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Brown Recluse Spider Bite or Community-Acquired Methicillin-Resistant Staphylococcus aureus: A Differential Diagnosis

Rose, Wendy

Journal of the Dermatology Nurses' Association: November/December 2012 - Volume 4 - Issue 6 - p 370–373
doi: 10.1097/JDN.0b013e318274b496
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ABSTRACT The diagnosis of brown recluse spider bite is frequently overused and erroneous. Patients concerned about a suddenly appearing necrotic lesion often present to their primary healthcare provider with the fear of a spider bite that, after a careful history, is unsupported. The suspected bite is either unwitnessed or did not occur, and the diagnosis is further complicated by the lack of a definitive test for brown recluse spider venom. Contrary to popular belief, most documented brown recluse bites are minor in nature and rarely cause complications or death. Treatment is supportive and conservative, as the tissue injury will resolve on its own. However, there is an ever-growing reality of community-acquired methicillin-resistant Staphylococcus aureus necrotic lesions. Community-acquired methicillin-resistant S. aureus can be identified through wound culture and responds well to oral antibiotics. If left untreated, the symptom sequelae for community-acquired methicillin-resistant S. aureus can lead to further tissue destruction, possible loss of limb, and long-term parenteral antibiotics. There are similarities between the symptoms of community-acquired methicillin-resistant S. aureus and the necrotic lesion presentation of the spider bite. Misdiagnosis can lead to an overtreated spider bite or undertreated community-acquired methicillin-resistant S. aureus.

Wendy Rose, ANP-C, CWOCN, Mercy Hospital Grayling, Grayling, MI.

Capstone Project for the University of Cincinnati.

The author has declared no conflict of interest.

Correspondence concerning this article should be addressed to Wendy Rose, ANP-C, CWOCN, Mercy Hospital Grayling, 1100 East Michigan Avenue, Grayling, MI 49738. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.