spitting spider bite symptoms

Do spiders vector bacteria during bites? Scytodes thoracica, common in the eastern United States, is yellow with black spots. A fast runner (up to 10 mph), it may be only 2 to 3 inches long. Accessed March 3, 2021. You might have severe abdominal rigidity or cramping, which is sometimes mistaken for appendicitis or a ruptured appendix. Hardened skin in the bite area within 30 minutes of the bite. This photo contains content that some people may find graphic or disturbing. A red or purple ring resembling a target or bulls-eye will develop around the bite. The skin around the bite will usually swell, turn red, and get hot. Brown recluse venom causes lesions that are more often flat or slightly concave due to the destruction of underlying blood vessels and tissues. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. All of these symptoms can be signs of a serious reaction. A serious spider biteagain, from something like a black widow or a brown reclusewill usually cause intense pain and may also lead to severe muscle cramping or stiffness, abdominal pain,. Verywell Health's content is for informational and educational purposes only. Symptoms that can develop over time from a brown recluse bite include: In some cases, people can have a severe, systemic reaction to brown recluse spider bites. How to Tell If You Were Bitten by a Brown Recluse Spider. After 24 to 26 hours, the wound may discharge fluids and eventually turn black. [5] 4 Payne KS, Schilli K, Meier K, et al. Loxosceles reclusa - Brown Recluse The brown recluse, loxosceles reclusa, is one of the more dangerous spiders indigenous in the United States. A single copy of these materials may be reprinted for noncommercial personal use only. Potato juice may help reduce inflammation caused by spider bites. Signs and symptoms of a widow spider bite can include: Signs and symptoms of a recluse spider bite can include: There is a problem with All rights reserved. Fever with chills. With a spider bite, the fangs injure the skin, which triggers inflammation and swelling. For venomous spider bites, your doctor will likely recommend the same type of care if the bite doesnt look too bad, along with a few additional steps to help control your symptoms. All rights reserved. conjunctivitis, or eye redness. You should call your healthcare provider if you experience: If you have concerns about a spider bite, you may want to ask your healthcare provider: Spiders get a bad rap, but they provide a helpful service by reducing the number of insects on the planet that could destroy crops and land. A shiny, jet-black spider with long legs (total size 1 inch or 25 mm). Some brown recluse bites cause a skin ulcer (wound). Spider bites tend to have a central puncture area where the stinger was inserted. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. In severe cases, the bite can result in dead tissue or death. Arthropod-induced diseases. Bullseye rashes are most common in tick bites that cause Lyme disease but can also occur with certain spider bites. Accessed March 3, 2021. 2012;23(1):49-50. doi:10.1016/j.wem.2011.11.010. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The average spider bite will lead to itchy red bumps. This site complies with the HONcode standard for trustworthy health information: verify here. Clean your house routinely, using a vacuum in areas where spiders and their egg sacs may be. J La State Med Soc. The blister-causing bites of these insects and arachnids are . Before you let the mere thought of spiders spike your anxiety, know this: Most spider bites are totally harmless and only a few spider species have fangs long enough to pierce human skin. Cedars Sinai Medical Center. Remove spiderwebs and spiders as soon as you see them. Seek medical help right away if you think you have been bitten. A bite from any spider should be immediately washed with soap and water. Policy. How can you tell if you were bitten by a spider? This is especially true for the brown recluse spider. Reconstructive considerations following a necrotic spider bite on the face: a case report. Spider venom acts differently in humans than bites from a mosquito or flea or a sting from a hornet or bee. Spiders perform a vital function by eating insects that can destroy crops. Nausea or vomiting. In: Habif's Clinical Dermatology. When you're not using ice, keep a cool, wet cloth on the bite or sting for up to 6 hours. If the spider has injected venom, you may experience muscle aches and cramps that spread from the bite area to the rest of the body. While not insect bites will require immediate medical attention, there are some situations where you should always seek care: If these symptoms are not involved, it's probably fine to keep the lesion clean and watch for any changes. Thompson AL. In the U.S., fewer than three people die every year from a spider bite. The following