Monday, June 20, 2005

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.



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10 comments:

  1. Your ignorance is amazing. "Wash your ass better"?? What about people who have cystic acne? Boils? Amazing.

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  2. And your inability to grasp hyperbole for the purpose of humor is stupendous.

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  3. I like the article it was great! I would have said the same thing about her ass, sick wipe it better or something! And for all of you other pussies dont get so worked up about something so simple! Thanks for the info I learned alot!!!!

    :)

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  4. I thought I had a spider bite too, but they said it was an abscess, and they had to cut it open, so they could get all the stuff out of it. I don't know how it got infected, because I take a good shower every day and keep clean, but I am diabetic and they said diabetics are more prone to get infections. Thanks for the information.

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  5. Oh, PS: They gave me antibiotics to take and also some pain pills and I have to go back in two days for them to take the packing out.

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  6. Aye thank you for the information. All the symptoms fit. But I have a few questions. How effective is this infectious bacteria infection? How are you sure that it isn't a spider bite?

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  7. this is distressing... I have a spider bite on my ass too. I'll give it a few days before I go to a doctor, it's pretty painful, maybe it's an abscess :O

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  8. These rogue beasties are terrorizing Florida too. Thank you for your candor. My inner monologue fights with my external dialogue every day. :)

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  9. Amen, sister. I'm a nurse in California and I have never had a "spider bite" patient EVER see the spider. Obviously, these patients aren't being malicious, but they're so sure it's a spider bite, and they don't even know what symptoms would accompany a spider bite. I think it's that a "skin infection" might indicate bad hygiene. What having spiders that are normally living in barns in the south/midwest running around in your house would indicate is beyond me.

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  10. Loved your article. I work in Urgent Care as a PA and it is a constant fight in the defense of spiders.

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