title: Systemic envenomation caused by the wandering spider Phoneutria nigriventer, with quantification of circulating venom.
abstract: BACKGROUND
  Bites by Phoneutria spp. spiders are common in Brazil, although only 0.5-1% result in severe envenomation, with most of these occurring in children. Cases of systemic envenomation in adults are very unusual, and no serum venom levels have been previously quantified in these cases.
  
  
  METHODS
  A 52-year-old man was bitten on the neck by an adult female Phoneutria nigriventer. Immediately after the bite, there was intense local pain followed by blurred vision, profuse sweating, tremors, and an episode of vomiting; 1-2 h post bite the patient showed agitation and a blood pressure of 200/130 mmHg, and was given captopril and meperidine. Upon admission to our service 4 h post bite (time zero - T0), his blood pressure was 130/80 mmHg with a heart rate of 150 beats/min, mild tachypnea, agitation, cold extremities, profuse sweating, generalized tremors, and priapism. The patient was treated with antivenom, local anesthetic, and fluid replacement. Most of the systemic manifestations disappeared within 1 h after antivenom. Laboratory blood analyses at T0, T1, T6, T24, and T48 detected circulating venom by ELISA only at T0, before antivenom infusion (47.5 ng/mL; cut-off, 17.1 ng/mL); his serum blood sugar was 163 mg/dL at T0. The patient was discharged on the second day with a normal arterial blood pressure and a follow-up evaluation revealed no sequelae.
  
  
  CONCLUSIONS
  This is the first report of confirmed moderate/severe envenoming in an adult caused by P. nigriventer with the quantification of circulating venom.
authors.affiliation: Pediatrics, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil. bucaret@fcm.unicamp.br
authors.forename: Fábio
authors.initials: F
authors.lastname: Bucaretchi
authors.forename: Sueli Moreira
authors.initials: SM
authors.lastname: Mello
authors.forename: Ronan José
authors.initials: RJ
authors.lastname: Vieira
authors.forename: Ronei Luciano
authors.initials: RL
authors.lastname: Mamoni
authors.forename: Maria Heloísa Souza Lima
authors.initials: MH
authors.lastname: Blotta
authors.forename: Edson
authors.initials: E
authors.lastname: Antunes
authors.forename: Stephen
authors.initials: S
authors.lastname: Hyslop
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002216:Captopril / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D001098:Spider Bites / Q000188:drug therapy / Q000503:physiopathology*; D013111:Spider Venoms / Q000493:pharmacokinetics / Q000506:poisoning*; D013112:Spiders; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D000997:Antivenins; D013111:Spider Venoms; D008614:Meperidine; D002216:Captopril