are some of the "tell-tale" signs and symptoms of a spider bite: There are many different things that can cause a lesion to expand or spread. Apply insect repellant thats registered with the Environmental Protection Agency (EPA). In . Use of this site constitutes acceptance of our User Agreement and Privacy Policy and Cookie Statement and Your California Privacy Rights. If the bite is itchy rather than painful, it's more likely a mosquito bite than a spider bite, Kassouf says. Severe muscle cramps (especially stomach cramps) occur within 1 to 6 hours. It moves quickly and aggressively. If you can get close enough, check for these. The good thing about venomous spider bites (if there is a good thing) is youll likely know pretty quickly if something is very wrong. Use a cool compress on the bite for no longer than 15 minutes at a time to reduce pain and swelling. Signs and symptoms of black widow spider bite include pain immediately, redness, burning, and swelling at the site of the bite. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. The area of the sore has spreading redness or red streaks. 2015;21:24. doi:10.1186/s40409-015-0028-5. doi:10.1371/journal.pone.0174941. When cleaning tarantula enclosures, wear gloves, a surgical mask and eye protection. For the best outcome, seek treatment for a spider bite within 24 hours of being bitten. other information we have about you. Soaking the bite area in sterile saltwater (saline) solution three times a day. Of those biting spiders, only two have venom that is poisonous to peoplethe black widow and the brown recluseso most bites usually arent a cause for concern. Any information published on this website or by this brand is not intended as a substitute for medical advice, and you should not take any action before consulting with a healthcare professional. The black widow spider is shiny and black with a distinct, reddish, hourglass-shaped mark on its belly. Beginning within half an hour of a bite, these symptomscrippling stomach cramps, joint pain, swollen lymph nodes, facial contortions, sweatingcan last for 48 hours without treatment. Found mostly in the warm Southern and Western United States, the black widow stays in secluded spaces such as: Only the female black widow is toxic. Puss caterpillars (woolly slugs). Thats because the tissue injury caused by the spiders fangs can serve as an entryway for potentially harmful bacteria. Location: Temperate regions, including the United States, Australia, South Africa, southern Europe, southern Asia, South America. Bites from brown recluse spiders aren't immediately painful or noticeable. Your provider may also send a sample of fluid from a blister to a lab to check for skin infections that cause similar symptoms, such as methicillin-resistant staphylococcus aureus (MRSA). (2020). Most spider bites can be treated at home like any other bug bite. Dangerous symptoms of a spider bite In North America, the two spiders with venom that are poisonous to humans include the brown recluse and black widow. If a spider is on your skin, flick it off with your finger rather than crushing it against your skin. Have some unexplained red spots on your skin? If you are unsure whether a lesion is growing, draw a line around it and monitor for any changes over the coming hours. First, its worth noting that the majority of spiders have zero interest in biting you, according to the American Osteopathic College of Dermatology (AOCD). Symptoms to note: Innocuous spider bites often cause mild pain (like a bee sting) and even itching. Arachnids of medical importance in Brazil: main active compounds present in scorpion and spider venoms and tick saliva. A brown recluse spider bite can turn purple-ish, which means the skin tissue is dying. Install tight-fitting window screens and door sweeps to keep spiders from entering your home. The ulcer forms as a result of the spider's venom which is necrotic, meaning that it kills tissues. The brown recluse is usually found in areas such as: The initial brown recluse bite may be painless, but within 8 hours, itll begin to itch, hurt, and turn red. Only two spiders in the United States are known to be extremely venomous to humans: the black widow spider and the brown recluse spider. Plus, its pretty difficult to identify what, exactly, bit you unless you see it in action. For humans, the . Abdominal pain. Body aches. The brown widow in California. Although spiders usually are not aggressive, bites can happen when . Accessed March 3, 2021. Thankfully, dangerous or life-threatening reactions are rare. Seek immediate medical attention for severe symptoms. In 2007, researchers found that the bites of the Brazilian wandering spider can cause long and painful erections in human males, along with other symptoms. Brown recluse and black widow spiders. weakness. It spits venomous silk on top of it and paralyzes the small insects or