Translated by: Katja Matešan, prof.
Department for health promotion
THE BLACK WIDOW SPIDER BITE
The black widow spider is the most poisonous spider in Europe. Despite her poison not being lethal and given the fact that this spider bites only in self-defense, its name provokes fear and uneasiness. In our area (Istria, Dalmatia, coast region, islands) we can find it outdoors from the mid June to the early autumn: When it gets cold, this spider dies, but before that she leaves numerous eggs in the hidden places. From these eggs young spiders derive, most frequently by the end of May, depending on the meteorological circumstances and moisture. The females are bigger and they grow up to 1-2 cm, while the males are smaller, 3-5 mm. These spiders are specific with a distinctive orange, red, or yellow “hourglass” shape on their underside with spots (usually 13). The spider has two poisonous glands, which shrink during bite and drop toxin extract. The poison quantity of black widow spider is only 0.3-0.5 mg, but it is very toxic. The black widow spider venom is neurotoxic, and it stimulates releasing of numerous neurotransmittors with the consequent excessive stimulation of neuromuscular synapses.
The bite of this spider is mostly painless and it does not show, so most people assume to have been stung of the thorn or some plants during outdoors activities or while working in the fields. After the initial redness in the bite area, pallid area of 5cm occur, while localized or generalized rash can occur occasionally. Ten minutes after the bite, one feels pain in the regional lymphatic nodes, and afterwords the pain is expanding in lower back, stomach, back, thighs and lower legs. The pain is getting stronger, with muscle cramps, skin becomes sweaty and touch sensitive, there are nervous outbursts and the patient begins to feel mortal fear. Most patients are not able to stand on their feet, so they generally lie down restless, while those standing on their feet are trembling with the whole body. The face gets specific look characterized by red, sweaty face with painful grimase, with drooping or constricted pupil, eyelids are swollen, with salivation and teardrops. Typically there is a rise in blood pressure, particularly diastolic, causing difficulty in breathing (breathing is shallow and irregular), as well as rapid heartbeat. Most patients feel nausea and/or vomit as well as chest pressure. Psychic symptoms can vary with potential visual obstacles, then delirium, hallucinations, anxiety and insomnia. Some patients can exhibit psychotic disorder symptoms. Symptoms can persist mostly 48-72 hours, and withdraw afterwords, while for complete recovery from bite several weeks are necessary.
The mortality rate is less than 3%; young children, elder population and heart disease patients are at higher risk of developing complications.
There is no real first aid, it is necessary to seek medical assistance immediately. The bite area is locally managed and it is important to examine immunization against tetanus. In medical treatment, painkillers and anticramp drugs, as well as calcium gluconate are used. Specific Anti-Latrodectus serum is used only if recommended by the doctor, depending on potential contraindications.
The best possible prevention is to avoid places inhabited by the black widow spider, information of which you can obtain by the domicile population.
Despite of more than one million insects, allergic reactions to an insect sting in our areas is most common after the bee, bumble-bee, hornet and ant stings. In case of bee sting, there is a sting with an air bubble from the abdomen remaining in the sore, and this sting is to be moved immediately. As opposed to bees and bumble-bees attacking only if disturbed, hornets and wasps are extremely aggressive insects, leaving no sting and stinging several times. Hornet and wasp venom is more toxic and the allergic reactions to their sting are generally more severe. The allergic reactions to ant sting are significantly rare.
Signs and symptoms at the sting area are initially dominated by redness, swelling and pain, resulting from venom. In certain cases, systemic allergic reaction manifesting as urticaria occur in a first degree. In the second degree, it is followed by general symptoms such as headache, nausea, vomiting, diarrhea and/or fatigue. The third degree is characterized by more severe symptoms such as breathing difficulties, chest pain, swallowing problems and disturbances of consciousness. The fourth and the hardest degree is indicated by the complete collapse, loss of consciousness, low blood pressure, blue coloured skin and mucosa as well as inability to keep urine and stool. It is important to know that allergic reactions can occur immediately after the first sting, however, these are more frequent in persons that have already experienced 2-3 stings (for example, at an apiarist).
If an insect sting reaction is localized, it is necessary to put a cold compress to the sting area, but if swelling and redness keep spreading, it is important to seek advice from medical doctor who often prescribes corticisteroid cream and/or antihistaminic drugs.
In case of systemic allergic reaction (anaphylactic shock) it is necessary to seek medical assistance immediately. Besides adrenaline, antihistaminic and corticisteroid drug use, persons having an anaphylactic reaction to the insect sting are to be hospitalized, as well as all persons with previous experience of systemic allergic reaction to an insect sting, angioedema (the swelling that happens just below the surface of the skin, most often around the lips and eyes) or bronchospasm (breathing difficulties).
Each person having experienced anaphylactic reaction to the insect sting (insect allergic individual) should carry self-help tool (adrenaline being administrated by autoinjector, antihistaminic pills and corticosteroids), and ask for medical help immediately.
