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Laude M, Lima S, Corsini T, Dussot A, Moniod L, Barjat T, Chauleur C. Cutaneous mammary loxoscelism: An unknown cause of breast inflammation: A case report and review of the literature. ANN CHIR PLAST ESTH 2021; 66:476-480. [PMID: 34686399 DOI: 10.1016/j.anplas.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.
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Affiliation(s)
- M Laude
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - S Lima
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - T Corsini
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - A Dussot
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - L Moniod
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - T Barjat
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
| | - C Chauleur
- Department of Obstetrics and Gynaecology, Hôpital Nord, Saint-Etienne University, Saint-Etienne, France.
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2
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Fusto G, Bennardo L, Duca ED, Mazzuca D, Tamburi F, Patruno C, Nisticò SP. Spider bites of medical significance in the Mediterranean area: misdiagnosis, clinical features and management. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20190100. [PMID: 33061945 PMCID: PMC7534902 DOI: 10.1590/1678-9199-jvatitd-2019-0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the disrepute spiders have had for centuries, their bite is a rare
occurrence. In the Mediterranean area, only two of the numerous known species
are considered of medical significance: Latrodectus
tredecimguttatus and Loxosceles rufescens. Spider
bites have no pathognomonic signs or symptoms, therefore most diagnoses are
presumptive; a spider bite can only be diagnosed when a spider (seen at the time
of the bite) is collected and identified by an expert, since most physicians and
patients are unable to recognize a certain spider species or distinguish spiders
from other arthropods. Skin lesions of uncertain etiology are too often
attributed to spider bites. In most cases, these are actually skin and
soft-tissue infections, allergic reactions, dermatoses etc. Misdiagnosing a
wound as a spider bite can lead to delays in appropriate care, cause adverse or
even fatal outcomes and have medical-legal implications. Concerningly,
misinformation on spider bites also affects the medical literature and it
appears there is lack of awareness on current therapeutic indications for
verified bites.
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Affiliation(s)
- Gabriele Fusto
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luigi Bennardo
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ester Del Duca
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy.,Department of Dermatology, Mount Sinai Medical Center, New York, USA
| | - Daniela Mazzuca
- Unit of Forensic Pathology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federica Tamburi
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Steven Paul Nisticò
- Unit of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Del Giudice P, Hubiche T, Fribourd A, Gillon J, Roudière L, Merle R, Tristan A, Vandenesch F, Blanc-Amrane V. [Spider bite or infection caused by Panton Valentine leucocidin-producing Staphylococcusaureus?]. Ann Dermatol Venereol 2019; 146:711-714. [PMID: 31627926 DOI: 10.1016/j.annder.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/13/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Spiders, especially those of the genus Loxoceles such as L. rufescens, endemic in Mediterranean regions, are frequently reported as causes of venom poisoning in humans in the south of France. The most common signs consist of cutaneous necrosis presenting initially as inflammatory cellulitis and progressing towards the emergence of a necrotic centre. PATIENTS AND METHODS We report 4 cases, initially considered as spider bites due to their sudden occurrence and pain. Rigorous clinical examination coupled with collection of samples for laboratory analysis ultimately enabled the diagnosis to be corrected to one of suppurative skin infection caused by Staphylococcusaureus producing the cytotoxin Panton Valentine leucocidin. DISCUSSION These observations highlight the potential for confusion between spider bites and infections with PVL-producing S. aureus.
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Affiliation(s)
- P Del Giudice
- Infectiologie-dermatologie, centre hospitalier intercommunal de Fréjus-Saint-Raphaël, 83660 Fréjus, France.