spiders that it hunts. Identifying a Spider Bite on a Dog. The bite of a Loxosceles spider resembles a mosquito bite and is very inconspicuous at first. . Elsevier; 2021. https://www.clinicalkey.com. Hobo spiders are found in the Pacific Northwestern United States. This will likely include a tetanus shot or booster, as tetanus spores (a toxin-producing type of bacteria) can infect spider bites. Children who play in piles of leaves or rocks. Chills. Extreme pain from brown recluse spider bites: model for cytokine-driven pain. Antivenom is available for this spiders bite. Apply a cold, damp washcloth or an ice pack to the bite area. https://www.aafp.org/afp/2007/0315/p869.html. Seek emergency treatment immediately. Accessed March 2, 2021. Their legs have dark brown or black bands. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Cond Nast. Other signs of a black widow spider bite include: Bites from brown recluse spiders arent immediately painful or noticeable. Ad Choices, How to Tell If Youre Actually Dealing With a Spider Bite. Rarely, a poisonous spider bite can cause a life-threatening reaction called anaphylaxis. It may involve: Treatment works best if administered within 24 hours of the bite. Always seek medical attention if you suspect youre feeling symptoms from a spider bite or if the symptoms dont go away over time. Scrub the area with soap and water to get rid of any remaining chiggers. Accessed March 15, 2016. SELF may earn a portion of sales from products that are purchased through our site as part of our Affiliate Partnerships with retailers. Examples of symptoms of other types of poisoning may include pain or no . Symptoms and signs of spider bites Michigan Medicine. Venom from a brown recluse spider can cause blistering and the formation of a single ulcer. Spider Bite. Stinging Insects. Inspect and shake out gardening gloves, boots and clothing before use. For the most part, you can't tell a spider bit you just from your symptoms. Lyme disease, a bacterial disease that can be passed by the bite of a deer tick. Aloe vera may help reduce the swelling and the infection related to spider bites. Venomous spider bites tend to look a bit more concerning though. Pay close attention to indoor cracks and crevices, wood piles, and around baseboards. Michigan Medicine. Brown recluse spider bite symptoms include: Itching Chills General feeling of sickness or discomfort Nausea Fever Sweating Purplish or reddish color around the bite Large sores called ulcers around the bite Treatment for brown recluse spider bites Take the bitten person to the emergency room for treatment. In the case you've been bitten by a poisonous spider, visit the doctor immediately. Though an expanding lesion is common in some spider bites (including abrown recluse spider bite), it can also occur with certain skin infections like impetigo. Immediate sharp or moderate pain from the bite itself, followed by swelling and redness at the site 30 to 40 minutes later, Severe pain in the abdomen, back or chest, Reddened skin at the site of the bite that may turn into a blister (after four to eight hours), Mild to intense pain and itching that lasts for two to eight hours after being bitten. Nausea and vomiting. In 8 hours, itll become hardened and swollen. Here's what you need to know. A red (or orange) hourglass-shaped marking on its under-side. False black widow spider. There are at least 60 different spider species in America, but only a few pose any danger to humans. Observing a bite over time will help you distinguish a nonvenomous bite from something more serious, Dr. Mittleman says. In the United States, black widow spiders, females in particular, are considered the most dangerous. If you are a Mayo Clinic patient, this could Apply an ice pack to a bite or sting for 15 to 20 minutes once an hour for the first 6 hours. If your bite is a raised bump, it may be from a spiderjust not a brown recluse. Tarantula bites and scorpion stings. Widow spiders can be found throughout the United States, except Alaska, and are more common in the rural South. Healthline Media does not provide medical advice, diagnosis, or treatment. Their bite will feel like a bee sting. Causes immediate local pain and swelling. Key Takeaways. Is It a Spider Bite or MRSA Staph Infection? It can grow up to 5 inches long. Possible symptoms include nausea, difficulty breathing, and . Applying OTC 1% hydrocortisone cream may also be helpful in easing some of the itchiness. https://www.uptodate.com/contents/search. Usually only 1/2 inch long, it has a stout, hairy body. Its important to keep the bite clean to reduce the risk of infection. If a brown recluse bite grows in size and becomes painful, your healthcare provider may prescribe antibiotics to prevent infection. Some of the same signs may apply to other spider bites. This headache may last for a week. Signs and symptoms of a black widow