Widow spider envenomation (latrodectism): a worldwide problem

Latrodectus envenomation in Ethiopia

Black widows, one of the few spiders that can sting humans with poison, are members of the spider genus Latrodectus and are well-known for the extraordinary potency of their neurotoxic venom. Latrodectism, a symptom marked by excruciating muscular pain, stomach pain, and diaphoresis after envenomation, is very typical. We described a black widow envenomation case that produced a significant reaction, including diaphoresis and excruciating pain throughout the left thigh that later spread to the lower leg, lower back, belly, and chest. Because of the patient's description of the spider that bit him and his typical clinical state, it was assumed that Latrodectus envenomation was the cause of his symptoms. The patient received 3 days of observation in the ED while receiving opioid analgesic pain management and muscle relaxant treatment with diazepam. The patient's pain and symptoms were satisfactorily managed, and he was sent home. This case report will help further research be done in the area where it was reported to see if there are cases with similar presentations misdiagnosed as other illnesses. Finally, immediate pain relief is the most critical goal for all patients.

Chromosome-level genome assembly of the black widow spider Latrodectus elegans illuminates composition and evolution of venom and silk proteins

BACKGROUND

The black widow spider has both extraordinarily neurotoxic venom and three-dimensional cobwebs composed of diverse types of silk. However, a high-quality reference genome for the black widow spider was still unavailable, which hindered deep understanding and application of the valuable biomass.

FINDINGS

We assembled the Latrodectus elegans genome, including a genome size of 1.57 Gb with contig N50 of 4.34 Mb and scaffold N50 of 114.31 Mb. Hi-C scaffolding assigned 98.08% of the genome to 14 pseudo-chromosomes, and with BUSCO, completeness analysis revealed that 98.4% of the core eukaryotic genes were completely present in this genome. Annotation of this genome identified that repetitive sequences account for 506.09 Mb (32.30%) and 20,167 protein-coding genes, and specifically, we identified 55 toxin genes and 26 spidroins and provide preliminary analysis of their composition and evolution.

CONCLUSIONS

We present the first chromosome-level genome assembly of a black widow spider and provide substantial toxin and spidroin gene resources. These high-qualified genomic data add valuable resources from a representative spider group and contribute to deep exploration of spider genome evolution, especially in terms of the important issues on the diversification of venom and web-weaving pattern. The sequence data are also firsthand templates for further application of the spider biomass.

First Record of Black Widow Spider Bite Latrodectus cinctus (Araneae: Theridiidae) From Iran

The genus Latrodectus contains the most medically important spiders around the world. This study describes the first case of Latrodectus cinctus Blackwall, 1865 bite and clinical treatment from Iran. Also, it is the first collection report from the southeast of the country that can enhance prior knowledge on the geographical distribution of this species. We describe a 42-year-old female patient with neurological pain caused by the spider bite. Also, a summary of the entomological survey and morphological identification of the collected species from the patient's house is presented.

Coexistence of Rhabdomyolysis, Myocarditis and Arrhythmia after Spider Bite: A Case Report

BACKGROUND

Rhabdomyolysis after spider bite has been reported in a small number of patients, and myocarditis in even fewer. However, arrhythmia associated with latrodectism in children has not been described in the literature to date.

CASE SUMMARY

A girl presented approximately 4.5 h after being bitten on the left ankle by a black spider. Two unifocal premature ventricular contractions (PVCs) were observed on the electrocardiogram. In laboratory tests, creatine kinase was elevated. On day 2, levels of troponin, pro-brain and natriuretic peptide were elevated. Electrocardiogram revealed inverted and biphasic T waves. Echocardiography revealed mild left ventricular dilation, mitral and aortic valve regurgitation. Holter electrocardiogram showed PVCs. Her laboratory and echocardiography findings completely normalized after discharge, and no arrhythmia was observed on the Holter electrocardiogram during outpatient follow-up.

CONCLUSION

Although spider bites are uncommon, they can cause serious systemic effects. These patients should be evaluated for arrhythmia, rhabdomyolysis and myocarditis.

