Do You Find MDs Often Miss MRSA Diagnosis?

[VivaLasViejas, ASN, RN]

That's what I think happened. I don't think she had MRSA to start with either, but she's got it now. Orders came in today for ABX and follow-up next week.

[Crash_Cart]

RE: Brown Recluse Spider Bites vs. MRSA

- Brown Recluse Spider Observations:

"Healing is problematic in some patients. Until recently, we did not fully understand that venom factors can remain in bite lesions for a relatively long time or that a bite we are treating is actually a recurrence rather than the initial lesion. (29) In patients with more severe bites, eschar may take months to develop and the skin may take several months more to heal. (1) These wounds may progress to significant tissue loss and spreading of ulcerations.

Delayed wound healing can occur despite appropriate medical treatment. (29) Why bites do not promptly heal is not clear, but the persistence of venom in the wound or the generation of secondary inflammatory mediators may play a role. In one study of brown recluse spider bites, Rees et al reported that some patients who had received skin grafts experienced repeated graft rejections for no obvious reason. (29) Eventually, the authors realized that these patients had developed pyoderma gangrenosum. Our patient 2 developed contact dermatitis, which manifested as several satellite lesions on the face, neck, and arm. Although the diagnosis of pyoderma gangrenosum was not made in this patient, the persistent presence of venom or secondary inflammatory mediators may have provoked the dermatitis that she did develop. Pyoderma gangrenosum as a complication of brown recluse spider bites appears to be associated with predisposing factors such as surgery near the time of the bite or a personal or family history of rheumatoid arthritis, ulcerative colitis, or Crohn's disease. (1)

Recurrent lesions may arise months after the bite and in adjacent areas. (29) Hoover et al advocated life-long follow-up at 6-month intervals in such patients to look for the development of squamous cell carcinoma. (30) Because the clinical course of healing is so difficult to predict with any brown recluse spider bite, reconstruction should not be attempted until healing is complete.

Source:

http://www.thefreelibrary.com/Brown+recluse+spider+bites+to+the+head:+three+cases+and+a+review-a0124261634

A few conclusions:

1. This and other similar published articles like this one clearly indicate recurring and difficult lesions are present in pt's who have encountered documented and confirmed Brown Recluse spider bites. (Translation: Not misdiagnosed or suspected MRSA cases.)

2. There doesn't appear to be any specific information which firmly suggests that you can tell the "visual differences" between MRSA or Spider Bites nor is the specific "length of time" lesions present themselves on the body alone can be in anyway considered as a main contributing conclusion diagnostic factor.

3. We must keep an open mind that there are quite literally 100's of other types of non infectious skin abnormalities that can equally present, visually appear and symptomatically seem like an MRSA or Spider Bite has occurred. (Lyme's disease comes to mind)

I'm not claiming to be an expert on the subject of spider bites vs. MRSA lesions however, I admit sometimes a little independent and somewhat interesting research on the subject does somehow make the proverbial noggin tick a little bit faster in the race doesn't it? :)

My Best.

[TiredMD]

That's what I think happened. I don't think she had MRSA to start with either, but she's got it now. Orders came in today for ABX and follow-up next week.

Good catch then. Easy to overlook a developing abscess in skin that is already diseased.