Arrogant yet interesting article. It speaks to the over diagnosis of recluse bites. Interesting read.

http://spiders.ucr.edu/necrotic.html

(Arrogance is defined as being when 57% of your footnotes refer to your own articles.)

Link to the article?

A lot of things coming into the ED that are diagnosed as "spider bites" may be MRSA.

While I am only a 4th yr, the attendings I have worked with say that spider bites account for a very, very small amount of the actual "spider bite" complaints in the ED. docB nice call on the self citation by the author.. That is a good way to define arrogance.

Link to the article?

A lot of things coming into the ED that are diagnosed as "spider bites" may be MRSA.

There's a link to the article right there in the post :confused:

There's a link to the article right there in the post :confused:

;) It wasn't there earlier. All is good.

Arrogance is saying things like this:

"It shouldn’t take a math whiz to realize that the medical community is overdiagnosing brown recluse spider bites."

"I have even seen specimens from ...."

"I have been identifying spiders that people THINK are or might be brown recluses and have received nearly 1,700 spiders as of October 2004..."

"I have heard of several verifications of brown recluses ..."

"If you wish a copy of either or both of these articles, contact me and I will send one to you electronically in PDF form or as a paper copy."

"Finally, many people have contacted me and explained in detail the progression of their wounds. Considering that the medical profession continues to misdiagnose skin conditions all the time and they see the wounds in person, there is little chance that I am going to be able to provide much more information from your written description over the internet other than the information I offer below."

"If you print out this website, try to educate your doctor and he/she refuses to listen to your concerns of alternative diagnoses, find another doctor who is more willing to be educated or who already knows there are no recluses in your area."

"I have been contacted by prisons in San Francisco, Los Angeles, San Diego, Ohio, Texas, and Arkansas"

Keep in mind he has a masters and has not gone to medical school.....so his expertise in diagnosis is limited.

It is also a good idea to not misspell words in an article....

Atleast he knows his limitations:
"Please don’t ask me what insects it might be, I don’t know much about them."

He may be arrogant, but he does make some good points.....

This actually isn't the only article on the topic. I'll look around to see if I can find the other ones I read a few years back. [edit: I think I read a few of the articles he cites] I find that when I mention it to people they usually have examples of friends with "brown recluse bites" who they insist were bitten though no spider was found, so the problem is probably fairly widespread.

Out of curiousity, has anybody here ever seen a brown recluse bite? How about other spider bites?

(Oh, and while I certainly agree that the tone is arrogant, perhaps he cites many of his own articles because he is one of the few people writing about this topic? He may simply not want to have to repeat everything he's written before, as this is a summary rather than a full academic treatment of the subject, so he simply refers to his earlier papers.)

Brown recluse bites are overdiagnosed. People frequently assume that they have been bit when they develop a skin abscess.

bkn

I'm frequently amazed at what patients purport to be spider bites. And they all seem to think that their *spider bite* is automatically a serious condition.

My residency "scholarly project" will prove that invisible spiders are actually the vector for community acquired MRSA abcesses.

My residency "scholarly project" will prove that invisible spiders are actually the vector for community acquired MRSA abcesses.
I think they're all coming from a big nest in a house near here owned by Some Dude.

I think they're all coming from a big nest in a house near here owned by Some Dude.
LOL Are you sure it isn't the storage building behind the apartment complex owned by That One Guy that harbors the nest? :meanie:

I've never seen a true brown recluse bite, but I did see a case of a black widow bite. God that looked like it sucked to be the patient.....

I can't help but wonder if all of this "misdiagnosis" business isn't just a issue of differentiating chief complaints from diagnoses. As an MS4 I've seen innumerable patients with CC of spider bite yet I have never diagnosed a spider bite -- it's always something else or something less specific than spider bite.

I've seen several actual brown recluses... but never a bite. I grew up in Missouri, endemic to the BR - and never met anyone who actually had suffered the classic necrotic bite.

People just think that "spider bite" sounds like a better reason to go to the ED than "mosquito bite." And anytime "spider bite" shows up on the board, it means MRSA absess until proven otherwise.

I remind/teach people all the time that the BR is not found here in Florida... not that it matters.

