Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon

Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a ‘sensation of receiving an electric shock’ throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.

First report of scorpionism caused by Tityus serrulatus, described by Lutz and Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará, Brazilian Amazon

This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon

First report of scorpionism caused by Tityus serrulatus, described by Lutz and Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará, Brazilian Amazon

This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon

First report of scorpionism caused by Tityus serrulatus, described by Lutz and Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará, Brazilian Amazon

Abstract This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon.

Fatal anaphylaxis to Jaguajir rochae (Borelli, 1910) (scorpiones, buthidae) in Brazil: a case report

A 44-year-old healthy farmer, was stung by a scorpion on his right hand while preparing soil for planting in the Caatinga area (a large area in the north-east of Brazil characterized by semiarid scrub forest), in the Catarina Municipality countryside, Ceará State, Brazil. According to the reports of carers and family members, the patient initially reported mild pain at the site of the sting, but within a few minutes he developed malaise, pruritus in the body and throat, edema in the nostrils, and a dry mouth which led to looking for water to drink. It rapidly evolved into sphincter, urinary and fecal release, salivation and a convulsive episode with loss of the senses. He was dead on arrival at Catarina Municipality Hospital emergency department. The necroscopic report indicated suffocation due to glottal edema and acute lung edema as the "cause of death". The animal which caused the accident was under a rock that the patient was manipulating at the time of the incident, and has been identified by experts as Jaguajir rochae (Borelli, 1910) scorpion species, formerly synonymized Rhopalurus rochae. This is the first report of a fatality due to an allergic reaction to the venom of this species. This leads to the possibility that deaths caused by stings from other scorpion species may be due to anaphylaxis, whose symptoms in some situations may be confused with severe envenomation.

Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon

Abstract INTRODUCTION This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. METHODS This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. RESULTS A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. CONCLUSIONS: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care.

Envenomations by colubrids: case reports

Introduction: Envenomations by non-venomous snakes in Brazil are poorly accounted for and classified as mild, in which pain, erythema and local edema are reported. Objective: To describe accidents by Philodryas olfersii and Hydrodynastes gigas that occurred in the State of Pará, Brazil. Case report: The patient bitten by Philodryas presented bleeding, pain, local edema and axillary adenopathy. The patient bitten by Hydrodynastes had pain, local growing edema, as well as ecchymosis, fever and headache. No laboratory tests were performed. The treatment was based on pain control after identification of the snakes. Conclusion: The local symptomatology of colubrids is similar to accidents with Bothrops. It is important that health professionals perform a correct diagnosis for proper treatment.

Dermatitis caused by centipede envenomation: a case report

Accidents caused by centipedes in Brazil result in mild envenomation, where pain, erythema and edema are predominant. Cases rarely evolve to complication stages. This report presents a clinical case of dermatitis produced by an unidentified centipede, registered at the Toxicological Information Center of Belém-Pará, which evolved to blisters and necrosis. The patient underwent treatment with antibiotics and oral anti-inflammatory drugs, topical bactericides and surgical cleaning; resulting in cicatrization of the wound. The purpose of this report is to inform health professionals of the possibility of complications, which should be considered and dealt with conventionally.

Spatial distribution of envenomation by scorpions in Pará state, Brazil

Scorpionism is recognized by the World Health Organization as a neglected disease and, in Pará State, Brazil, it is considered a public health hazard. The objective of this study was to describe the spatial distribution of envenomation caused by scorpions in Pará. The data related to envenomation were collected from 2007 to 2014 and used for both descriptive and transversal studies. For those studies records obtained from ongoing investigations from the database of the National Notifiable Diseases Information System at the Public Health Department of Pará State were used. Envenomation occurs year round, most often in the first half of the year, in males from the countryside, aged 20 to 59 years and taking up to 3 hours to reach medical care. The deaths occurred from ages 15 to 59. Regarding the severity of the cases, class I cases were the most frequent and class III cases were the least frequent, accounting for only 5.1% of all cases. Of the 144 municipalities of Pará State, in 126 the frequency of envenomation ranged from 1 to 1,208 cases per municipality. Thirteen municipalities located in the lower Amazon region and in the southwest of Pará State presented higher occurences, including the highest number of deaths. Scorpionism is present throughout Pará State. However, there were differences in severity and incidence in the various regions, with higher frequency in the southwest of the State and in the lower Amazon region, corresponding to the Tapajós and Guyana endemic areas in the Brazilian Amazon.

Dermatitis after contact with Pheropsophus sp (Coleoptera, Carabidae, Brachininae) in the Pará State, Brazilian Amazon

Abstract: Dermatitis caused by bombardier beetles is rarely reported. Here, we report a case of beetle-caused dermatitis that occurred in Pará State, the Brazilian Amazon. A female patient while putting on her shoes, felt a burning pain in the right hallux and noticed a beetle inside the shoe. During medical consultation, the physician observed that the injury site was brown and discolored. The patient complained of localized burning pain and blurred vision. The beetle responsible for the injury was identified as Pheropsophus sp. Administered treatment included cleaning with saline, analgesics, and topical hydrocortisone acetate and the patient was discharged without complaints.

