Accidents caused by Bothrops and Bothropoides in the State of Paraiba: epidemiological and clinical aspects

INTRODUCTION: Bothrops and Bothropoides snakes cause 70% of the ophidic accidents in Brazil. The species that cause ophidic accidents in State of Paraíba are Bothropoides erythromelas, Bothrops leucurus and Bothropoides neuwiedi. METHODS: This is a prospective and transverse study, following a quantitative approach of accidents involving Bothrops and Bothropoides admitted to the Toxicological Assistance and Information Centers of Campina Grande and João Pessoa (Ceatox-CG and Ceatox-JP), aimed at identifying the epidemiological and clinical profile of such accidents. All of the patients admitted had medical diagnoses and were monitored at Ceatox-CG or Ceatox-JP. RESULTS: The genera Bothrops and Bothropoides caused 91.7% of the ophidic accidents reported. Snake bites were frequent in men (75.1%), rural workers (65.1%), literate individuals (69%) between 11 and 20 years-old (21.7%), and toes the most common area attacked (52.7%). Most (86.6%) patients were admitted within 6 hours after the accident/bite, with a predominance of mild cases (64.6%). The annual occurrence in Paraíba was 5.5 accidents/100,000 inhabitants and lethality was 0.2%. CONCLUSIONS: Positive changes in the profiles of these accidents were verified, such as the non-application of inadequate solutions, including the use of tourniquet, coffee grounds, garlic, suction and/or cutting the bitten area. Moreover, the Itinerant Laboratory project, linked to Paraíba State University in partnership with Ceatox-CG, has contributed positively, providing several cities of the state with information regarding the prevention of accidents involving venomous animals. The local press has also contributed, reporting the educational work developed by the centers.

An outbreak of Portuguese man-of-war (Physalia physalis - Linnaeus, 1758) envenoming in Southeastern Brazil

Introduction Portuguese man-of-war, Physalia physalis (Linnaeus, 1758), are cnidarians capable of discharging intracellular organelles filled with venom, resulting in severe envenomation in humans. Methods We report the clinical and therapeutic aspects of 331 accidents involving Portuguese man-of-war in an outbreak on the coast of the State of São Paulo, Brazil. Results The clinical manifestations of envenomation were rare and mild and mostly local, systemic reactions; there was a low rate of late complications. Conclusions The consequences of envenomation were of moderate severity, and first aid measures were effective in controlling the pain. Outbreaks of accidents involving Portuguese man-of-war occur periodically in the area without a clear explanation.

Skin lesions simulating blue toe syndrome caused by prolonged contact with a millipede

Venomous animals are those that, by means of a hunting and defense mechanism, are able to inject their prey with a toxic substance produced in their bodies, directly from specialized glands (e.g., tooth, sting, spur) through which the poison passes. Millipedes are poisonous animals; they can be harmful to humans, and their effects usually manifest as erythematous, purpuric, and cyanotic lesions; local pain; and paresthesia. Here, we report a case of skin contact with a millipede for 6h resulting in skin lesions similar to blue toe syndrome.

Clinical update on scorpion envenoming

Abstract: Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.

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.

Polychromatism of populations of Corallus hortulanus (Squamata: Boidae) from the southern Amazon Basin, Brazil

The Amazon tree boa Corallus hortulanus is known for featuring a wide variation in color pattern and design markings. Although there are studies on its polychromatism, none of them addresses the geographic variation in the color pattern of this species. The aim of this study was to describe the chromatic variation found in the populations of C. hortulanus from the southern Amazon Basin and its relationship with geographic distribution of the species. Analysis of both design markings and color patterns on 112 C. hortulanus specimens from the southern Amazon Basin interfluves resulted in the identification of six distinct morphotypes. Grayish-brown coloration and elongated diamond-shaped patterns were the most frequent patterns. Two morphotypes showed a tendency of correlation with the geographical distribution of those species found in Madeira and Juruá Rivers. The small sample size does not allow for a robust conclusion on the possible cause of geographic variation. The distribution of morphological patterns of C. hortullanus in the Amazon Basin suggest that there is gene flow between populations, regardless of geographical distance and natural barriers. The variation in color pattern and markings may represent a phenotypic response to the characteristics of different habitats occupied by the species.

