Evidence against the involvement of Mycobacterium ulcerans in most cases of necrotic arachnidism

Abstract

Cutaneous lesions caused by M. ulcerans were shown to bear only a superficial resemblance to those produced by certain spider species. M. ulcerans was not found in either the venoms or the midguts of several Australian spiders, and deliberate contamination by inoculation of the fangs and digestive system of the wolf spider, Lycosa godeffroyi, did not result in permanent colonization. M. ulcerans was successfully introduced into the skin of mice through a small trauma site similar to that caused by a spider bite. However, because M. ulcerans was shown to survive on exposed surfaces for only a short period, a successful inoculation is likely only if the skin is contaminated with this organism after, or at the same time as, the skin suffers damage. The claim by other workers that M. ulcerans produces cutaneous ulcers by release of an exotoxin could not be confirmed. The authors conclude that M. ulcerans is not involved in most cases of necrotic arachnidism and hence there is no justification for prescribing anti-mycobacterial antibiotics to resolve alleged spider bite lesions unless the presence of M. ulcerans has been demonstrated by appropriate laboratory tests.