Fatal evolution of acute Chagas disease in a child from Northern Brazil: factors that determine poor prognosis.

Trypanosoma cruzi is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child from Northern Brazil. In the hospital admission, physical examination showed tachycardia, hepatomegaly, bipalpebral edema and anasarca. Trypanosoma cruzi trypomastigotes were found in microscopy during blood cell count. Twenty-three days before hospitalization, the child had ingested the "bacaba palm fruit's wine". Even with the appropriate diagnosis and starting of treatment, she did not survive. Quantitative analysis of Trypanosoma cruzi DNA in a blood sample resulted in 54,053.42 parasite equivalents/mL and the DTU TcIV was identified. The outcome may have been determined by several factors, including the delay to seek a medical service beyond the high parasitemia, detected by qPCR. DTU TcIV could also have influenced the natural history of the disease.

Anomalias cromáticas em Bothrops jararaca (Serpentes, Viperidae) Xantismo interfere na sobrevivência?

Esse artigo descreve pela primeira vez xantismo em dois exemplares de B. jararaca e um acidente ofídico causado por um desses espécimes. Possíveis vantagens adaptativas para as espécies portadoras de tal anomalia cromática são discutidas. Para isso, foram analisados um exemplar macho proveniente de Jaraguá do Sul – SC e uma fêmea (responsável pelo acidente ofídico) proveniente de São Roque – SP. Ambos os espécimes apresentaram coloração característica de xantismo. A dissecção e análises ovarianas demonstraram folículos em início de vitelogênese, indicativo de período reprodutivo e com características de nuliparidade. A dissecção e análise gonadal do macho mostraram a presença de ducto deferente enovelado, indicativo de maturidade sexual. O quadro clínico do paciente mostrou tratar-se de um caso típico de acidente botrópico, apresentando sintomatologia característica para esse tipo de acidente ofídico. Os resultados obtidos corroboram dados da literatura para outros casos de xantismo, com ocorrência em serpentes de hábito noturno, adultas e em idade reprodutiva. Foi constatada que a perda da coloração críptica habitual não conferiu vantagens, ou seja, o xantismo, provavelmente alterou as chances de sobrevivência em serpentes de hábitos não predominantemente noturnos.

Chromatic anomalies in Bothrops jararaca (Serpentes, Viperidae): Does xanthism affect survival? This article describes, for the first time, the xanthism in two specimens of B. jararaca. It also describes the snakebite caused by one of these specimens, followed by a discussion on the adaptive advantages (e.g. survival).

Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil.

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.

Clinical trial of two antivenoms for the treatmentof Bothrops and Lachesis bites in the northeastern Amazon region of Brazil

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n=38) or standard (n=36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.

Influência das alterações ambientais na epidemiologia dos acidentes ofídicos e na distribuição geográfica das serpentes de importância médica nos estados de São Paulo e Paraná: (Nota Prévia) / Influence of environmental changes in the epidemiology of snakebites and geographical distribution of snakes of medical importance in São Paulo and Paraná States, 1988-1997

BACKGROUND: Geographical distribution of snakebites and snakes of medical importance has a strong correlation with changes in the vegetation cover as a consequence of the expansion of agricultural frontiers. In São Paulo (SP) and Paraná (PR) the process of land occupation has led to a radical transformation in the natural landscape. The objective of this study was to analyze a historical series of snakebites and the geographical distribution of the main species of snakes, taking into account environmental changes of the landscape. MATERIAL AND METHODS: An observational study was conducted. A historical series (1988-1997) of snakebites was obtained from the notification records sent to the Health Secretaries of São Paulo (SP) and Paraná (PR) States. Registries of the herpetological collections were obtained from the Butantan Institute (SP), the Natural History Museum (PR) and from the Production and Research Center in Immunebiologics (PR). Data regarding vegetation cover and percentage of land occupation with the main agricultural practices were analyzed by the Pearson correlation coefficient. The sites of snakebites occurrence and capture of snakes were identified at the municipality level. Maps were obtained using a geographical information system using the software ArqView v.3.0. RESULTS: From the Bothrops species, B. jararaca showed a wide distribution in open fields, forests, and even in regions under anthropic influence, while B. moojeni and B. neuwiedi were found predominantly in open fields. Crotalus occupied areas originally constituted by semidecidual estacional forest and "cerrado". The annual incidence of snakebites varied from 4.31 to 10.57 cases per 100,000 population, decreasing through the period for both Bothrops (88%) and Crotalus (11%). Micrurus accidents were rare (1%) in São Paulo and absent in Paraná. The areas of greater risk for snakebites were coincident with the snakes distribution areas: the administrative regions of Registro and Sorocaba, in São Paulo, and União da Vitória, in Paraná, for Bothrops accidents, and Bauru and Presidente Prudente in Sao Paulo, Cascavel and Ivaiporã in Paraná, for Crotalus accidents. No correlation between snake distribution and vegetation cover was observed, except for B. jararacussu in the remaining forest at the Vale do Ribeira. No correlation was observed between land occupation and Bothrops snakebites. A small negative correlation was observed between Crotalus accidents and areas with sugar cane. CONCLUSIONS: A decreasing tendency was observed in the number of snakebites and snakes of medical importance. Maps of the distribution of poisonous snakes and snakebites allowed a better definition of risk areas. The anthropic pressure probably had influence on the result of no correlation between areas of distribution of snakes with the vegetation cover, while some agricultural practices may had resulted in changes in the risk areas for snakebites.

