Every week I scour the medical literature to keep abreast of new findings about traumatic brain injury, stroke, cerebral palsy and autism, among other things, that are of interest to the hyperbaric medicine community. I knew that sooner or later a week would go by without anything especially interesting being published and without anything unusual happening at Atlanta Hyperbaric. As a former Eagle Scout, however, I was prepared. This week I want to discuss an interesting event in Atlanta Hyperbaric’s history and also take a moment to discuss a special bane of Southern outdoorsmen: brown recluse spider bites.
First, a little background. This is what the brown recluse looks like. Some call it the violin spider because of the distinctive appearance of its head (arrow.) The brown recluse is found all over the South and into the Midwest. They are usually about 1/4 to 1/2 an inch in size. Although brown recluse are typically found outdoors, they do wander inside and account for some indoor workplace stings.
Second, a number of years ago, I got a call from a carpet manufacturer in Dalton, Georgia, the “carpet capital of the world.” The gentleman told me that three of his office workers had been bitten by brown recluse spiders that day and could he send them down to me right away. The workers arrived with typical blistering, we treated them and none of them went on to necrose their skin.
Third, it’s been known for years that hyperbaric oxygen therapy is extremely helpful in preventing the worst consequences of envenomation from the brown recluse. The mechanism of how hyperbaric oxygen works is not exactly known, however, high levels of oxygen are known to inactivate the venom directly in vitro, so it is not much of a stretch to think that the high level of tissue oxygen obtained under hyperbaric conditions inactivates the venom in vivo and animal models are consistent with this mechanism.
If left untreated, a bite from the brown recluse can go on to cause a full thickness, refractory wound, which often requires skin grafting to close. The clinical experience has been that almost all of these problems can be prevented by a few hyperbaric oxygen treatments within several days of the bite.