Clinical manifestations and diagnosis of widow spider bites
- David L Swanson, MD
David L Swanson, MD
- Associate Professor of Dermatology
- Mayo Clinic
- Richard S Vetter, MS
Richard S Vetter, MS
- Department of Entomology
- University of California, Riverside
- Julian White, AM, MB, BS, MD, FACTM
Julian White, AM, MB, BS, MD, FACTM
- The University of Adelaide
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the biology of widow spiders (genus Latrodectus) and the clinical manifestations, diagnosis, and differential diagnosis, of their bites. Management of widow spider bites, an overview of spider bites, and the management of bites of other spiders are discussed separately. (See "Approach to the patient with a suspected spider bite: An overview" and "Bites of recluse spiders".)
Both widow spiders and false widow spiders are of medical importance, although the bites of the former are generally of greater concern.
Widow spiders (Genus Latrodectus) — Widow spiders belong to the family Theridiidae, genus Latrodectus. Latrodectism is the term for the medical manifestations of bites by widow spiders [1,2]. (See "Approach to the patient with a suspected spider bite: An overview".)
There are approximately 30 species of widow spiders found worldwide . Not all have been implicated in human bites, although this may be partly due to the remote distribution of the spiders away from human populations. Female widow spiders are responsible for most significant bites. Males have less venom, smaller fangs, and weaker biting muscles.
Identification — Most adult widow spiders are shiny black with red markings on the body, although this is not universal. American widow spiders range from 5 to 15 mm (0.25 to 0.5 inch) in total body length with an abdominal diameter of about 10 mm (0.5 inch). The most common species of medical importance are the following:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Maretic Z, Lebez D. Araneism with special reference to Europe, Polit, Pula, Yugoslavia 1979.
- Vetter RS, Isbister GK. Medical aspects of spider bites. Annu Rev Entomol 2008; 53:409.
- Garb JE, González A, Gillespie RG. The black widow spider genus Latrodectus (Araneae: Theridiidae): phylogeny, biogeography, and invasion history. Mol Phylogenet Evol 2004; 31:1127.
- Muslimin M, Wilson JJ, Ghazali AR, et al. First report of brown widow spider sightings in Peninsular Malaysia and notes on its global distribution. J Venom Anim Toxins Incl Trop Dis 2015; 21:11.
- Brown KS, Necaise JS, Goddard J. Additions to the known U.S. distribution of Latrodectus geometricus (Araneae: Theridiidae). J Med Entomol 2008; 45:959.
- Müller GJ. Black and brown widow spider bites in South Africa. A series of 45 cases. S Afr Med J 1993; 83:399.
- Saibil HR. The black widow's versatile venom. Nat Struct Biol 2000; 7:3.
- Goddard J, Upshaw S, Held D, Johnnson K. Severe reaction from envenomation by the brown widow spider, Latrodectus geometricus (Araneae: Theridiidae). South Med J 2008; 101:1269.
- Kiriakos D, Núñez P, Parababire Y, et al. First case of human latrodectism in Venezuela. Rev Soc Bras Med Trop 2008; 41:202.
- Ramialiharisoa A, de Haro L, Jouglard J, Goyffon M. [Latrodectism in Madagascar]. Med Trop (Mars) 1994; 54:127.
- Nihei N, Yoshida M, Kaneta H, et al. Analysis on the dispersal pattern of newly introduced Latrodectus hasseltii (Araneae: Theridiadae) in Japan by spider diagram. J Med Entomol 2004; 41:269.
- Hann, SW. Evidence for the displacement of an endemic New Zealand spider, Latrodectus katipo Powell by the South African species Steatoda capensis. NZ J Zool 1990; 17:295.
- Vetter RS, Vincent LS, Danielsen DW, et al. The prevalence of brown widow and black widow spiders (Araneae: Theridiidae) in urban southern California. J Med Entomol 2012; 49:947.
- Südhof TC. alpha-Latrotoxin and its receptors: neurexins and CIRL/latrophilins. Annu Rev Neurosci 2001; 24:933.
- Garb JE, Hayashi CY. Molecular evolution of α-latrotoxin, the exceptionally potent vertebrate neurotoxin in black widow spider venom. Mol Biol Evol 2013; 30:999.
