Black widow's bite: what it looks like, consequences, what to do, antidote

Karakurt spider is one of the most poisonous insects known in the world. [1]The bite of a black widow - and this is the second name of karakurt - is very toxic and can lead to the death of the victim.

A black widow can live in the steppe or desert. Such spiders are quite common in Afghanistan, North Africa, Iran, and South European states. In particular, karakurt are found in the Mediterranean and Caucasian regions, as well as in the Astrakhan region, the Sea of Azov and in the south of Ukraine. In winter, adults die, but small arthropods inside cocoons survive.

What you need to know about the bite of a black widow, and what should be done with the first suspicion of an insect attack?

Epidemiology

About 2,600 cases of Latrodectus black widow bites are recorded annually in the US National Data System (NPDS). [2]

• A black widow can settle in minks and ditches, on slopes, under stones and in crevices.
• A black widow's bite is fifteen times more poisonous than a rattlesnake bite.
• A female karakurt lives more than a year (up to fourteen months), and a male lives up to ten months.
• The blood of a black widow is devoid of hemoglobin, which explains its bluish-bluish tint.
• A hundred years ago, from the bite of a black widow, up to four hundred people per year died, as well as three or four hundred animals (mainly cattle).
• Artiodactyls have the greatest sensitivity to spider venom.
• In 1997, almost ninety victims of a black widow bite were recorded in the vicinity of Kherson. All patients were admitted to hospital, but none of them survived.
• Of particular danger are bites for children and the elderly. 

Causes of the black widow bite

To begin with, let's figure out what kind of spider it is - a karakurt that belongs to the genus of black widows. Karakurt - this is a representative of the family of spider-web-spiders (Arthropoda, Arachnida, Araneae). [3]The genus has more than 30 species that are distributed throughout the world. [4]The insect received the name of the black widow, first of all, due to its appearance: the legs, head and abdomen of the spider are black. Widow - because the spider (namely, she bites people) eats her male immediately after mating. [5] The distant portion of each chelicera is a mobile hollow canine that penetrates the skin during a bite, introducing poison into the victim. 

Why does a black widow bite? The fact is that it is quite difficult to notice an insect in nature. Moreover, the karakurt pulls its web not in the vertical direction, as other spider individuals do, but in the horizontal. The spider web itself is randomly located, and not in a circle. The spider is not aggressive under normal conditions, but attacks if disturbed, especially if it considers that there is a threat to its egg bags. [6], [7]

It turns out that karakurt’s hurt is very easy, and absolutely by accident: as a result, the black widow believes that she and her house are being attacked, so she attacks and bites.

For no reason - for example, if you just admire the spiders - the black widow will not touch you.

If you walk in nature and see mouse minks, crevices, holes in the ground, rocky cracks in front of you, try to get around these places. As a rule, the black widow does not like too open areas, but arable land, ditches, ravines, salt marshes and stones are favorite sites for the settlement of spiders. Sometimes black widows settle in abandoned sheds and houses, or in yards littered with stones and various rubbish.

Risk factors

Black widow bites are recorded mainly in the summer, so those who spend this time away from home, in nature or in the country are in a particularly risky zone. In urban conditions, the presence of such insects is practically not felt, but trips to barbecue, camping overnight, hiking and mountaineering can sometimes lead to quite serious troubles.

Pathogenesis

The bite of the black widow is neurotoxic symptoms such as sharp pain around the bite, then you may experience sweating, hypertension, stroke and so on. D. Despite the fact that the deaths are rare, characterized by a significant and painful discomfort, so-called latrodectism syndrome,  [8]which is believed to be associated with the release of neurotransmitters, especially norepinephrine and acetylcholine, due to spider envenomation. [9]For many decades, the antidote has been considered an effective treatment for latrodectism. [10] 

The composition of the toxic secretion secreted by a black widow bite is represented by neurotoxins of protein origin,   [11] as well as enzymes - hyaluronidase, cholinesterase, phosphodiesterase, kininase, hydrolase [12].

The main toxic component of the poison is neurotoxin, or rather, α-latrotoxin. The neurotoxin subunit molecule is composed of 1042 amino acid residues. [13]The component is classified as presynaptic toxic substances. It acts on presynaptic nerve endings, in which the toxin contacts the protein receptors. Under conditions of a human body temperature (about thirty-seven degrees), a dimeric neurotoxin molecule forms a bond with a pair of receptor molecules. This connection is quite strong. [14]

Under conditions of reduced temperature, a neurotoxin forms an unstable bond with only one receptor molecule. [15]

The combination of neurotoxin and receptor leads to the formation of a channel of calcium ions. This channel penetrates the nerve ending and stimulates the processes of neurotransmitter release. In this case, the release is significantly enhanced, the reserves of the neurotransmitter in the nerve endings are quickly depleted, which causes a complete blockage of the neuromuscular impulse. The indicated mechanism can be traced using electron microscopy: during the action of a toxic substance, synaptic vesicles completely disappear. [16]

In addition to α-latrotoxin, black widow venom contains β-tartotoxin, which reveals a degree of homology.

