Epidemiologic and clinical survey of victims of centipede stings admitted to Hospital Vital Brazil (São Paulo, Brazil).

We retrospectively analyzed 98 proven cases of centipede stings admitted to Hospital Vital Brazil, Butantan Institute, São Paulo, Brazil, between 1990 and 2007. Most stings occurred at the metropolitan area of São Paulo city (n=94, 95.9%), in the domiciles of patients (n=67, 68.4%), and during the warm-rainy season (n=60, 61.2%). The mean age of the victims was 32.0+/-18.8-years-old. Cryptops and Otostigmus genera were responsible for most cases. Around 86% of the patients sought medical care within 6h after the sting. Both lower (56.1 %) and upper limbs (41.8 %) were most frequently bitten, especially the feet and hands (89.8%). The most frequent local clinical manifestations were pain (94.9%), erythema (44.9%) and edema (21.4%), and the latter was mainly observed in patients bitten by Otostigmus spp. Supportive treatment was used in only 28.6% of the patients, namely administration of local anesthesia (9.2%) and systemic analgesia (13.3%). No sequels or complications were observed in patients, and the prognostic was benign.

Failure of chloramphenicol prophylaxis to reduce the frequency of abscess formation as a complication of envenoming by Bothrops snakes in Brazil: a double-blind randomized controlled trial.

Bites by many species of venomous snake may result in local necrosis at, or extending from, the site of the bite. The use of prophylactic antibiotics to prevent infection as a complication of local necrotic envenoming is controversial. A double-blind randomized controlled trial was carried out to assess whether antibiotic therapy is effective in this situation. Two hundred and fifty-one patients, with proven envenoming by snakes of the genus Bothrops, admitted to two hospitals in Brazil, between 1990 and 1996, were randomized to receive either oral chloramphenicol (500 mg every six hours for five days) or placebo. One hundred and twenty-two of these patients received chloramphenicol (group 1) and 129 were given placebo (group 2). There were no significant differences between the groups at the time of admission. Necrosis developed in seven (5.7%) patients in group 1 and in five (3.9%) patients in group 2 (P>0.05) while abscesses occurred in six patients (4.9%) in group 1 and in six (4.7%) patients in group 2 (P>0.05). In conclusion, the use of orally-administered chloramphenicol for victims of Bothrops snake bite with signs of local envenoming on admission, is not effective for the prevention of local infections.

The calcium-dependent protease of Loxosceles gaucho venom acts preferentially upon red cell band 3 transmembrane protein.

Eighty micrograms red blood cell (RBC) ghosts from patients who had previously exhibited the cutaneous form of loxoscelism (presenting localized dermonecrosis) and the viscerocutaneous form of loxoscelism (presenting dermonecrosis, hemoglobinuria, hematuria, and jaundice) and from controls were incubated with 2.5 microg crude Loxosceles gaucho venom in 5 mM phosphate buffer, pH 7.4, at 37 C. Among all membrane proteins, quantitative proteolysis of the important integral transmembrane protein 3 increased with venom dose and with incubation time from 30 to 120 min, as demonstrated by gel densitometry. Similar quantitative data were obtained for RBC ghosts from patients and from control subjects, a fact that argues against the possibility of genetic factors favoring the hemolytic viscerocutaneous form. These data suggest that the clinical forms may be different types of the same disease, with the viscerocutaneous form being the result of large amounts of intravascularly injected venom and the superficial form being the result of in situ venom action. Since protein 3 is a housekeeping integral membrane protein, whose genetic deficiency leads to hemolytic anemia, it is reasonable to relate it to the hemolysis which occurs in the viscerocutaneous form of loxoscelism. The venom protease responsible for the process was not inhibited after 120-min incubation by 0.2 mM paramethylsulfonyl fluoride or by 0.2 mM N-ethylmaleimide but was inhibited by 25 mM ethylenediaminetetraacetic acid (a calcium-chelating agent) in 5 mM phosphate buffer at pH 7.4, which suggests that the enzyme is a calcium-dependent metalloprotease.

The calcium-dependent protease of Loxosceles gaucho venom acts preferentially upon red cell band 3 transmembrane protein

Eighty micrograms red blood cell (RBC) ghosts from patients who had previously exhibited the cutaneous form of loxoscelism (presenting localized dermonecrosis) and the viscerocutaneous form of loxoscelism (presenting dermonecrosis, hemoglobinuria, hematuria, and jaundice) and from controls were incubated with 2.5 æg crude Loxosceles gaucho venom in 5 mM phosphate buffer, pH 7.4, at 37ºC. Among all membrane proteins, quantitative proteolysis of the important integral transmembrane protein 3 increased with venom dose and with incubation time from 30 to 120 min, as demonstrated by gel densitometry. Similar quantitative data were obtained for RBC ghosts from patients and from control subjects, a fact that argues against the possibility of genetic factors favoring the hemolytic viscerocutaneous form. These data suggest that the clinical forms may be different types of the same disease, with the viscerocutaneous form being the result of large amounts of intravascularly injected venom and the superficial form being the result of in situ venom action. Since protein 3 is a housekeeping integral membrane protein, whose genetic deficiency leads to hemolytic anemia, it is reasonable to relate it to the hemolysis which occurs in the viscerocutaneous form of loxoscelism. The venom protease responsible for the process was not inhibited after 120-min incubation by 0.2 mM paramethylsulfonyl fluoride or by 0.2 mM N-ethylmaleimide but was inhibited by 25 mM ethylenediaminetetraacetic acid (a calcium-chelating agent) in 5 mM phosphate buffer at pH 7.4, which suggests that the enzyme is a calcium-dependent metalloprotease

Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital.

