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Lyme Disease in Virginia Grows

In Virginia the most common tick bite comes from the Lone Star tick. “You’ll pick up 50 to 100 Lone Stars for every one black-legged tick,” said David Gaines, state entomologist. Yet Lyme Disease, carried exclusively by the immature black-legged, or deer tick, is the most common tick-borne disease in the state, with more than 1,100 cases last year, according to Health Department statistics. Of those, the local region recorded only about two dozen. (more…)

CDC: Cut Back on Doxycycline Use

A continuing shortage of doxycycline means the drug should be used only for conditions that have no alternative treatments, the CDC advised this week. (more…)

Spider Season: The Brown Recluse

The Brown Recluse Spider
By Clifton Castleman, WEMT

What Do They Look Like?

Named for its habit of hiding in dark corners, the brown recluse spider (Loxosceles reclusa) is also known as the violin spider or fiddleback spider because of a violin-shaped marking. The brown recluse spider is about a half-inch long (including legs) and is a solid light brown color. The violin marking is configured with the base of the violin beginning at the eyes and the neck of the violin pointing toward the “waist.” The violin marking is difficult to see clearly.

Brown Recluse Spider

Brown Recluse spider

Two other features can help identify the brown recluse: it has six eyes rather than the typical eight and the tail-end segment has no markings. If you see a brown spider with markings on the tail end, it cannot be a brown recluse spider. Any markings, patterns or spots on the tail end of a spider immediately eliminates the possibility that it is a brown recluse spider. It is, instead, one of dozens of brown spiders that live in houses and yards. They may bite, but they are not dangerous.

Where Do They Live?

Spider experts across the US agree that the true brown recluse spider is native to Kansas, Texas, Oklahoma and Mississippi. There are many related species found in virtually all other states however, and have been spotted everywhere from the colder states like Maine and Vermont, to the Mojave and Sonoran deserts, but not in Northern California, Oregon and Washington states.

In any case, the brown recluse is called a “recluse” because it hides and is not commonly found out in the open. The brown recluse will hide in dark, moist, quiet, out-of-the-way areas where it will not easily be disturbed.

What If I’m Bitten?

In most cases of bites from these spiders, there is pain or burning at the bite site in the first 10 minutes. The bite from this group is usually described as looking like a “target” or “bull’s-eye.” The center of the wound is usually a blister surrounded by a reddened area. A pale or blanched area may surround the discolored reddened area. The blister may rupture, leaving an open ulcer. In severe cases the ulcer can become deep and infected causing tissue breakdown or tissue death (necrosis).

Worsening pain, itching and a burning sensation develop. A patient may also have symptoms such as a red, itchy rash over the torso, arms and legs that is usually seen in the first 24-72 hours. Patients may have pain in the muscles and joints, fever, chills, swollen lymph nodes, headaches, and nausea and vomiting.

Due to the necrotic nature of the brown recluse spider’s venom, a bite usually causes some pain or burning in the first 10 minutes, accompanied by itching. The wound takes on a bull’s-eye appearance, with a center blister surrounded by an angry-looking red ring and then a blanched (white) ring.

The blister breaks open, leaving an ulcer that scabs over. The ulcer can enlarge and involve underlying skin and muscle tissue which may grow for days – even with IV medications. Pain may be severe. A generalized red, itchy rash usually appears in the first 24-48 hours. Other symptoms include fever, chills, nausea, vomiting, muscle aches and hemolytic anemia (a condition where the red blood cells are destroyed).

People bitten by an unseen spider sometimes blame the brown recluse spider because their bite resembles a brown recluse spider bite. However, there are a number of other spiders and insects, as well as other medical conditions, that are capable of producing tissue wounds of similar appearance, but these are usually of a lesser severity.

What Is The Treatment?