Echocardiographic Abnormalities and Antiphospholipid Antibodies in Patients with Systemic Lupus Erythematosus

OBJECTIVE: Lupus anticoagulant and anticardiolipin antibodies (aCL) have been associated with thrombosis, recurrent abortion, and thrombocytopenia in patients with systemic lupus erythematosus (SLE), but their relationship with cardiac disease is less clear. The purpose of this study was to evaluate the association between antiphospholipid antibodies (aPL) and echocardiographic abnormalities in patients with SLE. METHODS: A total of 70 consecutive patients and 42 control subjects underwent M-mode, 2-dimensional and Doppler echocardiography and tests for lupus anticoagulant, aCL IgG, IgM, and IgA. Lupus anticoagulant was assayed with the dilute Russell viper venom time, and aCL IgG, IgM, and IgA were measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Lupus anticoagulant showed a prevalence of 10%. As a whole, aCL had a prevalence of 44.3% and aPL had a prevalence of 50%. Patients with echocardiographic abnormalities had a prevalence of 54.3% and showed a trend towards an association with aCL IgG (P=0.06). The presence of pulmonary hypertension (PH) was significantly associated with aCL IgG (p=0.02). CONCLUSION: aCL IgG was significantly associated with PH and showed a strong trend towards an association with echocardiographic abnormalities taken together. These findings suggest a role for aCL IgG in the development of lupus cardiovascular disease.

Comportamento alimentar e dieta de serpentes, gêneros Boiruna e Clelia (Serpentes, Colubridae)

Boiruna maculata Boulenger, 1896 and Clelia rustica (Cope, 1878) were observed in captivity feeding snakes and rodents, respectively. Both species have shown a similar procedure in relation to the prey. Major behavior differences among the two species were: rodents killed before being swallowed, and snakes were mostly swallowed alive; both species are able to find the rodents head faster than the snake one; the coils formed during constriction were also used to hold the prey, specially the last coil, while swallowing rodents. Informations on stomach contents was gathered by dissection of preserved specimens of Clelia clelia (Daudin, 1803) and C. plumbea (Wied, 1820) were also included in the dietary study. The majority of preys consisted on snakes and lizards. Other prey items were mammals and birds. Adult snakes prey relatively smaller animals than the juvenile snakes do.

Capacidade reprodutiva de Bothrops jararaca (Serpentes, Viperidae)

The relationship between female body size and egg number was examined in the snake Bothrops jararaca (Wied, 1924). Some authors have demonstrated that the estimated clutch size may be affected by the inclusion or exclusion of dead neonates or non-developed eggs. The reproductive system of 254 mature females newly arrived from nature was examined and 29.55% (n=75) had eggs in the oviducts in different stages of embryonic development. The presence of atresic eggs was observed in 34.5% of those females. A significant difference was observed in the number of eggs in the right and left oviducts (t=9.48, P<0.001), but not in the number of atresic eggs (t=1.110, P=0.278). The correlation of female body size and egg number was greater when all, the normal and atresic eggs were considered (r=0.63, P<0.001). The exclusion of atresic eggs from the clutch size decreased slightly this correlation (r=0.54, P<0.001).

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.

Estudo do mecanismo da hiperglicemia e da hipertensão arterial, produzidas pelo veneno de escorpião, no cão

In the present paper we studied the mechanism of the hyperglycemia and hypertension evoked by the intravenous injection of scorpion venom (Tityus bahiensis) in the dog. We used 34 dogs, of both sex, weighing between 4.3 to 22 kg. These animals were divided in 3 groups and the following experiments were performed: in the first group (8 dogs) the animals were adrenalectomized after the intravenous injection of chlorpromazine; in the second group (16 dogs) the animals were injected with ganglionic blocking drugs (9.295 Ciba and hexamethonium); in the third group (10 dogs) the naimals were injected with dibenamine, and in 3 of them the adrenal glands were removed. The dogs of each group were injected intravenously with aqueous extract of 2 telsons of scorpion/kg; the average weight of each telson was 6,5 mg. The following results were obtained: 1) The hyperglycemia evoked by scorpion venom, in adrenalectomized dogs, was inhibited by chlorpromazine; 2) Ganglionic blocking drugs (9.295 Ciba and hexamthonium) were inefective as far as the hyperglycemic and pressor effects of venom are concerned; 3) In the animals treated with dibenamine, the venom produced a fall in blood pressure, both in the controle and in the adrenalectomized. The present experiments suggest that the scorpion venom has, besides the central action already described by other investigators, an adrenergic action, very similar to the adrenaline. On basis of our experiments we think that the adrenergic action is responsible, in part, by the productrion of hyperglycemia and hypertension.