With the aim of preventing stings, it is necessary to carry out general precautions such as:
– never go barefoot
– to avoid bright-colored clothing and strong fragrances (since they attract insects)
– to avoid rapid moves such as hand waving in the vicinity of insects (since they stimulate insects to aggressive behaviour)
– not eating foods with strong odours outdoors (such as sweet fruit, salami etc)
– watch out for colour and odour intensive juices (insects often fall into glass)
– to keep the trash can lids closed
– to put windows safety netting in order to prevent insect entry
– to use repellents when being outdoors
THE SNAKE BITE
There are two kinds of poisonous snakes in our areas: viper (lat. Vipera ammodytes) and Vipera berus. Both snakes are characterized by the triangular heads, narrow elliptical eyes, short and stout bodies in relation to non-poisonous snakes, as well as dark wiggly line stretching from head to tail (so called Cain’s sign). However, the viper has a characteristic nose-horn, and it moves specifically.
At the bite area, there are usually two wounds from snake teeth bites, distant 6-8 mm from each other, although there can be a single wound or a scratch. Within a few minutes, or after several hours, there are swelling, pain (sharp, shooting), subcutaneous bleeding or even blood filled blisters.
Immediately after the bite, the bitten person feels general symptoms such as: headache, dizziness, fatigue, nausea and vomiting, and after some time regional lymphatic nodes become swollen. In cases of shock (the most frequent and major cause of death), there is a fall in blood pressure, increase in heart rate, pale, cold and sweaty skin as well as breathing failure.
Whether we are dealing with non-poisonous or poisonous snake bite, it is necessary to seek medical help. If you are certain that snake is non-poisonous, use water for wound cleansing, put on a sterile gauze and bandage, and call doctor to check if tetanus immunization is necessary. If it is poisonous snake bite, the bitten person needs to rest, and bitten area has to be immobilized, the wound needs to be covered with sterile gauze. The limb needs to be tied above the bitten area (5-10 cm), with an elastic bandage if possible, making grip necessary for preventing vein and lymphatic flow (in order to prevent venom from spreading), but not arterial one. To suck the venom out or other procedures including application of ice, plants or ointment, wound burning or cutting is not recommended. The bitten person should be transported to a health facility as soon as possible. The antidote is exclusively applied in health facilities, since its application is risky.
The bite prevention:
– if you notice snake, do not come close, do not touch it, even if it is dead
– wear appropriate footwear
– use the existing paths
– be careful on the rocks.
THE JELLYFISH STING
Jellyfish are free-swimming, non-aggressive, gelatinous marine animals surrounded by tentacles. These tentacles are covered with sacs (nematocysts) that are filled with poison (venom) that can cause a painful to sometimes life-threatening sting. Symptoms include an intense, stinging pain, itching, rash, and raised welts. The progressive effects of a jellyfish sting may include nausea, vomiting, diarrhea, lymph node swelling, abdominal pain, numbness/tingling, and muscle spasms. Severe reactions can cause difficulty breathing, coma and death. A sting from a box jellyfish or other venomous types of jellyfish can cause death in minutes. Seek immediate medical treatment if the person stung has:
– Difficulty breathing, difficulty swallowing, chest pain, or intense pain at the site of the sting.
– If the person has been stung in the mouth or placed tentacles in their mouth and are having voice changes, difficulty swallowing, or swelling of the tongue or lips.
– If the sting happened to someone who is very young or old.
– If the sting involves a large area of the body, the face, or genitals.
– If the patient continues to have itching, redness, pain, swelling of the skin around the sting,
see a doctor. The doctor may prescribe:
• diphenhydramine to help with the itching,
• pain medication for pain, and/or
• topical steroids or steroids by mouth to help with the swelling and itching.
• The doctor may also prescribe antibiotics if the patient has cellulitis. Take all medications as directed and until they are gone.
If you are stung by a box jellyfish, seek medical help immediately. While you are waiting for medical help, flood the area with vinegar until medical help is available and keep as still as possible. If you are not close to medical care, soak the area and tentacles for 10 minutes or more, before attempting to remove them. If the sting is on the arms or legs, you can place a pressure dressing around the sting. Be careful that you do not stop blood flow – the fingers and toes should always stay pink. This will help to slow down the spread of the toxin.
• For other jellyfish stings, soak or rinse the area in vinegar for 15-30 minutes to stop the nematocysts from releasing their toxins. If you do not have vinegar available, rinse in sea water,70% isopropyl alcohol. Do not use fresh water. Fresh water will cause the nematocysts to continue to release their toxin. For the same reason, do not rub the area, apply ice or hot water.
• Remove tentacles with a stick or a pair of tweezers. Wear gloves if you have them available.
• Apply shaving cream or a paste of baking soda to the area. Shave the area with a razor or credit card to remove any adherent nematocysts. Then reapply vinegar or alcohol. The shaving cream or paste prevents nematocysts that have not been activated from releasing their toxin during removal with the razor.
• Eye stings should be rinsed with a commercial saline solution; dab the skin around the eyes with a towel that has been soaked in vinegar. Do not place vinegar directly in the eyes.
• Mouth stings should be treated with 1/4 strength vinegar. Mix ¼ cup of vinegar with ¾ cup of water. Gargle and spit out the solution. Do not drink or swallow the solution.
• CPR may be necessary for all stings if the person stops breathing and/or no longer has a pulse.