RESUMEN
Jellyfish envenomation is a common problem in coastal areas all over the world; usually symptoms are self-limited with no long-lasting complications. Despite that, some jellyfish species, mainly populating the Indian Ocean, are renown to be potentially lethal and in some cases may cause severe myopathy. We report the first case of rhabdomyolysis following a jellyfish sting in the Mediterranean Sea. A 17-year-old patient was admitted to the intensive care unit of our hospital in life-threatening conditions. He was dyspnoeic and dysphagic with pain and functional impairment of upper and lower limbs. The evidence of a red mark in his face and the clinical presentation, coupled with the diagnostic test performed, allowed the diagnosis of toxidrome from jellyfish venom. Treatment with hydration, ventilatory support and steroids led to a progressive improvement of patient conditions. Our case report stresses the importance of prompt identification and treatment of potential rhabdomyolysis determined by jellyfish and rises awareness on the presence of such venomous species in the Mediterranean Sea.
Asunto(s)
Mordeduras y Picaduras , Venenos de Cnidarios , Escifozoos , Masculino , Animales , Humanos , Adolescente , Mar Mediterráneo , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/diagnósticoRESUMEN
Jellyfish stings are the most common cause of marine envenomation in humans. Various species of box jellyfish have been identified around Penang Island, Malaysia, and these include multitentacled and four-tentacled box jellyfish (class Cubozoa). The typical syndrome following envenomation from these jellyfish has been poorly documented, posing a greater challenge when managing an unidentified jellyfish sting from Penang Island. We report a case of a 32-y-old man from Penang Island who was stung by an unidentified jellyfish while walking into the sea. The patient reported that he felt an immediate and severe electric currentâlike pain over both thighs, left flank, and left forearm, followed by chest discomfort and breathlessness. Vinegar was applied over the affected areas, and he was rushed to a hospital, where he was treated with analgesia, steroids, and antihistamine. He refused hospitalization and was discharged against medical advice. He then presented to a noncoastal hospital 377 km away in Kuala Lumpur on the following day with severe pain over the affected sites as well as chest discomfort, shortness of breath, and abdominal cramps. The electrocardiograph demonstrated features of Wolff-Parkinson-White. Serial blood test results showed elevated creatine kinase but normal troponin I levels. The patient was managed symptomatically over a period of 4 d and was discharged with cardiology follow-up. Appropriate health-seeking behavior needs to be emphasized. This case report provides an opportunity to document the signs and symptoms of envenomation from possibly an undescribed jellyfish species near the coastal waters of Penang Island.
Asunto(s)
Mordeduras y Picaduras , Cnidarios , Venenos de Cnidarios , Cubomedusas , Escifozoos , Masculino , Animales , Humanos , Mordeduras y Picaduras/complicaciones , Dolor , Síndrome , HospitalesRESUMEN
BACKGROUND: While the majority of reported cases of jellyfish envenomation are self-limited with few lasting complications, a few can cause life-threatening and debilitating illnesses. We present the case of a 15-year-old male who had an unusual presentation of a jellyfish sting that led to acute compartment syndrome. CASE PRESENTATION: A 15-year-old Lebanese (Arab) boy was stung by a jellyfish, which led to acute compartment syndrome in the left arm. Decompression fasciotomy and local application of diluted nitroglycerin helped to relieve the ulnar and radial artery spasms. The patient was left with shoulder and elbow pain and elbow flexion weakness, which improved after physiotherapy over a period of 6 weeks. CONCLUSIONS: Current therapy recommendations for acute compartment syndrome following jellyfish stings are mainly based on case reports. Urgent fasciotomy and local application of nitroglycerin have been demonstrated to be helpful in severe jellyfish stings associated with acute compartment syndrome.
