The horrid thumb injury photos allegedly caused by a spider bite
Revised 9 Jun 2010
I have received the series of images of a horrid injury to a thumb from many people starting in June 2003 with the alleged cause being a spider bite, most commonly attributed to a brown recluse. It is possible that this is a spider bite, however, the stories surrounding this series of images have acquired the makings of an urban legend. I have now heard that this same wound supposedly was a brown recluse bite that occurred in 7 American states, 4 Canadian provinces and Costa Rica, was supposedly a hobo spider bite in British Columbia and a solifuge bite in Iraq. In August of 2005, a Belgian arachnologist informed me that this same series of photos has been circulating in Belgium as alleged African spider bites occurring in Belgian people, that you have only 14 minutes to get to a hospital for treatment and that 88% of the bite victims lose a limb due to the bite. So what is it? A recluse bite? A hobo spider bite? An African spider bite? Which is correct? The recluse bite? Why? Because you received an email saying that that was what it was? What is the proof that would allow any of these alleged causes to be accurate other than it was received as an email stating its alleged cause?
Obviously, this one series of pictures cannot be a recluse bite in all of these places and then also be an African spider bite in Belgium so one should REALLY question the validity of this information that is circulating. Unfortunately, I have heard that readily-accepting people have used these images for Powerpoint presentations in paramedic classes etc. which may be spreading misinformation rather than educating people. The picture of the recluse spider itself is not of the spider that caused the wound (as some have claimed) but is a stock photo from an Ohio university website. This image was used in 2002 in a hyperbolic news story in Long Island. Although it is possible that this is a recluse bite, no one can seem to verify where the alleged bite occurred, whether a spider was caught in the act of biting or at the scene of the crime, whether the victim was tested for additional etiologic agents of necrosis such as bacterial infection, if a doctor actually made the diagnosis or it was a self-diagnosis from the victim, if the diagnosis came from an area of the continent that actually has brown recluses, etc. Again, what proof is offered that this is a spider-related injury except for the fact that the email says so?
However, the main effect that this set of images will have is to cause paranoia in the non-arachnological public, bring out corroborative stories of people who have some alleged brown recluse story and will proliferate once again the hyperbolic message about recluses. One of the forms of this series that I saw was a statement something like, "warn people - save a life". Once again, hyperbole. I have added a webpage to my spiders.ucr.edu website lifting quotes from an article by Phillip Anderson, a Missouri dermatologist who specialized on brown recluse bites for over 30 years. Basically here is a summary from his article and several since then by other authors.
Many people contact me stating that their doctors diagnosed them with recluse bites and then gave antibiotics. Although antibiotics are not a bad idea overall, they do nothing to counteract the effects of venom. Antibiotics kill bacteria. The correct treatment for recluse bites is simply RICE therapy (rest, ice, compression and elevation). (Actually this has been modified from “ice” to “cold” because some people put ice directly on their skin and cause frozen tissue injuries.) So therefore when a doctor prescribes antibiotics for a “brown recluse bite”, the doctor is either treating it like a bacterial infection or prescribing the incorrect remedy.
The analogy I like to use with these images is that of a car accident. If you show a car wreck where the driver was going 130 miles an hour and then hit a bridge, the car would be totally wrecked into dozens of twisted pieces, body parts strewn all over the place and it would be horrendous. If people reacted to this the way they are reacting to the thumb picture, then they would make the assumption that every car wreck is just as catastrophic, cars are to be feared and no one should ever drive because they will end up obliterated across two counties. However, we all know that many car accidents are just bumper scrapers or fenderbenders, more serious accidents involve broken windows and minor injuries, even more serious and less common accidents involve smashed up cars and broken bones and maybe death. Similar to recluse bites, most bites are minor and heal by themselves, some are more serious and require more healing time and leave a scar, even more serious and less common bites require extensive supportive medical care and possibly skin grafts. However, the typical case for a brown recluse bite is minor in effect and prospects for healing are excellent.
One of the very real problems with recluse bites (and any arthropod bite for that matter) is that the bite causes itching, the victim scratches, introducing a secondary bacterial infection from grungy fingernails and such, a horrific wound shows up and then the wound is solely blamed on the arthropod when the real culprit is the bite victim him/herself. Additionally, besides horrific lesions being very rare in recluse bite situations, horrific recluse-induced wounds typically occur in obese people because recluse venom strongly affects adipose tissue. It does very little damage in muscular tissue. This wound is on the hand of a person who does not look obese as well as the hand is not an area of the body with lots of adipose tissue in comparison to the stomach and buttocks where most of the wounds in the obese occur. So, this is one strong argument against this injury being a recluse bite and therefore, possibly having a different causative agent. Additionally, I showed the images to a colleague of mine who is a dermatologist in Missouri who specializes in brown recluse bites and he thought it wasn’t a recluse bite and more likely is a bacterial infection.