We had a case of a Black Widow bite last year. Only knew for sure because the guy presented the now-dead spider that bit him. (And despite the resident asking him to leave it, the guy insisted on keeping it as a trophy.) He was a grocery stocker and the spider had hitchhiked here in a crate of bananas.

I've seen several actual brown recluses... but never a bite. I grew up in Missouri, endemic to the BR - and never met anyone who actually had suffered the classic necrotic bite.

People just think that "spider bite" sounds like a better reason to go to the ED than "mosquito bite." And anytime "spider bite" shows up on the board, it means MRSA absess until proven otherwise.

I remind/teach people all the time that the BR is not found here in Florida... not that it matters.

We had a case of a Black Widow bite last year. Only knew for sure because the guy presented the now-dead spider that bit him. (And despite the resident asking him to leave it, the guy insisted on keeping it as a trophy.) He was a grocery stocker and the spider had hitchhiked here in a crate of bananas.

Word is you are at ORMC, I was there in July. I had a guy who worked with meat at some grocery store and he flat out said it was a mosquito bite and he has a nasty looking abscess. I drained that puppy. Of course 90% of abscesses are due to the old BR which no one has seen.

I'm frequently amazed at what patients purport to be spider bites. And they all seem to think that their *spider bite* is automatically a serious condition.

A BR *is* a serious spider bite. Ever seen skin falling off a hand from a BR bite? It's ... icky.

A BR *is* a serious spider bite. Ever seen skin falling off a hand from a BR bite? It's ... icky.

I've seen a real one before, but not in the ER.

I know that brown recluse bites are serious, but with a few exceptions other spider bites are not.

Word is you are at ORMC, I was there in July.

Word is correct. :cool: I don't know if I met you or not... I spent July doing L&D at APH. You probably don't have any questions, but if you do, you can pm me. I know more about the off-service rotations than anything else, as I've done most of them at this point. If I don't get back to you right away, it's because I'm on the trauma surg service this month.

I had a patient come in with what I suspected was a brown recluse bite. He was a homeless individual who was sleeping underneath a freeway when he felt a sharp pain in his left calf. He presented the next day with a 2 cm circular area of white pus with slight necrosis, and 5cm surrounding tender area of errythema.

, and the attending quoted some obscure article which stated that brown recluses were not found in California at all. This article seems to suggest the same thing...

"fact that the brown recluse spider (Loxosceles reclusa) is native only to the South and central midwestern states (circumscribed by southeastern Nebraska south to Texas, east to Georgia/westernmost tip of South Carolina and southernmost Ohio with additional rare finds being made beyond this area"

and the attending quoted some obscure article which stated that brown recluses were not found in California at all. This article seems to suggest the same thing...
When I did residency in CA we reviewed some lit from the CA Dept of Agriculture that said they had been trying to find a brown recluse in CA for 30 years and had never seen one. I'll see if I can find it.

Although the brown recluse does not live in California, we do have four species of native recluse spiders. The most common Californian recluse spider is the desert recluse, L. deserta. It is found mostly in the Sonoran and Mojave deserts, in the foothills of the lower San Joaquin Valley, and in adjacent areas of Mexico, all of which are sparsely populated by humans.
There are fewer than 10 documented cases of the spider being collected in California, spanning more than 4 decades, typically in facilities that receive goods from out of state. Searching the immediate area yielded no additional brown recluses and therefore they were considered to be individual stowaways. Undoubtedly, more brown recluses have been inadvertently brought into the state via commerce and the relocation of household belongings; however, amazingly few specimens have ever been collected.

art ref (http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7468.html)

:)

I saw a few cases when I worked in Texas that fit the classic description, and one patient that brought in the brown recluse as proof. In my years in Florida and California, I have yet to see one.

I had a patient come in with what I suspected was a brown recluse bite. He was a homeless individual who was sleeping underneath a freeway when he felt a sharp pain in his left calf. He presented the next day with a 2 cm circular area of white pus with slight necrosis, and 5cm surrounding tender area of errythema.

, and the attending quoted some obscure article which stated that brown recluses were not found in California at all. This article seems to suggest the same thing...