| | - T Hubiche
- Infectiologie-dermatologie, centre hospitalier intercommunal de Fréjus-Saint-Raphaël, 83660 Fréjus, France
| | - A Fribourd
- Laboratoire de biologie, centre hospitalier intercommunal de Fréjus-Saint-Raphaël, 83660 Fréjus, France
| | - J Gillon
- Laboratoire de biologie, centre hospitalier intercommunal de Fréjus-Saint-Raphaël, 83660 Fréjus, France
| | - L Roudière
- Laboratoire de biologie, centre hospitalier intercommunal de Fréjus-Saint-Raphaël, 83660 Fréjus, France
| | - R Merle
- Service de chirurgie viscérale, centre Hospitalier d'Antibes Juan les Pins, 06600 Antibes, France
| | - A Tristan
- National reference center for Staphylococci, centre de biologie nord, hospices civils de Lyon, hôpital de la Croix-Rousse, Lyon, France
| | - F Vandenesch
- National reference center for Staphylococci, centre de biologie nord, hospices civils de Lyon, hôpital de la Croix-Rousse, Lyon, France
| | - V Blanc-Amrane
- Service de biologie, centre hospitalier d'Antibes Juan les Pins, 06600 Antibes, France
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4
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Dunbar JP, Sulpice R, Dugon MM. The kiss of (cell) death: can venom-induced immune response contribute to dermal necrosis following arthropod envenomations? Clin Toxicol (Phila) 2019; 57:677-685. [PMID: 30806093 DOI: 10.1080/15563650.2019.1578367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Snakes, insects, arachnids and myriapods have been linked to necrosis following envenomation. However, the pathways involved in arthropod venom-induced necrosis remain a highly controversial topic among toxinologists, clinicians and the public. On the one hand, clinicians report on alleged envenomations based on symptoms and the victims' information. On the other hand, toxinologists and zoologists argue that symptoms are incompatible with the known venom activity of target species. This review draws from the literature on arthropod envenomations, snakebite, and inflammatory processes to suggest that envenomation by a range of organisms might trigger an intense inflammatory cascade that ultimately lead to necrosis. If confirmed, these processes would have important implications for the treatment of venom-induced necrosis. Objectives: To describe two inflammatory pathways of regulated necrosis, tumour necrosis factor (necroptosis) and Neutrophil Extracellular Traps (NETosis); to discuss existing knowledge about snake venom and arachnid-induced necrosis demonstrating the involvement of tumour necrosis factor and neutrophils in the development of tissue necrosis following envenomation and to contribute to the understanding of venom-induced necrosis by arthropods and provide clinicians with an insight into little known inflammatory processes which may occur post envenomation. Methods: ISI Web of Science databases were searched using the terms "spider bite necrosis", "arthropod envenomation necrosis", "venom necrosis", "venom immune response", "loxoscelism", "arachnidism", "necroptosis venom", "necroptosis dermatitis", "tumour necrosis factor TNF venom", "scorpionism", "scolopendrism", "centipede necrosis", "NETosis venom", "NETosis necrosis". Searches produced 1737 non-duplicate citations of which 74 were considered relevant to this manuscript. Non-peer-reviewed sources or absence of voucher material identifying the organism were excluded. What is necrosis? Necrosis is the breakdown of cell membrane integrity followed by inflowing extracellular fluid, organelle swelling and the release of proteolytic enzymes into the cytosol. Necrosis was historically considered an unregulated process; however, recent studies demonstrate that necrosis can also be a programmed event resulting from a controlled immune response (necroptosis). Tumour necrosis factor and the necroptosis pathway: Tumour necrosis factor is a pro-inflammatory cytokine involved in regulating immune response, inflammation and cell death/survival. The pro-inflammatory cytokine TNF-α participates in the development of necrosis after envenomation by vipers. Treatment with TNF-α-antibodies may significantly reduce the manifestation of necrosis. Neutrophil Extracellular Traps and the NETosis pathway: The process by which neutrophils discharge a mesh of DNA strands in the extracellular matrix to entangle ("trap") pathogens, preventing them from disseminating. Neutrophil Extracellular Traps have been recently described as important in venom-induced necrosis. Trapped venom accumulates at the bite site, resulting in significant localized necrosis. Arthropod venom driving necrosis: Insects, myriapods and arachnids can induce necrosis following envenomation. So far, the processes involved have only been investigated in two arachnids: Loxosceles spp. (recluse spiders) and Hemiscorpius lepturus (scorpion). Loxosceles venom contains phospholipases D which hydrolyse sphingomyelin, resulting in lysis of muscle fibers. Subsequently liberated ceramides act as intermediaries that regulate TNF-α and recruit neutrophils. Experiments show that immune-deficient mice injected with Loxosceles venom experience less venom-induced inflammatory response and survive longer than control mice. Necrosis following Hemiscorpius lepturus stings correlates with elevated concentrations of TNF-α. These observations suggest that necrosis may be indirectly triggered or worsened by pathways of regulated necrosis in addition to necrotic venom compounds. Conclusions: Envenomation often induce an intense inflammatory cascade, which under certain circumstances may produce necrotic lesions independently from direct venom activity. This could explain the inconsistent and circumstantial occurrence of necrosis following envenomation by a range of organisms. Future research should focus on identifying pathways to regulated necrosis following envenomation and determining more efficient ways to manage inflammation. We suggest that clinicians should consider the victim's immune response as an integral part of the envenomation syndrome.
