title: Clinical presentation and outcome of brown recluse spider bite.
abstract: OBJECTIVE
  To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites.
  
  
  METHODS
  We assembled a retrospective case of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures were the need for skin grafting and the development of other complications.
  
  
  RESULTS
  The mean age of our subjects was 34 +/- 17 years. Thirteen patients (12%) brought the spider to the hospital, 22 (20%) saw a spider at the time of the bite, and an exclusively clinical diagnosis was made in the remaining 76 (68%). Most wounds (59%) involved the leg. At the time of presentation, 81% had central discoloration and 37% necrosis. Sixteen patients (14%) were systemically ill, and 6 (5%) were admitted to the hospital. Most (86%) were treated with antibiotics. Dapsone was infrequently used (9%) and had usually been prescribed before the patient's presentation to our ED. Only three patients (3%; 95% confidence interval, 1% to 8%) required grafting. Mild hemolytic anemia developed in one patient, and another had mild hemolysis and a mild coagulopathy; neither patient was taking dapsone. No deaths or serious complications occurred in our study group.
  
  
  CONCLUSIONS
  In our series, long-term outcome after brown recluse spider bite was good. Serious complications were rare, as was the need for skin grafting. Because the vast majority of bites heal with supportive care alone, aggressive medical therapy does not appear warranted.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Wright
authors.forename: K D
authors.initials: KD
authors.lastname: Wrenn
authors.forename: L
authors.initials: L
authors.lastname: Murray
authors.forename: D
authors.initials: D
authors.lastname: Seger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003622:Dapsone / Q000627:therapeutic use; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007866:Leg; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation; D001098:Spider Bites / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D003622:Dapsone