ABSTRACT
Resumo O presente estudo tem como objetivo caracterizar o perfil epidemiológico de vítimas de acidentes escorpiônicos e ofídicos e avaliar a adequação das prescrições de soros antivenenos. Estudo transversal cujas fontes de dados foram as fichas de notificação de acidentes por animais peçonhentos do Sistema de Informação de Agravos de Notificação no município de Vitória da Conquista (BA), Brasil. Foram incluídas as informações de acidentes escorpiônicos ou ofídicos no período entre julho de 2016 e junho de 2017 atendidos no município. Os dados obtidos e as variáveis de interesse foram analisadas de acordo com as perguntas deste estudo. No período observado foram atendidas 293 vítimas de acidentes por animais peçonhentos. Destas, 149 (50,9%) foram homens e 114 (38,9%) possuíam entre 20 a 59 anos. Foram 235 (80,9%) casos de escorpionismo e 58 (19,1%) de ofidismo. Destes, 203 (69,3%) foram classificados como leves e em 200 (68,5%) casos foi prescrita soroterapia para estes pacientes. Quanto à adequação das prescrições, 172 (59,7%) foram julgadas inadequadas e destas, o uso de número de ampolas acima do indicado foi a mais frequente. A prescrição inapropriada de soros antivenenos ocorreu em aproximadamente em 60% dos casos avaliados. Apesar disso, a maioria dos acidentes foi classificada como leve, em homens jovens.
Abstract This study aims to characterize the epidemiological profile of victims of scorpion and snakebite envenomations and to evaluate the adequacy of antivenom sera prescriptions. This is a cross-sectional study whose data sources were the envenomation notification information sheets of the Notifiable Diseases Information System in the city of Vitória da Conquista (BA), Brazil. We included information on scorpion or snakebite envenomations attended in the municipality in the period between July 2016 and June 2017. The data obtained and the variables of interest were analyzed according to the questions of this study. In the observed period, 293 victims of envenomations were treated. Of these, 149 (50.9%) were men, and 114 (38.9%) were 20-59 years old. In total, 235 (80.9%) cases of scorpionism and 58 (19.1%) of ophidism were reported. Of these, 203 (69.3%) were classified as mild, and in 200 (68.5%) cases, serum therapy was prescribed for the patients. Regarding the adequacy of the prescriptions, 172 (59.7%) were considered inadequate, and of these, the use of some vials above than indicated was the most frequent. The inappropriate prescription of antivenom sera occurred in approximately 60% of the evaluated cases. Despite this, most accidents were classified as mild - in young men.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Snake Bites/drug therapy , Scorpion Stings/drug therapy , Immunologic Factors/therapeutic use , Brazil , Antivenins/therapeutic use , Urban Health , Cross-Sectional Studies , Drug Utilization/statistics & numerical data , Emergency Medical Services , Emergency Treatment , Hospitals, Public , Middle AgedABSTRACT
Se ha observado la presencia de especies de Tityus en diferentes regiones del país, en las cuales su presencia no había sido comunicada previamente: 1- Tityus bahiensis en las provincias de Entre Ríos y Buenos Aires, en esta última en la localidad de Lanús y en San Clemente del Tuyú, y 2- Tityus confluens en la Ciudad Autónoma de Buenos Aires (CABA) y en la provincia de Buenos Aires en las localidades de Pilar, La Plata, Mar del Plata y Bahía Blanca. Estos hallazgos modifican el mapa de la distribución de escorpiones de importancia sanitaria en Argentina por lo que ante la picadura de escorpiones deben considerarse estos nuevos hallazgos. Esto es especialmente importante en el ámbito de la CABA y la provincia de Buenos Aires, en donde la enorme mayoría de los accidentes por escorpiones han sido causados por T. trivittatus y en donde ahora, al menos en algunas de sus regiones se pueden encontrar T. confluens y T. bahiensis. Se discuten posibles razones de esta nueva distribución así como la ocurrencia de accidentes graves en zonas donde no ocurrían históricamente y de sus posibles causas. En base a los casos graves producidos en los últimos tiempos y a este nuevo mapa de distribución, se hace énfasis en la necesidad de capacitación al personal de salud en general y de los médicos de guardia y terapistas en particular, para tratar adecuadamente los accidentes por escorpiones.
Several species of Tityus have been described in regions of Argentina where their presence had not been previously described. These are: 1- Tityus bahiensis in the provinces of Entre Ríos and Buenos Aires (in the localities of Lanús and San Clemente del Tuyú), and 2- Tityus confluens in the city of Buenos Aires and in the province of Buenos Aires in the localities of Pilar, La Plata, Mar del Plata and Bahía Blanca. These findings modify the distribution map of scorpions of sanitary importance in Argentina, reason for which this new distribution must be considered when facing a scorpion sting. This is especially important in the city of Buenos Aires and the province of Buenos Aires, where most of the accidents by scorpions are caused by Tityus trivittatus, and where at least in some of their regions, T. confluens or T. bahiensis can be found at present. The possible reasons of this new distribution, as well as the possible causes for the occurrence of severe envenomations in regions where these were not observed historically, are discussed. Based on the severe envenomations observed and on this new distribution map, emphasis is placed on the need to capacitate health personnel in general and intensivists or critical care physicians in particular to adequately treat scorpion accidents.
