Nwanyị di ya nwụrụ vs Brown Recluse Spider Ata: Mịkpọ ahụ Mgbochi vs Necrotic Skin Ulcer¶

N'ofe America, Australia, Europe, na Africa, ọgwụgwọ ududo ududo na-ekewa ụzọ abụọ na-emegide ọrịa ọrịa ahụike: ** neurotoxic latrodectism ** sitere na ududo di ya nwụrụ na Redback (* ụdị Latrodectus ) na ** cytotoxic loxoscelism ** sitere na Recluse ma ọ bụ Violin spiders ( Loxosceles * ụdị). Nwanyị di ya nwụrụ ma ọ bụ Australian Redback na-agbanye ** alpha-latrotoxin , neurotoxin presynaptic nke na-akpata pinprick dị nkọ ozugbo sochiri n'ime nkeji 30 ruo 90 site na nhụjuanya, akwara dị ka skeletal muscle cramps, ** osisi-dị ka ike siri ike nke mgbidi afọ nke na-eṅomi ngwa mgbakwunye gbawara agbawa, na-ahapụ ọsụsọ na-adịghị ala ala, na-ahapụ ọsụsọ na-adịghị ala ala. saịtị aru. N'aka nke ọzọ, Brown Recluse spider injects ** sphingomyelinase D (phospholipase D), enzyme na-ebibi anụ ahụ nke na-enwekarị mgbu na-enweghị mgbu n'oge a na-ata ya, mana ọ na-apụta ihe karịrị awa 6 ruo 72 n'ime ihe ncheta ** uhie, ọcha, na-acha anụnụ anụnụ na-acha uhie uhie, na-acha ọcha, na-acha anụnụ anụnụ na-acha odo odo na-akpata 10% nke na-akpata usoro ndụ. nnukwu hemolysis intravascular (hemoglobinuria aja aja, jaundice na akụrụ), ọkachasị ụmụaka. N'ụzọ dị mkpa, ** ihe karịrị pasenti 80 nke etuto uhie na-egbu mgbu, fụrụ akpụ nke ndị ọrịa chọpụtara dị ka ọnyà ududo bụ n'ezie nke obodo nwetara methicillin na-eguzogide Staphylococcus aureus (CA-MRSA) abscesses akpụkpọ*. Ọ bụrụ na onye a tara akpụ enwee nnukwu mgbaka afọ ma ọ bụ azụ azụ, ike iku ume, mmamịrị aja aja, ma ọ bụ na-agbasa akpụkpọ anụ ngwa ngwa, kpọọ mpaghara gị. nọmba mberede ozugbo. Nyochaakwa ntuziaka ụmụnna anyị na akọrọ na ududo taa, cellulitis, ọbara ọbara streaking, na MRSA akpụkpọ abscesses, na agwọ taa.

Ihe kacha gị mkpa bụ iji ncha na mmiri saa ahụ nke ọma, tinye ihe ** dị jụụ ma ọ bụ mkpọ ice nke a fụchiri n'ime ákwà** (e tinyela okpomọkụ n'ọkpụkpọ anụ ahụ, na etinyekwala bandeeji nlegharị anya ma ọ bụ Pressure Immobilization Bandage na ududo), nyochaa maka ịgbago akwara ike ma ọ bụ hemolysis systemic, wee chọọ nlekọta mberede ụlọ ọgwụ maka intravenous opioidctus. nlekota hemolytic na recluse ata.

