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Brown Recluse Spider Bites in Patients With Neutropenia

A Single-institution Experience

Hijano, Diego R., MD*,†; Otterson, Daniel, MD*; Homsi, Maysam R., MPH; Su, Yin, MS§; Tang, Li, PhD§; Kirby, Jeannette, MPH; Caniza, Miguela A., MD*,‡

Journal of Pediatric Hematology/Oncology: January 2019 - Volume 41 - Issue 1 - p 28–33
doi: 10.1097/MPH.0000000000001253
Original Articles

Brown recluse spider bites can cause local and systemic signs, including rash, dermonecrosis, edema, hemolysis, and acute kidney failure. These are mostly attributed to sphingomyelinase D, the main toxin. To evaluate the severity of the disease in pediatric patients with and without neutropenia, we retrospectively reviewed records of patients treated at St. Jude Children’s Research Hospital between 1970 and 2015 and identified 19 patients who met the inclusion criteria. Variables of interest included the type of underlying illness, presence of neutropenia, number of days of hospitalization, disease signs and outcome of the bite, and treatments administered. We used descriptive statistics to summarize the manifestations and severity of spider bites in patients with and without neutropenia. Six patients experienced pain from the bite, 11 had erythema, 7 developed edema, and 5 had fever. The response to spider bites in neutropenic patients was no milder than that in non-neutropenic individuals. Six patients developed systemic complications. Compared with non-neutropenic patients, neutropenic patients had antibiotics prescribed more often and experienced longer hospital stays. Spider bites do not seem to have a different clinical course in neutropenic patients. Therefore, a conservative approach may be best for these patients, with close monitoring and local wound care.

Departments of *Infectious Diseases

Global Pediatric Medicine

§Biostatistics, St. Jude Children’s Research Hospital

University of Tennessee Health Science Center, Memphis, TN

Supported by a Pediatric Oncology Grant from the National Institutes of Health and by ALSAC.

The authors declare no conflict of interest.

Reprints: Miguela A. Caniza, MD, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678 (e-mail:

Received March 23, 2018

Accepted June 4, 2018

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