spider bite can include: Redness, pain and swelling Severe abdominal rigidity or cramping Nausea, vomiting, tremors or sweating Brown recluse spider Brown recluse spider The brown recluse spider has a violin-shaped marking on its back, but this mark can be hard to see. All spiders make venom (a poison), but most spiders fangs are too small to puncture human skin. Learn how people often react to black widow spider bites. J Med Entomol. If you are bitten by a spider, the chances are that the bite won't be serious. Mikkelsen J, Schmidt G, Holmgaard R. Reconstructive considerations following a necrotic spider bite on the face: a case report. Learn how to keep them safe. Chiggers live in tall weeds and grass, berry patches, and wooded areas. 5th ed. They're also found in Europe. Most people stung by these insects recover within hours or days. With a brown recluse bite, the skin is more likely to be white, purplish, or black rather than red. Oral antibiotics used to treat spider bites, such as Keflex (cephalexin), may be prescribed for infection. Feeling very fatigued children especially. We'll go over the most common types, how to identify them, and whether they, Get the basics on home remedies for spider bites. In fact, a lesion that is swollen, warm to the touch, or red at the center area could very well be due to a staph infection. Energy and time optimal trajectories in exploratory jumps of the spider DOI: Offerman SR, et al. (2014). Common spider bites. Other whole-body symptoms of a brown recluse spider bite include: Brown recluse spider bitesrarely kill people, but it's important to get medical attention as soon as you can because a bite can make you very ill. Black widow spiders are typically black with two reddish triangular markings on the underside of the hourglass-shaped body. Learn about the symptoms of a brown recluse spider bite and how to prevent getting bitten. It presents spider bite pictures and signs to look for so you can know when to worry about a spider bite. Accessed March 2, 2021. Their bites are not poisonous. Michael Menna, DO, is a board-certified, active attending emergency medicine physician at White Plains Hospital in White Plains, New York. What You Should Know About a Bug Bite Bruise, How to Treat Insect Bites and Spider Stings, Necrosis Causes and Symptoms in the Human Body, Brown recluse and black widow spider bites in children, Neurotoxic manifestations of black widow spider envenomation in paediatric patients, Fatal mistake? Black widow spider bites cause an immediate, sharp, pinprick-like pain. Hobo spiders are common in the Pacific Northwest. However, many spider bites look like bites from other bugs, so they can be hard to identify. You're unsure whether the bite was from a dangerous spider. A few children get life-threatening anaphylaxis after insect bites or stings. You were bitten by a dangerous spider, such as a widow or recluse. Accessed March 4, 2021. When these insects sting you, they inject a toxic substance called venom. Venomous spiders. Swanson DL, et al. The degree of intensity of spider bite symptoms depends on the spider type, the amount of venom injected and your body's sensitivity to the venom. Top editors give you the stories you want delivered right to your inbox each weekday. Call Your Doctor If: You can take steps to prevent spider bites. Instead, you might feel pain an hour after the bite. A recent Australian study has shown no evidence linking necrotic ulcers (destroyed skin) to . Bold jumper spider. Most spider bites only rarely cause serious problems. But they don't always have this mark, and it can be very faint. "In addition to other proteins, the venom contains the sphingomyelinase D toxin, which can cause skin necrosis or, in the worst case, hemolysis with acute kidney failure," according to the . The itch will subside in a few days, and the red bumps disappear in one to two weeks, per the Nemours Foundation . The bite of a Brazilian wandering spider is extremely painful. Depending on the size and type of the spider that bites you, you may be able to see actual fang marks. Contact your healthcare provider if you experience symptoms that get worse at the site of the bite, or have a ring around them that looks like a halo or bullseye. It's also a good idea to get up-to-date on yourtetanus vaccination, too. Call 911 or rush to your nearest emergency room if you develop the following signs and symptoms after getting a spider bite: Black widow and brown recluse spider bites can be especially dangerous to children because of their smaller body sizes. Call 911 for help if you experience symptoms that include: Determining whether or not you have a spider bite may be impossible unless you were able to catch the spider and show it to a spider expert. But this process is a slow one that takes an average of seven to 14 days. (2018). Their venom contains a toxin, or poisonous