title: Complications and outcomes of brown recluse spider bites in children.
abstract: Brown recluse spider bites may cause severe local and systemic morbidity, but data regarding morbidity in children are limited. This study reviewed inpatient medical records (n = 26; 10 years) with a discharge diagnosis of "spider bite" from a tertiary pediatric hospital. The majority (85%) of children had an inflammatory response accompanying necrosis, usually with signs of secondary cellulitis (77%). Hemolytic anemia (50%), rhabdomyolysis (27%), and acute renal failure (12%) were the most prevalent systemic effects. Hemolytic anemia was bimodal in distribution relative to the time-of-onset of the bite (early, 2.2 ± 0.4; late, 6.9 ± 1.5 days postbite, respectively; P = .004). Although no fatalities occurred in the population, 65% of children had major morbidity, including wound complications requiring surgical care and acute orbital compartment syndrome. The findings emphasize the importance of anticipatory patient/family education for outpatients and careful monitoring for systemic morbidity in inpatients. Timely and appropriate supportive care should yield favorable outcomes in most cases.
authors.affiliation: Dept. of Pharmacology and Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Hubbard
authors.forename: Laura P
authors.initials: LP
authors.lastname: James
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000743:Anemia, Hemolytic / Q000453:epidemiology / Q000209:etiology; D000818:Animals; D002481:Cellulitis / Q000453:epidemiology / Q000209:etiology; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology; D010727:Phosphoric Diester Hydrolases / Q000633:toxicity*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology / Q000209:etiology; D001098:Spider Bites / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000601:surgery; D013111:Spider Venoms / Q000633:toxicity*; D055815:Young Adult
chemical_list: D013111:Spider Venoms; C055161:loxosceles venom; D010727:Phosphoric Diester Hydrolases