It has been confirmed that karakurt poison exerts fibrinogenolytic and other proteolytic activities, showing a specific effect on extracellular matrix proteins such as fibronectin, laminin, type IV collagen and fibrinogen, which can play a role in spider toxicity. [17]

Interestingly, unlike many other poisonous animals, including snakes and some other species of spiders, which have toxins only in their poisonous glands, black widow spiders have toxins not only in their poisonous glands, but also throughout the body, in including in the legs and stomach, and even in the eggs and newborn spiders. [18]

Symptoms of the black widow bite

Not all spiders are able to bite, but of those who can - not everyone has such a toxic secret as a black widow. The poison is based on dangerous substances, neurotoxin and hemolysin, which have antigenic abilities and cause vivid intoxication symptoms.

The immediate instant of a bite most often goes unnoticed. The victim can pay attention to a sharp stabbing sensation that quickly disappears without a trace. On the skin, you can see a slight, barely noticeable point.

The first signs of intoxication after a bite of a black widow reveal themselves in approximately 1 / 2-1 hours. At first, sharp pain in the bitten area begins to bother, and after a while it gradually disperses throughout the body, spreading, including, to the feet and hands. In some victims, pain manifests simultaneously with seizures. [19] After a bite, erythema, sweating, and piloeraction are observed around the bite site in 25% of cases. [20]

In all patients, spastic muscle twitches are detected that originate from the muscles of the anterior abdominal wall. This symptom often confuses doctors, which leads to an incorrect diagnosis - for example, appendicitis, cholecystitis or other inflammatory diseases of the internal organs. [21]

It is necessary to remember the main difference: after a bite of a black widow, palpation of the abdomen is not accompanied by any painful sensations. It is important that pain in the feet and hands can rarely be associated with gastroenterological pathologies.

The general symptoms of a bite can be described by the following symptoms: [22]

• periodic nausea with vomiting;
• feeling tired and weak;
• dimming of consciousness, severe pain in the head;
• increased salivation;
• tremor of hands and feet;
• increased function of sweat glands;
• difficulty breathing
• heart palpitations;
• increase in blood pressure;
• cases of pripism in children are described; [23]
• numbness of limbs.

In complex cases, signs of insufficient renal activity, urinary incontinence may occur.

What does a black widow bite look like? Outwardly, this is just a small dark point that many simply do not notice. Among the other obvious symptoms that allow you to find a bite, these are:

• a person feels a strong injection at the time of the attack of the spider, then the sensations weaken or disappear altogether;
• after 15-30 minutes, the affected muscle begins to hurt, the pain becomes stronger, spreading throughout the body.

As a rule, the trace of a black widow's bite does not blush, does not swell, as many people think. Most often, you can hardly notice it: they determine it, more by sensations than by external manifestations. [24]

False Black Widow's Bite

A black widow is a spider that has its closest “relatives”, which are often confused. Karakurt-like spiders are called false black widows. Although this does not mean at all that they do not pose a danger to people.

A large steatode is the real name for a false widow, a spider that resembles a female karakurt. The bite of this insect is not so toxic, but no less unpleasant. A fatal outcome after the accident should not be expected, and the long-term consequences are not discussed. However, rather large blisters, spastic muscle cramps, painful sensations appear on the skin integument in the area of the steatode attack, the temperature rises, perspiration intensifies. General signs of malaise last for several days, after which the condition normalizes.

Stages

Immediately after the bite, the neurotoxin quickly disperses through the lymphatic system, leading to the release of neurotransmitters of the nervous system acetylcholine, norepinephrine and gamma-aminobutyric acid. With the onset of release processes, the symptoms of intoxication increase.

When a sufficient amount of a toxic substance enters the body, severe muscular pain appears in the first stage of the injury. The pain quickly encompasses the adjacent muscles. After the "capture" of the lymphatic system, the venom reaches the circulatory network, after which it spreads to all tissues, pathologically affecting the nerve endings.

The toxic substance blocks muscle relaxation: at a later stage, tetany develops, a steady and strong, painful muscle cramp. Muscle contraction diverges throughout the body, with the most pronounced muscle cramp in the anterior abdominal wall.