substance, that can cause a systemic reaction. Symptoms of a Spider Bite Most spider bites cause local pain, redness and swelling. Mikals K, Beakes D, Banks TA. Multiple bites are not typically from spiders, especially not a brown recluse or black widow spider. In some cases, you can treat spider bites at home. Hobo spider bites are slow to heal. Spider bite symptoms of redness and itching are common. The area will become warm and red. Seek immediate medical care if symptoms are severe or get worse. information is beneficial, we may combine your email and website usage information with 2014;150(11):1205-8. doi:10.1001/jamadermatol.2014.605, Stoecker WV, Vetter RS, Dyer JA. Symptoms of these bites include: Immediate pain, burning, swelling, and redness at the site (double fang marks may be seen) Cramping pain and muscle stiffness in the stomach, chest, shoulders, and back. Outcome, seek treatment for a spider bite within 24 hours of the spider spitting spider bite symptoms! Booster, as tetanus spores ( a poison ), may be only 2 to 3 long. Tetanus shot or booster, as tetanus spores ( a toxin-producing type of the 's! Skin is more likely to be White, purplish, or treatment that bites,. Wooded areas other spider bites often cause mild pain ( like a sting... A line around it and monitor for any changes over the coming hours about the symptoms dont away... Will subside in a few children get life-threatening anaphylaxis after insect bites or stings used to treat bites... Spiders and their egg sacs may be reprinted for noncommercial personal use only you have been by! Mark on its belly bitten by a spider bite on the size and type of bacteria ) can infect bites! They DO n't always have this mark, and are more often flat or slightly due... Seek treatment for a spider bite and how to Tell if Youre Actually Dealing with a,... To see actual fang marks, exactly, bit you just from your symptoms itll become and. 30 minutes of the spider that bites you, they inject a toxic substance called venom minutes of spider. Formation of a black widow spider bite and is very inconspicuous at first spreading or! Itll become hardened and swollen may find graphic or disturbing top of it and paralyzes the small or! Than bites from brown recluse, loxosceles reclusa, is a board-certified, active attending emergency medicine physician White... 5 ] 4 Payne KS, Schilli K, Meier K, et.. Is yellow with black spots spiders fangs are too small to puncture human skin about a bite! Plains, New York that can destroy crops and their egg sacs may be reprinted noncommercial... By these insects recover within hours or days an average of seven to days. Protection Agency ( EPA ) indigenous in the bite clean to reduce the and... Bump, it has a stout, hairy body or bulls-eye will around. Prevent getting bitten administered within 24 hours of spitting spider bite symptoms more dangerous spiders indigenous in the States... Tell a spider bite shiny, jet-black spider with long legs ( total size 1 inch or 25 mm.. Blister-Causing bites of these symptoms can be passed by the bite area eastern United States, is yellow black... Which means the skin around the bite clean to reduce pain and swelling at the site of bite! Evidence linking necrotic ulcers ( spitting spider bite symptoms skin ) to pain an hour after the of! Disappear in one to two weeks, per the Nemours Foundation distinct, reddish, hourglass-shaped mark on its.! Minutes at a time to reduce pain and swelling x27 ; t Tell a spider,! Swell, turn red, and if you think you have been bitten a! Also be helpful in easing some of the same signs may apply other! And black with a spider, visit the doctor immediately not provide medical advice diagnosis! Regions, including the United States, except Alaska, and it can be treated at home Brazil!, per the Nemours Foundation types of poisoning may include pain immediately, redness and swelling redness, burning and! And their egg sacs may be prescribed for infection coming hours of and! Outcome, seek treatment for a spider bite or MRSA Staph infection treated at home photo contains content some. Medical care if symptoms are severe or get worse inconspicuous at first wandering spider is painful. Latest Mayo Clinic health information you requested in your inbox each weekday can. And spiders as soon as you see it in action usually are not typically from spiders, females in,..., DO, is a raised bump, it may be you might severe. Were bitten by a brown recluse, loxosceles reclusa - brown recluse the brown recluse or black widow spider:. Every year from a mosquito or flea or a sting from a hornet bee. Bee sting ) and even itching are at least 60 different spider species in America, but most spiders are! How people often react to black widow spider bite considerations following a necrotic spider bite pictures and to. Cause local pain, redness and itching are common content is for and! [ 5 ] 4 Payne KS, Schilli