Long Island testing for Anthrax in Spider Bite Cases

Newsday ^

[per loin]

As concerned Long Islanders called the Suffolk County Health Department yesterday to report possible brown recluse spider bites and offer specimens of eight-legged critters trapped in Tupperware, officials asked Mather Memorial Hospital to help them eliminate an even more worrying possibility - anthrax.

[per loin]

I guess I flubbed by posting whole article. It was pulled.

[eastsider]

A good friend of mine got bitten by one in Connecticut about three weeks ago -- it was in his shoe. Nearly had to have his leg amputated.

The tinfoil in me says that this and West Nile virus are related acts of bioterrorism.

[TrappedInLiberalHell]

A good friend of mine got bitten by one in Connecticut about three weeks ago -- it was in his shoe. Nearly had to have his leg amputated.

Where was he bitten? My Aussie girlfriend is a tad unnerved at the spiders she's seen around my house and yard. Plus I live near ground zero for Lyme disease (and the ticks that carry them are likely dropped in my yard by the herd of deer that wanders around it nearly every day).

Last August my father, down in Houston, Texas, took suddenly ill (later diagnosed somewhat wishy-washily as a stroke), and my sister and I were starting to become convinced he had St. Louis Encephalitis. THEN we found a web site which showed that a mosquito carrying SLE had been trapped within TWO BLOCKS of his house in Houston, Texas. Coincidence? Yeah, maybe. But he did have Lyme disease back in the early eighties, not to mention he took horrible care of himself and his house (bugs got in big gaping holes in window screens). So it is possible. He'll never be able to live on his own again.

So my radar goes up when I hear 'infectious disease' and 'anywhere near Connecticut'.

[eastsider]

He was bitten in New Canaan, the lap of luxury.

[rwfromkansas]

oh my gosh.......this is too funny for words. This is hysteria.

A rash of spider bites is not weird, people.

[eastsider]

Brown recluses are not indigenous to Long Island and Connecticut. (Neither is West Nile, by the way : ) Only reason I knew what the thing was is because I lived in Arizona for several years, where we had brown recluses, black widows, scorpions ... I a tokay gecko that lived under the refrigerator in my kitchen. Best exterminator I've ever had.

[TrappedInLiberalHell]

Yeah, my ex-wife used to work for the Stamford Advocate. New Canaan was her 'beat'. So I know what you mean by 'lap of luxury'.

[genefromjersey]

I don't think the presence of brown recluse spiders has anything to do with terrorism. The media believes these spiders don't exist in NY state-because somebody mis-informed them.

My Dad, Lord rest him, was bitten by a brown recluse in 1946.It was inside his boot,enjoying a snug wintertime home, and objected strenuously when its borrowed burrow was invaded.This happened in rural NY-about 45 miles north of "the big city"

Dad had blood poisoning, which laid him up for weeks; then began to suffer from a debilitating illness, that drove him to cane, crutches, and eventually left him bed-ridden.It seems he had been born with a potentially weak blood vessel near the base of his skull, and the long-term effects of the venom made it worse.He remained a partial cripple for a good 20 years, before finally passing away.

The ID of the "killer" was known: a nickel-sized brown spider, with "fiddleback" markings, I saw him fish out of his boot.

[TrappedInLiberalHell]

A rash of spider bites is not weird, people.

Not when taken out of context, it isn't. But given the times, and the fact that anthrax was found in New York City and in south-western Connecticut, it's worth the extra time to do the test, I think.

Before 9/11 the phrase might have been 'four Arab-looking guys on a plane is not weird, people'. But I bet most of us look a little more closely at our fellow passengers these days.

But your point is well taken -- we mustn't let these stories MAKE us hysterical. That would be, after all, the overt goal of terrorism -- to cause terror. (We all know what the real goal is -- to kill people).

[per loin]

I've no idea of your expertise, but here are a few relevent quotes from the original article. Please realize that the statistical improbabilities that they mention concerned 3, or possibly 4, cases. Those improbablities rise with each new case:

In what experts say is a rare if not near-impossible occurrence on Long Island, at least three people have been diagnosed with brown recluse spider bites this week and are being treated at a Port Jefferson hospital.

-----------------

Local hospitals polled Friday, including Central Suffolk Hospital in Riverhead and Nassau University Medical Center in East Meadow, reported only a handful of possible bites in the past several years.

The clustering of three or four cases in one week left many skeptical. "It just strikes me as very unusual," said Dr. Thomas Fischer, an emergency-room specialist at Stony Brook University Hospital. "I haven't come across one for years. It would be amazing, to me, for three people to be treated at one time on Long Island."

[auggy]

"Brown recluses are not indigenous to Long Island and Connecticut. (Neither is West Nile, by the way : ) Only reason I knew what the thing was is because I lived in Arizona for several years, where we had brown recluses, black widows, scorpions ... I a tokay gecko that lived under the refrigerator in my kitchen. Best exterminator I've ever had."