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Affiliation(s)
- John P Dunbar
- a Venom Systems and Proteomics Lab, School of Natural Sciences , Ryan Institute, National University of Ireland Galway , Galway , Ireland
| | - Ronan Sulpice
- b Plant Systems Biology Laboratory , Plant AgriBiosciences Research Centre, School of Natural Science, Ryan Institute, National University of Ireland Galway , Galway , Ireland
| | - Michel M Dugon
- a Venom Systems and Proteomics Lab, School of Natural Sciences , Ryan Institute, National University of Ireland Galway , Galway , Ireland
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Jerusalem K, Salavert Lletí M. Probable cutaneous loxoscelism with mild systemic symptoms: A case report from Spain. Toxicon 2018; 156:7-12. [PMID: 30391580 DOI: 10.1016/j.toxicon.2018.10.304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
We present a case from Valencia, Spain, of a 25-year-old woman who presented with a painful erythematous skin lesion, initially diagnosed as cellulitis. The lesion was unresponsive to antibiotic treatments and progressed into a hemorrhagic blister with necrotic ulcer formation. Posterior collection of a spider from the patient's home and expert identification of the spider as Loxosceles rufescens was achieved, establishing the diagnosis of probable cutaneous loxoscelism. Symptomatic treatment, general wound care and ultimately surgery, resulted in complete recovery with minor residual scarring. This case illustrates some of the difficulties encountered in the diagnosis and treatment of loxoscelism and adds to the increasing reports of loxoscelism in the Mediterranean Basin.
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Affiliation(s)
- Koen Jerusalem
- Department of Internal Medicine and Infectious Diseases, Manises Hospital, Av. Generalitat Valenciana 50, 46940, Manises, Spain.
| | - Miguel Salavert Lletí
- Head of the Unit of Infectious Diseases, University and Polytechnic Hospital La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, Spain
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Abstract
Necrosis is a hallmark of several widespread diseases or their direct complications. In the past decade, we learned that necrosis can be a regulated process that is potentially druggable. RIPK3- and MLKL-mediated necroptosis represents by far the best studied pathway of regulated necrosis. During necroptosis, the release of damage-associated molecular patterns (DAMPs) drives a phenomenon referred to as necroinflammation, a common consequence of necrosis. However, most studies of regulated necrosis investigated cell lines in vitro in a cell autonomous manner, which represents a non-physiological situation. Conclusions based on such work might not necessarily be transferrable to disease states in which synchronized, non-cell autonomous effects occur. Here, we summarize the current knowledge of the pathophysiological relevance of necroptosis in vivo, and in light of this understanding, we reassess the morphological classification of necrosis that is generally used by pathologists. Along these lines, we discuss the paucity of data implicating necroptosis in human disease. Finally, the in vivo relevance of non-necroptotic forms of necrosis, such as ferroptosis, is addressed.
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Affiliation(s)
- Wulf Tonnus
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Andreas Linkermann
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
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Petit A. [What's new in clinical dermatology?]. Ann Dermatol Venereol 2017; 144 Suppl 4:IVS1-IVS9. [PMID: 29249246 DOI: 10.1016/s0151-9638(17)31059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In addition to continuous medical education, medical journals offer to dermatologists a huge variety of news that differ by their content, validity, originality and clinical relevance. I collected here various articles relative to clinical dermatology that have been published between September, 2016 and September, 2017. These papers have been chosen in the aim of reflecting such diversity. I just excluded, as far as possible, articles dealing with other issues that the reader will find further in this booklet (such as research, pediatric, instrumental, oncologic or therapeutic dermatology, or dermatology and internal medicine). Space restriction required to skip some commentaries while keeping the references to the selected papers, which the reader will be able to read carefully in its original form.
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Affiliation(s)
- A Petit
- Service de dermatologie, AP-HP hôpital Saint-Louis, Paris, France.
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Nentwig W, Pantini P, Vetter RS. Distribution and medical aspects of Loxosceles rufescens, one of the most invasive spiders of the world (Araneae: Sicariidae). Toxicon 2017; 132:19-28. [PMID: 28408204 DOI: 10.1016/j.toxicon.2017.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 01/16/2023]
Abstract
Loxosceles rufescens is a circum-Mediterranean spider species, potentially harmful to humans. Its native area covers the Mediterranean Basin and Near East. Easily spread with transported goods, it is meanwhile an alien and invasive species to nearly all other continents and many islands. This species occurs in semi-arid steppe-like habitats, typically under stones and in cavities, which enables it to settle inside buildings when invading the synanthropic environment. This review analyses the literature of L. rufescens bites to humans (38 publications) of which only 11 publications refer to 12 verified spider bites (11% of the reported bites). Two published allegedly deadly spider bites (Thailand 2014 and Italy 2016) involve non-verified spider bites and are thus not reliable. The symptoms and therapy of these 11 verified bites are described: only five cases showed moderate systemic effects, nine cases developed necrosis, four cases needed surgical debridement, all cases healed without complications within a few weeks. In conclusion, L. rufescens is a spider species globally spread by human activity, it rarely bites humans and the bites are less harmful than often described. There is no known fatal issue.
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Affiliation(s)
- Wolfgang Nentwig
- Institute of Ecology and Evolution, University of Bern, CH 3012, Bern, Switzerland.
| | - Paolo Pantini
- Museo Civico di Scienze Naturali E. Caffi di Bergamo, Piazza Cittadella 10, I-24129, Bergamo, Italy
| | - Richard S Vetter
- Department of Entomology, University of California, Riverside, CA, 92521, USA
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