"fact that the brown recluse spider (Loxosceles reclusa) is native only to the South and central midwestern states (circumscribed by southeastern Nebraska south to Texas, east to Georgia/westernmost tip of South Carolina and southernmost Ohio with additional rare finds being made beyond this area"
I'm fortunate to have an exterminator here (we have problems with carpenter ants...) who is a retired college professor with a Ph.D. in entomology. He discovered that there's more money to be had in ridding homes of insects than in teaching about them. More on point, though, he mentioned to me that despite frequent reports of BR spider bites here, the spider is not native to the Pacific Northwest (SE Washington in particular) and none have ever been confirmed here. With thousands of other biting or venomous insects and arachnids living around us, it may be that the BR spider is a convenient "whipping boy" for people who lack the time, expertise and need to find a more precise cause of injury.

Ithe BR spider is a convenient "whipping boy" for people who lack the time, expertise and need to find a more precise cause of injury.
Ah yes, the "pit bull of spider-dom".

I've seen several actual brown recluses... but never a bite. I grew up in Missouri, endemic to the BR - and never met anyone who actually had suffered the classic necrotic bite.

People just think that "spider bite" sounds like a better reason to go to the ED than "mosquito bite." And anytime "spider bite" shows up on the board, it means MRSA absess until proven otherwise.

I remind/teach people all the time that the BR is not found here in Florida... not that it matters.

We had a case of a Black Widow bite last year. Only knew for sure because the guy presented the now-dead spider that bit him. (And despite the resident asking him to leave it, the guy insisted on keeping it as a trophy.) He was a grocery stocker and the spider had hitchhiked here in a crate of bananas.When I did residency in CA we reviewed some lit from the CA Dept of Agriculture that said they had been trying to find a brown recluse in CA for 30 years and had never seen one. I'll see if I can find it.


Tell him to try the Inyokern/Ridgecrest/Trona area near Death Valley. I lived there less than a year and saw four in situ. Identification was confirmed by an aquaintance who as in WU's entomology department at the time, because he flat refused to believe some observational claims, and I sent him specimens to prove them (black widows in huge numbers in open and relatively heavily trafficed areas with female samples having abdominal diameters almost twice the size considered "possible" by standard description, BR existing in that area at all, and samples of the "banana scorpion" [great desert scorpion, local name due to coloration] exceeding 9" in overall length).

They may be imports, but they live out there.

However, WA state, where I currently live, has an admited issue with misdiagnosis of "hobo spider" bites as BR bites, because the noticable symptoms of a hobo spider's bite resemble fairly early symptoms of a Fiddleback bite, and the spider itself is somewhat similar in appearance, to a layman, and AZ, where I've spent quite a bit of time, docs will admit they have a proliferate number of spider bites from the family of spiders known THERE as "wolf spiders" which are often misdiagnosed as BR bites, despite the incredible rarity of actual specimens of the BR...it's simply that when the patient is bit by a large spider, they often insist that it had to be a BR bite (especially if it was a spooky looking critter like the ones known in AZ as "wolf spiders"), and, doctors themselves not being immune to various levels of commonplace arachnophobia, many of them will look at an otherwise unexplicable abscess or MSRA, and pan up the simplest and most acceptable explanation available..."you musta been bit by a nasty li'l spider, and never noticed until it progressed"....docs are human, too, folks, and have their prejuduices, and HATE having to say "duuuuhhh...I dunno" to someone looking up to them, and expecting them to provide a solid answer, as much as anyone else would, guys...I don't like sayign "I don't know" to my kids, and most doctors don't like having to admit they don't know when someone goes to them and expects a solid answer, either, folks.

It just occurred to me that I should make clear that only ONE of the four sppiders I identified as BR was confirmed by an expert...the others, I wasn't about to try to collect, as the valve bunkers they were in were not big enough to get the mason jar (kill jar for my butterflies) into, nor was I going to try a fishtank net or anythign else the things might be able to bite me through or that placed them in range of a scamper onto my hands, but they looked exactly like the one I DID send in, to me...same basic coloration and markings.

So it could have been one transplanted one living in a valve vault/bunker/hole/whateverit'scalled, and three others doing a creditable lookalike gig in similar venues, but I'm not thinking so (obviously).