So the summary on this is that if it indeed is a brown recluse bite, then it is truly one of the very rare, horrific ones, however, there is not sufficient information provided with this image to ascertain whether it is credible or not. Yes, indeed, it is a horrible wound but unless a spider was found in the act of biting, there is no more reason to assume that this is a brown recluse bite than to assume that it is necrotizing bacteria or pyoderma gangrenosum or several other medical afflictions that manifest in the dermatologic eruption that can occur. An article of mine shows how unlikely recluse bites are: a family in Kansas collected over two thousand brown recluses in 6 months, and it took living there for 11 years in this highly infested home before the mother got a nip by a brown recluse when she reached inside the sleeve of a shirt while doing wash. The finger turned a little red, swelled a little and went back to normal in a few days. This latter message is rarely advertised by the hyperbolic news media or the easily scared general public because people have a tendency to overreact and want to believe the worse about a situation.
Please send this message back to whomever sent you the thumb images. Below my name is a list of my publications on spiders of medical importance, most of them in medical journals, many of them addressing the mythology of spider bites in both the medical community and the general public. Many are available in PDF form. Contact me and I will send whichever you request.
Rick Vetter
Entomology
Univ. Calif. Riverside
Riverside, CA 92521
Vetter, R. S. 2010. Myths based in science and medicine – how they initiate, propagate, and the role of peer-review research in dispelling them. Perspect. Agric. Veterin. Sci. Nutrition Natur. Resources [invited review] (in press as of June 2010)
Vetter, R. S. 2009. The distribution of the brown recluse spider in the southeastern quadrant of the United States in relation to loxoscelism diagnoses. Southern Med. J. 102:518-522. *PDF
Vetter, R. S. 2009. Arachnids misidentified as brown recluse spiders by medical personnel and other authorities in North America. Toxicon 54: 545-547. *PDF
Vetter, R. S., N. C. Hinkle and L. M. Ames. 2009. Distribution of the brown recluse spider (Araneae: Sicariidae) in Georgia with a comparison of poison center reports of envenomations. J. Med. Entomol. 46:15-20. *PDF
Pace, L. B. and R. S. Vetter. 2009. Brown recluse spider (Loxosceles reclusa) envenomation in small animals. J. Veterinary Emerg. Crit. Care 19:329-336. *PDF
Vetter, R. S. 2008. Spiders of the genus Loxosceles (Araneae, Sicariidae): a review of biological, medical and psychological aspects regarding envenomations. J. Arachnol. 36:150-163. *PDF
Vetter, R. S. and G. K. Isbister. 2008. Medical aspects of spider bites. Ann. Rev. Entomol. 53: 409-429. *PDF
Frithsen, I. L., R. S. Vetter and I. C. Stocks. 2007. Reports of envenomation by brown recluse spiders outnumber verified specimens of Loxosceles spiders in South Carolina. J. Amer. Board Fam. Med. 20:483-488. *PDF
Vetter, R. S. and D. L. Swanson. 2007. Of spiders and zebras: publication of inadequately documented loxoscelism case reports. J. Amer. Academy Dermatol. 56:1063-1064. *PDF
Vetter, R. S., B. B. Pagac, R. W. Reiland, D. T. Bolesh and D. L. Swanson. 2006. Skin lesions in barracks: consider community-acquired methicillin-resistant Staphylococcus aureus infection instead of spider bites. Military Medicine 171: 830-832. *PDF
Vetter, R. S. and J. O. Schmidt. 2006. Semantics of toxinology. Toxicon 48:1-3. *PDF
Vetter, R. S. and G. K. Isbister. 2006. Verified bites by the woodlouse spider, Dysdera crocata. Toxicon 47:826-829. *PDF
Vetter, R. S., G. K. Isbister, S. P. Bush and L. J. Boutin. 2006. Verified bites by Cheiracanthium spiders in the United States and Australia: where is the necrosis? Amer. J. Trop. Med. Hyg. 74:1043-1048. *PDF
Swanson, D. L. and R. S. Vetter. 2006. Loxoscelism. Clin. Dermatol. 24:213-221. *PDF
Vetter, R. S. and R. B. Furbee. 2006. Caveats in interpreting poison control centre data for spider bites in epidemiology studies. Public Health 120: 179-181. *PDF
Vetter, R. S. 2005. Arachnids submitted as suspected brown recluse spiders (Araneae: Sicariidae): Loxosceles spiders are virtually restricted to their known distributions but are perceived to exist throughout the United States. J. Med. Entomol. 42:512-521 *PDF
Isbister, G. K. and R. S. Vetter. 2005. Necrotic arachnidism: more myths and minor corrections. [Letter] Annals Emerg. Medicine 46: 205-206.