I live in NW Kentucky. 3 weeks ago we had an exterminator out for Brown Recluse. 2 weeks before the exterminator came, my wife had me to exterminate lizards around our house. We had 3 get into the house. I am sure the lizards were keeping the spiders away, but no, she would rather have the poisonous spiders. The exterminator I called said he had over 100 calls in one day for Brown Recluse Spiders. We live in a town of 20,000.

[John H K]

Answer may well be it's not brown recluse spiders, and it's not Anthrax, either; could be Lyme disease or a lot of things:

http://spiders.ucr.edu/necroti c.html

Causes of Necrotic Wounds other than Brown Recluse Spider Bites



by Rick Vetter, M.S.

Throughout the United States, spiders get blamed as the cause of many dermatological wounds in medical diagnoses. In virtually every case, No spider is seen nor felt inflicting a bite, nor is the alleged spider collected in the incident. "Potential spider bite" diagnoses are made solely on the symptoms of the lesion. In the case of necrotic wounds, "brown recluse spider bite" is a very common conclusion of medical personnel throughout the United States. This is in spite of the 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 and southernmost Ohio with additional rare finds being made beyond this area). In addition there are several related species that exist in the southwestern U.S. deserts from Texas to California, however, they do not include the coastal California regions where most of the human population is concentrated. The members of the genus Loxosceles are known as recluse, violin or fiddleback spiders. Occasional, RARE occurrences of the brown recluse do occur outside this region because of the spider's proclivity to hide in boxes and the subsequent movement of possessions or commerce from its native area. However, occurrences outside the native areas are still extremely rare and they encompass finds of single specimens only, not burgeoning populations of these spiders. When one finds a habitat that is conducive to recluse spider survival, no matter what the species, one does not find single specimens; one finds dozens of them. Therefore, transported spiders virtually never establish populations after being moved. They are typically considered to be a house spider and it isn't uncommon to find dozens of them under a single bed or in an attic when the habitat is right. If you truly think you were bitten by a recluse in your home or garden (then again, recluses do not live in moist gardens anyway), you should be able to find several specimens in a few days if you look for them.
In regard to diagnoses of "spider bites", the medical community is overreliant on the brown recluse in many portions of the United States as the causative agent of these wounds. In South Carolina, 940 physicians responding to a survey reported 478 brown recluse spider bites in their state in 1990; in stark contrast, the definitive scientific study on the distribution of all recluse spiders in the U.S. lists only 1 brown recluse from South Carolina. In the year 2000, over 300 brown recluse bites were reported to Florida poison control centers with 95 being reported from the 21 counties under the jurisdiction of the Tampa poison control. No brown recluses have EVER been found in any of these 21 Florida counties surrounding Tampa. In an ongoing study as of Sept 2001, I have been contacted in regard to over 120 brown recluse spider bite diagnoses made in California, Oregon, Washington and Colorado in only about 21 months. Less than 20 verified brown recluses have EVER been found in these 4 states. And in another ongoing study as of Sept 2001, a collaborator in Kansas who lives in a historic 19th-century stone-built home has collected over 1500 brown recluses in her house, with about 300 of them being big enough to cause an envenomation, yet her family of 4 has lived there for 6 years and nobody has ever shown evidence of a bite. What this paragraph should be hammering home to you is that 1) recluses spiders are common where they are found, 2) you need decent populations of them before you get a significant probability of a bite from one and 3) doctors from non-endemic areas are diagnosing bites from these spiders far out of proportion to the actual number of spiders that can be historically found in their states.
Medical personnel will diagnoses "brown recluse bite" because that is the most common and, unfortunately, most dynamic cause of necrotic wound that they have read about. Below is a list of skin afflictions that have been misdiagnosed as "brown recluse bite" by dermatologists; most of the conditions of this list are from Russell (see references below) as well as some additional ones added in later publications by various authors.

Conditions which can cause necrotic wounds, have been misdiagnosed as or could be confused with "brown recluse spider bite"
bacterial arthropod-induced
Staphylococcus infection bull's-eye wound of Lyme disease
Streptococcus infection Rocky Mountain Spotted Fever
gonococcal arthritis dermatitis bite of Ornithodoros coriaceus tick
viral tulemeric conditions
infected herpes simplex many insects
chronic herpes simplex topical
herpes zoster (shingles) chemical burn
fungal poison oak/poison ivy
sporotrichosis reaction to drugs
keratin cell mediated response to fungus erythema nodosum
lymphoproliferative disorders warfarin and heparin poisoning
lymphomatoid papulosis unknown causative agents
lymphoma periarteritis nodosa
blood disorders misc./ multiple causative agents
purpura fulminans Stevens-Johnson syndrome
thromboembolic phenomena erythema multiforme
focal vasiculitis bed sore
underlying disease states toxic epidermal necrolysis
pyoderma gangrenosum
diabetic ulcer
One of the more pertinent causes listed here is that the expression of Lyme disease can give the classic "bull's-eye" patterning characteristic of brown recluse bite. Misdiagnosis in this case can be rather disconcerting since Lyme disease can be treated and cured with common antibiotics. If diagnosed as "brown recluse bite" instead, it will obviously be treated as such and then the Lyme disease can progress into more serious symptoms of heart and central nervous system disorders. I have already helped one person in Rhode Island get away from his doctor's misdiagnosis of brown recluse bite (the closest native populations of recluse to Rhode Island is southernmost Ohio) and on to Lyme disease which is what it was. In treating alleged spider bite victims, a question that medical personnel should also be asking is whether the patient has recently traveled outside the area where they live in case the patient might have been exposed to ticks as well as being aware of potentially embarrassing etiological agents such as filthy lifestyle habits (squalid conditions that might encourage vermin such as bed bugs).

