Hey, Dr Bernard here.
There’s 2 known species of venomous spiders in the United States.
For both species, a bite leading to severe systemic illness is rare.
Let me say that again, systemic illness from a spider bite in the United States is rare.
This video is to teach about the medical side of cases like this, it’s not about scaring
people on spiders.
There’s simple steps to help prevent this from happening in the first place that I’ll
tell you about later in this video.
A boy put on a pair of socks he left on the floor on a hot summer morning.
This is what happened to his kidneys.
GG is a 17 year old boy, presenting to the emergency room in a panic.
He tells the admitting nurse that he tried to take a leak in the shower, and what should
have been urine was red that splashed everywhere.
Earlier the day before, GG was in his regular routine: he was getting ready for one of his
last days of high school.
As a person, he wasn’t.. the cleanest.
His parents were always neat and tidy, they believed if your living space is messy, your
mind is messy.
If you can’t control the placement of objects in your room, which is the one thing you absolutely
can control, then there’s no way you can control anything else in your life.
GG couldn’t be bothered.
He would leave his homework in stacks on the floor, claiming that there was an organization
amongst the chaos, that he’d only lose things when meddling mom and her trifling hands tried
to clean it up.
Whenever he’d change into his pajamas, he’d throw his clothes on the floor leaving piles
everywhere.
He’d do his own laundry, but he wouldn’t fold the clothes afterwards, and sometimes
clean clothes would get mixed with the dirty on the floor.
GG’s dad would tell him “you know, you probably have roaches and spiders living in
there.
They make a nest, they lay some eggs, they’re going to crawl all over you in your sleep
and theyre gonna take a nice bite out of you if they dont first crawl up your nose and
into your brain one day,” he joked.
But that day was now, and it wasn’t going to be a joke.
One evening, GG thought he felt a tickle on his skin in his sleep, and when he opened
his eyes, he saw a brown spider crawling around in the sheets.
In a panic, he cried out in fear.
He caught it in toilet paper, and flushed it down the toilet.
He couldn’t sleep the rest of the night, but it’s just getting warm now and the bugs
are out, he thought.
As the days passed, GG cleaned himself up.
At first, he would fold his clothes and put them away, but as time went on, he became
lazy again and started piling his clothes at the foot of his bed and on the floor.
One morning, GG was getting dressed for school.
It was almost time for summer break.
He picked out some socks from the pile of clothes on the floor.
Immediately after putting on the pair of socks, GG felt a little sting on his right foot maybe
like he had stepped on a little rock that was inside.
In an effort to not feel what he thought was the rock again, he started to change the way
he walked.
He didnt remember if these were clean or dirty, but as he put on his shoes, he felt the sting
again.
Shaking his foot and tapping the toe seemed to fix it.
Walk different, feel no rock.
Easy fix, he thought.
As the hours passed, GG started feeling like something was wrong.
He could feel his heart beat in his right foot.
He could feel just that one foot swelling.
In the afternoon, when he took off his sock, he noticed his foot was red and swollen.
He didnt think that a little rock could just mess up his foot like that.
He threw the dirty socks back in to the pile of clothes on the floor, and went to bed.
But when he woke up, he had a waffle for breakfast, and that waffle came right back up.
The smell of the syrup made his stomach squirm in a way like never before.
He stood up from his chair and felt a weakness wrap around his shoulders and felt gravity
drag his stomach into the ground.
He had the chills.
But then his back started to hurt as he noticed something was wrong with his breathing.
GG noticed that the wound on his foot started to look weird.
He didnt think that a small rock in his sock could just do this.
As he picked out those socks that he wore yesterday from his pile of dirty clothes on the floor and
turned it inside out, he found a brown spider, legs stemming out from a crushed body.
GG’s worst nightmare about his hygiene manifested in realtime, that it wasn’t a little rock
in his sock but that a spider had gotten in and bit him from the inside.
Even though his foot hurt and was swollen and red and looked like a giant bruise, he
still didnt think this was a problem.
