“Spider bites” are actually cellulitis, these days most commonly with community-acquired Methicillin Resistant Stalphlococcus Aureus. This misdiagnosis is horrendously common, and no matter how many times we correct the ED docs, they keep making the mistake.
Who are you and what are your qualifications? And what’s to say that cellulitis can’t be caused by spider bites once in a while?
It happens once in a while, but Teufel is right, most “spider bites” aren’t. In fact, when my patients complain of spider bites, I immediately put them on the “Rule out MRSA” protocol.
I’ve literally treated hundreds of cases of MRSA in the last 3 years.
QtM, MD
What’s MRSA?
My wild stab in the dark is Methicillin Resistant Stalphlococcus Aureus.
sticklers’ correct, MRSA is staph which is resistant to antibiotics. Resistant and/or suseptable staph are common skin flora on eveyone, if it gets under your skin through a minor cut, scrape, benign insect bite, or a spider bite, it can cause cellulitis.
Larry
And just for the record, the ER docs I work with are quick to de-emphasize spiders or other insects as culprits if it wasn’t an observed event.
Laryy
First, Teufel, welcome, we’re glad to have you with us.
Our archives contain many, many, many reports (and several about spiders), so it’s helpful when you start a thread if you provide a link, to help keep people on the same page. Yes, it’s on the front page at the moment, but in a few days, it will disappear into the mists. Slick has provided the link for you. No biggie, you’ll know for next time.
I confess that I’m a little confused. Your thread title implies that the staff report was incorrect in some way, but in fact Doug who wrote the staff report says exactly what you said: that lots of ailments are misdiagnosed as “spider bites.” So I think you’re in agreement with the Staff Report? Consequently, I’m modifying the title of your thread to be more clear, and not to get confused with the other thread on this topic: Poisonous spiders. I’m going to leave both threads, since this one seems focused on the medical diagnosis (what are those things that get called spider bites?) while the other is focused on the spiders.
And it is nasty, nasty, nasty. No fun at ALL.
Not resistant to all antibiotics. Yet.
Most of the strains in my institution can still be killed by the tetracyclines, clindamycin, and (in vitro at least) sulfa drugs and ciprofloxin. The latter two however, are not the best choices, for a number of reasons.
Rarely we get strains that are resistant to all except IV vancomycin. I hate when that happens.
CK,
Thank you for clearing up the posting confusion. I’ve been reading Straight Dope off and on for years, and have even had an account that I let lapse some time back. I haven’t felt the need to comment for a long time, though, until I came upon this article. A medical case was described that is not clearly a spider bite, and the article is does a good job of talking about why this is not the likely to be the case (as well as going into great depth on biting spiders) and echos my personal opinion on overdiagnosis, but I thought that there was some additional positive information to add - what most “spider bites” these days actually are. Community-acquired MRSA is probably a more relevant and interesting subject in medicine and health than biting spiders.
I believe that commenting on actual medical cases to anonymous involved parties is a dangerous practice, particularly for professionals - and I certainly don’t make a claim to know exactly what’s going on in this case - but I thought the infectious disease aspect needed a mention.
And, like Doug, I had to get in a little dig at the ED docs.
What’s Viagra have to do with this?
Any doc who makes more than 50% of his income for prescribing Viagra, Cialis, or whatever the hell the other drug is, needs smacking around. 
With an erection? I worried that penis might ensue.
I more worried that grammar bad. :smack:
It’s ok. We all know that english is not your first language.
You mean english is your first language???
Wait a second. Those little pimply things that most write off as “Spider bites” are actually a potentially life threatening condition?!? :eek:
Ah, I have something to contribute. As a one-time patient. I Am Not A Doctor, as will quickly become evident. Came needlessly close to winning me a Darwin Award, this did. Not a proud moment, but perhaps a warning to others: IF IN DOUBT, SEE A DOCTOR! Now would be good, sooner would be better.
One Saturday afternoon, took a nap in the park. Woke up with some kind of bite on my left arm. Figured, ah, it’s just a bite, let it heal. By the end of the evening, swelling was much worse. Slept like hell that night, high fever. Sunday, felt miserable, but at least the fever had gone down some. Figured I would see the doctor on Monday. Arm still badly swollen, of course. Slept pretty badly again.
Monday, called the doctor’s office, got told by his staff that there’s an appointment open in a few days. Finally, I showed a lick of sense, told them that I was going to see either the doc or the local hospital’s emergency room. They shifted gears, said come on in.
Doc looked at the bite, sliced it open a little, extracted a bee stinger. Nope, apparently I’m not allergic to bee stings. I am here writing this, after all.
The swelling? Infection, was what it was. Darned bee forgot to clean herself off before stinging, I guess.
Doc gave me antibiotic, said to call if I saw the redness advancing towards my, ah, heart. Early evening, I saw that this was indeed the case, perhaps called doctor away from his dinner. As may be, he said call back if it advanced any further. It didn’t. Phew.
He saw me the next day, was able to see the fading redness of the furthest advance of the swelling (right along the artery, I think) and was impressed, I think.
Okay, that’s the end of the story, and no, it wasn’t a spider bite. As others have said, that makes no difference; the infection was everything.
QtM, we’ve been seeing this in increasing numbers in our ED here in eastern North Carolina. We’re treating CA-MRSA with Septra DS for all cellulitis/abcesses that need drainage and in any that do not get better with typical treatment (ie Keflex). Most (should be all) are sent for cultures and sensitivities and so far all the ones I’ve treated have been susceptible and all the ones I’ve followed up on (yes, ER docs do follow-ups too on occasion), they’ve completely resolved in a few days.
Co-mordidities, age, etc may buy you an inpatient stay with Vanc until the sensitivies come back of course.
Any differences in the prison community? Are you still trying a cephalosporin first line? Are you sending cultures on all I&D’s?
Any cellulitis or pus-forming infection is assumed to be MRSA until proven otherwise by culture. If we are going to use an antibiotic, we start with minocycline (on the recommendation of our local university ID experts. We avoid the sulfas, because they penetrate abscesses poorly (per our ID folks. Other ID guys differ on this). We do NOT use cephalosporins at all.
I and D is often done on problem abscesses. It’s up to the doc as to whether antibiotics are used in addition to I and D. (I have seen dozens of MRSA abscesses heal up nicely without antibiotics just from proper drainage)
We also use bacitracin topically on the wound whenever the dressing is changed.
Our typical organisms are sensitive to the tetracyclines, and clindamycin, along with cipro and bactrim. We are encouraged to NOT use the latter two, as our experts find them to be less effective in vivo than in vitro. We’ve toyed with using rifampin along with the main agent, but haven’t been doing so lately, again based on our local ID guys recommendation.
Our inmates with a suspected MRSA are put on contact precautions, and given their own cell (which bores the hell out of most of them). But if the drainage is contained, they can be out of their unit. Gloves for dressing changes, antibacterial soaps, daily showers, and a follow-up to ensure resolution of the infection are ordered.
We do not reculture for test of cure unless drainage persists. And if it does persist, we generally just do a MRSA screen, to see if it is still present. If the patient has recurrent MRSA infections, we do cultures the nares to see if it is colonized with MRSA, and if so, treat the nares topically with Bactroban.
MRSA resistant to all but vanco and causing significant infection not treatable by I and D gets to stay in the infirmary on IV vanco until it gets better.