In very rare cases, bites can even cause hemolysis—the bursting of red blood cells. As suggested by its specific epithet "reclusa" (recluse), the brown recluse spider is rarely aggressive, and bites from the species are uncommon. In 2001, more than 2,000 brown recluse spiders were removed from a heavily infested home in Kansas, yet the four residents who had lived there for years were never harmed by the spiders, despite many encounters with them. The spider usually bites only when pressed against the skin, such as when tangled within clothes, shoes, towels, bedding, inside work gloves, etc. Many human victims report having been bitten after putting on clothes or shoes that had not been worn recently, or had been left for many days undisturbed on the floor. The fangs of the brown recluse are not large enough to penetrate most fabric. When both types of loxoscelism do result, systemic effects may occur before necrosis, as the venom spreads throughout the body in minutes. Children, the elderly, and the debilitatingly ill may be more susceptible to systemic loxoscelism. The systemic symptoms most commonly experienced include nausea, vomiting, fever, rashes, and muscle and joint pain. Rarely, such bites can result in hemolysis, thrombocytopenia, disseminated intravascular coagulation, organ damage, and even death. Most fatalities are in children under the age of seven or those with a weak immune system. While the majority of brown recluse spider bites do not result in any symptoms, cutaneous symptoms occur more frequently than systemic symptoms. In such instances, the bite forms a necrotizing ulcer as the result of soft tissue destruction and may take months to heal, leaving deep scars. These bites usually become painful and itchy within 2 to 8 hours. Pain and other local effects worsen 12 to 36 hours after the bite, and the necrosis develops over the next few days. Over time, the wound may grow to as large as 25 cm (10 inches). The damaged tissue becomes gangrenous and eventually sloughs away. There is now an ELISA-based test for brown recluse venom that can determine whether a wound is a brown recluse bite, although it is not commercially available and not in routine clinical use. Clinical diagnoses often use Occam's razor principle in diagnosing bites based on what spiders the patient likely encountered and previous similar diagnoses. A new mnemonic device, "NOT RECLUSE", has been suggested as a tool to help laymen and medical professionals more objectively screen and diagnose potential cases of loxoscelism.