Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo, Brazil

A retrospective study analysed 359 proven or presume cases of loxoscelism seen at the Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1985 and 1996. The spider was identified in 14%. The bites occurred predominantly in the urban areas (73%) between September and February. Patients > 14 years were commonest inflicted (92%) and 41% were bitten while getting dressed. Only 11% sought medical care within the first 12 hours post bite. Cutaneous loxoscelism was the commonest form presenting (96%); commonest manifestations were: pain (76%), erythema (72%), edema with enduration (66%), ecchymosis (39%). Skin necrosis occurred in 53% of patients, most frequently seen on trunk, tigh and upper arm, and when patients seek medical care more than 72 hours after bite. Local infection was detected in 12 patients (3%). Hemolysis was confirmed in 4 cases (1.1%). Generalised cutaneous rash, fever and headache were also observed in 48% of the total of patients. None of them had acute renal failure or died. Treatment usually involved antivenom administration (66%), being associated with corticosteroids (47%) or dapsone (30%). Presumptive diagnosis of loxoscelism may be established based on clinical and epidemiological findings. Further investigations are required to prove the value of antivenom and other treatment schedules.

The venomous toadfish Thalassophryne nattereri (niquim or miquim): report of 43 injuries provoked in fishermen of Salinópolis (Pará State) and Aracaju (Sergipe State), Brazil

Fishes of family Batrachoididae are responsible for great number of injuries in fishermen in North and Northeast regions of Brazil. The genus Thalassophryne presents various venomous species of fishes found in the Brazilian coast, T. nattereri being the most common of them. The venom is ejected through two hollow spines on the dorsal fin and two on pre-opercular regions, which present a venomous gland in the base and can be erected or depressed by the fish. The manifestations of the envenoming were intense local pain, edema and erythema in 43 patients observed in Salinópolis (Pará State) and Aracaju (Sergipe State). There were no systemic manifestations, but necrosis was detected in eight and bacterial infection in ten injured fishermen. The circumstances of the contacts and therapeutic aspects are discussed. Envenoming by the genus Thalassophryne is important and frequent and should be considered of moderate severity grade, since there are not the excruciating pain or the massive local necrosis provoked by scorpionfishes (Scorpaena) or stingrays injuries nor the systemic manifestations that are the most important marker of severe envenoming.

Description of an injury in a human caused by a false tocandira (Dinoponera gigantea, Perty, 1833) with a revision on folkloric, pharmacological and clinical aspects of the giant ants of the genera Paraponera and Dinoponera (sub-family Ponerinae)

The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world.

Bites by coral snakes (Micrurus spp.) in Campinas, State of São Paulo, Southeastern Brazil

Coral snakes (Micrurus spp.) are the main representatives of the Elapidae in South America. However, bites by these snakes are uncommon. We retrospectively reviewed the data from 11 individuals bitten by coral snakes over a 20-year period; four were confirmed (snake brought for identification) and seven were highly suspected (neuromuscular manifestations) cases of elapid envenoming. The cases were classified as dry-bite (n = 1, caused by M. lemniscatus; did not receive antivenom), mild (n = 2, local manifestations with no acute myasthenic syndrome; M. frontalis and Micrurus spp.), moderate (n = 5, mild myasthenia) or severe (n = 3, important myasthenia; one of them caused by M. frontalis). The main clinical features upon admission were paresthesia (local, n = 9; generalized, n = 2), local pain (n = 8), palpebral ptosis (n = 8), weakness (n = 4) and inability to stand up (n = 3). No patient developed respiratory failure. Antivenom was used in ten cases, with mild early reactions occurring in three. An anticholinesterase drug was administered in the three severe cases, with a good response in two. No deaths were observed. Despite the high toxicity of coral snake venoms, the prognosis following envenoming is good. In serious bites by M. frontalis or M. lemniscatus, the venom of which acts postsynaptically, anticholinesterases may be useful as an ancillary measure if antivenom is unavailable, if there is a delay in obtaining a sufficient amount, or in those patients given the highest recommended doses of antivenom without improvement of the paralysis or with delayed recovery.

South American rattlesnake bite and soft-tissue infection: report of a case

The case of a man bitten by a South American rattlesnake (Crotalus durissus) and who developed an abscess at the site of the bite is reported. Abcesses are a rare complication of this type of envenoming, possibly due to the lack of a strong cytotoxic action of Crotalus durissus venom.