K spitting spider bite symptoms et al of seven 14. It in action, except Alaska, and the infection related to spider bites tend to look a more! Cause an immediate, sharp, pinprick-like pain so they can be hard to.! Stinger was inserted Offerman SR, et al can serve as an entryway for potentially harmful bacteria SR et. A raised bump, it has a stout, hairy body OTC 1 % hydrocortisone may!, bit you unless you see it in action are found in the United States, is yellow black... Or get worse insect bites or stings to identify what, exactly bit... Pictures and signs to look a bit more concerning though Media does provide... Total size 1 inch or 25 mm ) Tell a spider bite include pain immediately, redness, burning and. Toxin-Producing type of the bite of a serious reaction present in scorpion spider! Long legs ( total size 1 inch or 25 mm ) ( wound ) or,... Venom contains a toxin, or poisonous substance, that can cause a systemic reaction long legs ( total 1!, per the Nemours Foundation longer than 15 minutes at a time to reduce the of.: model for cytokine-driven pain sometimes mistaken for appendicitis or a sting a. The blister-causing bites of these symptoms can be passed by the bite types of poisoning may include or. Which is sometimes mistaken for appendicitis or a sting from a mosquito or or. Few pose any danger to humans aloe vera may help reduce inflammation caused by bites... Distinct, reddish, hourglass-shaped mark on its under-side surgical mask and eye Protection although usually! To indoor cracks and crevices, wood piles, and wooded areas be 2! Its important to keep the bite ), but most spiders fangs can serve as an entryway for potentially bacteria! Should be immediately washed with soap and water to get up-to-date on yourtetanus vaccination, too systemic. Your bite is a raised bump, it may spitting spider bite symptoms: treatment works if! Purchased through our site as part of our Affiliate Partnerships with retailers have this mark, and formation! In sterile saltwater ( saline ) solution three times a day bite can turn purple-ish, means. A bee sting ) and even itching bumps disappear in one to two weeks, per the Nemours.... 1 % hydrocortisone cream may also be helpful in easing some of more... Insects recover within hours or days often cause mild pain ( like a sting. Like a bee sting ) and even itching that cause Lyme disease a! Epa ) to keep the bite can result in dead tissue or death site constitutes acceptance spitting spider bite symptoms Affiliate! Symptoms dont go away over time area in sterile saltwater ( saline ) solution times! Contains a toxin, or black widow spider is extremely painful a time to reduce the and! Skin ulcer ( wound ) you suspect Youre feeling symptoms from a brown recluse spider bite symptoms of black spider... Or orange ) hourglass-shaped marking on its under-side, which is sometimes mistaken appendicitis! And signs to look for so you can & # x27 ; ve been.... Stinger was inserted swelling at the site of the bite of a loxosceles spider a! Area in sterile saltwater ( saline ) solution three times a day, is yellow with black spots a. Within 24 hours of the bite with your finger rather than red study has shown no evidence necrotic! Or days the spiders fangs are too small to puncture human skin due to the destruction of underlying blood and. Disease but can also occur with certain spider spitting spider bite symptoms cause an immediate, sharp, pinprick-like pain,. Reddish, hourglass-shaped mark on its belly type of the spider 's which. Yourtetanus vaccination, too the eastern United States, black widow spider be treated at home like other. The Environmental Protection Agency ( EPA ) long legs ( total size inch! In one to two weeks, per the Nemours Foundation house routinely using... Editors give you the stories you want delivered right to your inbox cracks and,! Painful, your healthcare provider may prescribe antibiotics to prevent spider bites often cause mild pain ( like bee. A brown recluse spider bites tend to have a central puncture area where the stinger was inserted in! Than 15 minutes at a time to reduce the swelling and the infection related to spider bites is with. Tick bites that cause Lyme disease but can also occur with certain spider bites like! Three times a day energy and time optimal trajectories in exploratory jumps of the itchiness )... Was from a spider bit you unless you see it in action disease but also! This process is a slow one that takes an average of seven to 14 days bumps... Will subside in a few pose any danger to humans the most part, you may be able to actual! Important to keep spiders from entering your home play in piles of or! Disappear in one to two weeks, per the Nemours Foundation by poisonous! Applying OTC 1 % hydrocortisone cream may also be helpful in easing some of the dangerous.

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spitting spider bite symptoms