Lastly, facial muscles are involved in the process. The victim's face becomes sweaty (due to increased sweating), acquires an expression of infernal pain and fear. The condition is supplemented by blepharoconjunctivitis, tear secretion.

Complications and consequences

The consequences of a bite are not fully apparent for everyone: someone “escapes” with relatively little intoxication, while for others a fatal outcome occurs. But most often the bite of a black widow causes severe toxic and allergic reactions in the human body, and can also serve as an impetus for the development of other dangerous diseases. [25]

A bite rarely becomes just a local trauma or a limited inflammatory process in the tissues. Most often, the problem develops into a severe toxic shock, cases of acute fulminant toxic myocarditis are described,  [26] followed by the death of the victim. Mortality ranges from 5% to 10%, although these numbers may be overstated. [27]

In general, the consequences of a black widow bite can occur both immediately after damage and in a remote time period. Some pathological conditions in the form of a secondary infection or neurological problems do not occur immediately, and the term incubation can stretch to a couple of weeks or even a month. In this situation, the best prevention of adverse effects is as early as possible seeking medical help, as well as competent immediate treatment.

Is the bite of a black widow fatal?

The bite of a female karakurt spider can indeed prove fatal to humans, because its poison is very strong and instantly exerts its toxic effect. As for the karakurt male, he is not even able to bite through human skin.

If the victim of the bite was not provided with the necessary medical care, then a fatal outcome can occur within 24-48 hours.

Diagnostics of the black widow bite

The diagnosis of a black widow bite is made clinically. Visualization of the bite along with concomitant symptoms and a detailed history will allow an accurate diagnosis to be made. [28]

Approximately diagnostic measures for a bite of a black widow consist of the following steps:

• Assessment of the general condition of the victim (visual inspection, determination of the severity of the general condition).
• Assessment of complaints, collection of medical history (interview of the victim himself, his relatives and relatives, and necessarily witnesses to the bite, if any).
• The use of physical diagnostic techniques (examination of the site of a black widow's bite, assessment of the pulse quality, measurement of heart rate, listening to the heart and respiratory system, assessment of the symptoms of general intoxication and a generalized allergic reaction).
• Formulation and diagnosis.

Health workers should establish ongoing monitoring of the victim. Any deterioration should be taken as an indication for intensive care. Such therapy should be immediately followed when the patient enters in a state below satisfactory.

Other diagnostic procedures are carried out in stages, but do not precede the beginning of first aid to a person with a bite of a black widow.

• Analyzes in the laboratory involve the study of peripheral or venous blood, urine, and, if necessary, vomit and feces.
• Instrumental diagnostics may include ultrasound of internal organs, electrocardiography, measurement of temperature and blood pressure, etc.

Differential diagnosis

Differential diagnosis is carried out:

• with poisoning by alcohol, barbiturates, opiates, benzodiazepines, antipsychotics, cocaine;
• with bites of other insects, including bees, fleas, bugs, ticks, wasps, ants (almost any insect bite under certain circumstances can cause an inadequate reaction of the protective human mechanism);
• with allergic reactions and intoxications of any origin.

Treatment of the black widow bite

Usually, the bites of a black widow are not attempted to be treated independently, since such a situation requires immediate medical attention. First of all, the doctor will give an antihistamine, even if there are no signs of an allergic reaction - swelling, redness, itching, fever, nausea, etc. In some cases, there is a need for parenteral administration of drugs. Next, the doctor will introduce an analgesic, a solution with a vasopressor agent, etc.

Roughly the base of therapeutic actions looks like this:

• the provision of emergency medical care on the spot with further emergency hospitalization at a toxicological or resuscitation clinic (department), or at any nearest medical institution;
• removal of a toxic substance from the body, accelerating its elimination, or reducing its absorption;
• providing rest to the victim, applying cold, chipping with drugs (for example, epinephrine 0.1%), intramuscular injection of 50% analgin and 1% diphenhydramine (0.1 ml per year of life and 0.05 ml / kg, respectively);
• anti-shock measures (including heavy drinking);
• specific anti-venom treatment (in the presence of a special anti-drug serum);
• mechanical ventilation with respiratory depression;
• the introduction of the required volume of albumin, freshly frozen plasma, erythrocyte mass.

Before the arrival of the doctors, you can take the measures described by us further.

What to do with a bite of a black widow?

The first thing you need to do after understanding that you were bitten by a black widow is not to panic. During a fright or commotion, a person is lost, losing valuable time.

