Debunking spider bite myths
Julian White
MJA 2003; 179 (4): 180-181
Necrotising arachnidism should be a diagnosis of last resort
The article by Isbister and Gray (page 199),1 documenting 130 confirmed cases of bites by white-tail spiders, will, we hope, become one of the last acts in a prolonged and sad medical fable in Australia, regrettably now exported beyond our shores.2 In 1982, a paper on possible spider bite necrosis in Australia was presented at the International Society on Toxinology World Congress in Brisbane,3 and followed by an editorial in the MJA in 1983.4 In 1987, Spring reported a case of severe skin damage following a presumed spider bite;5 the article and the associated editorial6 mentioned the white-tail spider. Speculation about the causative spider continued, with two “likely” candidates charged with the crime by the non-medical media,7 supported by a few in the medical community. These spiders were the wolf spider and the white-tail spider. The former was suspected partly because of evidence from Brazil, subsequently debunked, implicating these spiders in causing skin necrosis. The actual cause in Brazil has since been shown to be recluse spiders (loxoscelism).8 However, it was the white-tail spider, Lampona cylindrata, that was the principal focus of attention. Within a short time, at least a few doctors were diagnosing necrotising arachnidism caused by these spiders, and within about five years the popular association of these spiders with skin necrosis was well established. The lack of strong evidence to support this association seemed to be a triviality to be ignored. Research projects were proposed and funded to examine white-tail spider venom to understand its necrotic potential. Calls were made for governments to fund development of an antivenom. General practitioners regularly and confidently diagnosed skin lesions as “white-tail spider bite”.
A few voices called “foul”. Where was the evidence to support the veracity of this new venomous scourge of urban Australia? Some confirmed bites by white-tail spiders were published, with no evidence of skin damage.9 Early research on the venom found no necrotic activity.10 The spider is native to Australia, yet most people ignored questions about the absence of cases of necrotising arachnidism in the 200 years before Spring’s article. Arachnologists questioning the validity of white-tail spider bite necrosis were also dismissed. In both the general and the medical community, the era of “white-tail spider bite necrosis” had arrived.
But the evidence cast ever stronger doubt about the veracity of white-tail spider bite necrosis, despite occasional published “cases”. What was needed was a large number of cases of confirmed white-tail spider bite to clearly show the true range of its effects. Isbister and Gray’s article defines a clear and consistent pattern of clinical effects, based on a large series, with no evidence of necrosis. As the authors point out, the inappropriate diagnosis of spider bite in cases of skin damage is not isolated to Australia or the white-tail spider, but our episode is particularly disturbing, because there was never any strong evidence to link this spider with necrosis. Publication of Isbister and Gray’s article should herald the demise of the spurious diagnosis of white-tail spider bite necrosis. This will, we hope, bring an end to conditions such as basal cell carcinoma being misdiagnosed as spider bite, and to cases of feigned white-tail spider bite necrosis (where the patient inflicts skin damage with chemicals, then claims a spider bite).
This does not mean spider bite never causes necrosis. Recluse spiders have clearly been shown to cause necrosis in some parts of the world, including two cases in Australia,11 where the spiders have been introduced. However, there is no evidence recluse spiders are widespread in Australia, and it would be erroneous to now label skin damage of uncertain origin as “loxoscelism” instead of “white-tail spider bite”. When presented with skin damage of initially uncertain origin, medical practitioners must look for all the many and varied non-spider-bite causes for such damage, leaving necrotising arachnidism as a diagnosis of last resort and uncertain validity after all other possibilities are excluded. Any future research into necrotising arachnidism in Australia should focus on accurately determining the cause.
Isbister GK, Gray MR. White-tail spider bite: a prospective study of 130 definite bites by Lampona species. Med J Aust 2003; 179: 199-202.<eMJA full text>
St George I. Skin necrosis after white tailed spider bite? N Z Med J 1991; 104: 207-208. <PubMed>
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Sutherland SK. Spider bites in Australia: there are still some mysteries. Med J Aust 1983; 2: 597. <PubMed>
Spring WJ. A probable case of necrotizing arachnidism. Med J Aust 1987; 147: 605-607. <PubMed>
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