Treatment consists of washing the wound and applying an antibiotic ointment. The victim should seek medical attention if there are signs of an infection, an ulcer that does not heal, a bite accompanied by nausea, vomiting, fever or a rash. There is no special treatment or medication used to treat a brown recluse spider bite. If infection develops, antibiotics are used. If a wound becomes deep and infected, occasionally surgery is needed. Anytime there is a bite or a wound that is not healing and getting worse, see a physician for evaluation.

While most spider bites are not dangerous, there is a group of spiders that can produce bite wounds that look similar to a brown recluse spider bite. Unless the spider was actually seen, captured and brought to the physician, the brown recluse spider is not likely to be the culprit. Some of the spiders in this group that can cause a nasty bite include the running spider, jumping spider, wolf spider, sac spider, orbweaver spider and the brown spider, also known as the hobo spider.

Frequently, when people with spider bites call Poison Control (800-222-1222) they think there is some special treatment that is necessary for their bite. There is no specialized therapy other than treating the symptoms. Most importantly, keep the wound clean to prevent infection. If the wound does not heal or does develop an infection, see your physician. Do not wait days and weeks while the wound continues to get worse.

There are tales of people having limbs amputated after spider bites. These involve people who refused to see a physician even though they had massive wounds that did not heal and became grossly infected. A wound that may have been originally treated with simple oral antibiotics, but left untreated, may require surgical intervention in extreme cases.

What Else Causes Similar Symptoms?

Kissing bugs, fleas, bed bugs, flies, mites, wasps, ants and blister beetles have produced lesions similar to a brown recluse spider bite. Many skin disorders and medical conditions can produce lesions that can also mimic a brown recluse spider bite. Some of these include infected herpes outbreaks, bedsores, diabetic ulcers, poison ivy/oak and Lyme disease. Again, use common sense: If there is a wound that is not healing as expected or getting worse, see a physician.

Deep in the Woods, Out on the River

Wilderness first aid required when medical technology is unavailable
By Michael Darzi

When calling 911 is not an immediate option and help in the form of a hospital or trauma center is more than an hour (or days) away, time becomes the essential element between wilderness first aid (WFA) and standard first aid. In such situations, the task of managing the injured and the ill will challenge one beyond basic first-aid knowledge, and require skills that make you think “outside the box.”

Wilderness medicine is required whenever medical technology is unavailable, whether due to a lack of adequate equipment or too distant medical facilities. WFA’s value makes it a requirement for many groups such as search-and-rescue and the Boy Scouts of America for its highadventure bases, and highly recommended for outdoor leaders and guides. WFA is an intensive 16-hour course that teaches students how to properly assess, treat, and manage common illnesses and injuries.

Long hikes, extended lengths of rivers, large expanses of ocean, and miles of asphalt may separate the patient from a medical facility. You may have to endure heat or cold, rain, wind, or darkness.

The equipment needed for treatment and evacuation may have to be improvised, and communication with the “outside world” may be limited or nonexistent. Remote locations and harsh environments may require creative treatments. All these things can be a part of the world of Wilderness First Aid.

The Sierra Club’s Potomac Region Outings (PRO) is teaming with The Center for Wilderness Safety to hold two Wilderness First Aid courses this summer. The courses, taught by The Center for Wilderness Safety at the Turkey Run Education Center in Prince William Forest Park, are sponsored by PRO.

Courses are open to all. Sierra Club outings leaders are eligible for reimbursement. CPR/AED certification is a prerequisite—if you do not have that, you may register for a CPR/AED course at TrinityPresbyterian Church, Herndon, VA. See the complete schedule at www.wildsafe.org/courses.

This WFA course covers more than the basic first-aid requirement for Sierra Club outings leaders. If you are interested only in a CPR/AED course, CWS also teaches American Red Cross CPR/AED and will gladly schedule a class to accommodate your schedule. See www.wildsafe.org/courses/cpr.htm for more information. Outings leaders are also eligible for reimbursement of basic first-aid training.

Michael Darzi is chair of Potomac Region Outings.

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