Hey, Dr Bernard here. There’s 2 known species of venomous spiders
in the United States. For both species, a bite leading to severe
systemic illness is rare. Let me say that again, systemic illness from
a spider bite in the United States is rare. This video is to teach about the medical side
of cases like this, it’s not about scaring people on spiders. There’s simple steps to help prevent this
from happening in the first place that I’ll tell you about later in this video. A boy put on a pair of socks he left on the
floor on a hot summer morning. This is what happened to his kidneys. GG is a 17 year old boy, presenting to the
emergency room in a panic. He tells the admitting nurse that he tried
to take a leak in the shower, and what should have been urine was red that splashed everywhere. Earlier the day before, GG was in his regular
routine: he was getting ready for one of his last days of high school. As a person, he wasn’t.. the cleanest. His parents were always neat and tidy, they
believed if your living space is messy, your mind is messy. If you can’t control the placement of objects
in your room, which is the one thing you absolutely can control, then there’s no way you can
control anything else in your life. GG couldn’t be bothered. He would leave his homework in stacks on the
floor, claiming that there was an organization amongst the chaos, that he’d only lose things
when meddling mom and her trifling hands tried to clean it up. Whenever he’d change into his pajamas, he’d
throw his clothes on the floor leaving piles everywhere. He’d do his own laundry, but he wouldn’t
fold the clothes afterwards, and sometimes clean clothes would get mixed with the dirty
on the floor. GG’s dad would tell him “you know, you
probably have roaches and spiders living in there. They make a nest, they lay some eggs, they’re
going to crawl all over you in your sleep and theyre gonna take a nice bite out of you
if they dont first crawl up your nose and into your brain one day,” he joked. But that day was now, and it wasn’t going
to be a joke. One evening, GG thought he felt a tickle on
his skin in his sleep, and when he opened his eyes, he saw a brown spider crawling around
in the sheets. In a panic, he cried out in fear. He caught it in toilet paper, and flushed
it down the toilet. He couldn’t sleep the rest of the night,
but it’s just getting warm now and the bugs are out, he thought. As the days passed, GG cleaned himself up. At first, he would fold his clothes and put
them away, but as time went on, he became lazy again and started piling his clothes
at the foot of his bed and on the floor. One morning, GG was getting dressed for school. It was almost time for summer break. He picked out some socks from the pile of
clothes on the floor. Immediately after putting on the pair of socks,
GG felt a little sting on his right foot maybe like he had stepped on a little rock that
was inside. In an effort to not feel what he thought was
the rock again, he started to change the way he walked. He didnt remember if these were clean or dirty,
but as he put on his shoes, he felt the sting again. Shaking his foot and tapping the toe seemed
to fix it. Walk different, feel no rock. Easy fix, he thought. As the hours passed, GG started feeling like
something was wrong. He could feel his heart beat in his right
foot. He could feel just that one foot swelling. In the afternoon, when he took off his sock,
he noticed his foot was red and swollen. He didnt think that a little rock could just
mess up his foot like that. He threw the dirty socks back in to the pile of clothes on the floor,
and went to bed. But when he woke up, he had a waffle for breakfast,
and that waffle came right back up. The smell of the syrup made his stomach squirm
in a way like never before. He stood up from his chair and felt a weakness
wrap around his shoulders and felt gravity drag his stomach into the ground. He had the chills. But then his back started to hurt as he noticed
something was wrong with his breathing. GG noticed that the wound on his foot started
to look weird. He didnt think that a small rock in his sock
could just do this. As he picked out those socks that he wore
yesterday from his pile of dirty clothes on the floor and turned it inside out, he found a brown spider,
legs stemming out from a crushed body. GG’s worst nightmare about his hygiene manifested
in realtime, that it wasn’t a little rock in his sock but that a spider had gotten in
and bit him from the inside. Even though his foot hurt and was swollen
and red and looked like a giant bruise, he still didnt think this was a problem. Until he went into the shower at night time,
GG panicked because when he urinated, he saw it was deep red at first before becoming brown