Expression of Brown and Southern Black Widow Spider (Araneae: Theridiidae) Latrotoxins Is Tissue- and Life Stage-Specific for α-Latroinsectotoxins and δ-Latroinsectotoxins and Is Ubiquitous for α-Latrotoxins

Widow spiders are widely known for their potent venom toxins that make them among the few spiders of medical concern. The latrotoxins are the most well-studied widow toxins and include both the vertebrate-specific latrotoxins and the insect-specific latroinsectotoxins (LITs). Previous studies have shown that toxins are not limited to expression in the venom glands of adult spiders; however, gaps exist in latrotoxin screening across all life stages for brown widows, Latrodectus geometricus and southern black widows, Latrodectus mactans. In this study, we screened male and female venom gland, cephalothorax, and abdomen tissues, spiderling cephalothorax and abdomen tissues, and eggs of both L. geometricus and L. mactans, for the presence of three latrotoxins: α-latrotoxin (α-LTX), and α- and δ-latroinsectotoxins (α/δ-LITs). Widows were locally collected. Extracted RNA was used to prepare cDNA that was analyzed by PCR for the presence or absence of latrotoxin expression. Results show that expression profiles between the two species are very similar but not identical. Expression of α-LTX was found in all life stages in all tissues examined for both species. For both species, no LIT expression was detected in eggs and variable patterns of α-LIT expression were detected in spiderlings and adults. Notably, δ-LIT could only be detected in females for both species. Our results show that latrotoxin expression profiles differ within and between widow species. Data on their expression distribution provide further insight into the specific latrotoxins that contribute to toxicity profiles for each life stage in each species and their specific role in widow biology.

Partial proteomic analysis of brown widow spider (Latrodectus geometricus) venom to determine the biological activities

Spiders use their venom for defence and to capture prey. These venoms contain a cocktail of biologically active compounds that display several different biological activities, such as large molecules and small molecules including peptides, proteins/enzymes, and other components. Thus, venom constituents have attracted the attention of biochemists and pharmacologists over the years. The brown widow spider (Latrodectus geometricus) is a venomous spider found worldwide, including in Thailand. This spider causes human injuries, and the venom has many potential applications. In this study, we investigated the complexity and pharmacology of brown widow spider venom. Spider crude venom was investigated using partial proteome techniques and enzymatic activity, toxicity, and antibacterial activity assessments. We found that crude venom displayed a wide range of molecular masses from 19 to over 97 kDa, with molecular masses of 66 kDa intensely stained. Peptides and proteins were identified by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS), which showed that the crude venom contained a variety of substances, including latrotoxins, apolipophorins, hemocyanins, chitinases, arginine kinase, allergen antigen 5-like protein, astacin-like metalloproteases, and serine proteases. High hyaluronidase activity was observed based on the turbidimetric method. The venom presented toxicity in crickets (PD₅₀ = 0.73 ± 0.10 μg/g body weight), and substantial envenomation symptoms, such as slow-motion movement, paralysis, and even death, were noted. Moreover, this venom exhibited potential antibacterial activity against the gram-positive Bacillus subtilis but not the gram-negative Pseudomonas aeruginosa. Spider venom contains numerous molecules with biological activity, such as latrotoxins, which affect insects, and enzymes. In addition to latrotoxins, certain enzymes in venom are hypothesized to exhibit toxicity and antimicrobial activity. This study provides important information for the further development of natural compounds or insecticidal toxins.

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8 proteins were identified using mass spectrometry.

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Venom exhibited potential hyaluronidase activity and antibacterial activity.

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Crude venom presented toxicity in crickets.

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The venom peptides can develop for a natural lead drug or an insecticidal toxin.

Envenomation by an arachnid (Latrodectus or Steatoda): Case report involving a woman and her female dog

Introduction: Accidents involving spiders bites usually cause mild medical reactions that lead to local symptoms and, less commonly, systemic effects. The most medically significant spiders belong to the genera Latrodectus and Loxosceles. This paper presents a posible case of steatodism in a young woman and her pet.Case description: 26-year-old female patient, who reports a clinical history characterized by paresthesia, malaise, fever, diarrea and a painful papule in the left cheek after being bitten by a spider. Immediately after being bit, the patient hit the spider with the back of her hand and it fell to the ground, where her dog swallowed it. The dog presented with vomiting and general discomfort after ingestion. Symptomatic therapy was given for comfort, and neither the patient nor the dog required antivenin therapy. Both evolved favorably.Discussion: The relevance of this case is the involvement of two mammals (a human and her dog) due to the accidental contact with a spider, possibly of the genus Latrodectus or Steatoda.Conclusion: Two possible cases of steatodism are described. Since spider bites are a relatively frequent reason for medical consultation in Colombia, it is important to diagnose and manage them properly.