Asunto(s)
Mordeduras y Picaduras , Síndromes Compartimentales , Escifozoos , Masculino , Animales , Humanos , Adolescente , Nitroglicerina/uso terapéutico , Mordeduras y Picaduras/complicaciones , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , ArtralgiaRESUMEN
Majocchi's granuloma is an uncommon fungal infection of the dermis and subcutaneous tissue. The most frequently identified cause of Majocchi's granuloma is anthropophilic Trichophyton rubrum, and it is most commonly located on the anterior aspect of the lower limbs in women. Here, we report a case of Majocchi's granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed a dense dermal infiltrate composed of lymphoplasmacytic cells and neutrophils, with hyphae in the dermis. The presence of the fungus, Trichophyton tonsurans, was confirmed by mycological examination and molecular methods. Therefore, histological and mycological examination confirmed the diagnosis of Majocchi's granuloma. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which facilitated a complete resolution of the lesions.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Granuloma/diagnóstico , Granuloma/microbiología , Tiña/diagnóstico , Tiña/microbiología , Animales , Antifúngicos/uso terapéutico , Arthrodermataceae/aislamiento & purificación , Perros , Femenino , Granuloma/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Tiña/tratamiento farmacológicoRESUMEN
Post-traumatic stress disorder is a debilitating condition that can develop after exposure to any potentially traumatic event (natural disaster, physical assault, and car accident). This study focused on four pediatric patients presenting with an early stress response after a motor vehicle accident who were offered early therapeutic and a preventive management by hypnotherapy shortly after exposure to the traumatic event. All patients improved after one or several sessions of hypnosis. The results indicate that hypnotherapy can immediately help patients during the early period following a traumatic event.
Asunto(s)
Accidentes/psicología , Hipnosis/métodos , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Accidentes de Tránsito/psicología , Adolescente , Animales , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/psicología , Niño , Preescolar , Perros , Femenino , Humanos , Masculino , Trastornos por Estrés Postraumático/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe the clinical presentation and outcome of a dog with primary hypoparathyroidism secondary to cervical bite wounds. CASE SUMMARY: A 3-year-old male intact Chihuahua presented after being attacked by a large breed dog. The dog sustained severe cervical lacerations, exposing the trachea and jugular veins. A portion of the right thyroid gland was missing. The dog was stabilized before wound debridement and closure. Ionized calcium concentrations were within reference range at the time of presentation. Forty-eight hours after the initial trauma, the dog was presented in lateral recumbency with signs of hypovolemic shock, muscle tremors, and hyperthermia. Bloodwork showed severe ionized hypocalcemia with low normal parathyroid hormone concentration consistent with acute primary hypoparathyroidism. The dog was managed initially with IV calcium gluconate and calcitriol, then long-term oral calcium carbonate and vitamin D3. After 6 months, the dog was successfully weaned off calcium supplementation. NEW OR UNIQUE INFORMATION PROVIDED: This is the first described case of traumatic primary hypoparathyroidism after a bite injury to the neck in a dog.
Asunto(s)
Mordeduras y Picaduras/veterinaria , Enfermedades de los Perros/etiología , Hipoparatiroidismo/veterinaria , Animales , Mordeduras y Picaduras/complicaciones , Calcio/sangre , Gluconato de Calcio/farmacología , Colecalciferol/administración & dosificación , Colecalciferol/uso terapéutico , Enfermedades de los Perros/patología , Perros , Femenino , Humanos , Hipocalcemia/etiología , Hipocalcemia/veterinaria , Hipoparatiroidismo/tratamiento farmacológico , Hipoparatiroidismo/etiología , Hipoparatiroidismo/patología , Masculino , Hormona Paratiroidea , Heridas y LesionesRESUMEN
INTRODUCTION: Between 40,000 and 50,000 divers and swimmers are envenomated each year and diving as a hobby is becoming increasingly popular. In the Mediterranean, envenomation is most often by Weever fish, Scorpion fish and jellyfish but coral and sea urchins may also be venomous. ENVENOMATION: Most stings cause local inflammation, oedema and pain. The severity of pain varies with the venom and the amount injected. In severe cases, stings may be life-threatening due to cardiogenic or anaphylactic shock or penetration of vital structures. MANAGEMENT: Most cases of envenomation are preventable with a combination of measures including the avoidance of contact through good buoyancy control, the wearing of body-suits, and by maintaining visual awareness. Immediate management is to return to the surface, elevate and wash the site of injury. Immersion in hot water followed by simple analgesics for pain relief has been shown to be more effective than other methods. More severe cases should be identified by symptoms including confusion and heavy bleeding and referred to qualified medical care. CONCLUSION: Envenomation by subaquatic species is common and preventable yet the dissemination of the appropriate knowledge is limited. This knowledge summary provides pertinent information aimed at divers in preventing and managing such injuries.