- Peterson ME. Black widow spider envenomation. Clin Tech Small Anim Pract 2006; 21:187.
- Nicholson GM, Graudins A. Spiders of medical importance in the Asia-Pacific: atracotoxin, latrotoxin and related spider neurotoxins. Clin Exp Pharmacol Physiol 2002; 29:785.
- Henkel AW, Sankaranarayanan S. Mechanisms of alpha-latrotoxin action. Cell Tissue Res 1999; 296:229.
- Orlova EV, Rahman MA, Gowen B, et al. Structure of alpha-latrotoxin oligomers reveals that divalent cation-dependent tetramers form membrane pores. Nat Struct Biol 2000; 7:48.
- Vetter RS, Adams RJ, Berrian JE, Vincent LS. The European spider, Steatoda nobilis (Araneae: Theridiidae), becoming widespread in California. Pan-Pac Entomol 2015; 91:98.
- Monte AA, Bucher-Bartelson B, Heard KJ. A US perspective of symptomatic Latrodectus spp. envenomation and treatment: a National Poison Data System review. Ann Pharmacother 2011; 45:1491.
- Vetter RS, Furbee RB. Caveats in interpreting poison control centre data in spider bite epidemiology studies. Public Health 2006; 120:179.
- Isbister GK, Fan HW. Spider bite. Lancet 2011; 378:2039.
- Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med 1992; 21:782.
- Bush SP. Black widow spider envenomation mimicking cholecystitis. Am J Emerg Med 1999; 17:315.
- Díez García F, Laynez Bretones F, Gálvez Contreras MC, et al. [Black widow spider (Latrodectus tredecimguttatus) bite. Presentation of 12 cases]. Med Clin (Barc) 1996; 106:344.
- Sutherland SK, Trinca JC. Survey of 2144 cases of red-back spider bites: Australia and New Zealand, 1963--1976. Med J Aust 1978; 2:620.
- Sotelo-Cruz N, Gómez-Rivera N. [Neurotoxic manifestations of black widow spider envenomation in paediatric patients]. Neurologia 2016; 31:215.
- La Grange MA. Pulmonary oedema from a widow spider bite. S Afr Med J 1990; 77:110.
- Kleiner-Baumgarten A. [Black widow spider bite in the Negev]. Harefuah 1991; 120:257.
- Levine M, Canning J, Chase R, Ruha AM. Cardiomyopathy following latrodectus envenomation. West J Emerg Med 2010; 11:521.
- Quan D, Ruha AM. Priapism associated with Latrodectus mactans envenomation. Am J Emerg Med 2009; 27:759.e1.
- Rosenthal G, Marcus M, Bakalash S, Lifshitz T. Late Horner's syndrome following the bite of a black widow spider. Int Ophthalmol 1999; 23:115.
- Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med 2005; 45:414.
- Welch KJ, Burke WA, Jones BE. Black widow spider poisoning as a possible cause of toxic epidermal necrolysis. Int J Dermatol 1991; 30:448.
- Press J, Gedalia A. [Spider bite in a child]. Harefuah 1989; 116:466.
- Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children? Pediatr Emerg Care 1996; 12:360.
- Isbister GK, Gray MR. Effects of envenoming by comb-footed spiders of the genera Steatoda and Achaearanea (family Theridiidae: Araneae) in Australia. J Toxicol Clin Toxicol 2003; 41:809.
- Dunbar JP, Afoullouss S, Sulpice R, Dugon MM. Envenomation by the noble false widow spider Steatoda nobilis (Thorell, 1875) - five new cases of steatodism from Ireland and Great Britain. Clin Toxicol (Phila) 2017; :1.
- Widow spiders (Genus Latrodectus)
- - Identification
- - Geographic distribution
- - Habitat
- - Venom properties
- False black widow spiders (Genus Steatoda)
- - Identification
- - Geographic distribution
- - Habitat
- CLINICAL MANIFESTATIONS
- Black widow spiders
- - History
- - Physical findings
- - Laboratory abnormalities
- False black widow spiders
- DIFFERENTIAL DIAGNOSIS
- Surgical abdomen
- Myocardial ischemia or infarction
- ADDITIONAL RESOURCES