Treatments for Latrodectism-A Systematic Review on Their Clinical Effectiveness

Latrodectism or envenomation by widow-spiders is common and clinically significant worldwide. Alpha-latrotoxin is the mammalian-specific toxin in the venom that results in toxic effects observed in humans. Symptoms may be incapacitating and include severe pain that can persist for days. The management of mild to moderate latrodectism is primarily supportive while severe cases have variously been treated with intravenous calcium, muscle relaxants, widow-spider antivenom and analgesic opioids. The object of this systematic review is to examine the literature on the clinical effectiveness of past and current treatments for latrodectism. MEDLINE, EMBASE and Google Scholar were searched from 1946 to December 2016 to identify clinical studies on the treatment of latrodectism. Studies older than 40 years and not in English were not reviewed. There were only two full-publications and one abstract of placebo-controlled randomised trials on antivenom use for latrodectism. Another two randomised comparative trials compared the route of administration of antivenom for latrodectism. There were fourteen case series (including two abstracts), fourteen case reports and one letter investigating drug treatments for latrodectism with the majority of these also including antivenom for severe latrodectism. Antivenom with opioid analgesia is often the major treatment reported for latrodectism however; recent high quality evidence has cast doubt on the clinical effectiveness of this combination and suggests that other treatments need to be investigated.

Recent Advances in Research on Widow Spider Venoms and Toxins

Widow spiders have received much attention due to the frequently reported human and animal injures caused by them. Elucidation of the molecular composition and action mechanism of the venoms and toxins has vast implications in the treatment of latrodectism and in the neurobiology and pharmaceutical research. In recent years, the studies of the widow spider venoms and the venom toxins, particularly the α-latrotoxin, have achieved many new advances; however, the mechanism of action of the venom toxins has not been completely clear. The widow spider is different from many other venomous animals in that it has toxic components not only in the venom glands but also in other parts of the adult spider body, newborn spiderlings, and even the eggs. More recently, the molecular basis for the toxicity outside the venom glands has been systematically investigated, with four proteinaceous toxic components being purified and preliminarily characterized, which has expanded our understanding of the widow spider toxins. This review presents a glance at the recent advances in the study on the venoms and toxins from the Latrodectus species.

Biochemistry of envenomation

Venoms and toxins are of significant interest due to their ability to cause a wide range of pathophysiological conditions that can potentially result in death. Despite their wide distribution among plants and animals, the biochemical pathways associated with these pathogenic agents remain largely unexplored. Impoverished and underdeveloped regions appear especially susceptible to increased incidence and severity due to poor socioeconomic conditions and lack of appropriate medical treatment infrastructure. To facilitate better management and treatment of envenomation victims, it is essential that the biochemical mechanisms of their action be elucidated. This review aims to characterize downstream envenomation mechanisms by addressing the major neuro-, cardio-, and hemotoxins as well as ion-channel toxins. Because of their use in folk and traditional medicine, the biochemistry behind venom therapy and possible implications on conventional medicine will also be addressed.

Black widow spider envenomation, a rare cause of Horner's syndrome

Horner's syndrome involves a triad of eyelid ptosis, miosis, and facial anhidrosis that results from disruption of the oculosympathetic pathway. Acquired Horner's syndrome is associated with a variety of medical conditions including Pancoast tumor and carotid dissection. We report the unique case of a 47-year-old man presenting with Horner's syndrome 4 weeks after black widow spider envenomation. Workup did not reveal any alternative explanatory etiology. We hypothesize that late sequelae of black widow spider envenomation secondary to autonomic nerve injury or retrograde axonal transport after mechanical inoculation may have led to an acquired defect in the oculosympathetic pathway resulting in a Horner's syndrome. This case introduces a rare cause of Horner's syndrome and highlights the importance of environmental exposures in the evaluation of these patients.

