite when it is actually an infection with methicillin-resistant Staphylococcus aureus (MRSA).[30] False reports of spider bites in some cases have led to misdiagnosis and mistreatment, with potentially life-threatening consequences.[31]

Prevention

Efforts to prevent bites include clearing clutter and the use of pesticides.[1]

OSHA recommends that workers take following measures to prevent spider bite:

  • Wear a long-sleeved shirt, hat, gloves, and boots when handling boxes, firewood, lumber, rocks, etc.
  • Inspect and shake out clothing and shoes before getting dressed.
  • Use insect repellents, such as DEET or picaridin, on clothing and footwear.[32][33]

Management

Most spider bites are harmless, and require no specific treatment. Treatment of bites may depend on the type of spider; thus, capture of the spider—either alive, or in a well-preserved condition, is useful.[34][35]

Treatment of spider bites includes washing the wound with soap and water and ice to reduce inflammation.[36] Analgesics and antihistamines may be used; however, antibiotics are not recommended unless there is also a bacterial infection present.[36] Black widow post-envenomation treatment seeks to control resulting pain and nausea.

In the case of bites by widow spiders, Australian funnel-web spiders, or Brazilian wandering spiders, medical attention should be sought immediately as in some cases the bites of these spiders develop into a medical emergency.[37][38] Antivenom is available for severe widow and funnel-web envenomation.[1]

Necrosis

In almost all cases, recluse bites are self-limited and typically heal without any medical intervention.[29] Recommendations to limit the extent of damage include elevation and immobilization of the affected limb, application of ice. Both local wound care, and tetanus prophylaxis, are simple standards. There is no established treatment for more extensive necrosis. Many therapies have been used including hyperbaric oxygen, dapsone, antihistamines (e.g., cyproheptadine), antibiotics, dextran, glucocorticoids, vasodilators, heparin, nitroglycerin, electric shock, curettage, surgical excision, and antivenom. None of these treatments conclusively show benefit. Studies have shown surgical intervention is ineffective and may worsen outcome. Excision may delay wound healing, cause abscesses, and lead to objectionable scarring.[39]

Dapsone, an antibiotic, is commonly used in the United States and Brazil for the treatment of necrosis. There have been conflicting reports with some supporting its efficacy and others have suggested it should no longer be used routinely, if at all.[40]

Antivenom

Use of antivenom for severe spider bites may be indicated, especially in the case of neurotoxic venoms.[41] Effective antivenoms exist for Latrodectus, Atrax, and Phoneutria venom. Antivenom in the United States is in intravenous form but is rarely used, as anaphylactic reaction to the antivenom has resulted in deaths. In Australia, antivenom in intramuscular form was once commonly used, but use has declined. In 2014 some doubt as to antivenom effectiveness has been raised.[42][43] In South America an antivenom is available for Loxosceles bites, and it appears antivenom may be the most promising therapy for recluse bites. However, in experimental trials recluse antivenom is more effective when given early, and patients often do not present for 24 or more hours after envenomation, possibly limiting the effect of such intervention.[44]

Epidemiology

Estimating the number of spider bites that occur is difficult as the spider involvement may not be confirmed or identified.[21] Several researchers recommend only evaluating verified bites: those that have an eyewitness to the bite, the spider is brought in, and identified by expert. With "suspected arachnidism" the diagnosis came without a spider positively identified.[29]

Africa

Several Latrodectus species (button spiders) live in Africa. South Africa also has six-eyed sand spiders (Hexophthalma species), whose bite may potentially cause skin necrosis. Physicians are advised that the diagnosis may be difficult without a spider.[45]

Australia

Bites by the redbacks (Latrodectus hasselti) number a few thousand yearly throughout the country. Antivenom use is frequent but declining.[43] Children may have less complications of bite.[46] Funnel web spider bites are few 30–40 per year and 10% requiring intervention. The Sydney funnel web and related species are only on the east coast of Australia.[47][10]

