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Funnel-web spider bite: a systematic review of recorded clinical cases

Med J Aust 2005; 182 (8): 407-411.

Summary

Objective: To investigate species-specific envenoming rates and spectrum of severity of funnel-web spider bites, and the efficacy and adverse effects of funnel-web spider antivenom.

Data sources: Cases were identified from a prospective study of spider bite presenting to four major hospitals and three state poisons information centres (1999–2003); museum records of spider specimens since 1926; NSW Poisons Information Centre database; MEDLINE and EMBASE search; clinical toxinology textbooks; the media; and the manufacturer’s reports of antivenom use.

Data extraction: Patient age and sex, geographical location, month, expert identification of the spider, clinical effects and management; envenoming was classified as severe, mild–moderate or minor/local effects.

Data synthesis: 198 potential funnel-web spider bites were identified: 138 were definite (spider expertly identified to species or genus), and 77 produced severe envenoming. All species-identified severe cases were attributed to one of six species restricted to NSW and southern Queensland. Rates of severe envenoming were: Hadronyche cerberea (75%), H. formidabilis (63%), Atrax robustus (17%), Hadronyche sp. 14 (17%), H. infensa (14%) and H. versuta (11%). Antivenom was used in 75 patients, including 22 children (median dose, 3 ampoules; range, 1–17), with a complete response in 97% of expertly identified cases. Three adverse reactions were reported, all in adults: two early allergic reactions (one mild and one with severe systemic effects requiring adrenaline), and one case of serum sickness.

Conclusions: Severe funnel-web spider envenoming is confined to NSW and southern Queensland; tree-dwelling funnel webs (H. cerberea and H. formidabilis) have the highest envenoming rates. Funnel-web spider antivenom appears effective and safe; severe allergic reactions are uncommon.

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  • Geoffrey K Isbister1
  • Michael R Gray2
  • Corrine R Balit3
  • Robert J Raven4
  • Barrie J Stokes5
  • Kate Porges6
  • Alan S Tankel7
  • Elizabeth Turner8
  • Julian White9
  • Malcolm McD Fisher10

  • 1 Menzies School of Health Research, Charles Darwin University, Darwin, NT.
  • 2 Australian Museum, Sydney, NSW.
  • 3 NSW Poisons Information Centre, Sydney, NSW.
  • 4 Queensland Museum, Brisbane, QLD.
  • 5 University of Newcastle, Newcastle, NSW.
  • 6 Gosford Hospital, Gosford, NSW.
  • 7 Coffs Harbour Base Hospital, NSW.
  • 8 Tasmanian Museum, Hobart, TAS.
  • 9 Women’s and Children’s Hospital and University of Adelaide, SA.
  • 10 Royal North Shore Hospital, Sydney, NSW.

Correspondence: 

Acknowledgements: 

We thank the following for additional clinical information on spider bites: Dr Dean Powell, Dr Rochelle Facer (Concord Hospital); Dr Elizabeth Swinbourne (Mona Vale Hospital); Dr Alan Giles (Liverpool Hospital); Dr Bartrim (Ipswich Hospital); Dr Henry Kilham (Children’s Hospital at Wesmead); Dr David Lee (Blue Mountains Hospital); Dr Betty Chan (Prince of Wales Hospital); Dr Jeffrey Lui (St George Hospital); Professor Ian Whyte (Newcastle Mater Hospital); Dr Mark Miller (John Hunter Hospital); Dr Robert Dowsett (Westmead Hospital); Graham Wishart, David Hirst (South Australian Museum); Dr Lisa Boutin (Queen Victoria Museum in Launceston); Dr Richard Faulder (Yanco Agricultural Institute); and Dr Ken Walker (Museum Victoria).

Competing interests:

Associate Professor White is employed by the Women's and Children's Hospital, Adelaide, which is paid by CSL Ltd to provide a consultant clinical toxinology service for users of CSL antivenom and venom detection products.