like Coca Cola. In a frenzy, he called for 911, and hes brought
to the emergency room where we are now. At examination, GG told the medical team about
the bite on his foot. He showed them the spider remains because
he brought the sock. The lesion on his foot had a red, white and
blue pattern, from a pale bruising. When the medical team looked at the spider
remains, they saw 3 pairs of eyes arranged in a nontouching pattern, with a violin shape
on the body. The eyes of the spider and the knowledge of
the geographic location where all of this was happening, tells doctors that GG is suffering
from a bite from Loxosceles reclusa, also known as the brown recluse spider. Typically, when a lesion like this appears
on the skin, most people aren’t going to see what caused that lesion. Unless you live in this region in the United
States, or in Central or South America, it’s highly unlikely to be a brown recluse spider
bite. Their name is Recluse, and they’re known
to not be aggressive in the first place. Even if you do live in this area, a Kansas
family once trapped 2,055 brown recluses over 6 months in their house and no one there ever
received a bite that they knew about. It’s not often that the spider is caught
in the act and presented to the medical team to confirm that it is a spider bite, but sometimes
it is. And in GG’s case, they were able to confirm
the bite, but something’s wrong. Typically, early after the bite, a blister can form without
pus. Usually if these are accompanied with ecchymoses,
which are skin discolorations due to bleeding underneath, that strongly suggests that an envenomation did happen, when the spider can’t be retrieved or identified. These can become an ulcer, and the tissue
can necrose looking worse and worse over time before healing over several weeks. This cutaneous loxoscelism, cutaneous referring
to the skin and loxoscelism denoting a pathological condition from the genus of Loxosceles, means
that the spider bite is localized to the skin, but is it really? Loxosceles venom contains biologically active
substances that the spider needs to survive. This should make sense, spider eat bug. Spider need venom that neutralizes bug. But it also has several enzymes, which are
proteins, one called sphingomyelinase D, and this is what appears to cause most of the
damage to human tissue. And humans have more tissues than just skin,
bringing us back to GG. A blood test finds that GG has anemia. An meaning without and emia meaning presence
of blood. Red blood cells have a protein called hemoglobin. It’s how they transport oxygen throughout
the body. When hemoglobin is low, it could mean that
parts of the body might not be able to get enough oxygen. And in GG, his hemoglobin was low. But why? Hemoglobin contains heme, something that has
iron in it, and it’s how blood transports oxygen. My second, in-depth channel named Heme Review
talks more about venomous spiders link in the description below. Sometimes, a little hemoglobin is floating
around freely in the blood. Iron can react with structures in the body
causing oxidative damage, so it needs to be contained. And the body can do that because the liver
makes something called haptoglobin that captures that free hemoglobin (and this complex is
destroyed in the liver.) If haptoglobin levels in the blood are undetectable,
that could mean that all of it has been consumed by hemoglobin floating freely around. And in GG, the medical team notes his haptoglobin
levels were undetectable. Looking further at the blood test results,
the medical team noticed that the level of a substance that’s released when red blood
cells are smashed and broken apart, was high. And this explains everything. His haptoglobin is undetectable, they were
all consumed by hemoglobin released when blood cells were broken and this hemolytic anemia,
an absence of the presence of blood, because those blood cells are getting smashed and
broken apart, means something terrible is happening to GG. He put on a pair of socks he left in a pile
of clothes on the floor. There was a brown recluse spider inside that
sock. Pressing the spider up against the sock and
the skin of his foot, agitated it, caused it to bite him. In the aftermath, the venom from the bite
didnt just result in cutaneous loxoscelism, the spider venom somehow also got into his
blood stream and caused systemic loxoscelism. As the spider venom activates some of the
immune system, red blood cells get attacked and shatter. Hemoglobin spills into the circulation and
when it reaches the kidneys, pigments and iron deposit in, causing massive damage, leading
to the kidneys shutting down from permanent damage, letting blood and hemoglobin to spill
