Aug 9, 2011 - Oh no! A spider bit me!

This is one of the most common complaints we hear in the urgent care setting. People walk in to the clinic with a complaint of a painful, swollen area of skin. Often the pain will be severe and it is always worsening by the time patients present for care. There can be draining pus and surrounding redness. Sometimes there is a black center. More often than not, however, the spider is innocent and another culprit is guilty of this crime.

Spider bites are rare in Tampa, and even the venomous spiders usually live alongside humans without causing problems. In one study, over 2,000 brown recluse spiders were found in a home in Kansas. Not one member of the family living in the home had ever been bit! (Vetter and Barger 2002, Journal of Medical Entomology 39: 948-951) Often patients will not see a spider, but will assume that they have been bitten based on the severity of the sore. In most instances spiders will only bite when provoked. Most of the lesions seen in the urgent care setting are not true spider bites, but are instead MRSA (Methicillin Resistant Staph Aureus) bacteria. These lesions can start as an area of localized redness that is tender. The area will grow, become swollen and hard, and can sometimes drain pus. Staph bacteria are commonly found on human skin. In most instances they cause no problems. MRSA is different, however. MRSA is not only resistant to many common antibiotics, but it is also more aggressive. While ordinary staph may not break down tissues and cause infection, MRSA certainly will.

How is MRSA treated?If the infection is small enough antibiotics are typically all that is needed. Once the infection spreads beyond the size of a dime, however, it will usually need to be drained. This is not very complex or sophisticated, but it is the mainstay of care. This procedure, called an incision and drainage, is often the most important part of treatment. Often, a small incision will be left open to allow any remaining pus to drain. Any pus expressed from the lesion is often sent to the lab for culture to confirm the diagnosis of MRSA. In recent years, MRSA has become so common that the usual treatments (either Bactrim or Doxycyline) will often be started even before the culture results have returned.How do I care for the wound?This depends on the location as well as the depth of the wound. Frequently a small amount of surgical gauze will be left in the incision to act as a wick and bring out the pus. This will need to be replaced or removed in the office. There should be bandages overlying the wound to absorb any drainage that may be coming out. Often there will need to be repeated office visits to ensure that the wound is healing and that repeated surgical incision is not needed.Will I get this again?Recurrent MRSA infection is a common problem. If a patient has had multiple MRSA infections we will often prescribe topical creams for the fingernails and nose (where MRSA can live) as well as an antibacterial body wash. It is important to keep a close eye on any skin lesions so that they can be treated early. Always inform your physician of any previous MRSA infection.

Jan 13, 2011 - New Website is Launched!

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