Mee nke a ugbu a¶

1. ** Ihuenyo ozugbo maka akara sistemụ na-eyi ndụ egwu wee kpọọ nọmba mberede mpaghara gị ma ọ dị.** Kpọọ 911 na United States na Canada, 000 na Australia, 111 na New Zealand, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ lelee akwụkwọ ndekọ aha zuru ụwa ọnụ nke anyị. nọmba mberede Ọ bụrụ na onye ahụ amalite ** oke mgbu n'ime afọ, azụ, obi, ma ọ bụ apata ụkwụ **, ike iku ume, njigide obi, oke ọbara mgbali elu, isi ọwụwa, ihe ọkụ ọkụ zuru oke, ahụ ọkụ, jaundice (anya odo), ma ọ bụ ** mmamịrị agba tii ma ọ bụ agba agba ***.
2. ** Were foto nke ududo ahụ n'enweghị nsogbu (ma ọ bụ weta ụdị agbajiri agbaji n'ime ite ejiri akara) naanị ma ọ bụrụ na ọ dị ebe ahụ, na-etinyeghị nri nke abụọ n'ihe egwu.** Nchọpụta ezigbo entomological nke spider ojii na-egbu maramara nke nwere glaasi na-acha uhie uhie (* Latrodectus ) n'akụkụ ududo tan nwere anya violin gbara ọchịchịrị na* atọ. (* Loxosceles*) na-eduzi nlekọta toxicology ụlọ ọgwụ ozugbo.
3. **Jiri ncha dị nro na mmiri dị jụụ saa ebe ahụ a na-ata ahụhụ, ma wepụ ihe mgbanaka niile, elekere, ọla aka, ma ọ bụ akpụkpọ ụkwụ siri ike n'akụkụ akụkụ ahụ tara akpụ. Ọ bụrụ na apịa Loxosceles atapịa ma ọ bụ gbarie ya, a na-amanye sphingomyelinase D n'ime abụba dị n'okpuru anụ ahụ na arịa anụ ahụ, na-abawanye ọnya necrotic nke ukwuu.
4. ** Tinye akwa dị ọcha, dị jụụ ma ọ bụ mkpọ akpụrụ akpụ nke etinyere na towel (nkeji 10 ruo 15 na, nkeji iri na ise) na ebe a na-ata ahụhụ, na etinyela ihe mkpuchi ọkụ ma ọ bụ mpikota onu ọkụ na ihe a na-enyo enyo na Brown Recluse ata ahụhụ. Ikpo oku akpụkpọ ahụ na-eme ka ọrụ enzyme dị ngwa, nnabata neutrophil, na ọnwụ anụ ahụ dermal, ebe ịdị jụụ dị nro na-ebelata mgbawa enzymatic sphingolipid ma na-ebelata mgbu mpaghara na ma nwanyị di ya nwụrụ na nkwụsị ata.
5. ** etinyela Bandage Pressure Immobilisation Bandage (PIB) ma ọ bụ njem nlegharị anya akwara na nwanyị di ya nwụrụ, Redback, ma ọ bụ Brown Recluse spider bite.** N'okpuru Australian Resuscitation Council (ANZCOR Guideline 9.4.2) na North America toxicology iwu, Nrụgide Immobilization Bandages bụ ** egbochiri ha abụọ (Redback) * Loxosceles* (Recluse) ata: ịnya anụ di ya nwụrụ na-abawanye mgbu na-egbu mgbu, yana ọnyà recluse venom na-etinye enzymes na-ebibi anụ ahụ n'otu ebe, na-akawanye njọ necrosis anụ ahụ. (Rịba ama: A na-eji PIB maka ududo ududo Australia Funnel-Web [Atrax / Hadronyche]** na ata agwọ, ọ bụghị maka Redback, Di ya nwụrụ, ma ọ bụ Recluse spiders.)
6. ** Lelee ụcha mmamịrị na njem ụlọ ịsa ahụ ọ bụla maka awa 72 mgbe a na-enyo enyo na Brown Recluse na-ata, karịsịa na ụmụaka.** Ọ bụrụ na mmamịrị na-atụgharị pink, ọbara ọbara, nchara, ma ọ bụ agba aja aja dị ka Coca-Cola, venom ahụ abanyela n'ọbara ma na-ebibi mkpụrụ ndụ ọbara uhie (** systemic viscerocutaneous loxoscelism / Coombs-negative hemotric), nke na-achọ ọgwụgwọ hemotric ozugbo. maka hydration intravenous ike na nkwado mmịnye ọbara.

Osisi mkpebi: ududo aru vs MRSA abscess na neurotoxic vs cytotoxic triage¶

flowchart TD
    A["Ihe a na-enyo enyo na ọta udide ma ọ bụ ọnya anụ ahụ na-egbu mgbu"] --> B{"Ị hụrụ udide na-ata akpụkpọ ahụ n'oge ọ mere?"}
    B -->|No spider seen; swollen painful red bump draining pus| C["Onwere ike dị elu (karịa 80%) nke ọnya anụ ahụ nke CA-MRSA"]
    B -->|Yes, or classic clinical toxidrome developing| D{"Kedu ihe mgbaàmà kachasị n'ime awa 1 ruo 24?"}
    C --> E["AGHỊ APỤTA; Chọpụta ókè na pen; hụ dọkịta maka mbepụ na drainage + ọgwụ nje MRSA"]
    D -->|Immediate pinprick, target halo with sweating/goosebumps, then severe muscle cramps in back, abdomen, or chest| F["Latrodectism: Nwanyị di ya nwụrụ ma ọ bụ ududo redback (alpha-latrotoxin)"]
    D -->|Painless or mild sting initially; at 2 to 24 hr develops Red-White-and-Blue plaque with central pale blister| G["Loxoscelism: Brown Recluse / Violin Spider (sphingomyelinase D)"]
    D -->|Australia eastern coast: large black spider, immediate severe pain, profuse sweating, drooling, muscle twitching| H["Ọstrelia Funnel-Web Spider: tinye PIB ozugbo + kpọọ 000 maka Funnel-Web Antivenom"]
    F --> I["Jiri ncha na mmiri saa; tinye mkpọ akpụrụ akpụ; Ọ dịghị mgbe itinye PIB; gaa na ED"]
    I --> J["Ụlọ ọgwụ ED: IV opioids + benzodiazepines + Equine Latrodectus Antivenom maka oke mgbu ma ọ bụ ọbara mgbali elu."]
    G --> K["Jiri nwayọ saa; mkpakọ dị jụụ; ebuli elu; etinyela okpomọkụ, PIB, ma ọ bụ ịwa ahụ n'oge"]
    K --> L{"Ahụ ọkụ, ọkụ ọkụ, jaundice, mmamịrị aja aja, ma ọ bụ nwatakịrị?"}
    L -->|Yes: Systemic Viscerocutaneous Loxoscelism| M["Mbanye ICU ozugbo: mmiri mmiri IV, ụlọ nyocha hemoglobin/hemolysis serial, mmịnye RBC"]
    L -->|No: Cutaneous Loxoscelism only| N["Nlekọta ọnya mpaghara, mmelite tetanus, nkwụsịtụ igbu oge naanị mgbe eschar dechara n'ime izu isii ruo asatọ."]