Some new species of Caryospora (Apicomplexa: Eimeriidae) from brazilian snakes, and a re-description of C. jararacae Carini, 1939

The mature ooxysts of six new species of Caryospora are described from the faeces of Brazilian snakes. They are differentiated from other species previously recorded from reptiles, largely on the size and shape of the oocyst and sporocyst, structure of the oocyst wall, and presence or absence of a polar body. C. paraensis n. sp., and C. carajasensis n. sp., are from the "false coral", Oxyrhopus petola digitalis; C. pseustesi n. sp., from the "egg-eater", Pseustes sulphureus sulphureus; C. epicratesi n. sp., from the "red boa", Epicrates cenchria cenchria; and C. micruri n. sp., and C. constancieae n. sp., from the "coral snake", Micrurus spixii spixii. A re-description is given of C. jararacae Carini, 1939, from the "jararaca" Bothrops atrox, embodying some additional morphological features.

Plants against snakebites

Small molecular weight compounds from Mandevilla velutina and from Eclipta prostata were found to be active against snakebite.

Occurrence of Cryptosporidium (Apicomplexa, Cryptosporidiidae) in Crotalus durissus terrificus (Serpentes, Viperidae) in Brazil

The objective of the present study was to investigate the prevalence of Cryptosporidium (Apicomplexa, Cryptosporidiidae) in the snake Crotalus durissus terrificus (Serpentes, Viperidae). Fifty animals were evaluated for the presence of oocysts of Cryptosporidium sp. at the time of arrival and 30 and 60 days later. Intestinal washings with saline solution (1% body weight), fecal samples, and organ scrapings were collected during the study. Oocysts were concentrated by an ether-phosphate-buffered saline sedimentation technique and then separated by a density gradient centrifugation technique. Smears were made with the sediment and submitted to modified acid-fast and auramine-rhodamine staining. Cryptosporidium-positive smears were used as controls for the experimental findings. The overall prevalence of Cryptosporidium sp. oocysts was 14%. Among the positive snakes, oocysts were detected only in the intestinal washing in two specimens, only in the feces in four specimens, and in both materials at least once in one specimen. The positive snakes were predominantly from Santa Maria da Serra city State of São Paulo (57.1%). We also observed that all of the examinations that presented positive results were obtained at least 27 days after the capture of the animals.

Antimycobacterial neolignans isolated from Aristolochia taliscana

Tuberculosis (TB - Mycobacterium tuberculosis) is an ancient infectious disease that has appeared once again as a serious worldwide health problem and now comprises the second leading cause of death resulting from a single infection. The prevalence of multidrug resistance (MDR) TB is increasing and therapeutic options for treatment are not always accessible; in fact, some patients do not respond to the available drugs. Therefore, there is an urgent need to develop novel anti-TB agents. The aim of the present study was to screen extracts of Aristolochia taliscana, a plant used in traditional Mexican medicine to treat cough and snake bites, for antimycobacterial activity. The hexanic extract of A. taliscana was tested by microdilution alamar blue assay against Mycobacterium strains and bioguided fractionation led to the isolation of the neolignans licarin A, licarin B and eupomatenoid-7, all of which had antimycobacterial activity. Licarin A was the most active compound, with minimum inhibitory concentrations of 3.12-12.5 μg/mL against the following M. tuberculosis strains: H37Rv, four mono-resistant H37Rv variants and 12 clinical MDR isolates, as well as against five non-tuberculous mycobacteria (NTM) strains. In conclusion, licarin A represents a potentially active anti-TB agent to treat MDR M. tuberculosis and NTM strains.