Until he went into the shower at night time, GG panicked because when he urinated, he saw
it was deep red at first before becoming brown like Coca Cola.
In a frenzy, he called for 911, and hes brought to the emergency room where we are now.
At examination, GG told the medical team about the bite on his foot.
He showed them the spider remains because he brought the sock.
The lesion on his foot had a red, white and blue pattern, from a pale bruising.
When the medical team looked at the spider remains, they saw 3 pairs of eyes arranged
in a nontouching pattern, with a violin shape on the body.
The eyes of the spider and the knowledge of the geographic location where all of this
was happening, tells doctors that GG is suffering from a bite from Loxosceles reclusa, also
known as the brown recluse spider.
Typically, when a lesion like this appears on the skin, most people aren’t going to
see what caused that lesion.
Unless you live in this region in the United States, or in Central or South America, it’s
highly unlikely to be a brown recluse spider bite.
Their name is Recluse, and they’re known to not be aggressive in the first place.
Even if you do live in this area, a Kansas family once trapped 2,055 brown recluses over
6 months in their house and no one there ever received a bite that they knew about.
It’s not often that the spider is caught in the act and presented to the medical team
to confirm that it is a spider bite, but sometimes it is.
And in GG’s case, they were able to confirm the bite, but something’s wrong.
Typically, early after the bite, a blister can form without pus.
Usually if these are accompanied with ecchymoses, which are skin discolorations due to bleeding
underneath, that strongly suggests that an envenomation did happen, when the spider can’t be
retrieved or identified.
These can become an ulcer, and the tissue can necrose looking worse and worse over time
before healing over several weeks.
This cutaneous loxoscelism, cutaneous referring to the skin and loxoscelism denoting a pathological
condition from the genus of Loxosceles, means that the spider bite is localized to the skin,
but is it really?
Loxosceles venom contains biologically active substances that the spider needs to survive.
This should make sense, spider eat bug.
Spider need venom that neutralizes bug.
But it also has several enzymes, which are proteins, one called sphingomyelinase D, and
this is what appears to cause most of the damage to human tissue.
And humans have more tissues than just skin, bringing us back to GG.
A blood test finds that GG has anemia.
An meaning without and emia meaning presence of blood.
Red blood cells have a protein called hemoglobin.
It’s how they transport oxygen throughout the body.
When hemoglobin is low, it could mean that parts of the body might not be able to get
enough oxygen.
And in GG, his hemoglobin was low.
But why?
Hemoglobin contains heme, something that has iron in it, and it’s how blood transports
oxygen.
My second, in-depth channel named Heme Review talks more about venomous spiders link in
the description below.
Sometimes, a little hemoglobin is floating around freely in the blood.
Iron can react with structures in the body causing oxidative damage, so it needs to be
contained.
And the body can do that because the liver makes something called haptoglobin that captures
that free hemoglobin (and this complex is destroyed in the liver.)
If haptoglobin levels in the blood are undetectable, that could mean that all of it has been consumed
by hemoglobin floating freely around.
And in GG, the medical team notes his haptoglobin levels were undetectable.
Looking further at the blood test results, the medical team noticed that the level of
a substance that’s released when red blood cells are smashed and broken apart, was high.
And this explains everything.
His haptoglobin is undetectable, they were all consumed by hemoglobin released when blood
cells were broken and this hemolytic anemia, an absence of the presence of blood, because
those blood cells are getting smashed and broken apart, means something terrible is
happening to GG.
He put on a pair of socks he left in a pile of clothes on the floor.
There was a brown recluse spider inside that sock.
Pressing the spider up against the sock and the skin of his foot, agitated it, caused
it to bite him.
In the aftermath, the venom from the bite didnt just result in cutaneous loxoscelism,
the spider venom somehow also got into his blood stream and caused systemic loxoscelism.
As the spider venom activates some of the immune system, red blood cells get attacked
and shatter.
Hemoglobin spills into the circulation and when it reaches the kidneys, pigments and
iron deposit in, causing massive damage, leading to the kidneys shutting down from permanent
damage, letting blood and hemoglobin to spill into the urine.