ntụnyere isi na isi: Nwanyị di ya nwụrụ (Latrodectism) vs Brown Recluse (Loxoscelism) vs MRSA Abscess¶

N'ihi na ndị nkịtị na ndị ụlọ ọgwụ na-ahụ maka nlekọta mbụ na-agbagha ugboro ugboro nrịanrịa nke nwanyị di ya nwụrụ, necrotic recluse ata, na etuto nje bacteria, ọdịiche dị n'akụkụ n'akụkụ dị oke mkpa:

Nwanyị di ya nwụrụ na Spiders Redback (* Latrodectus*) na Neurotoxic Latrodectism¶

Molecular pathophysiology nke Alpha-Latrotoxin¶

Nwanyị di ya nwụrụ spiders (* Latrodectus mactans * [Ndịda nwa di ya nwụrụ], * Latrodectus hesperus * [Western Black di ya nwụrụ], * Latrodectus variolus * [Northern Nwanyị di ya nwụrụ], * Latrodectus tredecimguttatus * [Mditerranean Black di ya nwụrụ], na * nwere red venom glands na chitinous fanng nwere oghere ruo ogologo oge iji banye n'ime akpụkpọ ahụ mmadụ (ebe obere ududo ududo di ya nwụrụ enweghị ike ịdụpu akpụkpọ ahụ mmadụ).

1. ** Presynaptic Calcium Pore Formation: *** Isi vertebrate neurotoxin na * Latrodectus* venom bụ ** alpha-latrotoxin **, protein 130-kDa nke na-aga site na ọwa lymphatic n'ime mgbasa ozi sistemu ma jikọta ya na nnukwu mmekọrịta na ** neurexin *** na **latrophilin na njedebe nke autoplatelesy na-adịghị. akwara ọnụ.
2. ** Mkpochapụ Neurotransmitter na-achịkwaghị achịkwa:** Mgbe ejikọtara, mkpụrụ ndụ alfa-latrotoxin anọ na-agbakọta n'ime tetramer wee tinye n'ime bilayer lipid nke ọdụ akwara, na-etolite ọwa cation nke calcium na-adịgide adịgide **. ions calcium extracellular na-ejupụta na njedebe akwara presynaptic, na-akpalite nnukwu exocytosis nke vesicles synapti nwere ** acetylcholine ** (na skeletal neuromuscular junctions) na ** norepinephrine na epinephrine ** (na njedebe autonomic ọmịiko).
3. ** Ọgba aghara dị ka tetanic spasms na-enweghị ọnwụ akwara na-adịgide adịgide:** N'adịghị ka toxin botulinum, alfa-latrotoxin anaghị emebi moto axon kpamkpam. Kama nke ahụ, acetylcholine na-ekpochi akwara skeletal n'ime ** tetanic, mgbagha mgbagha ** mgbe ọmịiko norepinephrine na-akpata ** na-akpata ọsụsọ mpaghara, piloerection, na ọbara mgbali elu **, na-ebelata ** 48 ruo 96 awa *** ka a na-emegharị vesicles.

N'ịghọta ọganihu ụlọ ọgwụ nke Latrodectism¶

1. ** Nkeji 1: Pinprick na Target Halo (Nkeji 0 ruo 30):** N'adịghị ka ọnyà nkwụghachi azụ, ** 75 ruo 90 pasent nke ndị ududo udide di ha nwụrụ na-enweta ata ozugbo ọ na-eme *, na-abụkarị pinprick dị nkọ mgbe ị na-etinye uwe ma ọ bụ akpụkpọ ụkwụ, na-ebuli nkụ, ma ọ bụ iru n'okpuru arịa ụlọ. N'ime nkeji 15 ruo 30, aru ahụ na-etolite oghere okirikiri na-acha ọcha nke gbara ya gburugburu nke obere uhie uhie gbara ya gburugburu, yana ** obere ụmụ irighiri ọsụsọ na ọsụsọ na-ebuli elu ozugbo na ebe a na-ata ụta.
2. ** Usoro nke abụọ: Mgbago Lymphatic na mpaghara akwara mpaghara (Nkeji 30 ruo 90):** Ọkpụkpụ lymph mpaghara na ukwu ma ọ bụ ogwe aka na-adị nro, na ike anụ ahụ a na-ahụ anya na nke miri emi, vise-dị ka cramps na-arịgo n'akụkụ ahụ a tara akpụ n'akụkụ ogwe ahụ.
3. ** Usoro 3: Latrodectism zuru oke, bọọdụ-dị ka afọ, yana Latrodectus Facies (awa 1 ruo 12):**
4. ** Ọkụ dị ala-ngwugwu *** na-agbapụta n'apata ụkwụ, spine lumbar, na ** mgbidi afọ azụ **, na-akpọchi akwara abdominis rectus n'ime ** bọọdụ dị ka isi ike ** na ebili mmiri na-ama jijiji 10/10.
5. *Mkpịsị aka elu ma ọ bụ n'olu na-apụta n'ime ** n'ubu, mọzụlụ intercostal, na mgbidi obi ***, na-eme ka obi sie ike na dyspnea na-eṅomi nkụchi obi.
6. ** Atọ n'onwe na enweghị izu ike: *** Ụdị dị egwu ** ọsụsọ (diaphoresis) ***, ** ọbara mgbali elu siri ike ** (na-adịkarị karịa 180/110 mmHg), na *** Latrodectus facies *** (mmanya na-agba agba, ihu na-ama jijiji na nku anya fụrụ akpụ na ọsụsọ ọkpọiso). N'adịghị ka onye ọrịa nwere ezigbo peritonitis ịwa ahụ (appendix gbawara agbawa) nke dinara n'enweghị ihe ọ bụla n'elu ebe a na-agbatị, ** onye ọrịa di ya nwụrụ na-agbaji mgbe niile, na-agba ọsọ ma na-agbachi azụ ya na-agbalị ịgbatị uru ahụ na-akpụ akpụ.