Europe

In Switzerland about ten to one hundred spider bites occur per one million people per year.[48] During epidemics of latrodectism from the European black widow upwards of 150 bites a year were documented.[49]

North America

The American Association of Poison Control Centers reported that they received calls regarding nearly 10,000 spider bites in 1994.[21] The spiders of most concern in North America are brown recluse spiders, with nearly 1,500 bites in 2013[50] and black widow spiders with 1,800 bites.[50] The native habitat of brown recluse spiders is in the southern and central United States, as far north as Iowa. Encounters with brown recluse outside this native region are very rare and bites are thought to be suspect.[29] A dozen major complications were reported in 2013.[50][51]

South America

Numerous spider bites are recorded in Brazil with 5000+ annually. Loxosceles species are responsible for the majority of reports. Accidents are concentrated in the southern state of Parana with rates as high as 1 per 1,000 people.[52] Bite from Phoneutria (Brazilian wandering spider) number in the thousands with most being mild. Severe effects are noted in 0.5% of cases, mostly in children.[53]

History

Recorded treatment from the 1890s for spider bites in general was rubbing in tobacco juice to the bitten skin,[54] similar to some of the traditional uses of the tobacco plant for various bites and stings from Central and South America. Wild dancing and music was the cure for tarantism— the frenzy was believed to arise from the bite of a spider.[55] An antivenom was developed against wolf spiders in Brazil and used for decades. Wolf spiders have since been exonerated—they never caused illness.[56]

