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Published on: November 3, 2014
Treatment of pediatric black widow spider envenomation: A national poison center's experience
Miguel Glatstein1, Gary Carbell2, Dennis Scolnik3
1Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine at Anschutz Medical Center, Aurora, CO, USA; Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, University of Tel Aviv, Israel; Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Israel.
Insights
Black widow spider envenomation in children can cause severe symptoms, but antivenom is underutilized. When used, black widow antivenom rapidly improved symptoms and shortened hospital stays.
Area of Science:
- Toxicology
- Pediatric Medicine
- Epidemiology
Background:
- Black widow spider (Latrodectus species) envenomation presents with painful muscle rigidity and autonomic disturbances.
- Pediatric patients, particularly young children and adults, may experience more severe symptoms.
- This study focuses on black widow spider exposures and treatments within the pediatric population.
Purpose of the Study:
- To describe black widow spider exposures and treatment outcomes in children.
- To investigate the reasons for the underutilization of antivenom in severe pediatric cases.
- To evaluate the efficacy of antivenom in managing black widow envenomations.
Main Methods:
- A retrospective review of all black widow exposures reported to the Rocky Mountain Poison Center from 2012 to 2015.
- Demographic data were collected and patients were categorized into two groups based on the source of contact (residence/schools vs. healthcare facilities).
- Severity grading (1-3) was applied to symptomatic patients, and antivenom usage was analyzed.
Main Results:
- Out of 93 pediatric patients, 46.2% had grade 1, 17.2% grade 2, and 36.5% grade 3 envenomations.
- Only 41.1% of patients with envenomations received antivenom.
- Antivenom administration led to rapid symptom improvement and short hospital stays without complications.
- Key reasons for not administering antivenom included physician preference, patient allergies, and antivenom unavailability.
Conclusions:
- Most symptomatic black widow envenomations in this pediatric cohort were minor.
- Despite underutilization, antivenom use was linked to shorter symptom duration in moderate to severe cases.
- Improving antivenom accessibility and addressing physician hesitancy are crucial for optimal pediatric care.
Background:
Black widow species (Latrodectus species) envenomation can produce a syndrome characterized by painful muscle rigidity and autonomic disturbances. Symptoms tend to be more severe in young children and adults. We describe black widow spider exposures and treatment in the pediatric age group, and investigate reasons for not using antivenom in severe cases.
Methods:
All black widow exposures reported to the Rocky Mountain Poison Center between January 1, 2012, and December 31, 2015, were reviewed. Demographic data were recorded. Patients were divided into 2 groups. Group 1: contact through families from their place of residence, public schools and/or cases where patients were not referred to healthcare facilities. Group 2: patient contact through healthcare facilities.
Results:
93 patients were included. Forty (43%) calls were in Group 1 and 53 (57%) in Group 2. Symptoms were evident in all victims; 43 (46.2%) were grade 1, 16 (17.2%) grade 2 and 34 (36.5%) grade 3, but only 14 patients (41.1%) of this group received antivenom. Antivenom use was associated with improvement of symptoms within minutes, and all treated patients were discharged within hours, without an analgesic requirement or any complications. Reasons for not receiving antivenom included: skin test positive (2/20), strong history of asthma or allergies (2/20), physician preference (2/20), non-availability of the antivenom at the health care facility (14/20).
Conclusion:
In our study, most symptomatic black widow envenomations were minor. Relatively few patients received antivenom, but antivenom use was associated with shorter symptom duration among moderate and major outcome groups.
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