Nlekọta ụlọ ọgwụ nke Nwanyị di ya nwụrụ na Envenomation Redback¶

1. ** Gịnị kpatara Calcium Gluconate n'ime eriri afọ ji kwụsị:** Usoro ụlọ ọgwụ a na-achịkwa gosipụtara na IV calcium gluconate adịghị arụ ọrụ ma e jiri ya tụnyere ** opioids intravenous jikọtara ya na benzodiazepines**.
2. ** Usoro ọgwụgwọ mbụ (IV Opioids + IV Benzodiazepines):** Onye nlekọta titrated ** IV morphine ** (0.1 mg / kg) ma ọ bụ ** IV fentanyl ** (1 mcg / kg) maka mgbu siri ike, jikọtara ya na ** IV benzodiazepine *** dị ka ** IV ka ọ bụ diazepam 1 mg (pam)* ruo 2 mg IV) iji welie mgbochi GABA-A nke azụ azụ, mee ka ahụ ike tetanic kwụsị, na ịchịkwa ọbara mgbali elu.
3. ** Ngwọta doro anya: Equine * Latrodectus * Antivenom: ** Na North America (** Antivenin * Latrodectus mactans ) na Australia ( CSL Redback Spider Antivenom), ** 1 ka 2 vials nke equine antivenom nyere ihe karịrị 15 ruo 30 nkeji na nkeji 30 na-enye ** zuru ezu muscle mkpebi nke gara aga. nkeji*. A na-egosi ya maka nnukwu mgbu na-egbochi opioids na benzodiazepines, nsogbu ọbara mgbali elu, ** ime ime ** (iji gbochie ọrụ akabeghị aka ma ọ bụ nkwụsị nke placental), na nnukwu envenomation na ** ụmụaka na-eto eto ma ọ bụ ndị okenye na-esighị ike **.

Brown Recluse na Violin Spiders (* Loxosceles*) na Necrotic ma ọ bụ Sistemu Loxoscelism¶

Na-achịchapụ ata ududo adịgboroja: Ọ BỤGHỊ KWESỊRỊ Mnemonic¶

Ndị dibịa bekee na-enyochakarị nje bacteria CA-MRSA abscesses, ọnya ọrịa shuga, herpes simplex, ma ọ bụ Lyme erythema migrans ka Brown Recluse na-ata ahụhụ na mpaghara ebe ọ nweghị * Loxosceles* spiders bi. Ndị ọkachamara n'ihe banyere ihe na-egbu egbu na-eji akara mnemonic akwadoro ** BỤGHỊ KWESỊRỊ *** iji chịpụ ata ahụhụ ma chọpụta ọrịa nje:

• ** N (Ọtụtụ):** Ihe karịrị 90% nke ezigbo ọnyà Brown Recluse bụ ** otu ọnya pụrụ iche** (site na ịtụgharị otu ududo tọrọ atọ n'àkwà ma ọ bụ yikwasị uwe). Otutu ọnya na-arụtụ aka na fleas, bedbugs, ma ọ bụ etuto MRSA, ọ bụghị nkwụsịtụ.
• ** O (Ememme): *** Na North America, * Loxosceles reclusa * bụ nwa amaala ** naanị na South-Central na Midwestern US ** (Nebraska na Iowa gbadara Texas, ọwụwa anyanwụ ruo ọdịda anyanwụ Georgia na ndịda Ohio). Na mpụga mpaghara Loxosceles (ma ọ bụ South America maka L. laeta), ịta ahụhụ agaghị ekwe omume.
• ** T (Oge oge):** Ihe karịrị 85% nke enwetara * Loxosceles reclusa * ata na-eme n'oge ọnwa ọkụ (** Eprel ruo Ọktọba **).
• ** R (Ebe Uhie Uhie):** Ezigbo Brown Recluse aru na-etolite ebe etiti ischemic na-acha anụnụ anụnụ na-acha odo odo, na-acha ọcha ma ọ bụ na-acha anụnụ anụnụ ** (n'ihi na sphingomyelinase D na-egbochi arịa akpụkpọ ahụ). Ọnya nwere ** uhie na-egbuke egbuke, etiti dị ọkụ ** bụ ọrịa nje.
• ** E (Dome dị elu):** ezigbo nri Brown Recluse bụ ** dị larịị ma ọ bụ gbadaa n'okpuru akpụkpọ ahụ gbara ya gburugburu ** (n'okpuru 1 centimita oke). A ** weliri elu, dome fụrụ akpụ karịa 1 centimita elu** bụ ọnya nje na-ejupụta (osi).
• C (na-adịghị ala ala karịa ọnwa 3): Ọbụlagodi nnukwu ọnya necrotic recluse na-agwọ n'ime izu asatọ ruo iri na abụọ ***. Ọnya na-adịgide ọnwa 3 gara aga chọrọ biopsy maka ọrịa kansa anụ ahụ, pyoderma gangrenosum, ma ọ bụ ọrịa fungal.
• ** L (Onye buru ibu karịa 10 cm):** Ihe karịrị 90% nke ọnya mweghachi dị obere karịa 3 ruo 10 centimita (1.2 ruo 4 inch).
• ** U (Ulcerates Too Early, Under 7 Days):** N'ezie Brown Recluse aru, the central ischemic skin na-etolite akọrọ ojii skaab (** eschar**) n'elu 5 ka 14 ụbọchị na ** adịghị slough emeghe n'ime a crater ọnya ruo ụbọchị 7 ruo Day 14 . Ọnya na-agbawa ma na-amịpụta mmiri odo odo n'ụbọchị 2 ma ọ bụ ụbọchị 3 bụ ** nje MRSA obụpde.
• S (Ọzịza): Ewezuga na nkuchianaya ma ọ bụ ụkwụ, ata ahụhụ anaghị ebute nnukwu ọzịza n'ụkwụ boggy na-enweghị gravitational erythema.
• E (Exudative Pus): Real Brown Recluse ata ahụhụ bụ ** nkụchi akpụkpọ anụ ischemic kpọrọ nkụ**. ** Ọkụ na-acha odo odo ma ọ bụ ọcha pụtara ọrịa nje, ọ bụghị nsị udide.**

Pathophysiology nke Cutaneous Loxoscelism: Red, White, and Blue and Gravitational Spread¶

Mgbe a na-apịa ududo * Loxosceles * n'ime akpụkpọ ahụ n'ime uwe ma ọ bụ akwa akwa, anụ ya na-agbanye ** spingomyelinase D (phospholipase D)* yana hyaluronidase:

1. ** Awa 6 ruo 48 (Akara uhie, ọcha na anụnụ anụnụ):**
2. ** Ebe na-acha anụnụ anụnụ/acha odo odo:** Sphingomyelinase D na-agbajikwa endothelial sphingomyelin, na-akpalite nchịkọta platelet, ntinye neutrophil, na ** microvascular thrombosis ***. N'ịbụ onye agụụ na-eru n'ọbara, etiti dermis na-atụgharị -acha anụnụ anụnụ-acha anụnụ anụnụ ma ọ bụ odo odo (na-enwekarị ọnya hemorrhagic).
3. Mgbanaka etiti na-acha ọcha: gbara gburugburu isi ihe na-acha odo odo na-acha odo odo bụ ihe dị warara, ** mgbanaka na-acha uhie uhie na-acha uhie uhie ** kpatara vasoconstriction reflex.
4. ** Red Outer Halo: ** Gburugburu mgbanaka ọcha bụ nnukwu halo nke ** erythematous vasodilatory mbufụt **.
5. ** Gravitational Downward Spread na Eschar Sloughing (Dysbọchị 5 ruo 21):** N'ihi na Loxosceles venom nwere ** hyaluronidase** (ihe na-agbasa), ike ndọda na-adọta enzyme ala site n'ụgbọ elu abụba subcutaneous ka ọ bụrụ ọdịdị anya mmiri. N'ime pasent 10 ruo 30 nke ata ndị na-aghọ necrotic (karịsịa n'elu ebe ndị nwere abụba dị ka apata ụkwụ, ụkwụ, ma ọ bụ afọ), ebe etiti na-acha anụnụ anụnụ na-esiwanye ike n'ime sunken, akọrọ, akpụkpọ anụ ojii ** eschar ** site na Ụbọchị 5 ruo 7, nke na-ekewa n'etiti ** Ụbọchị 7 na Ụbọchị 21 **, na-ahapụ ọnyá miri emi nke na-agwọ n'ime izu 4 ** .