If nothing is done about this, electrolytes can become imbalanced leading to the heart
to beat irregularly.
Hypoxemia, low oxygen presence in blood can cause other organs to start to shut down.
To will lead to acid build up in his body, GG’s heart can then stop beating, but not before massive bleeding
happens to him because an inappropriate amount of blood clots are formed in small blood vessels.
Can the medical team do anything about this systemic loxoscelism?
Maybe.
Spider bites are the weird cases that come in to the hospital, strange looking lesion
on the skin, but no body knows what caused it, and the spider got away.
Without actually presenting the spider to the medical team at the hospital, we can’t
say 100% for sure that what’s on the skin is because of a spider.
This is why we don’t actually know how many real brown recluse spider bites actually become
necrotic.
Lots of times they dont.
Lots of times, people get these bites and they dont go to the hospital so they’re
never reported.
This means that cutaneous loxoscelism, the bruising and the ulcer and the skin necrosis
doesnt always follow a bite.
And many times, it just stops at the skin.
The wound can look terrible, but no systemic illness will happen.
On the flip side, sometimes the cutaneous signs and symptoms are mild, nothing more
than a little bruising, but the patient’s organs have completely shut down due to systemic
loxoscelism, so what happens on the skin can’t predict what can happen to the rest of the
body.
Systemic illness from these bites in the United States is rare.
Sometimes, brown recluse spider bites are diagnosed in areas where the spider doesnt
live, because a skin lesion is there, and there’s no way of knowing exactly what caused
it.
Very rarely, the spider is presented to the medical team, and it is confirmed to be a loxosceles bite
and that spider was transported somehow to this non-endemic area,
and it could bite someone when it arrives, but the number of moving parts
in that sequence of events makes it unlikely.
A kind of spider bite that can happen anywhere in the United States is from the female Black
Widow spider.
They can be found throughout North America.
Black Widow venom is a neurotoxin, it can cause the muscles to cramp, it can make the
face and the eyelids swell up, it can make it hard to breathe while heart beats uncontrollably
faster and harder, and it can lead to stroke and a seizure in the worst cases, which are rare
In the continental United States, lower 48, the black widow and brown recluse are the
only 2 known venomous spiders.
If you dont live in this region, which is where the brown recluse lives, there’s only
the black widow.
And as scary as Black Widow bites may be, there hasn’t been any recorded fatalities
from it since the early 1980s when it started to be tracked.
Daddy longlegs is not known to be venomous, there’s a Hobo spider if you Google it a
website says it’s venomous, but there isn’t good evidence so far for it to be venomous,
in a way that causes illness needing urgent medical care
and that’s documented in medical literature.
For GG, when he got the bite the first time, what he could have done is use a cold compress,
because brown recluse venom is temperature sensitive.
Enzymes are proteins, and they can change activity and conformation based on temperature.
But for his systemic loxoscelism, there is no antivenom, there is no antidote to this
spider bite available in the United States.
Central and South America have some antivenoms, but their Loxosceles spiders are related,
a little different, and the bites are more common, and can be just as severe, if not
worse.
If GG’s red blood cells were smashed and broken apart, then he can be treated by replacing
those lost with blood products.
If his kidneys have shut down, hydrate him.
Correct his electrolyte levels and prevent his heart from beating erratically.
So that acid won’t build up in his blood, and that hypoxemia won’t happen shutting
down the rest of his organs.
The spider venom is the underlying cause.
With time, it will wear off because more of it isn't being continuously added to his body.
With supportive care, and a lesson to clean his room, to fold his clothes and have them
tucked away properly in a dresser, to organize and fold his socks in a way where he knows
what’s inside and knows which ones are clean versus soiled, and to never leave any of his
clothes in a careless pile on the floor while living in a geographical region endemic to
the Brown Recluse spider, and to check his bed
every night before he goes to sleep,
GG was able to make a full recovery. Thanks so much for watching.
Take care of yourself. And be well.