Scorpionism by Tityus silvestris in eastern Brazilian Amazon

Background Scorpionism is a serious public health problem in Brazil. Although cases of envenomation by scorpions are frequent in Brazil, Tityus silvestris - found throughout the Amazon region - is considered of minor medical significance and with only a few descriptions in the literature. This article aims to describe for the first time the epidemiological characteristics and clinical manifestations of scorpion stings by T. silvestris that occurred in eastern Brazilian Amazon. Methods A prospective and observational study was carried out on 13 confirmed cases of T. silvestris envenomation registered from 2007 to 2011 in the cities of Belém and Ananindeua, Pará state, Brazil. Results The stings occurred mainly during daytime, at domiciliary environment, and the scorpions were found in clothing, fruits or vegetables. Envenomation was more frequent in the age group between 21 and 30 years old, upper limbs were more affected and medical aid was usually provided within two hours. Men and women were equally affected. Regarding severity, ten patients were classified as Class I and three patients as Class II according to the Scorpion Consensus Expert Group. Local manifestations were present in all patients, being pain the most common symptom. Mild systemic manifestations including nausea, vomiting, somnolence, malaise and prostration were observed in three victims. Symptomatic treatment of pain was offered to all patients, and only one received specific antivenom. All victims had a favorable outcome. Conclusions To the best of our knowledge, this study is the first to report the systemic symptomatology of envenomation by T. silvestris in the Brazilian Amazon, highlighting the medical relevance of the species in this region. Further research on the venom and clinical manifestations of envenomation by T. silvestris should be conducted in order to verify the relevance of this species to public health.(AU)

Scorpionism by Tityus silvestris in eastern Brazilian Amazon

Scorpionism is a serious public health problem in Brazil. Although cases of envenomation by scorpions are frequent in Brazil, Tityus silvestris found throughout the Amazon region is considered of minor medical significance and with only a few descriptions in the literature. This article aims to describe for the first time the epidemiological characteristics and clinical manifestations of scorpion stings by T. silvestris that occurred in eastern Brazilian Amazon. Methods A prospective and observational study was carried out on 13 confirmed cases of T. silvestris envenomation registered from 2007 to 2011 in the cities of Belém and Ananindeua, Pará state, Brazil. Results The stings occurred mainly during daytime, at domiciliary environment, and the scorpions were found in clothing, fruits or vegetables. Envenomation was more frequent in the age group between 21 and 30 years old, upper limbs were more affected and medical aid was usually provided within two hours. Men and women were equally affected. Regarding severity, ten patients were classified as Class I and three patients as Class II according to the Scorpion Consensus Expert Group. Local manifestations were present in all patients, being pain the most common symptom. Mild systemic manifestations including nausea, vomiting, somnolence, malaise and prostration were observed in three victims. Symptomatic treatment of pain was offered to all patients, and only one received specific antivenom. All victims had a favorable outcome. Conclusions To the best of our knowledge, this study is the first to report the systemic symptomatology of envenomation by T. silvestris in the Brazilian Amazon, highlighting the medical relevance of the species in this region. Further research on the venom and clinical manifestations of envenomation by T. silvestris should be conducted in order to verify the relevance of this species to public health.

Hemorrhagic stroke in children caused by Bothrops marajoensis envenoming: a case report

According to the World Health Organization, snakebites are considered neglected diseases. Bothrops, the genus most frequently implicated in envenomations in Brazil, includes the species B. marajoensis Hoge, 1966, part of the complex B. atrox, which is found in the savannas of Marajó Island, Pará state, Brazil, a region that presents scarce epidemiological data. This work reports the first case of hemorrhagic stroke in a child, attributed to delayed medical care after snakebite envenoming by Bothrops marajoensis in Anajás city, Marajó Island, Pará, Brazil, which led to permanent hemiplegia as a sequela.

Hemorrhagic stroke in children caused by Bothrops marajoensis envenoming: a case report

According to the World Health Organization, snakebites are considered neglected diseases. Bothrops, the genus most frequently implicated in envenomations in Brazil, includes the species B. marajoensis Hoge, 1966, part of the complex B. atrox, which is found in the savannas of Marajó Island, Pará state, Brazil, a region that presents scarce epidemiological data. This work reports the first case of hemorrhagic stroke in a child, attributed to delayed medical care after snakebite envenoming by Bothrops marajoensis in Anajás city, Marajó Island, Pará, Brazil, which led to permanent hemiplegia as a sequela.(AU)

Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases / Envenenamento por coral do gênero Micrurus na Amazônia brasileira: relato de dois casos

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.