Loxoscelism Systemic Viscerocutaneous (hemolysis intravascular: Ezi ihe iyi egwu ndụ)¶

Na ** 1 ruo 2 pasent nke North America * Loxosceles reclusa * ata ** (na ruo ** 10 ruo 15 pasent nke South America * Loxosceles laeta * ata ***), karịsịa na ** ụmụaka **, sphingomyelinase D na-abanye n'ọbara ma jikọta na-ekesa ** mkpụrụ ndụ ọbara uhie **:

• Fulminant Intravascular Hemolysis: Ọbụlagodi mgbe aru anụ ahụ dị obere, sistemu sphingomyelinase D na-ewepụ glycophorins site na mkpụrụ ndụ ọbara uhie na-arụ ọrụ nkwado, na-ebute ** nnukwu hemolysis intravascular ** n'ime awa 24 ruo 72 nke aru**.
• ** Ihe ịrịba ama dị ize ndụ ị ga-elele n'ime awa 72 mbụ: ***
• ** Ahụ ọkụ, oyi, ọgbụgbọ, nkwonkwo mgbu, na ihe ọkụ na-acha uhie uhie na-agbasa ** malite awa 12 ruo 48 ka atachara ya.
• Mmiri gbara ọchịchịrị, agba tii, ma ọ bụ mmamịrị agba agba (hemoglobinuria) ka mkpụrụ ndụ ọbara uhie lysed wụsara haemoglobin n'efu n'ime plasma na akụrụ, na-ebute ** nnukwu mmerụ ahụ akụrụ (AKI)**.
• ** hemoglobin na-ada ngwa ngwa (anaemia), pallor, tachycardia, na ** jaundice *** (anya edo edo) n'akụkụ DIC.
• ** Protocol ụlọ ọgwụ: ** Nwa ma ọ bụ okenye ọ bụla nwere ahụ ọkụ, ọkụ ọkụ, ma ọ bụ mmamịrị gbara ọchịchịrị mgbe a na-enyo enyo na ọ ga-ata ahụhụ na-achọ ** nnabata ụlọ ọgwụ ozugbo , ọnụọgụ ọbara ( hemoglobin kwa awa 6 ruo 12 , ** LDH, bilirubin -apụtaghị ìhè, haptoglobin**, **haptoglobin hydration *, na ** mịnye mkpụrụ ndụ ọbara uhie juru* maka haemoglobin na-agbada n'okpuru 7 ruo 8 g/dL.

Mpempe akwụkwọ dị nkenke na Spiders Funnel-Web Australian (Atrax & Hadronyche): Ewezuga PIB¶

N'ebe ọwụwa anyanwụ ma ọ bụ n'ebe ndịda ụsọ oké osimiri nke Australia *** (Sydney na Great Dividing Range si Queensland ruo Tasmania), ata si a ** nnukwu, nwa ududo na-egbuke egbuke (Atrax robustus ma ọ bụ Hadronyche ụdị)** injects delta-atracotoxins, na-eme ka ndụ-egwu egwu neuromus autonomic n'ime nkeji 1 na mpaghara ** 1 nkeji. mgbu, tingling perioral, ire mkpọmkpọ ebe, oké mmiri ozuzo na ọsụsọ, ọbara mgbali elu, pulmonary edema, na iku ume). ** N'adịghị ka Redback/Nwanyị di ya nwụrụ ma ọ bụ spiders recluse, onye Australian Funnel-Web (ma ọ bụ Mouse Spider) na-ata ahụhụ na-achọ ka Bandage Immobilization Pressure (PIB) + siri ike, nkwụsị zuru oke, na njem ụgbọ ala ozugbo (000) maka ** CSL Funnel-Web Spider Antivenom

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911 maka oke ahụ ike siri ike, obi / afo mgbu, ike iku ume, ma ọ bụ akara ngosi sistemu. Kpọọ ** US Control Poison na 1-800-222-1222** (ma ọ bụ Canadian Provincial Poison Center) 24/7 maka ntụzịaka toxicologist na ahụike na Latrodectus antivenum ma ọ bụ * Loxosceles* hemolysis nlekota.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand. Soro ** Ntuziaka ANZCOR 9.4.2 (Envenomation: Spider Bite) ***:
• Maka ** Ududo Redback (Latrodectus hasselti)** ma ọ bụ spiders izugbe ndị ọzọ: tinye ihe nkpuchi oyi ** (mkpọ ice akpọchiri ruo nkeji iri abụọ); E tinyela bandeji na-eme ihe nrụgide. Chọọ nlekọta ụlọ ọgwụ maka analgesia na CSL Redback Antivenom ma ọ bụrụ na mgbu siri ike.
• Maka Big Black Spiders (Funnel-Web Atrax/Hadronyche ma ọ bụ Mouse Spider Missulena): tinye bandage Pressure Immobilization Bandage (PIB) wee gbawaa ozugbo wee kpọọ 000. Kpọọ ** Ebe Ozi Ihe Nsi Ọstrelia na 13 11 26**.
• United Kingdom: Kpọọ 999 maka ihe mberede ma ọ bụ NHS 111 maka nyocha ụlọ ọgwụ ngwa ngwa. Rịba ama na ọ bụghị ezi ndị di ha nwụrụ ma ọ bụ Brown Recluses bụ nwa amaala UK; nwa amaala ** Noble False Spider di ya nwụrụ (Steatoda nobilis)** na-ebute mgbu dị ka mpaghara mgbu na ahụ ọkụ dị nro ("steatodism") na-eji ncha / mmiri ịsacha, mkpakọ dị jụụ, na analgesics nke ọnụ, ebe ọ bụ na ọ fọrọ nke nta ka ọ bụrụ nje cellulitis ma ọ bụ abscesses na-achọ ọgwụ nje.
• European Union na Mediterranean: Kpọọ 112. Na Southern Europe (Spain, Italy, Greece, Southern France, Balkans), ma ndị ** Mediterranean Black di ya nwụrụ (Latrodectus tredecimguttatus)** na ** Mediterranean Recluse (* Loxosceles rufescens*)** bụ ụmụ amaala; gaa n'ihu na ngalaba mberede ụlọ ọgwụ kacha nso maka ọnya ahụ siri ike ma ọ bụ plaques necrotic.
• South America (Brazil, Peru, Chile, Argentina) na South Africa: Kpọọ 192/193 na Brazil, 131 na Chile, 106 na Peru, ma ọ bụ 10177/112 na South Africa. Na Brazil na Peru, ebe ike * Loxosceles laeta * na * Loxosceles intermedia * na-eme ka ọnụ ọgụgụ dị elu nke hemolysis systemic viscerocutaneous hemolysis, ** polyvalent ma ọ bụ kpọmkwem equine anti-loxoscelic / anti-arachnid antivenom (* soro antiaracnídico / antiloxoscélico*) na-elekọta ụlọ ọgwụ 8 nke mbụ n'ime ụlọ ọrụ 8 nke ụlọ ọgwụ na-elekọta 3. awa nke agafeghị oke-na-oke loxoscelism.