Subject(s)
Humans , Animals , Scorpion Venoms/toxicity , Scorpions/classification , Antivenins/therapeutic use , Animal Distribution , Argentina/epidemiology , Public Health , Scorpion Stings/drug therapy , Scorpion Stings/therapy , Scorpion Stings/epidemiologyABSTRACT
Abstract Herein, four cases of scorpion stings caused by Tityus apiacas recorded from the municipality of Apuí, in the southern region of the Brazilian Amazon, are described. Patients showed systemic clinical manifestations, described as unusual, involuntary, and generalized tingling and numbness, reported by patients as an electric shock sensation, lasting up to 24 hours after the sting. All patients described local pain and sensation, along with other clinical symptoms including local edema and erythema. Systemic manifestations were not life threatening. Antivenom therapy was administered to all patients, who were discharged without complaints.
Subject(s)
Humans , Animals , Male , Female , Child , Adolescent , Scorpions/classification , Antivenins/therapeutic use , Scorpion Stings/drug therapy , Middle AgedABSTRACT
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.
Subject(s)
Humans , Animals , Scorpion Venoms/poisoning , Severity of Illness Index , Antivenins/therapeutic use , Scorpion Stings/complications , Scorpion Stings/diagnosis , Scorpion Stings/drug therapy , Prognosis , BrazilABSTRACT
Os escorpiões representam um grave risco à saúde pública brasileira, especialmente nas ßreas urbanas, devido à alta incidência e potencial gravidade de casos ocorridos por acidentes com esses animais peçonhentos. Do ponto de vista médico-sanitario, o gênero Tityus, com destaque para a espécie Tityus serrulatus é, atualmente, o reponsßvel pelo maior número de casos de picadas de escorpião no país. O objetivo do presente estudo foi relatar e comparar dois casos clínicos de escorpionismo ocorridos no mês de março do ano de 2012, na região metropolitana de Belo Horizonte, Minas Gerais, Brasil. Ambos os acidentes foram classificados como graves. Entre- tanto, as diferenças na abordagem e no manejo entre os dois casos clínicos foram consideradas fatores determinantes nas suas evoluções e prognósticos. Desta forma, fazer o diagnóstico e iniciar a administração de soroterapia antiveneno específica adequada o mais precocemente possível são essenciais nos casos de envenenamento por picada de escorpião, sendo os Centros de Informações e Assistência Toxicológi- cas (CIATs) ferramentas fundamentais...
Scorpions represent a serious risk to public health in Brazil, especial/y in urban areas due to lhe high incidence and potential severity of cases occurred in accidents with these poisonous animais. From the perspective of health care, the Tityus gender, especially the Tityus serrulatus species, is currently responsible for the largest number of cases of scorpion stings in the country. The purpose of the present work was to report and compare two clinical cases of scorpion envenomation occurred in March of 20/2, in the metropolitan region of Belo Horizonte, Minas Gerais, Brazil. Both accidents were classified as severe cases. However, the differences in approach and management between the two clinical cases were considered determinant in their evolution and prognosis. Therefore, make the diagnosis and initiate the administration of properly specific antivenom serotherapy as early as possible are core in cases of poisoning by scorpions sting, and the Centers for Toxicological Information and Assistance (CIATs) are fundamental tools...
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Immunization, Passive , Scorpion Stings/complications , Scorpion Stings/diagnosis , Scorpion Stings/drug therapy , DeathABSTRACT
El escorpionismo, en su aspecto clínico es un envenenamiento de causa accidental producido por la inoculación del veneno de un alacrán o escorpión, que en Argentina ocurre predominantemente en áreas urbanas, en el ámbito domiciliario o peridomiciliario. En nuestro país son tres las especies de escorpiones de interés médico-sanitario: Tityus (T.) trivittatus, T. confluens y T. bahiensis. El cuadro clínico se caracteriza por presentar dolor agudo con escaso compromiso cutáneo y manifestaciones sistémicas que, sin tratamiento pueden provocar la muerte, principalmente en niños. El objetivo de esta comunicación es dar a conocer el primer caso de escorpionismo grave, ocurrido en la Ciudad Autónoma de Buenos Aires, en una niña de 4 años de edad y describir el cuadro clínico característico y la necesidad del tratamiento precoz en los casos moderados y severos.
Scorpionism in its clinical aspect is an envenoming caused by accidental sting and inoculation of venom from a scorpion, which in Argentina occurs predominantly in urban areas, in the home environment or peridomiciliary. In our country there are three species of scorpions of medical-health concern: Tityus (T.) trivittatus, T. confluens and T. bahiensis. The clinical picture is characterized by severe pain with limited cutaneous and systemic manifestations, that without treatment can cause death, especially in children. The aim of this communication is to present the first case of severe scorpionism occurred in the City of Buenos Aires, in a 4 years old girl, and to describe the characteristic clinical picture and the need for early treatment in moderate and severe cases of scorpionism.