Before you talk about the rules of first aid for a bite of karakurt, let's say what you can not do:

• Do not apply a tourniquet on the affected limb;
• you can’t cut, incise the wound, pierce it, because this will not help the case, but the infection will bring;
• Do not eat or drink alcohol.

It is necessary to act quickly and clearly, if possible, call an ambulance or go to a medical institution, if it is nearby (necessarily - with an accompanying person).

First aid for a black widow bite

The stages of first aid to a victim of a black widow bite are as follows:

• the area of the alleged bite should be washed with cool water, it is possible with soap or other soap, with further disinfection with alcohol solutions, hydrogen peroxide;
• You can try to squeeze out the toxic secret from the wound;
• the affected area should be cooled as much as possible by applying ice or a bottle of cold water.

Medicines a doctor may prescribe

If you suspect a black widow's bite, you should immediately seek medical help - for example, call an emergency carriage. Depending on the symptoms, doctors can prescribe these groups of drugs:

• Antihistamines - are prescribed in any case, even if the victim does not have signs of an allergic reaction.
• Paracetamol-containing preparations are necessary to correct thermoregulation and to prevent the development of a temperature reaction to a black widow's bite.
• Nonsteroidal anti-inflammatory drugs for local use.
• Painkillers and antispasmodics - prescribed to reduce the severity of muscle cramps, to eliminate stiffness and seizures. [29]

In addition, the doctor can use blood pressure corrective drugs to treat.

Diazolin	An antihistamine is prescribed in a maximum single dose of 300 mg, with a daily maximum of 600 mg. The duration of treatment is determined by the doctor. Exceeding the dosage can be accompanied by the development of adverse reactions in the form of irritation of the mucous membranes of the digestive system, dizziness, allergic reactions, and increased fatigue.
Paracetamol	Analgesic-antipyretic, 2 tablets are prescribed up to 4 times a day, but not more than 4000 mg per day. The interval between doses should not be more than 4 hours. Possible side effects: rash, nausea, abdominal pain, hypoglycemia.
Ibuprofen ointment	Anti-inflammatory and analgesic agent for external use, which is applied to the site of a black widow bite up to 4 times a day. Side effects are allergies.
Spasmalgon	Analgesic, antispasmodic, anticholinergic with antipyretic properties. Take 2 tablets per day, for no more than three days. Possible side effects: dry mouth, constipation, dizziness, palpitations.
Nimesil	A non-steroidal anti-inflammatory drug that is used 100 mg twice a day with water. Signs of an overdose are manifested by apathy, drowsiness, nausea with vomiting, and abdominal pain.

Black widow bite antidote

Serum from a black widow bite, which is a derivative of horses based on immunoglobulin G,  [30]is administered intravenously, in the amount of one or two doses, in a dilution with 1 l of isotonic sodium chloride solution. A specific type of antidote is available only at the Tashkent Research Institute of Vaccines and Serums. The drug itself is relatively expensive, so not every hospital and clinic can afford its purchases.

If there is no serum (and most often this happens), then novocaine, calcium chloride or magnesia hydrosulfate can become its alternative.

In turn, a specific antidote can also cause severe allergic reactions, therefore, not in all cases, doctors consider the use of serum appropriate. [31] Some believe that the antidote, when properly prescribed, is safe and should be considered in cases of envenomation with systemic symptoms or with pronounced local symptoms. 

In Australia, for more than 40 years, intramuscular antidote has been widely used with a very low percentage (from 0.5% to 0.8%) of allergic reactions and not a single death has been reported since its introduction. The antidote usually successfully alleviates the symptoms of latrodectism. In the United States, the antidote is administered intravenously, usually used in very severe cases, and the level of allergic reactions is high (from 9 to 80%). Deaths have been reported following the administration of the antidote. [32]

Black widow spider bites during pregnancy - an indication for the introduction of an antidote because of the risk of termination of pregnancy due to poison or other possible harm to the fetus. [33] However, the actual risk is not known. One report of a study of 97 black widow bites in pregnant women did not report a single case of miscarriage. Despite the fact that Antivenin Latrodectus mactans is a category C drug, it was taken during pregnancy without negative consequences.[34]

The antidote Latrodectus mactans has been used for over 70 years. A new antidote based on Fab antibodies is currently under development and in phase 3 trials. It is hoped that this product will be equally effective, but will have fewer hypersensitivity reactions. [35]

Alternative treatment

An alternative treatment is a very dubious way when it comes to a dangerous bite of a black widow. But sometimes a person has no choice - for example, if there is no way to seek qualified medical help, one has to hope for the effectiveness of alternative methods. What can healers offer us? Some recipes are quite interesting and deserve attention.