Swanson, D. L. and R. S. Vetter. 2005. Bites of brown recluse spiders and suspected necrotic arachnidism. New Engl. J. Med. 352:700-707. *PDF
Vetter, R. S. 2005. Arachnids submitted as suspected brown recluse spiders (Araneae: Sicariidae): Loxosceles species are virtually restricted to their known distributions but are perceived to exist throughout the United States. J. Med. Entomol. 42: 512-521. *PDF
Vetter, R. S. and D. L. Swanson. 2005. Arthropods in dermatology: errors in arachnology [letter]. J. Amer. Academy Dermatol. 52: 923.
Isbister, G. K., J. White, B. J. Currie, S. P. Bush, R. S. Vetter and D. A. Warrell. 2005. Spider bites: addressing mythology and poor evidence. Amer. J. Tropical Med. Hygiene 72:361-364.
Isbister, G. K. and R. S. Vetter. 2005. Necrotic arachnidism: more myths and minor corrections. [Letter] Annals Emerg. Medicine 46: 205-206.
Vetter, R. S. and S. P. Bush. 2004. Additional considerations regarding brown recluse spider bites and dapsone therapy [letter]. Amer. J. Emerg. Med. 22:494-495.
Vetter, R. S. and G. K. Isbister. 2004. Do hobo spider bites cause dermonecrotic injuries? Annals Emerg. Med. 44:605-607 *PDF
Bennett, R. G. and R. S. Vetter. 2004. Erroneous attribution of dermonecrotic lesions to brown recluse or hobo spiders in Canada. Canadian Family Physician 50:1098-1101 *PDF
Vetter, R. S. 2004. Myths about spider envenomations and necrotic skin lesions. Lancet 364:484-485. *PDF
Vetter, R. S., G. B. Edwards and L. F. James. 2004. Reports of envenomation by brown recluse spiders (Araneae: Sicariidae) outnumber verifications of Loxosceles spiders in Florida. J. Medical Entomol. 41:593-597 *PDF
Vetter, R. S., P. E. Cushing, R. L. Crawford and L. A. Royce. 2003. Diagnoses of brown recluse spider bites (loxoscelism) greatly outnumber actual verifications of the spider in four western American states. Toxicon 42:413-418 *PDF
Vetter, R. S. 2003. Brown recluse spider bite diagnoses and lawsuits. Pediatric Emergency Care. 19:291-292 *PDF
Vetter, R. S., A. H. Roe, R. G. Bennett, C. R. Baird, L. A. Royce, W. T. Lanier, A. L. Antonelli and P.E. Cushing. 2003. Distribution of the medically-implicated hobo spider (Araneae: Agelenidae) and its harmless congener, Tegenaria duellica in the United States and Canada. J. Med. Entomol. 40: 159-164. *PDF
Vetter, R. S. and D. K. Barger. 2002. An infestation of 2,055 brown recluse spiders (Araneae: Sicariidae) and no envenomations in a Kansas home: implications for bite diagnoses in non-endemic areas. J. Med. Entomol. 39:948-951. *PDF
Vetter, R. S. and S. P. Bush. 2002. Chemical burn misdiagnosed as brown recluse spider bite. Amer. J. Emerg. Medicine 20: 68-69.
Vetter, R. S. and S. P. Bush. 2002. The diagnosis of brown recluse spider bite is overused for dermonecrotic wounds of uncertain etiology. Ann. Emerg. Medicine 39: 544-546.
Vetter, R. S. and S. P. Bush. 2002. Reports of presumptive brown recluse spider bites reinforce improbable diagnosis in regions of North America where the spider is not endemic. Clinical Infectious Diseases 35:442-445
Bush, S. P., P. Giem, and R. S. Vetter. 2000. Green lynx spider (Peucetia viridans) envenomation. Amer. J. Emerg. Medicine 18:64-66
Vetter, R. S. 2000. Myth: idiopathic wounds are often due to brown recluse or other spider bites throughout the United States. Western J. Medicine 173:357-358
Vetter, R. S. 1999. Identifying and misidentifying the brown recluse spider. Dermatol. Online 5 (2): http://matrix.ucdavis.edu/DOJvol5num2/special/recluse.html
Vetter, R.S. 1998. Envenomation by an agelenid spider, Agelenopsis aperta, previously considered harmless. Ann. Emerg. Med. 32:739-741. *** common spider was misidentified as a brown recluse by doctor***