Ajụjụ a na-ajụkarị¶

Kedu otu m ga-esi amata ọdịiche dị n'etiti ata nwanyị di ya nwụrụ na ata Brown Recluse?¶

Ha na-emepụta ihe mgbaàmà kpamkpam. Nwanyị di ya nwụrụ na-ata ahụhụ ka ọ na-adị nkọ ozugbo, ọ fọrọ nke nta ka ọ bụrụ ihe ọ bụla mebiri akpụkpọ ahụ (naanị obere mgbanaka na-acha odo odo nwere obere ọsụsọ na ọsụsọ na-akpata), na n'ime nkeji 30 ruo 90 na-akpata nhụjuanya, ebili mmiri dị ka akwara dị na apata ụkwụ, azụ azụ, obi, na afọ (na-atụgharị akwara afọ na-esi ike) tinyere ọbara mgbali elu na ọsụsọ. Nri Brown Recluse na-enwekarị mgbu na mbụ, ọ dịghị mgbe ọ na-akpata nhịahụ ahụ ike, na ihe karịrị awa 6 ruo 48 na-emepụta ihe mgbakwasị ụkwụ na-acha uhie uhie, ọcha na acha anụnụ anụnụ na akpụkpọ ahụ nke nwere ike ịghọ skaab ojii nke dara ada (eschar) na ọnya na-agwọ ngwa ngwa.

Kedu ihe kpatara na-egbu mgbu, fụrụ akpụ uhie "udide ududo" n'ezie nje nje bacteria MRSA?¶

Ọ gwụla ma ị hụrụ n'ezie udide na-ata gị ozugbo ọ mere, nchọpụta na ngalaba mberede na-egosi na ihe karịrị pasent 80 nke ọnya ndị ọrịa kwenyere na ọnya udide bụ n'ezie abscesses ( etuto) nke methicillin na-eguzogide Staphylococcus aureus (MRSA) kpatara. A ezigbo Brown Recluse aru dị larịị ma ọ bụ gbarie ya na etiti na-acha anụnụ anụnụ ma ọ bụ na-acha anụnụ anụnụ na-acha anụnụ anụnụ na ọnwụ anụ ahụ akọrọ, ebe ọnya na-ebili dị ka dome fụrụ akpụ, na-ekpo ọkụ ma na-acha uhie uhie n'etiti, na-agbapụta mmiri mmiri na-acha odo odo ma ọ bụ ọcha n'ime ụbọchị ole na ole bụ ọrịa nje na-achọ ọgwụgwọ ọgwụ na ọgwụ nje.

Gịnị kpatara na ududo ududo di ya nwụrụ na-ata afọ gị ka ọ siri ike dị ka osisi, dị ka ihe mgbakwunye gbawara agbawa?¶

Venom nke di ya nwụrụ nwere alfa-latrotoxin, neurotoxin nke na-esi na aru ya n'ụkwụ ma ọ bụ n'ụkwụ na-agbago n'ime mmiri lymph ma na-akụnye pores calcium n'ime njedebe akwara moto na-enye nnukwu uru nke apata ụkwụ, ala azụ, na mgbidi afọ. Oke mkpofu nke neurotransmitter acetylcholine na-egbochi akwara afọ ime ka ọ bụrụ mkpụkọ tetanic na-aga n'ihu. Ndị dọkịta na-amata ọdịiche dị na ya na appendicitis n'ihi na onye ọrịa ahụ adịghị ahụkebe ma na-ama jijiji kama ịgha ụgha, ọ dịghị ezi mmetụta dị n'ime peritoneal rebound, na mgbu na-edozi ngwa ngwa na opioids intravenous, benzodiazepines, ma ọ bụ Latrodectus antiven.