  • 1. Gray M. Distribution of the funnel web spiders. In: Covacevich J, Davie P, Pearn J, editors. Toxic plants and animals: a guide for Australia. 1st ed. Brisbane: Queensland Museum, 1987: 313-321.
  • 2. Gray MR. Aspects of the systematics of the Australian funnel-web spiders (Araneae: Hexathelidae: Atracinae) based upon morphological and electrophoretic data. In: Austin AD, Heather NW, editors. Australian arachnology. Brisbane: Australian Entomological Society, 1988: 76-89.
  • 3. Fisher MM, Carr GA, McGuinness R, Warden JC. Atrax robustus envenomation. Anaesth Intensive Care 1980; 8: 410-420.
  • 4. Hartman LJ, Sutherland SK. Funnel-web spider (Atrax robustus) antivenom in the treatment of human envenomation. Med J Aust 1984; 141: 796-799.
  • 5. Fisher MM, Bowey CJ. Urban envenomation. Med J Aust 1989; 150: 695-698.
  • 6. Isbister GK, Gray MR. Bites by Australian mygalomorph spiders (Araneae, Mygalomorphae), including funnel-web spiders (Atracinae) and mouse spiders (Actinopodidae: Missulena spp). Toxicon 2004; 43: 133-140.
  • 7. Fisher MM, Raftos J, McGuinness RT, et al. Funnel-web spider (Atrax robustus) antivenom. 2. Early clinical experience. Med J Aust 1981; 2: 525-526.
  • 8. Isbister GK, Gray MR. A prospective study of 750 definite spider bites, with expert spider identification. QJM 2002; 95: 723-731.
  • 9. Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust 1992; 157: 734-739.
  • 10. StatsDirect [computer software]. Version 1.900.0.14. Cambridge, MA: Cytel Software Corporation, 2002.
  • 11. StatXact [computer software]. Version 4.0, Cambridge, MA: Cytel Software Corporation, 1998.
  • 12. Miller MK, Whyte IM, White J, Keir PM. Clinical features and management of Hadronyche envenomation in man. Toxicon 2000; 38: 409-427.
  • 13. Harrington AP, Raven RJ, Bowe PC, et al. Funnel-web spider (Hadronyche infensa) envenomations in coastal south-east Queensland. Med J Aust 1999; 171: 651-653. <MJA full text>
  • 14. Grant SJ, Loxton EH. Effectiveness of a compression bandage and antivenene for Sydney funnel-web spider envenomation. Med J Aust 1992; 156: 510-511.
  • 15. Dieckmann J, Prebble J, McDonogh A, et al. Efficacy of funnel-web spider antivenom in human envenomation by Hadronyche species. Med J Aust 1989; 151: 706-707.
  • 16. White J, Hirst D, Hender E. 36 cases of bites by spiders, including the white-tailed spider, Lampona cylindrata. Med J Aust 1989; 150: 401-403.
  • 17. Sutherland S. Sydney funnel web spider bite. Aust Fam Physician 1985; 14: 316.
  • 18. Knight J, Sutton L. Successful treatment of Atrax formidabilis envenomation. Med J Aust 1982; 2: 434-435.
  • 19. Torda TA, Loong E, Greaves I. Severe lung oedema and fatal consumption coagulopathy after funnel-web bite. Med J Aust 1980; 2: 442-444.
  • 20. Miller MK, Whyte IM, Dawson AH. Serum sickness from funnelweb spider antivenom. Med J Aust 1999; 171: 54.
  • 21. Rendle Short H. Mouse spider envenomation. Proceedings of the 10th Australian and New Zealand Intensive Care Society Scientific Meeting [abstract]. Brisbane, 1985: 25.
  • 22. Irwin RS. Funnel-web spider bite. Med J Aust 1952; 342.
  • 23. Musgrave A. Some poisonous Australian spiders. Records of the Australian Museum, 1927: 34-46.
  • 24. Ingram WW, Musgrave A. Spider bite (arachnidism): a survey of its occurrence in Australia, with case histories. Med J Aust 1933; II: 10-15.
  • 25. Beazley RN. Deaths from the bite of a trapdoor spider. Med J Aust 1930; I: 255-256.
  • 26. Watkins AM. A bite by Atrax robustus. Med J Aust 1939; I: 710.
  • 27. Wiener S. Observations on the venom of the Sydney funnel-web spider (Atrax robustus). Med J Aust 1961; II: 693-699.
  • 28. Sutherland SK. The Sydney funnel-web spider (Atrax robustus). 3. A review of some clinical records of human envenomation. Med J Aust 1972; 2: 643-647.
  • 29. Sutherland SK, Tibballs J. The genera Atrax and Hadronyche funnel web spiders. Australian animal toxins: the creatures, their toxins and care of the poisoned patient, 2nd ed. Melbourne: Oxford University Press, 2001: 402-464.
  • 30. Sutherland SK, Duncan AW. New first-aid measures for envenomation: with special reference to bites by the Sydney funnel-web spider (Atrax robustus). Med J Aust 1980; 1: 378-379.
  • 31. Graudins A, Wilson D, Alewood P, et al. Cross-reactivity of Sydney funnel-web spider antivenom: neutralization of the in vitro toxicity of other Australian funnel-web (Atrax and Hadronyche) spider venoms. Toxicon 2002; 40: 259-266.

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