Spider bites in Australia: There are still some mysteries
Spider bites in Australia: There are still some mysteries
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澳大利亚蜘蛛咬伤事件：仍有一些谜团
DOI：
10.5694/j.1326-5377.1983.tb122690.x
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发表时间：
1983
影响因子：
11.4
通讯作者：
S. Sutherland
中科院分区：
文献类型：
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作者：
S. Sutherland
所有的澳大利亚蜘蛛都有毒牙和毒腺，除了少数几种，如小驼峰蜘蛛。与流行的观点相反，即使是“长腿叔叔”也是如此。在澳大利亚至少有2000种已命名的蜘蛛，可能还有更多的蜘蛛尚未被发现。因此，它们代表了澳大利亚分布最广、变化最多的有毒生物。澳大利亚目前的蜘蛛咬伤问题可以简单总结如下。每年都有数百人被红背蜘蛛咬伤。自从1956年扫罗·维纳的抗蛇毒血清问世以来，再也没有发生过死亡事件，对那些有明显中毒迹象的人的处理几乎成了例行公事。然而，总是有一些新的或不寻常的报告，如优秀的病例报告伯恩和彭伯顿这是发表在这一问题的杂志（第665页）。红背蜘蛛通常只有在与人类皮肤接触时才会咬人。这通常发生在捡车库垃圾或几个月来第一次使用园艺手套的时候。这种咬伤会引起尖锐的刺痛，一般来说，蜘蛛会引入足够的毒液来产生严重的疾病。(This与通常的蛇咬伤后遗症形成鲜明对比，当时许多人并没有生病。）Latrodectism发展比大多数其他envenomations更慢，很少提出诊断问题，因为它的经典特征的迁移区域的大量出汗和疼痛。通常在她“犯罪”的现场就能找到容易辨认的罪魁祸首，并且通过抗蛇毒血清的管理，该综合征被迅速中止。自1926年以来，漏斗网蜘蛛只造成了13人死亡，最近的一些发展已经降低了进一步死亡的可能性。压力/固定型急救延缓了主要毒素的中枢运动，甚至可能导致某些局部失活。提高公众对这一技术的认识，以及向新南威尔士州和昆士兰州的选定医院发放有效的抗蛇毒血清，应能成功地管理大多数病例，如果不是所有病例的话。因此，数百万可能被悉尼漏斗网蜘蛛（Atrax robustus）和同样危险的北方漏斗网蜘蛛（Atrax formidabilisi）咬伤的人可能会感到相当安全。然而，关于漏斗网毒液的一些有趣的问题仍然没有答案。例如，为什么人类和猴子的神经组织对毒液高度敏感，而大多数实验动物和家养动物的神经组织却几乎免疫？这对神经生理学家来说是一个令人着迷的问题。转向其他澳大利亚蜘蛛，我们面临着一个大杂烩的事实，不确定性，奇怪的故事，并在过去的几年里，认识到一个奇怪的新疾病。在许多情况下，当园丁被咬伤时，蜘蛛并没有被准确地识别出来，病例报告对研究人员来说也没有什么价值。尽管如此，已知至少有20种蜘蛛会给人类造成重大疾病，但没有死亡的记录。这类蜘蛛包括常见的黑屋蜘蛛或窗蜘蛛（Ixeuticus robustus），它咬一口会很痛，有时会伴有呕吐、头晕和出汗。猎人蜘蛛（Sparassidae家族）的咬伤可能会持续几个小时极度痛苦。上面提到的奇怪的新疾病被贴上了“坏死性蜘蛛病”的标签，值得一些强调，因为许多从业者不知道这个问题。近年来，在澳大利亚东部各州，一些患者出现了以前没有描述过的不寻常的损伤类型。自1978年以来，整形外科医生已经治疗了至少12例此类损伤。最重要的病历最近已经发表。“已经看到了三种不同类型的伤害。在最轻的形式中，发生缓慢的、进行性的、相对无痛的全层皮肤损失，在某些情况下，该损失延伸到50埃或更大的面积。细菌培养不产生生长，也不会发生系统性紊乱。在第二种类型中，可能被咬伤的区域周围会出现剧烈的疼痛，并且在24小时内会出现不同程度的皮肤脱落。有时，疼痛和发红可能持续数天，但不会发生皮肤脱落。在第三，也是最严重的，介绍，局部皮肤迅速变色和全层皮肤损失发生。在皮肤损伤区域附近可能会出现严重肿胀，但引起最大关注的是全身毒性。全身症状包括休克、虚脱和严重腹泻。后者导致一名儿童出现危及生命的脱水。最初，没有发热，血培养结果为阴性。在血片中可见一些非特异性的毒性改变。在1例病例中，发生了肾病综合征，导致患者死亡。某些蜘蛛，如狼蛛属的蜘蛛，受到怀疑，但罪魁祸首尚未确定。另一种可疑的蜘蛛是白尾蜘蛛（Lamponacylindrata），它通常出现在卧室旁边。虽然在澳大利亚发现了几个Loxosceles属的物种，但迄今为止所见的蛛形纲动物病例并不与Loxoscelism非常相似。在确定引起这些综合征的生物之前，不可能开始制备抗蛇毒血清。在此期间，建议所有园丁都应该戴上合适的手套，在戴上手套之前应该彻底摇晃手套。
ALL Australian spiders have fangs and venom glands, apart from a few species such as the little humped spiders. Contrary to popular opinion, even the "daddy-long-legs" is so equipped. Thereare at least2000namedspecies of spiders in Australia, and probably many moreare yet to berecognized. They thus represent the most widely distributed and most variable form ofvenomous life inAustralia. Thecurrentproblemwith spider bitesin Australia can be briefly summarized as follows. Each year, hundreds of people are bitten by red-back spiders. Since Saul Wiener's antivenom became available in 1956, no further deathshaveoccurred, and the management of thosewho developed evidence of significant poisoning has become almost routine. However, there is always something newor unusual to report,suchas the excellent case report by Byrne and Pemberton which is published in this issue of the Journal (page 665). Red-back spiders usually bite only when they are brought abruptlyinto contact withthe humanskin. Thisoftenoccurs when garage rubbish is picked up or gardening gloves are usedfor the first timein months. The bitecauses a sharppinpricking pain and, generally, the spider introduces sufficient venom to produce a significant illness. (This is in contrast with the usual sequel to snake bite, when many people do not become ill.) Latrodectism develops more slowly than most other envenomations, and rarely presents a diagnostic problem because of its classic features of migratory regions of profuse sweating and pain. The easily identified culprit is usually found at the scene of her "crime", and the syndrome is promptly aborted by the administration of antivenom. Funnel-web spiders have caused only 13 proven fatalities since 1926, and the likelihood