Venomous mollusks: the risks of human accidents by conus snails (gastropoda: conidae) in Brazil

Mollusks of the genus Conus present a venomous apparatus composed of radulae, a chitin structure linked to glands, which injects potent neurotoxic peptides, causing serious human envenomation and even death, associated with the blockage of certain receptors and muscular paralysis. No reported envenomation has occurred in Brazil, but certain populations are at risk of accidents.

First case of human latrodectism in Venezuela

The first case of envenoming by Latrodectus geometricus in Venezuela is described. The accident occurred at the victim's home, in Aragua de Barcelona, Anzoátegui State. The 31-year-old female victim was bitten twice on the left scapular region, in quick succession (within seconds). She developed a hyperactive state of the central, autonomic and peripheral nervous systems with minor local symptoms.

Tityus stigmurus (Thorell, 1876) (Scorpiones; Buthidae): response to chemical control and understanding of scorpionism among the population

In this study, the events following application of the insecticideDemand 2.5 concentrated solution (CS) in the field, to control Tityus stigmurus, were investigated. Data on attitudes and practices relating to scorpionism were collected using a questionnaire. During the months of May to July 2005, 69 premises were monitored on different days following insecticide treatment, focusing on scorpion frequency and mortality. According to the results, 42% of the premises showed scorpion incidence, with an average of three specimens per house. The highest incidence was recorded during the first week following the treatment. Only 7% of the specimens were found dead. Most (72%) of the population showed knowledge about prevention and control measures. Despite this, 100% of the premises presented breeding sites, mainly in debris (79.7%). These results indicate that the scorpion control method used by health agents during this investigation was not efficient, and the results suggest that the method may have had a dispersive effect on these animals.

Accident caused by Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), native to the Caribbean, in Brazilian airport

Describes the case of a 6-year-old girl who was stung by a Centruroides testaceus, a scorpion native to the Lesser Antilles, in the Guarulhos International Airport, São Paulo, Brazil, as she disembarked from a flight coming from the Caribbean. The patient presented only local symptoms (a small area of erythema and pain at the sting site), which were resolved after a few hours with analgesics, without the need for antivenom. Physicians who treat patients stung by scorpions should be alert to the possibility of such accidents being caused by non native species, especially those cases that occur near airports or ports.

Bilateral posterior circulation stroke secondary to a crotalid envenomation: case report

Snake bite envenoming is a disease with potential serious neurological complications. We report a case of an adolescent who was bitten by a rattlesnake and developed bilateral posterior circulation stroke. The rattlesnake was later identified as being Crotalus durissus terrificus. Stroke was probably due to toxic vasculitis or toxin-induced vascular spasm and endothelial damage.

Pediatric epidemiological aspects of scorpionism and report on fatal cases from Tityus stigmurus stings (Scorpiones: Buthidae) in State of Pernambuco, Brazil

Introduction Envenomation by scorpion stings is a major public health problem in numerous tropical countries because of its frequent incidence and potential severity. Approximately 1,900 species of scorpions are known in the world, and at least 130 of these have been described in Brazil. Methods This work reports on 3 child deaths caused by Tityus stigmurus stings and characterizes epidemiological and clinical surveys on pediatric cases of scorpionism recorded in the Centro de Assistência Toxicológica de Pernambuco (Ceatox-PE). Results Scorpion stings accounted for more than 60% of all cases recorded for venomous animals. The children were from 37 cities of the Pernambuco state and accounted for 28.8% of the victims treated for scorpion stings, with the highest incidence in the metropolitan area of Recife. Stings occurred throughout the year and slightly increased during the rainy season. Independent of the elapsed time for a prognosis, most cases showed mild symptoms. Three moderate cases that resulted in death featured cardiogenic shock and/or pulmonary edema or severe neurological symptoms. For the first time, death attributed to T. stigmurus was confirmed by the presence of the scorpion. Conclusions These results suggest that scorpionism in Pernambuco is a public health problem that needs to be monitored carefully throughout the year by the government.

Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas

Envenoming snakebites are thought to be a particularly important threat to public health worldwide, especially in rural areas of tropical and subtropical countries. The true magnitude of the public health threat posed by snakebites is unknown, making it difficult for public health officials to optimize prevention and treatment. The objective of this work was to conduct a systematic review of the literature to gather data on snakebite epidemiology in the Amazon region and describe a case series of snakebites from epidemiological surveillance in the State of Amazonas (1974-2012). Only 11 articles regarding snakebites were found. In the State of Amazonas, information regarding incidents involving snakes is scarce. Historical trends show an increasing number of cases after the second half of the 1980s. Snakebites predominated among adults (20-39 years old; 38%), in the male gender (78.9%) and in those living in rural areas (85.6%). The predominant snake envenomation type was bothropic. The incidence reported by the epidemiological surveillance in the State of Amazonas, reaching up to 200 cases/100,000 inhabitants in some areas, is among the highest annual snakebite incidence rates of any region in the world. The majority of the cases were reported in the rainy season with a case-fatality rate of 0.6%. Snakebite envenomation is a great disease burden in the State of Amazonas, representing a challenge for future investigations, including approaches to estimating incidence under-notification and case-fatality rates as well as the factors related to severity and disabilities.

Soldadura por uma das extremidades de dois cromossômios homólogos do tityus

In this paper the author describes a very interesting case of union of two homologous chromosomes of the scorpion Tityus bahiensis just by the opposite extremities. The two normal pairs of chromosomes behave as ordinarily, the members of each pair showing at times a slight disturbance in their regular parallelism. The complex chromosome, on the contrary, behaves itself as if it were devoid of kinetochores, that is, it does not orient like normal chromosomes nor reveal any kind of active movement. The fusion of the chromosomes has resulted from terminal breakage at the opposite ends, the correspondig fragments having been found unpaired in a cell in which two pairs of chromosomes were present. Consequently, the compound chromosome, like the normal ones, is provided with a kinetochore at each one of the free ends. Being thus a centric chromosome its behavior, or more exactly, its kinetic inactivity may be compared with that of the monovalents found elsewhere in meioses. It is due o the failure of a partner. The fusion of two homologous chromosomes has transformed them into a new chromosomal unit in whose corresponding parts the ability of pairing was entirely abolished. This result is in full contradiction with the theory of a point-to point attraction between homologous chromosomes attributed to particular power of the genes, since, if genes really exist, being placed in their original loci, they would promote the union side by side of the members of the compound chromosome. If an attraction loci-to-loci should prevail the compound chromosome would be bent as in Fig. 8, C or form a ring similar to the loops observed in the inverted segment of sailvary chromosomes of Drosophila, as represented in the Fig. 8, D and this, in accordance with the order of the loci resulting from an union of corresponding or opposite ends of the fused chromosomes, as indicated in the Fig, 8 A and B. The evidence in hand points to a fusion by non homologous extremities. The expected rings, however, have never been found in metaphase plates. From this fact the author concludes that there is no point-to-point attraction between chromosomes, a conclusion in full agreement with the behavior of Hemipteran chromosomes which, in spite of geing composed of two equivalent halves do not bend in order to adjust the corresponding loci. (Cf. the papers on Hemiptera published by the author in this volume).

Bothriurus pichicuy, nuevo escorpión chileno del grupo vittatus (Scorpiones, Bothriuridae)

Bothriurus pichicuy, a new scorpion species from the center coast of Chile, is described. It belongs to the vittatus species-group, and differs from the others species in the group by the pigmentation patterns of the prosoma, mesosoma and venter of metasoma, by the development and arrangement of the ventral keels of caudal segment V, and for its small size. The species is the only representative of the vittatus species-group that lives in sympatry with another Bothriurus species: B. coriaceus Pocock, 1893, from the coastal desert of Chile. Records of B. pichicuy came from the provinces of Petorca and Choapa.

Hiperglicemia na intoxicação escorpiônica experimental em cão

The production of hyperglycemia during the acute phase of scorpion poisoning produced by T. bahiensis in dogs is confirmed now. The highest degree on average, was reached 10 minutes after the injection of venom. In our hands, the previous bilateral adrenalectomy did not avoid the hyperglycemia. The average of the blood sugar level has been similar to that observed in dogs with adrenal glands, the highest blood sugar level was also registered after 10 minutes. The hyperglycemia obtained in adrenolectomized dogs is, probably, due to the liberation of Sympatin (Nor-adrenalin and adrenalin) as a consequence of the central excitation by the poison on the hepatic nerves and other ganglionar terminations of the Sympathetic Nervous System. Our present researches suggest that the venom has adrenergic action besides the central action.