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

The black widow spider is one of the most poisonous insects known in the world. [ 1 ] The bite of a black widow spider, another name for the black widow, is highly toxic and can be fatal to the victim.

The black widow can live in the steppe or desert. Such spiders are quite common in Afghanistan, North Africa, Iran, and southern European countries. In particular, black widows are found in the Mediterranean and Caucasian regions, as well as in the Astrakhan region, the Azov region, and in the south of Ukraine. In winter, adult individuals die, but small arthropods inside the cocoons survive.

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

Epidemiology

Approximately 2,600 black widow Latrodectus bites are reported annually to the US National Spider Data System (NPDS).[ 2 ]

• The black widow can settle in burrows and ditches, on slopes, under stones and in crevices.
• The bite of a black widow is fifteen times more venomous than that of a rattlesnake.
• The female karakurt lives for more than a year (up to fourteen months), and the male – up to ten months.
• The black widow's blood lacks hemoglobin, which explains its bluish-blue tint.
• Just a hundred years ago, up to four hundred people died a year from the bite of a black widow, as well as three or four hundred animals (mostly cattle).
• Even-toed ungulates are the most sensitive to spider venom.
• In 1997, almost ninety victims of black widow bites were recorded in the vicinity of Kherson. All patients were hospitalized, but none of them survived.
• Bites are especially dangerous for children and the elderly.

Causes of the black widow's bite

First, let's figure out what kind of spider this is - the karakurt, which belongs to the genus of black widows. The karakurt is a representative of the family of web-weaving spiders (Arthropoda, Arachnida, Araneae). [ 3 ] The genus has more than 30 species that are distributed throughout the world. [ 4 ] The insect received the name black widow, first of all, due to its appearance: the legs, head and abdomen of the spider are black. Widow - because the female spider (and it is she who bites people) eats her male immediately after mating. [ 5 ] The remote part of each chelicerae is a movable hollow fang that penetrates the skin during a bite, injecting poison into the victim.

Why does the black widow bite? The fact is that it is quite difficult to notice the insect in nature. Moreover, the karakurt does not stretch its web vertically, as other spiders do, but horizontally. The web itself is located randomly, 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 sacs. [ 6 ], [ 7 ]

It turns out that it is very easy to hurt a black widow, and completely by accident: as a result, the black widow believes that she and her home are being encroached upon, so she attacks and bites.

Without a reason - for example, if you are simply admiring spiders - the black widow will not touch you.

If you are walking in nature and see mouse holes, crevices, depressions in the ground, rocky cracks in front of you, then try to avoid 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 places for spiders to settle. Sometimes black widows settle in abandoned sheds and houses, or in yards littered with stones and various rubbish.

Risk factors

Black widow bites are registered mainly in the summer, so those who spend this time away from home, in nature or at the dacha are at particular risk. In urban conditions, the presence of such insects is practically not felt, but trips to barbecues, overnight stays in tents, hiking and mountain tourism can sometimes lead to quite serious troubles.

Pathogenesis

The bite of the black widow spider causes neurotoxic symptoms such as severe pain around the bite site, which may be followed by sweating, hypertension, paralysis, etc. Although deaths are rare, significant and excruciating discomfort, called latrodectism syndrome, is common,[ 8 ] which is thought to be related to the release of neurotransmitters, especially norepinephrine and acetylcholine, due to the spider's envenomation.[ 9 ] For many decades, antivenom has been considered an effective treatment for latrodectism.[ 10 ]

The composition of the toxic secretion released during the bite of a black widow 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 a neurotoxin, or more precisely, α-latrotoxin. The neurotoxin subunit molecule consists of 1042 amino acid residues. [ 13 ] The component is classified as a presynaptic toxic substance. It acts on presynaptic nerve endings, where the toxin binds to protein receptors. At human body temperature (about thirty-seven degrees), the dimeric neurotoxin molecule forms a bond with a pair of receptor molecules. This bond is quite strong. [ 14 ]

At low temperatures, the neurotoxin forms a weak bond with only one receptor molecule. [ 15 ]

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

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

Black widow spider venom has been confirmed to have fibrinogenolytic and other proteolytic activities, showing specific effects on extracellular matrix proteins such as fibronectin, laminin, type IV collagen and fibrinogen, which may play a role in the spider's toxicity.[ 17 ]

Interestingly, unlike many other venomous animals, including snakes and some other types of spiders, which only have toxins in their venom glands, black widow spiders have toxins not only in their venom glands, but throughout their entire bodies, including their legs and abdomen, and even in their eggs and hatchlings.[ 18 ]

Symptoms of the black widow's bite

Not all spiders are capable of biting, and of those that can, not all have such a toxic secretion as the black widow. The basis of the poison is the dangerous substances neurotoxin and hemolysin, which have antigenic properties and cause vivid intoxication symptoms.