into the urine. If nothing is done about this, electrolytes
can become imbalanced leading to the heart to beat irregularly. Hypoxemia, low oxygen presence in blood can
cause other organs to start to shut down. To will lead to acid build up in his body, GG’s heart
can then stop beating, but not before massive bleeding happens to him because an inappropriate amount
of blood clots are formed in small blood vessels. Can the medical team do anything about this
systemic loxoscelism? Maybe. Spider bites are the weird cases that come
in to the hospital, strange looking lesion on the skin, but no body knows what caused
it, and the spider got away. Without actually presenting the spider to
the medical team at the hospital, we can’t say 100% for sure that what’s on the skin
is because of a spider. This is why we don’t actually know how many
real brown recluse spider bites actually become necrotic. Lots of times they dont. Lots of times, people get these bites and
they dont go to the hospital so they’re never reported. This means that cutaneous loxoscelism, the
bruising and the ulcer and the skin necrosis doesnt always follow a bite. And many times, it just stops at the skin. The wound can look terrible, but no systemic
illness will happen. On the flip side, sometimes the cutaneous
signs and symptoms are mild, nothing more than a little bruising, but the patient’s
organs have completely shut down due to systemic loxoscelism, so what happens on the skin can’t
predict what can happen to the rest of the body. Systemic illness from these bites in the United
States is rare. Sometimes, brown recluse spider bites are
diagnosed in areas where the spider doesnt live, because a skin lesion is there, and
there’s no way of knowing exactly what caused it. Very rarely, the spider is presented to the medical team, and it is confirmed to be a loxosceles bite and that spider was transported somehow to this non-endemic area, and it could bite someone when
it arrives, but the number of moving parts in that sequence of events makes it unlikely. A kind of spider bite that can happen anywhere
in the United States is from the female Black Widow spider. They can be found throughout North America. Black Widow venom is a neurotoxin, it can
cause the muscles to cramp, it can make the face and the eyelids swell up, it can make
it hard to breathe while heart beats uncontrollably faster and harder, and it can lead to stroke
and a seizure in the worst cases, which are rare In the continental United States, lower 48,
the black widow and brown recluse are the only 2 known venomous spiders. If you dont live in this region, which is
where the brown recluse lives, there’s only the black widow. And as scary as Black Widow bites may be,
there hasn’t been any recorded fatalities from it since the early 1980s when it started
to be tracked. Daddy longlegs is not known to be venomous,
there’s a Hobo spider if you Google it a website says it’s venomous, but there isn’t
good evidence so far for it to be venomous, in a way that causes illness needing urgent medical care and that’s documented in medical literature. For GG, when he got the bite the first time,
what he could have done is use a cold compress, because brown recluse venom is temperature
sensitive. Enzymes are proteins, and they can change
activity and conformation based on temperature. But for his systemic loxoscelism, there is
no antivenom, there is no antidote to this spider bite available in the United States. Central and South America have some antivenoms,
but their Loxosceles spiders are related, a little different, and the bites are more
common, and can be just as severe, if not worse. If GG’s red blood cells were smashed and
broken apart, then he can be treated by replacing those lost with blood products. If his kidneys have shut down, hydrate him. Correct his electrolyte levels and prevent
his heart from beating erratically. So that acid won’t build up in his blood,
and that hypoxemia won’t happen shutting down the rest of his organs. The spider venom is the underlying cause. With time, it will wear off because more of it isn't being continuously added to his body. With supportive care, and a lesson to clean
his room, to fold his clothes and have them tucked away properly in a dresser, to organize
and fold his socks in a way where he knows what’s inside and knows which ones are clean
versus soiled, and to never leave any of his clothes in a careless pile on the floor while
living in a geographical region endemic to the Brown Recluse spider, and to check his bed every night before he goes to sleep, GG was able to make a full recovery. Thanks so much for watching. Take care of yourself. And be well.
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