of further deaths has been reduced by some recent developments. First aid of the pressure/immobilization type retards the central movement of the main toxin,and mayeven leadto some local inactivation. Increased public awareness of this technique, and the issue of an effective antivenom to selected hospitals in New South Wales and Queensland, should enable the successful management of most, if not all, cases. Thus, the several million people potentially at riskof bites both by the Sydney funnel-web spider (Atrax robustus) and by the equally dangerous northern funnel-web spider (Atrax formidabilisi mayfeel reasonably safe. Nevertheless, some intriguing questions about funnel-web venom remain unanswered. Why, for example, is the nervous tissue of humans and monkeys highly susceptible to the venom, yet that of most experimental and domestic animals practically immune? This is a fascinating problem for neurophysiologists. Turningto other Australian spiders, weface a hotchpotch of facts, uncertainties, odd stories and, over the last few years, the recognition of a strange new disease. In many cases, whengardeners are bitten, the spider is not accurately identified and the case report is of little value to the researcher.Nevertheless, at least20species of spiders are known to cause significant illness in humans, but no fatalities have beenrecorded. Suchspiders include the COmmon black house or window spider (Ixeuticus robustus) which gives a very painful bite, sometimes associated with vomiting, giddiness and sweating. Bites by huntsmen spiders (family Sparassidae) may be excruciatingly painful for hours. The strange new disease mentioned above has been labelled "necrotizing arachnidism", and warrants some highlighting, as many practitioners are unaware of the problem. In recentyears, in easternStatesof Australia, some patients have presented with unusual injuries of a type which had not previously been described. Plastic surgeons have treatedat least 12cases of suchinjuries since 1978. The most significant casehistories have beenpublished recently.' Three distinct types of injuries have been seen. In the mildest form,a slow, progressive, and relatively painless fullthickness skin loss occurs which extends, in some instances, to an area of 50 em' or larger. Cultures for bacteria produce no growth, and no systemic disturbances occur. In the second type,excruciating painoccurs around the region of the probable bite, and varying degrees of skin loss become apparent within 24 hours. Sometimes, pain and redness may persist for a number of days, but no skin loss occurs. In the third, and most severe, presentation, local skin rapidly discolours and full-thickness skin loss occurs. Gross swelling may develop near the area of skin damage, but it is the systemic toxicity which causes greatest concern. The systemic signs consist of shock, prostration, and severe diarrhoea. The latter resulted in life-threatening dehydration in a child. Initially, there is no pyrexia and the results of blood cultures are negative. Some non-specific toxic changes are seen in blood films. In one case, a nephrotic syndrome developed which contributed to the patient's death. Certain spiders, such as those of the genus Lycosa, are under suspicion, but the culprit(s) have yet to be definitely identified. Another suspect is the white-tailed spider (Lamponacylindrata), whichiscommonly foundinside bedrooms. Although several species of the genus Loxosceles have been found in Australia, the cases of arachnidism seen to date do not closely resemble loxoscelism. Until the creature (or creatures) responsible for these syndromes isdetermined, it is not possible to begin workon antivenom preparation. In the meantime, it is recommended that all gardeners should wear suitable gloves, and that they should shake them thoroughly before putting them on.