The immediate moment of the bite most often remains unnoticed. The victim may notice a sharp stabbing sensation that quickly disappears without a trace. On the skin, you can see a small, barely noticeable point.

The first signs of intoxication after a black widow bite appear approximately 1/2-1 hour later. At first, a sharp pain in the bitten area begins to bother, and after a while it gradually spreads throughout the body, including the feet and hands. In some victims, pain appears simultaneously with convulsions. [ 19 ] After a bite, in 25% of cases, erythema, sweating and piloerection are observed around the bite site. [ 20 ]

All patients experience spastic twitching of the muscles, which originate from the muscles of the anterior abdominal wall. This symptom often confuses doctors, which leads to incorrect diagnosis – for example, appendicitis, cholecystitis or other inflammatory diseases of the internal organs. [ 21 ]

It is important to remember the main difference: after a black widow bite, 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 gastrointestinal pathologies.

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

• periodic nausea with vomiting;
• feeling of fatigue and weakness;
• clouding of consciousness, severe headaches;
• increased salivation;
• tremors of the arms and legs;
• enhancing the function of sweat glands;
• difficulty breathing;
• increased heart rate;
• increased blood pressure;
• Cases of pripism in children have been described; [ 23 ]
• sensation of numbness in the limbs.

In complex cases, signs of insufficient renal function and urinary incontinence may appear.

What does a black widow bite look like? Externally, it is just a small dark spot that many simply do not notice. Among other obvious symptoms that allow you to find the bite site, the following are distinguished:

• a person feels a strong prick at the moment of the spider's attack, then the sensation weakens or disappears altogether;
• After 15-30 minutes, the affected muscle begins to hurt, the pain becomes more and more intense, spreading throughout the body.

As a rule, the bite mark of a black widow does not turn red or swell, as many people think. Most often, it is barely noticeable: it is determined more by sensations than by external manifestations.

False Black Widow Bite

The black widow is a spider that has its closest "relatives" that are often confused with each other. Spiders that look like black widows are called false black widows. Although this does not mean that they do not pose a danger to people.

Steatoda major is the real name of the false widow, a spider that has an external resemblance to the female black widow. The bite of this insect is not as toxic, but no less unpleasant. A fatal outcome after the incident should not be expected, and there is no talk of long-term consequences. However, on the skin in the area of the attack of the steatoda, fairly large blisters appear, muscle spasms, painful sensations, the temperature rises, and sweating increases. General signs of malaise continue for several days, after which the condition normalizes.

Stages

Immediately after the bite, the neurotoxin quickly spreads through the lymphatic system, causing the release of the nervous system mediators acetylcholine, norepinephrine and gamma-aminobutyric acid. With the onset of the release processes, the symptoms of intoxication increase.

When a sufficient amount of toxic substance enters the body, the first stage is characterized by severe muscle pain in the area of damage. The pain quickly spreads to the adjacent muscles. After "capturing" the lymphatic system, the poison reaches the circulatory system, after which it spreads throughout all tissues, pathologically affecting the nerve endings.

The toxic substance blocks muscle relaxation: at a later stage, tetany develops, a persistent and severe, painful muscle spasm. The muscle contraction spreads throughout the body, with the most pronounced spasm occurring in the muscles of the anterior abdominal wall.

The facial muscles are the last to be involved in the process. The victim's face becomes sweaty (due to increased sweating), and takes on an expression of hellish pain and fear. The condition is accompanied by blepharoconjunctivitis and lacrimation.

Complications and consequences

The consequences of a bite do not manifest themselves fully in everyone: some “get off” with relatively minor intoxication, while for others it is fatal. But most often, a black widow bite causes severe toxic and allergic reactions in the human body, and can also serve as an impetus for the development of other dangerous diseases. [ 24 ]

A bite rarely becomes just a local injury or a limited inflammatory process in the tissues. Most often, the problem develops into severe toxic shock; cases of acute fulminant toxic myocarditis have been described, [ 25 ] followed by the death of the victim. Mortality varies from 5% to 10%, although these figures may be overstated. [ 26 ]

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

Is a black widow bite fatal?

The bite of a female black widow spider can indeed be fatal to a person, because her poison is very strong and immediately has its toxic effect. As for the male black widow spider, it is not even capable of biting through human skin.

If the bite victim has not received the necessary medical care, then death may occur within 24-48 hours.

Diagnostics of the black widow's bite

The diagnosis of a black widow bite is made clinically. Visualization of the bite along with accompanying symptoms and obtaining a detailed anamnesis will allow an accurate diagnosis to be made. [ 27 ]

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

• Assessment of the general condition of the victim (visual examination, determination of the severity of the general condition).
• Evaluation of complaints, collection of anamnesis (questioning the victim himself, his relatives and friends, and necessarily witnesses to the bite, if any).
• Use of physical diagnostic techniques (examination of the black widow bite site, assessment of pulse quality, measurement of heart rate, listening to the heart and respiratory system, assessment of symptoms of general intoxication and generalized allergic reaction).
• Formulation and diagnosis.