Asunto(s)
Antivenenos/uso terapéutico , Mordeduras y Picaduras , Buceo , Primeros Auxilios/métodos , Animales , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/terapia , Servicios Médicos de Urgencia , Venenos de los Peces/envenenamiento , Humanos , Toxinas Marinas/envenenamiento , Venenos de Moluscos/envenenamiento , EscifozoosAsunto(s)
Infecciones por Bacterias Gramnegativas/complicaciones , Isquemia/etiología , Choque Séptico/complicaciones , Piel/irrigación sanguínea , Alprostadil/uso terapéutico , Amputación Quirúrgica , Animales , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/microbiología , Capnocytophaga , Terapia Combinada , Coagulación Intravascular Diseminada/etiología , Perros , Femenino , Dermatosis del Pie/etiología , Dermatosis del Pie/microbiología , Dermatosis del Pie/cirugía , Dermatosis del Pie/terapia , Gangrena/etiología , Gangrena/cirugía , Dermatosis de la Mano/etiología , Dermatosis de la Mano/microbiología , Dermatosis de la Mano/terapia , Humanos , Oxigenoterapia Hiperbárica , Isquemia/cirugía , Isquemia/terapia , Persona de Mediana Edad , Necrosis , Piel/patología , Infección de Heridas/complicaciones , Infección de Heridas/microbiologíaRESUMEN
Jellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, although we are unable to confirm this. With this case report, we aim to inform on the serious issue of toxicity associated with jellyfish species that bloom mainly along Korean, east Chinese, and Japanese shores and to discuss appropriate first aid methods in case of jellyfish stings.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Venenos de Cnidarios/envenenamiento , Edema Pulmonar/etiología , Escifozoos , Animales , Mordeduras y Picaduras/patología , Mordeduras y Picaduras/fisiopatología , Mordeduras y Picaduras/terapia , Niño , Resultado Fatal , Femenino , Humanos , Corea (Geográfico) , Edema Pulmonar/patología , Edema Pulmonar/fisiopatología , Edema Pulmonar/terapiaRESUMEN
Jellyfish is the number one cause of human pathologies due to contact with marine organisms. Jellyfish stings can cause a vast number of symptoms in humans like contact derma-titis, itching, pain, cardiovascular problems, anaphylaxis, and even death. This case report is about a 72-year-old woman with intermittent severe hypertension after being stung by jellyfish. Because of tourism and jellyfish migration the prevalence of patients with symptoms after jellyfish stings is increasing.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Cubomedusas , Hipertensión/etiología , Escifozoos , Anciano , Animales , Venenos de Cnidarios/efectos adversos , Eritema/etiología , Femenino , Humanos , Mar Mediterráneo , Enfermedad Relacionada con los ViajesAsunto(s)
Alérgenos/inmunología , Mordeduras y Picaduras/complicaciones , Colágeno/inmunología , Hipersensibilidad Inmediata/etiología , Escifozoos/inmunología , Anciano , Animales , Humanos , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/inmunología , Inmunoglobulina E/sangre , MasculinoRESUMEN
BACKGROUND: Dog bites are a frequent injury, but the incidence and type of lesions vary across countries. Although only few patients develop complications, the treatment of advanced injuries has a considerable medical, social and economic impact. A frequently isolated pathogen in dog bite wounds is Capnocytophaga canimorsus, a bacterium that can cause sepsis or meningitis. Hyperbaric oxygen (HBO2) therapy has been shown to be useful in treating anaerobic infections, most likely because it creates an inhospitable environment for the bacterium and enhances the patient's immune response. AIM: We present a case series of C. canimorsus infections treated with HBO2 in adjunction to antibiotic therapy. Furthermore, we tested the in vitro activity of ceftaroline against C. canimorsus, alone and in association with hyperbaric oxygen therapy. METHODS: We included nine (9) patients admitted to the surgery department of "A. Cardarelli" Hospital (Naples) after dog bite, from 2010 to 2016. All were initially treated with antibiotics and required transfer to the intensive care unit due to worsening conditions. C. canimorsus was isolated from wounds, and HBO2 therapy was administered in adjunction to antibiotics, until clinical improvement and microbiological test negativity. We tested the activity of hyperbaric oxygen therapy in adjunction to ceftaroline on cultured plates with C. canimorsus versus ceftaroline alone. Minimal inhibitory concentration was evaluated. CONCLUSIONS: Our findings confirm the utility of HBO2 therapy after biting injuries. Indeed, increased oxygen supply to the wound (as well as in vitro) may be toxic for bacteria, can improve healing and may improve the effectiveness of antibiotics.