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Isbister, GK; Fan, HW (10 December 2011). "Spider bite". Lancet. 378 (9808): 2039–47. doi:10.1016/s0140-6736(10)62230-1. PMID 21762981. S2CID 27408940.
  2. 1 2 3 4 5 "Spider Bites - Injuries; Poisoning". MSD Manual Professional Edition. Archived from the original on 30 December 2021. Retrieved 1 August 2022.
  3. 1 2 "Venomous Spiders: Recommendations for Employers & Workers | NIOSH | CDC". www.cdc.gov. 15 September 2021. Archived from the original on 12 May 2022. Retrieved 1 August 2022.
  4. 1 2 3 4 5 Kang, JK; Bhate, C; Schwartz, RA (September 2014). "Spiders in dermatology" (PDF). Seminars in Cutaneous Medicine and Surgery. 33 (3): 123–27. doi:10.12788/j.sder.0107. PMID 25577851. Archived from the original (PDF) on 2015-02-14. Retrieved 2021-03-24.
  5. 1 2 Diaz, JH; Leblanc, KE (15 March 2007). "Common spider bites". American family physician. 75 (6): 869–73. PMID 17390599.
  6. 1 2 3 Braitberg, George (2009). "spider bites: Assessment and management" (PDF). Australian Family Physician. 38 (11): 862–67. PMID 19893831. Archived from the original (PDF) on 2013-11-01. Retrieved 2021-03-24.
  7. 1 2 3 Stuber, Marielle; Nentwig, Wolfgang (2016). "How informative are case studies of spider bites in the medical literature?". Toxicon. 114: 40–44. doi:10.1016/j.toxicon.2016.02.023. PMID 26923161.
  8. ↑ Donaldson, LJ; Cavanagh, J; Rankin, J (July 1997). "The dancing plague: a public health conundrum". Public Health. 111 (4): 201–04. doi:10.1016/s0033-3506(97)00034-6. PMID 9242030.
  9. 1 2 "Global Family Doctor". Archived from the original on 2012-03-13.
  10. 1 2 Isbister GK, Gray MR (November 2002). "A prospective study of 750 definite spider bites, with expert spider identification". QJM. 95 (11): 723–31. doi:10.1093/qjmed/95.11.723. PMID 12391384.
  11. ↑ Offerman, SR; Daubert, GP; Clark, RF (Summer 2011). "The treatment of black widow spider envenomation with antivenin latrodectus mactans: a case series". The Permanente Journal. 15 (3): 76–81. doi:10.7812/tpp/10-136. PMC 3200105. PMID 22058673.
  12. ↑ Sandlin, Nina (5 August 2002). "Convenient culprit: Myths surround the brown recluse spider". American Medical Association. Archived from the original on 13 March 2015. Retrieved 2 March 2015.
  13. ↑ Vetter, RS (June 2013). "Spider envenomation in North America". Critical Care Nursing Clinics of North America. 25 (2): 205–23. doi:10.1016/j.ccell.2013.02.006. PMID 23692939.
  14. 1 2 Stoecker, William V.; Vetter, Richard S.; Dyer, Jonathan A. (2017-05-01). "NOT RECLUSE – A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites". JAMA Dermatology. 153 (5): 377–78. doi:10.1001/jamadermatol.2016.5665. ISSN 2168-6068. PMID 28199453.
  15. ↑ White, Julian; Weinstein, Scott A. (2014). "A phoenix of clinical toxinology: White-tailed spider (Lampona spp.) bites. A case report and review of medical significance". Toxicon. 87: 76–80. doi:10.1016/j.toxicon.2014.05.021. PMID 24923740.
  16. ↑ Isbister, G. K.; Gray, M. R. (2003-08-18). "White-tail spider bite: a prospective study of 130 definite bites by Lampona species". Medical Journal of Australia. 179 (4): 199–202. doi:10.5694/j.1326-5377.2003.tb05499.x. PMID 12914510. Archived from the original on 2010-08-08. Retrieved 2021-03-24.
  17. ↑ McKeown, Nathanael; Vetter, Richard S.; Hendrickson, Robert G. (2014). "Verified spider bites in Oregon (USA) with the intent to assess hobo spider venom toxicity". Toxicon. 84: 51–55. doi:10.1016/j.toxicon.2014.03.009. PMID 24726469.
  18. ↑ Lucas, Sylvia M. (December 2015). "The history of venomous spider identification, venom extraction methods and antivenom production: a long journey at the Butantan Institute, São Paulo, Brazil". Journal of Venomous Animals and Toxins Including Tropical Diseases. 21 (1): 21. doi:10.1186/s40409-015-0020-0. ISSN 1678-9199. PMC 4470033. PMID 26085831.
