This is a strange case-a really strange case when a man lands up in hospital with urinary retention after bite of a black Widow Spider.The case has been reported in Canadian Journal of emergency medicine.
Latrodectism is the clinical term used to describe the local and systemic clinical manifestations that result from Black Widow spider bites.
A 50 years old man in Canada reportedly got bitten by a black widow spider on his foot when he was walking through tall grass at his cottage in Ontario.He didnot take notice of the same and brushed aside the insect without realising how grave it could be.
After two hours he felt severe pain in his foot and by the next morning, the pain was so severe that he had also developed cramps in his abdomen.He rushed to the emergency room. The doctors examined him and thought that abdominal pain was due to kidney stones and suspected the spider bite was just a coincidental occurrence.The patient was asked to go back home at that time .He was refererred to a larger hospital when he returned later that day because his abdominal pain had worsened.
The man arrived at the emergency room in Ottawa Hospital with a lot of pain and heavy sweating , and both of his eyelids were swollen. His blood pressure was extremely high and a CT scan revealed that his bladder was massively distended, according to the case report.
The man apprised doctors about the spider bite, but after carefully examining his skin, they found no evidence of a bite or rash. However, despite the lack of a mark, doctors suspect the man was bitten by a northern black widow spider, a species found in southern Ontario.
The venom from a black widow spider contains a variety of toxins that may have been responsible for the man’s range of symptoms following the bite. Black widow venom causes a medical syndrome known as “latrodectism,” which can include symptoms such as high blood pressure, heavy sweating and muscle pain. The toxins found in the venom contain enzymes that cause a flood of neurotransmitters, which are chemicals that transmit signals from one neuron to the next, as well as vasodilators, which are substances that widen blood vessels and increase blood flow.
The venom from a Black Widow spider contains a variety of toxins including alpha-latrotoxin. This toxin leads to massive exocytosis of cells from presynaptic membranes leading to release of various neurotransmitters (glutamate, gamma-aminobutyric acid [GABA], acetylcholine, and catecholamines). The release of these neurotransmitters helps to explain the varied symptoms of latrodectism (including, but not limited to, tachycardia, hypertension, muscle rigidity, muscle pain, and diaphoresis).
The release of one such neurotransmitter, called acetylcholine, may be one reason why the man developed urinary retention and had difficulty in urination after the spider bite. Most cases of latrodectism completely resolve without intervention by 72 hours. While many cases of latrodectism can be managed symptomatically with intravenous opiates and benzodiazepines, a minority of cases require antivenin for severe symptoms (hemodynamic instability and severe pain).
Latrodectism following Black Widow envenomation is rare in Canada.But due to climate change more cases of Latrodectism may be seen in the future and it should be considered as a differential diagnosis in anyone presenting with an acute abdomen after an insect bite.
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