Toxicology in the ICU: part 3: natural toxins

This is the third article of a three-part series that reviews the care of poisoned patients in the ICU. This article focuses on natural toxins, such as heavy metals and those produced by plants, mushrooms, arthropods, and snakes. The first article discussed the general approach to the patient, including laboratory testing; the second article focused on specific toxic agents, grouped into categories.

A US Perspective of Symptomatic Latrodectus spp. Envenomation and Treatment: A National Poison Data System Review

Background:

Black widow spider (Latrodectus spp.) envenomation remains the most clinically significant spider envenomation in the US. The syndrome is characterized by painful muscle rigidity and autonomic disturbances. Treatment has ranged from symptomatic care to administration of specific antivenom. Declining antivenom availability and, possibly, the fear of hypersensitivity allergic reactions, has limited antivenom use in the US.

Objective:

To describe Latrodectus spp. exposures and the subsequent treatment reported to US poison centers; the secondary objective was to Identify factors associated with shorter duration of symptoms (<24 hours).

Methods:

All Latrodectus spp. exposures reported to the National Poison Data System (NPDS) between January 1, 2000, and December 31, 2008, were reviewed. Cases with at least minor clinical effects due to Latrodectus spp. exposure were extracted. Descriptive statistics were generated. The probability that symptom duration was less than 24 hours was modeled, using logistic regression.

Results:

From 2000 through 2006, a total of 23,409 Latrodectus spp. exposures were reported in 47 states; 9872 cases had at least minor clinical effects and were included in the subsequent analysis. Exposures peaked in September and fell to a nadir in January and February. Fifty-eight percent of the cases involved males, and the mean (SD) age was 31.5 (17.4) years. Sixty-five percent of the patients had minor clinical effects, 33.5% had moderate effects, 1.4% had major effects, and there were no deaths. Antivenom use was associated with symptom duration of less than 24 hours in moderate and major outcome groups. There was no evidence of shorter symptom duration in patients who received benzodiazepines or calcium. Adverse drug reactions were more common in patients receiving benzodiazepines and antivenom.

Conclusions:

In the US, most symptomatic Latrodectus spp. exposures reported to the NPDS are minor. Few patients receive antivenom, although antivenom is associated with shorter symptom duration among moderate and major outcomes.

Black widow spider envenomation in pregnancy

OBJECTIVE

Little data exist regarding the optimal treatment and outcomes of pregnancies complicated by black widow spider envenomation. Our objective is to evaluate the clinical effects, medical outcomes, and treatment differences between pregnant and nonpregnant women.

METHODS

This observational study is based on a review of the database maintained by the American Association of Poison Control Centers from 2003 to 2007.

RESULTS

Of the 12,640 human black widow spider envenomations reported at 61 poison centers in the United States, 3194 (25.3%) involved women of reproductive age, defined as age 15-45 years of age, with 97 (3.0% of reproductive-age women) being pregnant. Comparing pregnant and nonpregnant women, there were no significant differences in recommended or administered treatments. Pregnant women were more likely than nonpregnant women (OR: 1.84, 95% CI: 1.20-2.83) to have outcomes coded as minor, moderate, or major rather than no effect. Significantly higher percentages of pregnant patients were treated at a healthcare facility where they were either released (36.1% vs. 19.9%, p  < 0.001) or admitted (13.4% vs. 4.0%, p  < 0.001), than nonpregnant women. There were no documented pregnancy losses.

CONCLUSIONS

Black widow spider envenomation is a rare occurrence in pregnant women and the short-term outcomes appear to be favorable.