Asunto(s)
Mordeduras y Picaduras/microbiología , Capnocytophaga , Infecciones por Bacterias Gramnegativas/terapia , Oxigenoterapia Hiperbárica , Adolescente , Adulto , Animales , Antibacterianos/farmacología , Mordeduras y Picaduras/complicaciones , Capnocytophaga/aislamiento & purificación , Cefalosporinas/farmacología , Terapia Combinada/métodos , Perros , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , CeftarolinaRESUMEN
The greater weever (Trachinus draco) is the only venomous fish in Denmark, and if stung by the weever the venom may cause symptoms such as pain, headache, nausea, dizziness and in severe cases systemic allergic reaction or tissue necrosis. The venom is heat-labile and should therefore be treated with warm water to the afflicted area. We report a case of a patient who was stung in the second finger and because of the treatment, he got a second-degree burn, that may have enhanced the effect of the venom, thus resulting in partial finger amputation.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Quemaduras/etiología , Traumatismos de los Dedos/etiología , Peces Venenosos , Hipertermia Inducida/efectos adversos , Amputación Quirúrgica , Animales , Mordeduras y Picaduras/patología , Mordeduras y Picaduras/terapia , Quemaduras/patología , Quemaduras/cirugía , Traumatismos de los Dedos/patología , Traumatismos de los Dedos/cirugía , Venenos de los Peces/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To investigate the effectiveness of hot water immersion for relieving the pain of major box jellyfish (Chironex fleckeri) stings.Design, interventions: Open label, randomised controlled trial comparing the effects of hot water immersion (45°C) and icepacks.Setting, participants: 42 patients with suspected C. fleckeri stings treated in the emergency department of the Royal Darwin Hospital during September 2005 - October 2008. MAIN OUTCOME MEASURES: The primary outcome was pain severity, assessed with a visual analogue scale (VAS). Secondary outcomes included crossover to the alternative treatment, use of opioid analgesia, emergency department length of stay (LOS), and delayed urticaria. RESULTS: Of 42 patients (26 males; median age, 19 years; IQR, 13-27 years), 25 were allocated to icepack treatment and 17 to hot water immersion. The demographic and baseline VAS data for the two groups were similar. After 30 minutes of treatment, 11 patients (65%) treated with hot water and 14 (56%) treated with icepacks had clinically improved pain scores (absolute difference, 9%; 95% CI, -22% to 39%; P = 0.75). One patient treated with icepacks crossed over to heat immersion. Two patients in each arm received intravenous opioid analgesia. Median emergency department LOS was 1.6 h (IQR, 1.0-1.8 h) for icepack patients and 2.1 h (IQR, 1.6-2.8 h) for heat immersion patients (P = 0.07). Five of seven patients who were followed up developed delayed urticaria. CONCLUSION: Hot water immersion was no more effective than icepacks for reducing the acute pain of box jellyfish stings, but increased emergency department LOS by about 30 minutes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12605000007639.
