Toxicon : official journal of the International Society on Toxinology · 2026
Latrodectism in Europe (1973-2025): A systematic review of clinical manifestations, management and outcomes.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Terzi Irene, Delivalta Nikoletta, Ntoga Melina, Stamatiou Iliana
Аннотация
BACKGROUND: Latrodectus tredecimguttatus, the Mediterranean black widow spider, accounts for most clinically significant spider bites in Europe. Although its toxidrome has long been recognized, contemporary evidence is fragmented, and the evolving clinical spectrum - including emerging cardiac complications - has not been systematically reviewed.
METHODS: We performed a systematic review of PubMed/MEDLINE and Scopus (inception-September 2025) following PRISMA 2020 guidelines. Eligible studies included case reports, case series, and observational datasets reporting confirmed or presumed L. tredecimguttatus envenomation in Europe. Data on demographics, clinical features, management, and outcomes were extracted and synthesized descriptively.
RESULTS: Thirty-six publications met inclusion criteria, representing approximately 500 reported envenomations. Cases occurred mainly in Mediterranean agricultural regions during summer, most often affecting adult men. Severe local pain was nearly universal, accompanied by neuromuscular and autonomic features. Multiple reports documented cardiac involvement - including myocarditis, pulmonary edema, arrhythmias, and Takotsubo-like cardiomyopathy - highlighting an increasingly recognized complication pattern. Supportive therapy (analgesia, benzodiazepines) remained the primary treatment. Antivenom use, limited to a few European settings, was associated with rapid symptom relief and shorter hospitalization. The overall case fatality rate was ∼1.3%, with deaths mainly due to cardiogenic complications.
CONCLUSIONS: L. tredecimguttatus envenomation in Europe is uncommon yet clinically significant. While most patients recover with supportive care, emerging cardiac manifestations underscore the need for enhanced monitoring, improved antivenom availability, and deeper investigation into venom-induced cardiac toxicity.
METHODS: We performed a systematic review of PubMed/MEDLINE and Scopus (inception-September 2025) following PRISMA 2020 guidelines. Eligible studies included case reports, case series, and observational datasets reporting confirmed or presumed L. tredecimguttatus envenomation in Europe. Data on demographics, clinical features, management, and outcomes were extracted and synthesized descriptively.
RESULTS: Thirty-six publications met inclusion criteria, representing approximately 500 reported envenomations. Cases occurred mainly in Mediterranean agricultural regions during summer, most often affecting adult men. Severe local pain was nearly universal, accompanied by neuromuscular and autonomic features. Multiple reports documented cardiac involvement - including myocarditis, pulmonary edema, arrhythmias, and Takotsubo-like cardiomyopathy - highlighting an increasingly recognized complication pattern. Supportive therapy (analgesia, benzodiazepines) remained the primary treatment. Antivenom use, limited to a few European settings, was associated with rapid symptom relief and shorter hospitalization. The overall case fatality rate was ∼1.3%, with deaths mainly due to cardiogenic complications.
CONCLUSIONS: L. tredecimguttatus envenomation in Europe is uncommon yet clinically significant. While most patients recover with supportive care, emerging cardiac manifestations underscore the need for enhanced monitoring, improved antivenom availability, and deeper investigation into venom-induced cardiac toxicity.