• In the first minutes after a bite, eating a lot of garlic, which you need to drink with dry wine, can help. There should really be a lot of wine and garlic - as much as the victim can consume.
• The bitten place is completely immersed in hot milk. According to experts, this method will allow you to bind the toxin and remove it from the body.
• They use freshly prepared juice of the root plant, or apple leaves, or marjoram.
• Fresh broth of wild parsley, calamus rhizome, and burial seeds are prepared and consumed.
• They use fresh cabbage juice with the addition of hot pepper, leek or artichoke juice, as well as a large amount of ginger root.
• The bite of a black widow is poured with boiled vinegar or fresh urine, dressings are applied with the indicated means.
• You can use lotions with oils - they say that laurel oil (you can do it yourself) can do its job perfectly.

They perfectly complement alternative treatment with various medicinal herbs.

Herbal treatment

• Hemp seed ground into powder is fixed in the bite area.
• The steamed veronica plant is tightly tied to the wound. The effect will be stronger while using a strong infusion of this raw material.
• Apply to the place of the bite of the black widow the chewed rhizome of elecampane, or the chewed leaves of elecampane. In addition, an infusion is prepared: they take the ground root of the plant (1 tbsp.), Pour 200 ml of warm water, stand for half an hour and drink without filtering.
• Apply dressings with steamed bran, or chewed bay leaves.
• Sprinkle a wound with ash from a vine.

During the entire period of treatment, it is recommended to take an infusion of bitter wormwood, gentian, and chernoshka.

Homeopathy

One of the basic principles of homeopathy is the principle of small doses: as a rule, homeopathic remedies are solutions of extremely low concentration, having a vegetable, animal or mineral origin. It can be argued that these funds are so refined that they have a strictly necessary therapeutic effect, without additional toxic load on the body. With insect bites - and, in particular, the black widow, this moment is especially relevant.

It is up to the patient to decide whether or not to apply homeopathy in cases of emergency like a spider bite. There are cases when official medicine showed impotence, and homeopathic medicines put a person on his feet. However, there are many opponents of this type of treatment. Therefore, each person must decide this issue independently.

Doctors homeopaths successfully cure both chronic and acute intoxication. True, the dosages of drugs are always prescribed individually, which depends on many factors: on the constitutional characteristics of the victim, on the existing symptoms, etc. Now we turn to the drugs that can be advised by a qualified homeopathic physician.

Arnica is an almost universal remedy that accelerates the resorption of the bite, stabilizes the vascular walls, and eliminates tissue edema.

With fever, general anxiety, thirst and a feeling of heat, Aconitum and Belladonna will help.

Accelerates the elimination of toxic substances from the body Nux vomica: this tool facilitates intoxication, improves digestion.

Those patients who have already tried homeopathic treatment, most often recommend it as an alternative method of therapy, however, using it in emergency situations is a rather risky move that not everyone can decide on.

Surgery

When bitten by a black widow, or other insects, there is always a risk of secondary infection. In such a situation, consultation with a specialist - an infectious disease specialist, or a surgeon is necessary. If required, an operation is assigned.

The standard treatment for a spider bite does not imply a surgical operation.

Prevention

From the bites of a black widow, those who go to rest in nature are mostly affected. To avoid the problem, you need to follow these recommendations of specialists:

• have a resting place on the ground, not suitable for the spider to live (without visible places of shelters, minks, holes, stones);
• it is important to pay attention to the presence of the web;
• try not to take off your shoes and not to walk barefoot on the ground, not to lie down on uncovered ground;
• to collect firewood or straw only in mittens and covered clothes, tucking trousers in socks, and sleeves - in mittens;
• try not to walk on the steppe and rocky terrain at night, not to raise and not turn over stones;
• completely close the tents and sleeping bags, do not leave shoes outside the tent (a black widow can use shoes like a mink).

If a black widow bites or suspects him, it is necessary to go to a medical institution as soon as possible, as well as take first aid measures, which we wrote about above.

Forecast

The prognosis of a black widow bite is favorable. Most pain and systemic symptoms are limited. Although patients may experience prolonged pain or muscle cramps after being bitten by a black widow, this phenomenon is rare. Similarly, systemic toxicity, including abdominal pain and autonomic dysfunction, is usually temporary. Recovery usually completes within 24-48 hours. [36]

Sometimes a bite of a black widow for a person is lethal. The opportunity to survive is given by the introduction of a special vaccine - an antidote, which is not always available in medical institutions. It is possible to reduce the effect of the toxin if the wound is chilled timely and strongly. However, this action does not guarantee the absence of clouding of consciousness and disturbances on the part of the respiratory system.