  19. ↑ Isbister, Geoffrey K.; Framenau, Volker W. (5 November 2004). "Australian Wolf Spider Bites (Lycosidae): Clinical Effects and Influence of Species on Bite Circumstances". Journal of Toxicology: Clinical Toxicology. 42 (2): 153–61. doi:10.1081/CLT-120030941. PMID 15214620. S2CID 24310728.
  20. 1 2 "Workplace Safety & Health Topics Venomous Spiders". cdc.gov. February 24, 2012. Archived from the original on 13 February 2015. Retrieved 15 February 2015.
  21. 1 2 3 Diaz, JH (August 2004). "The global epidemiology, syndromic classification, management, and prevention of spider bites". The American Journal of Tropical Medicine and Hygiene. 71 (2): 239–50. doi:10.4269/ajtmh.2004.71.2.0700239. PMID 15306718.
  22. ↑ "Spider Bite First Aid". firstaidkits.org. Archived from the original on 2016-03-03. Retrieved 2007-08-23.
  23. ↑ Chippaux, JP; Goyffon, M (August 2008). "Epidemiology of scorpionism: a global appraisal". Acta Tropica. 107 (2): 71–9. doi:10.1016/j.actatropica.2008.05.021. PMID 18579104.
  24. 1 2 Isbister, GK; Gray, MR (February 2004). "Bites by Australian mygalomorph spiders (Araneae, Mygalomorphae), including funnel-web spiders (Atracinae) and mouse spiders (Actinopodidae: Missulena spp)". Toxicon. 43 (2): 133–40. doi:10.1016/j.toxicon.2003.11.009. PMID 15019472.
  25. ↑ Erdur, B; Turkcuer, I; Bukiran, A; Kuru, O; Varol, I (February 2007). "Uncommon cardiovascular manifestations after a Latrodectus bite". The American Journal of Emergency Medicine. 25 (2): 232–5. doi:10.1016/j.ajem.2006.11.005. PMID 17276832.
  26. ↑ Manríquez, JJ; Silva, S (October 2009). "[Cutaneous and visceral loxoscelism: a systematic review]". Revista Chilena de Infectologia. 26 (5): 420–32. PMID 19915750.
  27. ↑ Isbister, Geoffrey K & White, Julian (2004), "Clinical consequences of spider bites: recent advances in our understanding", Toxicon, 43 (5): 477–492, doi:10.1016/j.toxicon.2004.02.002, PMID 15066408
  28. ↑ Vetter, R.S. (2008). "Spiders of the genus Loxosceles (Araneae, Sicariidae): a review of biological, medical and psychological aspects regarding envenomations". The Journal of Arachnology. 36: 150–163. doi:10.1636/RSt08-06.1. S2CID 7746032.
  29. 1 2 3 4 Swanson, DL; Vetter, RS (17 February 2005). "Bites of brown recluse spiders and suspected necrotic arachnidism". The New England Journal of Medicine. 352 (7): 700–07. doi:10.1056/nejmra041184. PMID 15716564.
  30. ↑ "Methicillin-resistant Staphylococcus aureus (MRSA) Infections". cdc.gov. September 10, 2013. Archived from the original on 15 February 2015. Retrieved 15 February 2015.
  31. ↑ Vetter, R. S. (2000). "Myth: idiopathic wounds are often due to brown recluse or other spider bites throughout the United States". Western Journal of Medicine. 173 (5): 357–358. doi:10.1136/ewjm.173.5.357. PMC 1071166. PMID 11069881.
  32. ↑ "Protect yourself! Workers may be exposed to Black Widow Spider" (PDF). OSHA Fact Sheet. October 2005. Archived (PDF) from the original on August 9, 2016. Retrieved July 13, 2016.
  33. ↑ "Protect yourself! Workers may be exposed to Brown Recluse spider" (PDF). OSHA. October 2015. Archived (PDF) from the original on August 9, 2016. Retrieved July 13, 2016.
  34. ↑ Spiders Archived 2013-10-29 at the Wayback Machine, Retrieved December 1, 2013
  35. ↑ Spider bites Archived 2016-07-10 at the Wayback Machine, Retrieved December 1, 2013
  36. 1 2 Diaz, JH; Leblanc, KE (15 March 2007). "Common spider bites". American Family Physician. 75 (6): 869–73. PMID 17390599.
  37. ↑ Spider bites: First aid Archived 2016-07-05 at the Wayback Machine, Retrieved December 1, 2013
  38. ↑ "Spider Bites". Health Direct Australia. Archived from the original on 2021-04-12. Retrieved 2021-03-24.
  39. ↑ Rees R, Altenbern D, Lynch J, King L (1985). "Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision". Ann Surg. 202 (5): 659–63. doi:10.1097/00000658-198511000-00020. PMC 1250983. PMID 4051613.