Medical workers must establish constant observation of the victim. Any deterioration in the condition should be perceived as an indication for intensive therapy. Such therapy should immediately follow even if the patient is admitted in a condition less than satisfactory.

Other diagnostic procedures are performed in a step-by-step manner, but do not precede the initiation of first aid for a person with a black widow bite.

• Laboratory tests involve examination 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 diagnostics are carried out:

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

Treatment of the black widow's bite

Usually, black widow bites are not treated independently, as such a situation requires immediate medical attention. First, 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. Then the doctor will administer an analgesic, a solution with a vasopressor, etc.

The approximate basis of treatment actions looks like this:

• provision of emergency medical care on site with subsequent emergency hospitalization in a toxicology or intensive care clinic (department), or in any nearest medical and preventive institution;
• removal of a toxic substance from the body, acceleration of its elimination, or reduction of its absorption;
• ensuring rest for the victim, applying cold, injecting with medications (for example, 0.1% epinephrine), 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 drinking plenty of fluids);
• specific antidote treatment (if a special anti-black widow serum is available);
• artificial ventilation in case of respiratory depression;
• introduction of the required volume of albumin, fresh frozen plasma, and red blood cell mass.

Before the doctors arrive, you can take the measures we describe below.

What to do if bitten by a black widow?

The first thing you need to do after realizing that you have been bitten by a black widow is not to panic. During fear or panic, a person gets lost, wasting precious time.

Before we talk about the rules for providing first aid for a black widow bite, let's talk about what you shouldn't do:

• Do not apply a tourniquet to the affected limb;
• you can’t cut, incise or pierce the wound, as this won’t help the matter, but will introduce an infection;
• You cannot eat food or drink alcohol.

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

First Aid for a Black Widow Bite

The steps for first aid for a victim of a black widow bite are as follows:

• the area of the suspected bite should be washed with cool water, possibly with laundry or other soap, followed by disinfection with alcohol solutions, hydrogen peroxide;
• you can try to squeeze out the toxic secretion from the wound;
• The affected area should be cooled as much as possible by applying ice or a bottle of cold water.

Medicines that a doctor may prescribe

If you suspect a black widow bite, you should seek medical help immediately, such as calling an ambulance. Depending on the symptoms, doctors may prescribe the following groups of medications:

• Antihistamines are prescribed in any case, even if the victim does not show signs of an allergic reaction.
• Paracetamol-containing drugs are necessary to correct thermoregulation and to prevent the development of a temperature reaction to a black widow bite.
• Non-steroidal anti-inflammatory drugs for topical use.
• Painkillers and antispasmodics are prescribed to reduce the severity of muscle spasms, to eliminate stiffness and cramps. [ 28 ]

Additionally, the doctor may use medications to correct blood pressure for treatment.

Diazolin	The 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 may be accompanied by the development of side effects in the form of irritation of the mucous membranes of the digestive system, dizziness, allergic reactions, and increased fatigue.
Paracetamol	An analgesic-antipyretic, prescribed 2 tablets up to 4 times a day, but not more than 4000 mg per day. The interval between doses should not exceed 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 - allergy.
Spazmalgon	Analgesic, antispasmodic, anticholinergic with antipyretic properties. Take 2 tablets per day for no more than three days. Possible side effects: dry mouth, constipation, dizziness, rapid heartbeat.
Nimesil	A nonsteroidal anti-inflammatory drug, which is used 100 mg twice a day, with water. Signs of overdose are apathy, drowsiness, nausea with vomiting, abdominal pain.

Antidote for black widow bite

The black widow bite serum, which is an equine immunoglobulin G derivative, [ 29 ] is administered intravenously in one or two doses, diluted with 1 liter of isotonic sodium chloride solution. A specific type of antidote is produced only at the Tashkent Research Institute of Vaccines and Serums. The drug itself is relatively expensive, so not every hospital and clinic can afford to purchase it.

If there is no serum (and this is most often the case), then novocaine, calcium chloride or magnesium hydrosulfate can be used as an alternative.

