Cause of Toxic Shock Reaction Can Be Elusive

“To think,” says Valerie Slimp, spreading out her amputated arms in bold display, “that a little spider did all this.”

Medical and entomology experts aren’t so quick to blame a spider, though.

When the Mira Loma housewife was hospitalized last July with what appeared to be severe flu-like symptoms and her left leg began to discolor, the attending physician speculated about whether she had been bitten by a spider, said Slimp’s husband, Randy. For lack of another explanation, the spider-bite assumption was pursued and bolstered to some degree by a follow-up test.

Within days, samples of skin tissue had been sent to Midwest experts in infectious diseases, and Slimp’s medical report was amended to read that she was reacting to toxic shock prompted by the bite of a brown recluse spider--a member of the Loxosceles spider family that is common in the Midwest but rare in California.

Loxosceles spiders are popularly known as violin spiders because of the shape of the marking on their backs.

Although the bite of a brown recluse may not be detected for several hours, it typically is felt as an immediate sharp sting--which Slimp said she does not recall. The stinging sensation commonly is followed by intense pain. A blister rises and swells and is extremely sensitive to touch. The bite victim may develop a fever and become restless. In days, the skin at the bite site dies, sloughs away and reveals a sunken scar surrounded by dense scar tissue.

The venom of a Loxosceles spider does not usually affect the body beyond the site of the bite, although there are some documented cases of a general systemic reaction to a brown recluse bite, according to researchers at the University of Arkansas.

Some experts suggest that even if Slimp was bitten by a Loxosceles spider, which is unlikely, the trauma she suffered was not caused by the bite itself but by her body’s reaction to a resulting infection. Likely culprits are ubiquitous Streptococcus or Staphylococcus bacteria that entered through the initial wound--whether it was a spider bite, a mosquito bite, a scrape or an open sore.

(More than half of all toxic shock cases are related to menstrual toxic shock, associated during the late 1970s and early 1980s with the prolonged use of highly absorbent tampons.)

Individual reaction to Streptococcus or Staphylococcus bacteria varies widely; in Slimp’s severe case, her body concentrated on fighting the infection at the expense of blood circulation to her limbs, which died, said Dr. David Vannix, her surgeon at the San Bernardino County Medical Center.

Whether Slimp’s trauma was triggered by a spider bite or something else is essentially a moot issue, but still is a matter of discussion among doctors and leading entomologists.

Dr. Gary Wasserman, the toxicologist at the poison control center at Children’s Mercy Hospital in Kansas City, Mo., sent samples of Slimp’s infected tissue to the University of Arkansas, which was developing a screening process to identify brown recluse spider bites.

The results were consistent with the venom of a brown recluse spider. But the test, he said, is not 100% accurate and could not rule out venom of other Loxosceles spiders, he said.

Although bites of violin spiders are popularly blamed for injuries, Wasserman said no one knows how many Loxosceles spider bites occur, “since people don’t catch the spider and there’s no test to really prove it.” At his hospital, Wasserman says he sees maybe a dozen bites a year so severe as to leave a hole in the skin that are presumed to be brown recluse bites.

Wasserman said he has heard of only one other case nationwide where the spider bite led to an infection as severe as what apparently afflicted Slimp.

Saul Frommer, senior museum scientist and curator at the UC Riverside entomological teaching and research collection, said there have been only two documented findings of the brown recluse in California.

Gail Van Gordon, a spider expert with the Los Angeles County Department of Health, and Minoo Madon of the California Department of Health Service, who is qualified as an expert court witness on Loxosceles spiders, searched the two Slimp homes inside and out. They said they could find no evidence of Loxosceles spiders in cracks or crevices, such as irregular webs or other clues.

“I can assure you, no Loxosceles spider was involved in this incident,” Madon said.

Van Gordon said there was a very slim possibility that the fangs of any spider might have been contaminated with bacteria that could have ignited the devastating reaction.

“Spiders get a bad rap. Spiders don’t walk up to a person and bite. It takes a great deal to promote them to bite,” she said.

Beware of the Spider

The brown recluse spider (Loxosceles reclusa) that may have bitten Valerie Slimp is relatively common in the Midwest, especially Missouri, but rarely found in California. Its presence in this state has been documented only twice by entomologists .

What it looks like: About three-eighths of an inch long and half as wide, with legs longer than its main body. Color ranges from light fawn to dark brown. Most distinguishing mark is a violin shape on its back, similar to other species in the Loxosceles spider group. It is sometimes called the violin spider.

Where it lives: In dark, undisturbed crevices and cracks or in unused clothing. It weaves an irregular web with a maze of fibers extending in all directions and no discernible pattern.

Behavior: Retreats when disturbed.

Bite: Usually felt as a sharp sting, followed by intense pain. A blister rises and swells; the victim experiences fever and restlessness. The skin tissue affected by the venom dies off and sloughs away, revealing a sunken scar surrounded by dense scar tissue. More serious complications may arise because of the wound, including bacterial infection. There is no antidote to its venom.

In Southern California: Of several varieties of Loxosceles spiders, also known as violin spiders, the most common is L. deserta , found in desert regions. The most dangerous, L. laeta , which is native to South America, was discovered in Sierra Madre, Alhambra and downtown Los Angeles in the 1960s. There are no documented cases of L. laeta bites in California.

SOURCES: Saul Frommer, senior museum scientist, Entomological Museum, UC Riverside. Minoo Madon, public health biologist, California Department of Health Services. Also, published papers by Agricultural Experiment Station, University of Missouri, Columbia; Division of Agriculture, University of Arkansas, Fayetteville; “Urban Entomology,” UCLA.