  40. ↑ Bryant S, Pittman L (2003). "Dapsone use in Loxosceles reclusa envenomation: is there an indication?". Am J Emerg Med. 21 (1): 89–90. doi:10.1053/ajem.2003.50021. PMID 12563594.
  41. ↑ Espino-Solis GP, Riaño-Umbarila L, Becerril B, Possani LD (March 2009). "Antidotes against venomous animals: state of the art and prospectives". Journal of Proteomics. 72 (2): 183–99. doi:10.1016/j.jprot.2009.01.020. PMID 19457345.
  42. ↑ Isbister, GK; Page, CB; Buckley, NA; Fatovich, DM; Pascu, O; MacDonald, SP; Calver, LA; Brown, SG; RAVE, Investigators (December 2014). "Randomized controlled trial of intravenous antivenom versus placebo for latrodectism: the second Redback Antivenom Evaluation (RAVE-II) study". Annals of Emergency Medicine. 64 (6): 620–8.e2. doi:10.1016/j.annemergmed.2014.06.006. hdl:2123/14928. PMID 24999282.
  43. 1 2 Isbister, GK; Gray, MR (21 July 2003). "Latrodectism: a prospective cohort study of bites by formally identified redback spiders". The Medical Journal of Australia. 179 (2): 88–91. doi:10.5694/j.1326-5377.2003.tb05442.x. PMID 12864719.
  44. ↑ Isbister G, Graudins A, White J, Warrell D (2003). "Antivenom treatment in arachnidism". J Toxicol Clin Toxicol. 41 (3): 291–300. doi:10.1081/CLT-120021114. PMID 12807312. S2CID 37946164.
  45. ↑ Muller GJ, Wium CA, Marks C, Plessis CE, Veale DJ (2012). "Spider bite in southern Africa: diagnosis and management". CME. 30 (10): 382–391.
  46. ↑ Mead, H.J.; Jelinek, G.A. (August 1993). "Red-back spider bites to Perth children, 1979-1988". Journal of Paediatrics and Child Health. 29 (4): 305–308. doi:10.1111/j.1440-1754.1993.tb00518.x. PMID 8373679. S2CID 25640556.
  47. ↑ Braitberg, G; Segal, L (November 2009). "Spider bites—Assessment and management". Australian Family Physician. 38 (11): 862–7. PMID 19893831.
  48. ↑ Nentwig, Wolfgang; Gnädinger, Markus; Fuchs, Joan; Ceschi, Alessandro (October 2013). "A two year study of verified spider bites in Switzerland and a review of the European spider bite literature". Toxicon. 73: 104–110. doi:10.1016/j.toxicon.2013.07.010. PMID 23872119.
  49. ↑ Bettini, S (October 1964). "Epidemiology of Latrodectism". Toxicon. 2 (2): 93–102. doi:10.1016/0041-0101(64)90009-1. PMID 14301291.
  50. 1 2 3 Mowry, James B.; Spyker, Daniel A.; Cantilena, Louis R.; McMillan, Naya; Ford, Marsha (December 2014). "2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report". Clinical Toxicology. 52 (10): 1032–1283. doi:10.3109/15563650.2014.987397. PMC 4782684. PMID 25559822.
  51. ↑ The California Poison Control System > Spider bites Archived 2012-01-20 at the Wayback Machine, managed by the University of California. Retrieved July 2010
  52. ↑ Marques-da-Silva, E.; Souza-Santos, R.; Fischer, M. L.; Rubio, G. B. G. (2006). "Loxosceles spider bites in the state of Paraná, Brazil: 1993-2000". Journal of Venomous Animals and Toxins Including Tropical Diseases. 12 (1). doi:10.1590/S1678-91992006000100009.
  53. ↑ Bucaretchi, Fábio; Deus Reinaldo, Cláudia Regina de; Hyslop, Stephen; Madureira, Paulo Roberto; De Capitani, Eduardo Mello; Vieira, Ronan José (February 2000). "A clinico-epidemiological study of bites by spiders of the genus Phoneutria". Revista do Instituto de Medicina Tropical de São Paulo. 42 (1): 17–21. doi:10.1590/S0036-46652000000100003. PMID 10742722.
  54. ↑ Rawson, Wilhelmina (1894). Australian Enquiry Book of Household and General Information . Pater & Knapton, Printers & Publishers. p. 165 – via Wikisource. [scan Wikisource link]
  55. ↑ "Tarantism: Form of Hysteria". Encyclopædia Britannica. Archived from the original on 2 April 2015. Retrieved 22 March 2015.
  56. ↑ Crawford, Rod. "Myths, Misconceptions, and Superstitions About Spiders". Burke Museum. University of Washington. Archived from the original on 17 March 2015. Retrieved 22 March 2015.
Classification
External resources
This article is issued from Offline. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.