If you have been diagnosed as having a brown recluse bite and you do not live within the native range of any recluse spider (see the map ) then there is minimal chance that your wound was caused by a recluse spider. If you wish to contact me about your "bite" diagnosis or especially if your doctor diagnosed a brown recluse bite and it turned out to be something else, I would appreciate hearing from you.

References
Anderson PC. Letter to the editor. Toxicon 1982; 20:533
Anderson PC. Loxoscelism threatening pregnancy: five cases. Am J Obstet Gynecol 1991; 165:1454-1456
Kunkel DB. The myth of the brown recluse spider. Emerg Med 1985; 17:124-128.
Osterhoudt KC, Zaoutis T, Zore JJ. Lyme disease masquerading as brown recluse spider bite. Ann Emer Med: (in press)
Rosenstein ED, Kramer N. Lyme disease misdiagnosed as a brown recluse spider bite. Ann Intern Med 1987; 107:782.
Russell FE, Gertsch WJ. Letter to the editor. Toxicon 1982; 21:337-339.
Russell FE. A confusion of spiders. Emerg Med 1986; 18:8-13
Russell FE, Waldron WG. Letter to editor. Calif Med 1967; 106:248-249
Vetter RS. Myth: idiopathic wounds are often due to brown recluse and other spider bites throughout the United States West J Med 2000; 173:357-358
Vetter RS. Brown recluse and other recluse spiders: Integrated pest management in and around the home. Univ. Calif. Pest Notes 2000; #7468, 4pp.
Vetter RS, Bush SP. Chemical burn misdiagnosed as brown recluse spider bite. Amer J Emerg Med 2002: (in press)
Vetter, RS, Visscher PK. Bites and stings of medically important venomous arthropods. Intl J Dermatol 1998; 37:481-496

[eastsider]

That's a sad story about your dad. Some people have an acute reaction to insect venom. A woman I worked with in Phoenix had high blood pressure, and was laid up in the hospital for about a week because of a black widow.

I realize that an occasional brown recluse is not unknown in these parts, but the recent cluster of incidents gives me pause to wonder just what the heck is going on.

[eastsider]

I am sure the lizards were keeping the spiders away, but no, she would rather have the poisonous spiders.

LMBO!! : )

[per loin]

Good post. I've seen simular data on mis-diagnosed brown recluse bites in Cal. I've tried to locate comprehensive figures on the annual rates of those hospitalized with spider bite diagnoses, but no success yet. Are you familiar with any source for such data?

[John H K]

I just stumbled on that doing a google search on "brown recluse spider."

I suspect what you've also got going on is what I call "trailer park tornado" syndrome. Tornados actually don't hit trailer parks more often than anywhere else, it's just that many "tornadoes" in trailer parks aren't actually tornadoes...just strong straight-line thunderstorm winds or downbursts. Since trailers are so much more vulnerable to wind, they get rolled a lot.

The NWS can often take days to a week to complete a survey and determine whether a given storm was a tornado or not. By then, it was already proclaimed a "tornado" by the local news, and the breathless eyewitness accounts of the survivors (replete with standardized "It sounded like a freight train!" story.)

If your house is destroyed, you WANT it to be a tornado; it's a more interesting and exciting story than "straight line winds" and it's also less embarassing. (Was an interesting case in Upstate NY where the wall of a school collapsed in strong straight-line winds, killing a bunch of kids; local politicos leaned on the local NWS office to declare it a tornado when it wasn't; wanted to avoid questions about shoddy construction, etc.

Anyway, my point is, I suspect people with a bad necrotizing lesion who get diagonsed with a spider bite make NO effort to get a second opinion whatsoever. Having it caused by a spider bite is exciting and interesting, and elicits more shock and sympathy from friends and family when you tell them.

[AlGone2001]

The tinfoil in me says that this and West Nile virus are related acts of bioterrorism.

I work with a guy in Atlanta that is thought to have contracted the West Nile Virus, after a trip to Florida.

[eastsider]

I understand it's all over New Orleans. And it started here in New York when? Three years ago?

[per loin]

What interests me here is the apparently anomolous number of diagnosed cases on Long Island. BTW, if someone did wish to assure the maximum coverage for a small bioterroist event, what better place for it than the Hamptons. I'm not aware of any cases that far east on the island yet, nor of any evidence of a bioterrorist event. So far, all we have is an apparently anomolous spate of spider bite diagnoses. But even that alone bears watching.

[per loin]

Re-activation bump for the folks of evening.