Dois acidentes por coral verdadeira são descritos em Belém, Pará. O primeiro caso foi decorrente de envenenamento por Micrurus surinamensis, no qual a vítima necessitou ventilação mecânica por insuficiência respiratória. O segundo, causado por Micrurus filiformis, apresentou apenas manifestações leves. Ambos os pacientes receberam soro antielapídico específico e evoluíram sem complicações. Acidentes por coral verdadeira na região Amazônica são raramente descritos e podem cursar com um largo espectro de alterações, que variam desde quadros de envenenamento muito leves até manifestações com risco de óbito.

Intoxicações por agentes químicos em adolescentes / Adolescents chemical poisonings

descrever as intoxicações por agentes químicos em adolescentes notificadas ao CIT-Belém.Método: estudo transversal analítico das 491 ocorrências de intoxicações por agentes químicos emadolescentes notificados ao Centro de Informações Toxicológicas de Belém (CIT-Belém), período de marçode 1998 a março de 2006. A análise foi feita no programa Epi-Info 6.04 e a apresentação em tabelas noOpenOffice.org 2.2.0. Resultados: de todas as causas de intoxicações registradas no serviço, 491(5,5%)foram por agentes químicos em adolescentes. Destes, 71,3% corresponderam à faixa etária tardia (15 a 19anos) e 68,8%, ao sexo feminino. A tentativa de suicídio contou com 44,6%. Os medicamentos e raticidasforam responsáveis por 36,1% e 30,6% dos casos, respectivamente. A maioria evoluiu para cura (60,1%).Considerações finais: a evolução emocional e cognitiva, provavelmente, diminui as intoxicações acidentaistípicas da faixa pediátrica e amadurecem a concepção de morte, tornando-a um possível escape para osproblemas dos adolescentes

describing adolescents' chemical poisoning informed to CIT-Belém. Method: analytic study ofchemical poisoning in adolescents registered in the database of the ?Centro de Informações Toxicológicas?(CIT-Belém), in a period that goes from March 1998 to March 2006. The analysis was performed in the Epi-Info 6.04 software and the table's presentation in OpenOffice.org Calc 2.2.0. Results: from all the causes ofthe poisonings in adolescents registered in the service, 491 (5.5%) had a chemical nature. Out of this amount,71.3% corresponded to late adolescence (ages 15-19) and 68.8% to female adolescents. Suicide attemptscounted on 44.6% of the cases. Medicines and rodenticides were responsible for 36.1% and 30.6% of thecases, respectively. The most common outcome was cure (60.1%). Conclusion: the emotional and cognitiveevolution probably diminishes the typical accidental poisonings in pediatric age, and ripens the concept ofdeath, turning it into a possible escape for adolescents' problems

Envenomation caused by the consumption of pufferfish liver / Intoxicação causada por consumo de fígado de baiacu

to report case of poisoning by consumption of the liver of the fresh water baiacu(puffer fish), reported in Toxicological Information Center (CIT) in Belém, Pará, whichoccurred in 2008. Case report: female, 37 years, in July 2008, after ingestion of liver of themarine baiacu presented continuous emesis, gastric fullness, dyspnea, cephalalgia, dizziness,sialorrhea, dysphagia and paresthesia in the lower limbs. Symptomatic treatment was indicated,treatment support, gastric lavage, activated charcoal, saline cathartic and clinical care. Whencured, patient was discharged. Final Considerations: alert health professionals to the risks ofconsumption of aquatic poisonous animals.

relatar caso de intoxicação pelo consumo do fígado do peixe baiacú (Colomesusasellus), descrevendo a sintomatologia dos agravos ocorridos com a paciente notificada noCentro de Informações Toxicológicas (CIT) em Belém-Pará, ocorrido no ano de 2008. Relatode caso: sexo feminino, 37 anos, apresentou em 14 de julho de 2008 êmese incoercível,indigestão, dispneia, cefaleia, tontura, sialorreia intensa, dificuldade de deglutição e parestesianos membros inferiores. A paciente havia ingerido fígado do baiacu, peixe venenoso. Foiindicado tratamento sintomático, tratamento de suporte, lavagem gástrica, carvão ativado,catártico salino e observação clinica. A paciente evoluiu com alta médica. Consideraçõesfinais: alertar os profissionais de saúde para os riscos do consumo de animais marinhosvenenosos

Acidente vascular cerebral hemorrágico associado à acidente ofídico por serpente do gênero bothrops: relato de caso / Hemorrhagic stroke related to snakebite by bothrops genus: a case report

Este trabalho tem como objetivo relatar um caso de acidente vascular cerebral hemorrágico, associado à acidente ofídico por serpente do gênero bothrops e hipertensão arterial sistêmica grave. Apesar do ofidismo botrópico ser frequente no Estado do Pará, tais associações são incomuns, necessitando de uma abordagem especializada e precoce, visando menores complicações.

This research reports a clinical case of hemorrhagic stroke due to envenomation by bothrops snakebite associated with severe hypertension. Although bothrops snakebites are frequent in the State of Pará, such associations are uncommon, requiring specialized and early management to avoid severe complications.