Activities against hemostatic proteins and adrenal gland ultrastructural changes caused by the brown widow spider Latrodectus geometricus (Araneae: Theridiidae) venom

Brown widow spider (BrWS) (Latrodectus geometricus) venom produces intense systemic reactions such as cramps, harsh muscle nociceptive, nauseas, vomiting and hypertension. The proposed pathogenic mechanisms resulting in these accidents have principally been damages occurring at the nervous system. However, it is suspected that there is also damage of the adrenal glands, as a result of the experimental animal's clinical manifestations, which developed symptoms compatible with acute adrenal insufficiency. We have currently found that the adrenal gland is damaged by this venom gland homogenates (VGH) producing severe alterations on cortex cells resulting in death by acute adrenal insufficiency. In general, the ultrastructural study on the glands of mice under transmission electronic microscopy observations showed alterations in the majority of the intracellular membranes within 3 to 24h. BrWSVGH also showed specific actions on extracellular matrix proteins such as fibronectin, laminin and fibrinogen. In addition, zymogram experiments using gelatin as substrates detected gelatinolytic activity. The molecular exclusion fractionation of crude BrWSVGH resulted in 15 fractions, of which F1 and F2 presented alpha/beta-fibrinogenase and fibronectinolytic activities. Fractions F6, F14 and F15 showed only alpha-fibrinogenase activity; in contrast, the gelatinolytic action was only observed in fraction F11. Only metalloproteinase inhibitors abolished all these proteolytic activities. Our results suggest that adrenal cortex lesions may be relevant in the etiopathogenesis of severe brown widow spider envenoming. To our knowledge, this is the first report on adrenal gland damages, fibrinogenolytic activity and interrelations with cell-matrix adhesion proteins caused by L.geometricus VGH. The venom of this spider could be inducing hemostatic system damages on envenomed patients.

Latrodectism in New Caledonia: first report of presumed redback spider (Latrodectus hasselti) envenomation

We describe a recent case of presumed redback spider (Latrodectus hasselti) envenomation observed near Noumea in New Caledonia. This is the first local reported case in this archipelago, where L. hasselti is currently considered a native species. We highlight the challenge of providing appropriate analgesia in this situation and believe that the use of specific redback spider antivenom should be considered in New Caledonia.

Spider bite (latrodectism) in Mashhad, Iran

Background: Spider (Latrodectus tredecimguttatus) bites are relatively common in North East Iran. They induce morbidity and rarely mortality. We aimed to investigate clinical, electrocardiographic and para-clinical changes in patients with this bite. Methods: All consecutive patients admitted with suspected spider bites between September 2005 and September 2006 were studied prospectively. Results: Spider bites accounted for 56 cases (0.5% of all poisoning, 21% of all admitted envenomated). The patients’ mean (SD) age was 32 (16) years. The most common findings were pain (90%) mainly in their back (45%), stomach (35%), lower limbs (33%), upper limbs (19%) and chest (14%). Other clinical findings included were sweating (55%), chills (29%), dyspnea (25%), flushing (14%), spasm (12%), headache (12%), nausea (12%) and vertigo (12%). On electrocardiograph (ECG); ST segments were depressed in 25% of cases in at least two of the pre-cordial leads. Laboratory findings were in normal ranges. All the patients recovered following supportive and symptomatic treatment (no anti-toxin available in Iran), with a mean hospitalization period of 1.9 (1.3) days. Conclusions: Spider (L. Tredecimguttatus) bite is relatively common in Mashhad, which induces latrodectism with relatively different findings and cardiac toxicity. ECG monitoring should be considered, particularly when specific anti-toxin is not available.

Proteomic analysis of Latrodectus tredecimguttatus venom for uncovering potential latrodectism-related proteins

Black widow spider is one of the most poisonous spiders in the world. Up to now, there have been few systematic analyses of the spider venom components, and the mechanism of action of the venom has not been completely understood. In this work, we employed combinative proteomic strategy to analyze the venom collected from living adult spider Latrodectus tredecimguttatus by electrical stimulation. The experiments demonstrated that the venom is primarily composed of high molecular weight proteins and has high abundance proteins around 100 kDa. The content of peptides and proteins with low molecular weight is low. A total of 75 nonredundant venom proteins with distinct function were unambiguously identified. Besides the known black widow spider venom proteins including latrotoxins, a variety of hydrolases and other proteins with special activity were found in the venom, such as proteinase, phospholipase, phosphatase, nuclease, fucolectin, venom allergen antigen 5-like protein and trypsin inhibitor, and so on. Their possible biological actions and relationship with latrodectism were discussed. The results help to understand the complexity and action mechanism of L. tredecimguttatus venom.