In turn, the specific antidote can also cause severe allergic reactions, so not in all cases do doctors consider it appropriate to use the serum. 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, intramuscular antivenom has been widely used for over 40 years with a very low rate (0.5% to 0.8%) of allergic reactions and no deaths have been reported since its introduction. The antivenom is usually successful in relieving the symptoms of latrodectism. In the United States, antivenom is given intravenously, usually for very severe cases, and the rate of allergic reactions is high (9 to 80%). Deaths have been reported following antivenom administration.[ 30 ]

Black widow spider bites during pregnancy are an indication for antivenom administration due to the risk of venom-induced miscarriage or other possible harm to the fetus.[ 31 ] However, the actual risk is unknown. In one study of 97 black widow bites in pregnant women, no cases of miscarriage were reported. Although Antivenin Latrodectus mactans is a category C drug, it has been taken during pregnancy without adverse effects.[ 32 ]

Latrodectus mactans antivenom has been in use for over 70 years. A new Fab-based antivenom is currently in development and in phase 3 trials. It is hoped that this product will be equally effective but have fewer hypersensitivity reactions.[ 33 ]

Folk remedies

Folk remedies are a rather dubious method when it comes to a dangerous black widow bite. But sometimes a person has no choice – for example, if there is no way to seek qualified medical help, one has to rely on the effectiveness of folk methods. What can healers offer us? Some recipes are quite interesting and deserve attention.

• In the first minutes after the bite, it may help to eat a large amount of garlic, washed down with dry wine. There really should be a lot of both wine and garlic – as much as the victim can consume.
• The bitten area is completely immersed in hot milk. According to experts, this method will bind the toxin and remove it from the body.
• They use freshly prepared juice of the rue plant, or apple leaves, or marjoram.
• Prepare and consume a fresh decoction of wild parsley, calamus rhizomes, and graveyard seeds.
• They consume fresh cabbage juice with the addition of hot pepper, leek or artichoke juice, as well as a large amount of ginger root.
• The site of the black widow bite is doused with boiled vinegar or fresh urine, and bandages with the indicated agents are applied.
• You can use lotions with oils - they say that laurel oil (you can make it yourself) copes with this task perfectly.

They perfectly complement folk treatment with the use of various medicinal herbs.

Herbal treatment

• Apply ground hemp seed powder to the bite area.
• Tightly tie a steamed veronica plant to the wound. The effect will be stronger if a strong infusion of this raw material is consumed at the same time.
• Apply chewed elecampane rhizome or chewed elecampane leaves to the site of the black widow bite. In addition, prepare an infusion: take the ground root of the plant (1 tbsp), pour 200 ml of warm water, leave for half an hour and drink without straining.
• Apply dressings with steamed bran or chewed bay leaves.
• Sprinkle the wound with grapevine ash.

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

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, of plant, animal or mineral origin. It can also be argued that these remedies are so refined that they have a strictly necessary therapeutic effect, without additional toxic load on the body. In case of insect bites - and, in particular, black widow, this point is especially relevant.

It is up to the patient to decide whether to use homeopathy in such emergency cases as a spider bite. There are known cases where official medicine has shown impotence, and homeopathic medicines have put a person back on his feet. However, there are many opponents of this type of treatment. Therefore, each person must decide this issue independently.

Homeopathic doctors successfully treat both chronic and acute intoxication. However, the dosage of drugs is always prescribed individually, which depends on many factors: the constitutional characteristics of the victim, the symptoms present, etc. Now let's move on to the drugs that a qualified homeopathic doctor can recommend.

Arnica is a virtually universal remedy that accelerates the resorption of the bite site, stabilizes vascular walls, and eliminates tissue swelling.

For fever, general restlessness, thirst and a feeling of heat, Aconitum and Belladonna will help.

Accelerates the removal of toxic substances from the body Nux vomica: this remedy alleviates intoxication and improves digestion.

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

Surgical treatment

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

Standard treatment for a spider bite does not involve surgery.

Prevention

Black widow bites mostly affect those who go on vacations in nature. To avoid the problem, you need to follow these recommendations from experts:

• locate the resting place on ground that is not suitable for the spider to live in (without visible hiding places, burrows, holes, stones);
• It is important to pay attention to the presence of cobwebs;
• try not to take off your shoes and do not walk on the ground barefoot, do not lie down on uncovered ground;
• collect firewood or straw only wearing gloves and closed clothing, tucking trousers into socks and sleeves into gloves;
• try not to walk on steppe and rocky terrain at night, do not lift or turn over stones;
• Tents and sleeping bags should be completely closed, and shoes should not be left outside the tent (the black widow can use shoes as a mink).

If you are bitten by a black widow or suspect that you have been bitten, you should go to a medical facility as soon as possible and take the first aid measures that we wrote about above.

Forecast

The prognosis for a black widow bite is good. Most pain and systemic symptoms are limited. Although patients may experience prolonged pain or muscle spasms after black widow bites, this is rare. Likewise, systemic toxicity, including abdominal pain and autonomic dysfunction, is usually temporary. Recovery is usually complete within 24 to 48 hours.[ 34 ]

Sometimes a black widow bite is fatal for a person. The chance to survive is provided by the introduction of a special vaccine - an antidote, which is not always available in medical institutions. The effect of the toxin can be reduced if the bite wound is cooled in a timely manner and strongly. However, this action does not guarantee the absence of clouding of consciousness and respiratory system disorders.