Global Spider and Scorpion Envenomation Management

BACKGROUND

Spider and scorpion envenomations can occur in many environments in which the military operates.1 While most spider and scorpion envenomations result in mild symptoms, severe toxicity and death can occur.

Arthropods are a diverse group of animals with numerous species producing a wide array of toxins. Many arthropods possess a significant venom but lack a sufficient apparatus (fangs or talon) to inject it into humans. Most bites and stings involve more danger from anaphylaxis, but several species of spiders and scorpions have significant neurotoxic, cytotoxic, or hemotoxic venoms. Unfortunately, reliable data evaluating the impact of spider bites and scorpion stings on humans are lacking. Most knowledge is based on case reports and case series, frequently lacking expert review. Furthermore, the public frequently spreads inaccurate information (i.e. reporting a skin abscess resulting from Staph. aureus is a “spider bite”).

Unlike other types of injuries, patients may not even recognize they were envenomated by arthropods, as many injuries are painless or felt as a pinprick. Anaphylaxis is the most concerning initial effect. Recognize and treat it immediately using standard acute allergic reaction therapies. Anaphylaxis from an arthropod envenomation is not an indication for antivenom. For all bites/stings, assess tetanus status and administer vaccine and/or immunoglobulin (for those not previously immunized against tetanus) if required. The following section describes the more clinically significant species of venomous arthropods, the toxicological syndrome they produce, and the treatment. Consider toxicology consultation using the ADvanced VIrtual Support for OpeRational Forces (AD.VI.S.O.R) line in any patient with systemic symptoms secondary to a spider or scorpion envenomation – Commercial: 1 (833)-ADVSRLN (238-7756) or DSN (312) 429-9089.