DELINEAMENTO DO PROBLEMA: A distribuição geográfica dos acidentes ofídicos e das serpentes de interesse médico guarda estreita correlação com as mudanças na cobertura vegetal, decorrentes da expansão de fronteiras agrícolas, notadamente em São Paulo (SP) e Paraná (PR), onde o processo de ocupação da terra levou a uma transformação radical da paisagem natural. O objetivo deste trabalho foi realizar levantamento de série histórica sobre a ocorrência de acidentes e a distribuição das espécies de serpentes, levando em conta as alterações ocorridas na cobertura vegetal. MATERIAL E MÉTODOS: Foi realizado levantamento de série história (1988-1997) dos acidentes ofídicos, a partir das fichas de notificação encaminhadas às Secretarias de Estado da Saúde do Paraná e São Paulo e registro das coleções herpetológicas do Instituto Butantan (SP), Museu de História Natural (PR) e Centro de Produção e Pesquisa em Imunobiológicos (PR). Dados sobre cobertura vegetal e percentual de ocupação do solo das principais práticas agrícolas foram correlacionados, utilizando-se o coeficiente de correlação de Pearson. As localidades de ocorrência dos acidentes e de coleta das serpentes foram identificadas por município. Foram obtidos mapas, por meio de um sistema de informação geográfica, no programa ArqView versão 3.0. RESULTADOS: Das espécies de Bothrops, a B. jararaca mostrou ampla distribuição em formações abertas, florestas e até regiões sob influência antrópica, enquanto que B. moojeni e B. neuwiedi foram encontradas em formações abertas. As Crotalus ocuparam áreas originalmente formadas por floresta estacional semidecidual e cerrado. A incidência anual dos acidentes ofídicos variou de 4,31 a 10,57 casos por cem mil habitantes, com queda ao longo do período, tanto dos acidentes botrópicos (88%) como dos crotálicos (11%). Os acidentes elapídicos foram raros (1%) em São Paulo e ausentes no Paraná. As áreas de maior risco para os acidentes foram coincidentes com as áreas de distribuição das serpentes, destacando-se, para os acidentes botrópicos, as regiões administrativas de Registro e Sorocaba em São Paulo e União da Vitória no sul do Paraná e, para os acidentes crotálicos, Bauru e Presidente Prudente em São Paulo, Cascavel e Ivaiporã no Paraná. Não houve relação entre áreas de ocorrência de serpentes e cobertura vegetal atual, com exceção da sobreposição de B. jararacussu nos remanescentes de mata no Vale do Ribeira. Não se observou correlação entre ocupação do solo e acidentes botrópicos, havendo, nos acidentes crotálicos, pequena correlação negativa com a ocupação por cana-de-açúcar. CONCLUSÕES: Observou-se tendência de queda no número de acidentes ofídicos e de serpentes de importância médica. Mapas de distribuição de serpentes peçonhentas e de acidentes ofídicos permitiram melhor definição das áreas de risco. A influência antrópica provavelmente influenciou a não-correlação com a cobertura vegetal atual, enquanto que práticas agrícolas podem ter determinado deslocamento nas áreas de maior risco de acidentes.

Ocorrência de intoxicação por ingestão de baicu / Occurrence of Intoxication from eating globfish

Os peixes considerados venenosos ou sarcotóxicos possuem toxinas na pele, músculos, víceras e gônodas. Dentre as 80 espécies existentes no Brasil, em Santa Catarina destaca-se o baiacu, cuja toxina (tetrodotoxina) apresenta propriedades neurotôxicas. Os acidentes causados pela ingestão de baiacu tem sido descrita ocasionalmente no estado de Santa Catarina....

Ocorrência de acidentes provocados por peixes peçonhentos / The occurrence of accidents caused by poisonous fish species

O acidente provocado por peixes peçonhentos ou acantóxicos denomina-se ictismo. Peixe peçonhento ou acantóxico é aquele que possui glândulas epidérmicas de veneno associadas com esporões em nanadeiras e cauda. Há poucos estudos sobre os casos de ictismo no Brasil, embora existam aproximadamente 130 espécies de peixes que provocam acidentes entre os pescadores, mergulhadores e banhitas...