Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort.

PMID- 28422977
OWN - NLM
STAT- MEDLINE
DA  - 20170419
DCOM- 20170427
LR  - 20170427
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - Defining the complex phenotype of severe systemic loxoscelism using a large
      electronic health record cohort.
PG  - e0174941
LID - 10.1371/journal.pone.0174941 [doi]
AB  - OBJECTIVE: Systemic loxoscelism is a rare illness resulting from the bite of the 
      recluse spider and, in its most severe form, can lead to widespread hemolysis,
      coagulopathy, and death. We aim to describe the clinical features and outcomes of
      the largest known cohort of individuals with moderate to severe loxoscelism.
      METHODS: We performed a retrospective, cross sectional study from January 1,
      1995, to December 31, 2015, at a tertiary-care academic medical center, to
      determine individuals with clinical records consistent with moderate to severe
      loxoscelism. Age-, sex-, and race-matched controls were compared. Demographics,
      clinical characteristics, laboratory measures, and outcomes of individuals with
      loxoscelism are described. Case and control groups were compared with descriptive
      statistics and phenome-wide association study (PheWAS). RESULTS: During the time 
      period, 57 individuals were identified as having moderate to severe loxoscelism. 
      Of these, only 33% had an antecedent spider bite documented. Median age of
      individuals diagnosed with moderate to severe loxoscelism was 14 years old (IQR
      9.0-24.0 years). PheWAS confirmed associations of systemic loxoscelism with 29
      other phenotypes, e.g., rash, hemolytic anemia, and sepsis. Hemoglobin level
      dropped an average of 3.1 g/dL over an average of 2.0 days (IQR 2.0-6.0). Lactate
      dehydrogenase and total bilirubin levels were on average over two times their
      upper limit of normal values. Eighteen individuals of 32 tested had a positive
      direct antiglobulin (Coombs') test. Mortality was 3.5% (2/57 individuals).
      CONCLUSION: Systemic loxoscelism is a rare but devastating process with only a
      minority of patients recalling the toxic exposure; hemolysis reaches a peak at 2 
      days after admission, with some cases taking more than a week before recovery. In
      endemic areas, suspicion for systemic loxoscelism should be high in individuals, 
      especially children and younger adults, presenting with a cutaneous ulcer and
      hemolysis or coagulopathy, even in the absence of a bite exposure history.
FAU - Robinson, Jamie R
AU  - Robinson JR
AUID- ORCID: http://orcid.org/0000-0003-0888-0156
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center,
      Nashville, TN, United States of America.
AD  - Department of General Surgery, Vanderbilt University Medical Center, Nashville,
      TN, United States of America.
FAU - Kennedy, Vanessa E
AU  - Kennedy VE
AD  - Department of Internal Medicine, Stanford University, Stanford, CA, United States
      of America.
FAU - Doss, Youssef
AU  - Doss Y
AD  - Yale University, New Haven, CT, United States of America.
FAU - Bastarache, Lisa
AU  - Bastarache L
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center,
      Nashville, TN, United States of America.
FAU - Denny, Joshua
AU  - Denny J
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center,
      Nashville, TN, United States of America.
AD  - Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,
      United States of America.
FAU - Warner, Jeremy L
AU  - Warner JL
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center,
      Nashville, TN, United States of America.
AD  - Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,
      United States of America.
LA  - eng
PT  - Journal Article
DEP - 20170419
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Hemoglobins)
RN  - 0 (Spider Venoms)
RN  - EC 1.1.1.27 (L-Lactate Dehydrogenase)
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Adolescent
MH  - Animals
MH  - Bilirubin/blood
MH  - Brown Recluse Spider/*pathogenicity
MH  - Case-Control Studies
MH  - Child
MH  - Cross-Sectional Studies
MH  - Disseminated Intravascular Coagulation/blood/*diagnosis/mortality/physiopathology
MH  - Electronic Health Records/statistics & numerical data
MH  - Female
MH  - Hemoglobins/metabolism
MH  - Hemolysis/drug effects
MH  - Humans
MH  - L-Lactate Dehydrogenase/blood
MH  - Male
MH  - Phenotype
MH  - Retrospective Studies
MH  - Spider Bites/blood/*diagnosis/mortality/physiopathology
MH  - Spider Venoms/*toxicity
MH  - Survival Analysis
MH  - Young Adult
EDAT- 2017/04/20 06:00
MHDA- 2017/04/28 06:00
CRDT- 2017/04/20 06:00
PHST- 2016/12/26 [received]
PHST- 2017/03/18 [accepted]
AID - 10.1371/journal.pone.0174941 [doi]
AID - PONE-D-16-51072 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 19;12(4):e0174941. doi: 10.1371/journal.pone.0174941.
      eCollection 2017.

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