Extraction and protein component analysis of venom from the dissected venom glands of Latrodectus tredecimguttatus

Black widow spiders (genus Latrodectus) have attracted increasing attention due to frequently reported human injuries caused by them and the potential applications of biologically active components in their venoms. Although a number of studies have described the biological properties and structures of several venomous proteins such as latrotoxins, a comprehensive analysis of protein component of the venom from the spider is not available. We used combinative proteomic strategies to assess the protein components of the crude venom collected from Latrodectus tredecimguttatus by extracting the dissected venom glands. The experiments demonstrated that the crude venom of L. tredecimguttatus has a high abundance of acidic proteins with molecular masses greater than 15 kDa, and the content of proteins and peptides of below 15 kDa is low. 86 unique proteins were identified, part of which were contaminations of cellular components during the extraction, determined in comparison with venom obtained by electrostimulation. Except for members of latrotoxin family that were commonly considered as the primary toxic components of the venom, several other special enzymes and proteins were detected such as protease, phosphatase, lysozyme, inhibitory protein, and so on. These protein components, particularly the proteases, were speculated to play important roles in the action of L. tredecimguttatus venom.

Envenomations

Numerous types of envenomations may be encountered by health care workers depending on where in North America they work. Clinicians should be familiar with the animals in their region that may lead to envenomation.A rational approach with use of poison center or medical toxicology consultation services ensures that cases are managed appropriately.

Morsures d’araignées : les aranéismes d’importance médicale

LIMITED RISKS: Although most species of spiders are venomous, only ten or so are able to induce human envenomations. From a systematic point of view, it is possible to distinguish the araneomorph spiders - or "true" spiders - from the mygalomorph spiders. Dangerous species for humans can be found in both groups. Regarding "true' spiders, two kinds of envenomation are frequent, ubiquitous and potentially severe: latrodectism (neurotoxic symptomatology) due to the Widow spiders of the Latrodectus species,and loxoscelism (viscero-cutaneous symptomatology). Regarding the mygalomorph spiders, the Australian species responsible for atraxism (neurotoxic symptomatology) are considered as the most dangerous. Most of the other mygalomorph spiders, when they bite, only provoke benign loco regional problems. A supplementary defensive weapon exists in certain South-American species: urticating hairs which may induce severe ocular damage.

Neutralization of Latrodectus mactans and L. hesperus venom by redback spider (L. hasseltii) antivenom

OBJECTIVE

To test the effectiveness of L. hasseltii (redback spider) antivenom in neutralizing the lethal effects of L. hesperus and L. mactans (North American black widow) venoms.

METHODS

LD50 values for the L. hesperus and L. mactans venom preparations were determined. A prospective, randomized, double-blind antivenom efficacy experiment was then performed for each venom using a mouse envenomation model. The following treatments were premixed and incubated at 25 degrees C for 1 hour prior to intraperitoneal injection: 1) saline control + protein control, 2) saline control + L. hasseltii antivenom, 3) L. hesperus or L. mactans venom + protein control, and 4) L. hesperus or L. mactans venom + L. hasseltii antivenom. The study endpoints were time elapsed until death and survival at 24 hours.

RESULTS

The mouse LD50 values for L. hesperus and L. mactans venoms were 0.64 mg/kg and 0.26 mg/kg, respectively. In the efficacy trial, all mice in group 3 (L. hesperus or L. mactans venom and protein control) died. In both experiments, all mice in group 4 (L. hesperus or L. mactans venom + antivenom) survived (p < 0.0001).

CONCLUSION

This is the first study to derive mouse LD50 values for L. hesperus and L. mactans venom obtained by electrical stimulation of live adult spiders. Redback spider antivenom is effective in neutralizing the lethal effects of L. hesperus and L. mactans venoms in a mouse envenomation model. While this study is limited by the optimized premixing of antigen with antibody, it generates the hypothesis that redback antivenom would be effective in the treatment of latrodectism in humans caused by the two clinically relevant species of North American widow spiders.