That's not a spider bite

From the number of complaints, one would think that the spiders of Texas have begun a guerilla war against humanity. At least once a week there's someone in the ER pointing at a swollen, red bump as evidence of a spider bite. The thing is, it's not a spider bite. It's an abscess, a localized accumulation of pus due to infection, most commonly by Staphylococcus aureus (sometimes called golden staph).


At any time, about a quarter of the population has it on their skin. Fortunately, skin is a good barrier to infection. In people with an abscess, they had a cut or puncture, didn't keep it clean, and an infection developed. Often breaking the skin is accidental. Sometimes it's on purpose. For instance, skin-popping heroin with a dirty needle.

The abscess is actually beneficial in that it walls off the infection, slowing its spread. Still, it's rather nasty. Thankfully the infection usually responds well to first-line antibiotics. I say usually because strains of antibiotic-resistant Staphylococcus aureus that previously were seen almost exclusively in hospitals and nursing homes among the already ill are showing up in the otherwise healthy general population. Called community-associated methicillin-resistant staphylococcus aureus (CA-MRSA), it's a growing problem (geez that's a terrible pun). Articles about CA-MRSA can be found here and here. The Centers for Disease Control has an information page as well.

Now that we have the public health lesson out the way, let's move on to an admittedly extreme case of mistaken "spider bite" self-diagnosis.

A woman I'll call Carla came in saying she had been bitten on the ass by a brown recluse. Brown recluses do live in Texas, but they rarely bite people, and their bite doesn't look like what Carla described (and presumably what the triage nurse saw). For the curious, here's a description of a real bite.

What Carla actually had was an abscess. When she found out she wouldn't be immediately whisked in to see a doctor, out came the attitude,

"But I was bitten by a brown recluse spider. That's serious."

How she felt qualified to make such a specific diagnosis is beyond me. She sure didn't give the impression of being an arachnologist. Truth be told, ER docs often misdiagnose brown recluse bites as well, but at least they went to medical school.

After enduring a third round of complaints about her "dangerous" condition, the terrible pain when she sat down, and that *gasp* other people were being seen before her, I longed to say,

"Sweetie, you weren't bitten by a brown recluse or any other kind of spider. You have a local bacterial infection. It's not an emergency. Sit, stand, whatever. You're going to have to wait like all the other non-emergency patients. Next time, wash your ass better."

Of course what I actually said was, "Mmm. Unfortunately there is a wait."

The lesson here is that if you somehow break the skin, wash the area well with soap and water, bandage it, and keep it clean. For all my IV drug-using readers, here's some valuable information. For the rest of you, here's a bizarre little illustration from the Tacoma/Pierce County Health Department that accompanies their page on CA-MRSA.



Technorati tags: spider bite, abscess, MRSA