Ekwesịrị m itinye ice ma ọ bụ ikpo ọkụ na mgbanaka Brown ma ọ bụ oji udide di ya nwụrụ?¶

Na-eji mkpakọ dị jụụ ma ọ bụ mkpọ akpụrụ akpụ n'ime akwa dị ọcha mgbe niile (maka nkeji 10 ruo 15 n'otu oge), etinyekwala ihe mkpuchi ọkụ ma ọ bụ mmiri ọkụ na ihe a na-enyo enyo na Brown Recluse. Enzyme na-ebibi anụ ahụ na Brown Recluse venom (sphingomyelase D) na-arụ ọrụ ngwa ngwa na okpomọkụ dị elu; itinye okpomọkụ na-eme ka necrosis anụ ahụ dịkwuo elu, ebe ọ dị nro na-ebelata enzyme ahụ ma na-ebelata mgbu na mpaghara na Brown Recluse na Black di ya nwụrụ.

Kedu ihe kpatara o ji dị oke mkpa ịlele ụcha mmamịrị nwatakịrị ruo ụbọchị 3 mgbe a na-enyo enyo na Brown Recluse tara?¶

N'ime pasent 1 ruo 10 nke Brown Recluse na-ata ahụhụ, yana n'ụzọ na-ezighi ezi na ụmụaka, venom enzyme sphingomyelinase D na-abanye n'ọbara ma wakpo mpụta nke mkpụrụ ndụ ọbara uhie, na-eme ka ha gbawaa n'ime arịa ọbara (hemolysis intravascular systemic) n'etiti awa 24 na 72 ka aruchara ya. Ọbụlagodi na aru akpụkpọ ahụ dị obere, mkpụrụ ndụ ọbara uhie na-agbawa na-eme ka mmamịrị ahụ na-agba ọchịchịrị, agba ajari, ma ọ bụ agba kola (hemoglobinuria) ma nwee ike ibute anaemia na ọdịda akụrụ na-eyi ndụ egwu na-achọ hydration ICU ozugbo na mmịnye ọbara.

Ị kwesịrị ị kechie bandeeji siri ike ma ọ bụ ihe nkiri nlegharị anya na gburugburu nwanyị di ya nwụrụ ma ọ bụ Brown Recluse?¶

Mba. Ejila bandeeji nlegharị anya ma ọ bụ ihe na-agbanwe agbanwe na nwanyị di ya nwụrụ, redback, ma ọ bụ Brown Recluse ata. Trapping Brown Recluse venom n'otu ebe na-etinye uche na enzyme na-agbaze anụ ahụ ma na-ebute necrosis anụ ahụ miri emi, ebe ijikọ nwanyị di ya nwụrụ ma ọ bụ Redback ata na-akawanye mgbu na mpaghara na-emeghị ka ọ pụta ìhè. (A na-eji bandeeji na-eme ka nrụgide nrụgide mee ihe maka spiders Funnel-Web nke Australia na agwọ na-egbu egbu, ọ bụghị maka ududo di ya nwụrụ ma ọ bụ Recluse.)

Isi mmalite na nduzi ọchịchị¶

• ** American Association of Poison Control Centers (AAPCC) & American College of Medical Toxicology (ACMT, United States):** * Ntuziaka nlekọta ahụike na nyocha toxicology na Latrodectus (Nwanyị di ya nwụrụ) na Loxosceles (Recluse) Envenomations * na * Ọ BỤGHỊ KWESỊRỊ DIAgnostic Mnemonic * (Vetter) et al.
• ** Australian Resuscitation Council (ANZCOR, Australia na New Zealand):** * Ntuziaka ANZCOR 9.4.2: Envenomation, Spider Bite* (Redback Spider oyi-mkpọ protocol vs. Funnel-Web Spider Pressure Immobilization Bandage Protocol).
• ** Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC / NIOSH, United States): *** Ududo na-egbu egbu (Nwanyị di ya nwụrụ na Brown Recluse): njirimara, enyemaka mbụ, na nlekọta ụlọ ọgwụ, gbakwunyere ọdịiche dị na CA-MRSA Skin Infection *.
• ** Òtù Ahụ Ike Ụwa (WHO) & Pan American Health Organisation (PAHO):** * Nlekọta ahụike nke Loxoscelism (Cutaneous na Viscerocutaneous Hemolytic Syndromes) na Latrodectism na America.
• ** National Health Service (NHS, United Kingdom) & National Poiss Information Service (NPIS):** * Udo ududo: Enyemaka mbụ, Steatoda (Nwanyị di ya nwụrụ ụgha) njikwa, na ọrịa nje na-efe efe na-acha uhie uhie *.

Ntuziaka emetụtara¶

• Akọrọ na ududo na-ata enyemaka mbụ
• Na-agbasa cellulitis, ọbara ọbara lymphangitis streaks, na MRSA akpụkpọ abscesses
• Ata agwọ na ihe mberede ihe mberede na-akpụ akpụ
• Mmeri akụrụ dị oke njọ, rhabdomyolysis, na mbelata mmamịrị gbara ọchịchịrị
• Nọmba mberede site na obodo