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case
report
ACUPUNCTURE
FOR TREATMENT OF A NONHEALING
BROWN RECLUSE SPIDER BITE: A CASE REPORT
Fred P. Swing, MD
ABSTRACT
The venom from a brown recluse spider
bite can cause tissue damage and necrosis. If left untreated,
loss of limb or death may result. The following case report describes
a patient with a nonhealing brown recluse spider bite wound, which
resolved on treatment with medical acupuncture.
KEY WORDS
Brown Recluse Spider, Venom, Electroacupuncture
INTRODUCTION
Brown recluse (Loxosceles reclusus) is
the common name for a small, brownish spider found mainly in the
central and southern United States. It has an oval, light-fawn
to dark-chocolate-brown body that is approximately 0.4 in (1.0-
1.5 cm) long and 0. 16 in (0.4 cm) wide. Also known as the "violin"
or "fiddle back" spider, it is characterized by a distinctive
patch (marking) in the shape of a violin (fiddle) on its cephalothorax,
and has 3 pairs of eyes. Because of its timid nature, it is commonly
found in closets, among clothing, in storage boxes, and in other
seldom-disturbed, darkened areas of the home.1
Venom (Toxin or Poison)
Brown recluse spider venom contains
at least 9 different poisonous protein enzymes, similar to rattlesnake
venom. It affects blood vessels in the area of the bite, causing
ischemia and tissue damage and death. The bite wound may fester
and form new wounds (ulcers) as cellular damage from the venom
progresses for a prolonged but unpredictable period, resulting
in the possible loss of limb and even death.
Symptoms
Local Reactions. A typical
brown recluse spider bite is not very painful initially, causing
only mild itching and a little redness. Since the bites frequently
occur during sleep or in the dark, they may be confused with mosquito
or other insect bites. Later, pain and severe itching begin, and
the injury progresses to a blister with tissue death underneath,
and ultimately, the formation of a wound. These wounds can become
the size of a quarter, a half-dollar, or larger. Without intervention,
tissue can continue to die. The venom can migrate and form new
satellite wounds. This process continues until the toxin runs
, its course, which may take several months to years. In some
cases, these spider bites have resulted in loss of entire limbs,
multiple surgeries, and even death.
Systemic Reactions. Systemic sequelae
may be lifethreatening and can include fever, flu-like symptoms,
bleeding, and renal failure. These bites need immediate medical
care.
REPORT
OF A CASE
Report of a nonhealing brown recluse
spider bite successfully treated with medical acupuncture techniques
follows. Treatment of 3 other patients for brown recluse spider
bites have shown similar results.
History
A 43-year-old woman sustained an insect
bite on the lower left leg. It appeared as a 0.8-in (2-cm) red
raised area with a fluid-filled center approximately 0.4 in (1
cm) in size. After 3 days, the wound opened and drained. The red
area enlarged to 2 in (5 cm) in size, and the pain increased at
the wound site and also spread to cover the leg area from the
knee to the ankle. The wound was treated with normal saline rinse
and a dry dressing twice a day. The necrotic center gradually
enlarged.
On day 5, the patient was prescribed
amoxicillin-clavulanate and dapsone orally. Nevertheless, the
pain intensified and ambulation was increasingly difficult.
On day 8, the patient was referred to
another physician (infectious disease/internal medicine specialist).
Intravenous vancomycin was prescribed for 12 days. During this
period, the patient experienced cellulitis, which resolved within
a month. Unfortunately, the wound remained open and did not heal.
Acupuncture Treatment
Several weeks after the bite, the
patient presented with a nonhealing wound on her left lower leg.
The wound was about 0.08 in (2 mm) deep, and its diameter was
approximately 1 to 1.2 in (2.5-3 cm), about the size of a quarter.
The patient requested acupuncture, hoping to enhance healing.
Several needles were placed around
the wound periphery. The positive and negative leads of an electroacupuncture
stimulator2 were connected
to metal needles in an alternate fashion, and adjusted to a frequency
of 5 Hz and to a comfortable intensity level.1
The 20-minute treatment was repeated again 3 days later. The patient
remarked that when she awoke on the morning of treatment 2, she
was sleeping on her left side for the first time in 2 months because
90% of the pain was gone. Examination confirmed that the cyanotic
rim around the wound was now pink, and granulation tissue was
forming at the bottom edge of the wound. 1 40 Medical Acupuncture
- SpringlSummer 1999 - Volume 11 /Number I Acupuncture was repeated
in the same manner 2 days later (treatment 3). At that time, the
patient reported the cessation of pain. The wound continued to
till with granulation tissue. Acupuncture treatment was performed
for the last time 2 days later (treatment 4). The whole crater
of the wound was filling in with granulation tissue, and the wound
diameter decreased by 0.08 in (2 mm). The patient reported that
4 to 5 days after the fourth acupuncture treatment, a scab formed
over the wound. The scab remained over the wound for another 4
or 5 days and then came off.
DISCUSSION
Medical opinion says that the brown recluse
spider bite introduced a recurring vasoconstrictive toxin, and
that the acupuncture destroyed the toxin and broke up the vasospasm
(constricted blood vessel) on the rim of the wound, thus allowing
the wound to heal. The patient's wound was completely healed within
17 days after the first acupuncture treatment.
With any wound, good standard care must
be performed. Any systemic illnesses that reduce blood oxygenation
to the tissues must be addressed. Because nicotine causes vasoconstriction
of the small blood vessels, it should be avoided.
SUMMARY
Treatment with acupuncture and conventional
wound care may produce rapid and dramatic results. The cyanotic
rim around the wound starts turning pink during the treatment,
and wound healing begins almost immediately.
For wound healing to begin, it is imperative
to neutralize the venom; it appears that electroacupuncture may
accomplish this in the first several treatments.3
In addition, the acupuncture treatment increases the blood flow
to and in the wound area. As evidence of this, during the treatment,
the wound turns bright red. This increased blood flow decreases
the healing time by 59% to 70%.
Prompt treatment with acupuncture to
neutralize the venom is extremely important once a brown recluse
spider bite has been diagnosed. It is vital to begin treatment
immediately to prevent the discomfort and life-threatening consequences
that can result from a brown recluse spider bite.
REFERENCES
1. Smith DB, Ickstadt J, Kucera
J. Brown recluse spider bite: a case study. J Wound Ostomy Continence
Nurs. 1997;24:137-143.
2.
IC-1107 Acupuncture Electro-Stimulator. Specitications: 500-ohm
test load; frequency setting (adjustable), 1-500 Hz; low volts
and current 0-10 V, 0 to 20 milliamps; high volts and current
0-20 V, 0 to 40 milliamps; voltage max, 30 V (100 kohm load);
pulse width, 70 microseconds; pulse shape, asymmetric biphasic
square wave; pulse mode, continuous; 3 independent intensity channels;
no point detection; power source, 9-V battery; frequency indicator,
flashing red light; size, 4.5" x 3.2" x 3"; weight, 0.3 lbs.
3.
Osborn CD. Treatment of spider bites by high voltage direct current.
J Okla State Med Assoc. 1991;84:257-260.
AUTHOR
INFORMATION
Dr Fred P. Swing is in private practice, specializing in Anesthesia
and Medical Acupuncture. He is Director of Anesthesia at Bon Secours-St.
Joseph Hospital in Port Charlotte, Florida.
Fred
P. Swing, MD
Bon Secours-St. Joseph Hospital
Medical Acupuncture Center
2400 Harbor Blvd, Suite 16
Port Charlotte, FL 33952
Phone: 941-629-7337 - Fax: 941-629-5738 - E-mail: fswing@sunline.net
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