Asunto(s)
Mordeduras y Picaduras/terapia , Cubomedusas , Calor/uso terapéutico , Hielo , Inmersión , Adolescente , Adulto , Analgésicos Opioides/uso terapéutico , Animales , Mordeduras y Picaduras/complicaciones , Femenino , Humanos , Masculino , Dolor/etiología , Manejo del Dolor/métodos , Dimensión del Dolor , Resultado del Tratamiento , Urticaria/etiología , Adulto JovenAsunto(s)
Mordeduras y Picaduras/patología , Escifozoos , Animales , Mordeduras y Picaduras/complicaciones , Preescolar , Venenos de Cnidarios/efectos adversos , Enfermedad Crítica , Humanos , Hipertensión/etiología , Masculino , Enfermedades de la Piel/etiología , Enfermedades de la Piel/patología , Inconsciencia/etiologíaRESUMEN
Jellyfish are of particular concern for marine finfish aquaculture. In recent years repeated mass mortality episodes of farmed fish were caused by blooms of gelatinous cnidarian stingers, as a consequence of a wide range of hemolytic, cytotoxic, and neurotoxic properties of associated cnidocytes venoms. The mauve stinger jellyfish Pelagia noctiluca (Scyphozoa) has been identified as direct causative agent for several documented fish mortality events both in Northern Europe and the Mediterranean Sea aquaculture farms. We investigated the effects of P. noctiluca envenomations on the gilthead sea bream Sparus aurata by in vivo laboratory assays. Fish were incubated for 8 hours with jellyfish at 3 different densities in 300 l experimental tanks. Gill disorders were assessed by histological analyses and histopathological scoring of samples collected at time intervals from 3 hours to 4 weeks after initial exposure. Fish gills showed different extent and severity of gill lesions according to jellyfish density and incubation time, and long after the removal of jellyfish from tanks. Jellyfish envenomation elicits local and systemic inflammation reactions, histopathology and gill cell toxicity, with severe impacts on fish health. Altogether, these results shows P. noctiluca swarms may represent a high risk for Mediterranean finfish aquaculture farms, generating significant gill damage after only a few hours of contact with farmed S. aurata. Due to the growth of the aquaculture sector and the increased frequency of jellyfish blooms in the coastal waters, negative interactions between stinging jellyfish and farmed fish are likely to increase with the potential for significant economic losses.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Enfermedades de los Peces/fisiopatología , Branquias/fisiopatología , Escifozoos/fisiología , Dorada/fisiología , Animales , Acuicultura/economía , Acuicultura/métodos , Enfermedades de los Peces/etiología , Enfermedades de los Peces/mortalidad , Branquias/patología , Mar Mediterráneo , Tasa de Supervivencia , TúnezRESUMEN
INTRODUCTION: Jellyfish burning is not commonly part of the professional finding in the central Europe health care laboratory. Holiday seaside tourism includes different and unusual presentations of diseases for our worklplaces. Sea water-sports and leisure is commonly connected with jellyfish burning and changes in the skin, that are not precisely described. AIM: Authors focused their research on detection of morphological and quantitative changes of some inflammatory cells in the skin biopsy of a 59-years-old woman ten days after a jellyfish stinging. Because of a comparison of findings the biopsy was performed in the skin with lesional and nonlesional skin. METHODS: Both excisions of the skin were tested by imunohistochemical methods to detect CD68, CD163, CD30, CD4, CD3, CD8, CD20 a CD1a, to detect histiocytes, as well as several clones of lymphocytes and Langerhans cells (antigen presenting cells of skin), CD 117, toluidin blue and chloracetase esterase to detect mastocytes and neutrophils. Material was tested by immunofluorescent methods to detect IgA, IgM, IgG, C3, C4, albumin and fibrinogen. Representative view-fields were documented by microscope photocamera Leica DFC 420 C. Registered photos from both samples of the skin were processed by morphometrical analysis by the Vision Assistant software. A student t-test was used for statistical analysis of reached results. RESULTS: Mean values of individual found cells in the sample with lesion and without lesion were as follows: CD117 -2.64/0.37, CD68-6.86/1.63, CD163-3.13/2.23, CD30-1.36/0.02, CD4-3.51/0.32, CD8-8.22/0.50, CD3-10.69/0.66, CD20-0.56/0.66, CD1a-7.97/0.47 respectively. Generally mild elevation of eosinofils in lesional skin was detected. Increased values of tested cells seen in excision from lesional skin when compared with nonlesional ones were statistically significant in eight case at the level p = 0.033 to 0.001. A not statistically significant difference was found only in the group of CD163+ histiocytes. CONCLUSION: Authors detected numbers of inflammatory cells in lesional skin after the stinging by a jellyfish and compared them with the numbers of cells in the nonlesional skin of the same patient. Statistically significant differences were seen in the level of selected inflammation cells and numerically documented changes of cellularity in the inflammatory focus were caused by a hypersensitivity reaction after jellyfish injury in the period of 10 days after attack.