The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming (P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations < or = 1.5 g/L (P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet (P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs > or = 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.

Myocardial necrosis after envenomation by the scorpion Tityus serrulatus.

A 4 years old boy died a few hours after he had been stung by a scorpion (Tityus serrulatus). At necropsy, there were multiple foci of coagulative myocytolysis in the myocardium and pulmonary oedema. Myocardial necrosis was probably associated with the sympathetic storm induced by scorpion envenomation, and may have contributed to cardiac failure and death.

Loxoscelismo: estudo de 242 casos (1980-1984) / Loxoscelism: study of 242 cases (1980-1984)

Foram analisados 242 acidentes atribuídos a aranhas do gênero Loxosceles Heinecken & Lowe atendidos no Hospital Vital Brazil do Instituto Butantan (1980-1984). L. gaucho Gertsch foi o agente agresssor mais comum e a espécie capturada com maior frequência nos locais de acidente vistoriados. L. laeta e L. intermedia Mello-Leitäo também estiveram representados no material estudado. Noçöes de reconhecimento e biologia dessas aranhas assim como a distribuiçäo geográfica das espécies brasileiras foram incluídas, para orientaçäo de médicos e pessoal relacionado a acidentes por animais peçonhentos. Os sinais característicos de síndrome loxoscélica e sua frequência na casuística em estudo foram mencionados e uma comparaçäo foi feita com dados correspondentes encontrados na literatura sulamericana

Acidentes do trabalho por animais peçonhentos / Occupational accidents by poisonous animals

Os autores analisaram 2757 prontuários do Hospital Vital Brazil relativos aos atendimentos feitos durante o ano de 1983. Foram encontrados 561 casos de ofidismo (20,3% dos atendimentos), 1136 casos de araneísmo (41,2%) e 390 casos de escorpionismo (14,1%). Os restantes (24,4%) foram atendimentos de picadas de abelhas, outros insetos, dermatites por taturanas etc. Dos 561 casos de ofidismo, 247 foram por Bothrops (44%), 19 por Crotalus (3,4%), 1 por Micrurus (0,2%), 294 por serpentes näo peçonhentas e/ou näo picadas (52,3%). Dos casos de ofidismo, 64,1% eram maiores de 18 anos e destes , 77% do sexo masculino. Os autores chamam a atençäo para os casos de acidentes do trabalho: 135 casos, o que representa 24% e registram acidentes ocorridos em menores de idade: 10,4%. É feita uma descriçäo das ocupaçöes mais atingidas, estando os lavradores em primeiro lugar. Foram encontrados 1136 casos de araneísmo (41,2%), 680 casos foram picados por Phoneutria (59,8%), 62 casos por Loxosceles (5,4%), 134 por Lycosa (11,9%), 35 casos por outras aranhas (3,1%) e 225 (19,8%) por araneísmo provável. Dos casos de araneísmo, 780 foram em adultos (68,7%) e destes, 459 do sexo masculino (58,8%). Foram caracterizados 131 casos de acidentes do trabalho (11,5%), sendo que 6 ocorreram em menores de idade. As atividades de maior risco foram a lavoura, o manuseio e comércio de bananas e a construçäo civil. Dos 390 casos de escorpionismo, 69,3% ocorreram em adultos e destes, 62,7% do sexo masculino. Foram caracterizados 48 casos de acidentes do trabalho, que representam 12,3%, sendo que 5 atingiram menores de idade (8,6%). A atividade de maior risco foi a construçäo civil

Acidentes do trabalho por animais peçonhentos

Os autores analisaram 2757 prontuários do Hospital Vital Brazil relativos aos atendimentos feitos durante o ano de 1983. Foram encontrados 561 casos de ofidismo (23.3% dos atendimentos), 1136 casos de araneismo (41.2%) e 390 casos de escorpionismo (14.1%). Os restantes (24,4%) foram atendimentos de picados de abelhas, outros insetos, dermatites de taturanas, etc. Dos 561 casos de ofidismo, 247 foram por Bothrops (44%), 19 por Crotalus (3.4%), 1 por Micrurus (0.2%), 294 por serpentes näo peçonhentas e/ou näo picados (52.3%). Dos casos de ofidismo, 64.1% eram maiores de 18 anos e destes, 77% do sexo masculino. Os autores chamam a atençäo para os casos de acidentes do trabalho: 135 casos, o que representa 24% e registram acidentes ocorridos em menores de idade: 10.4%. É feita uma descriçäo das ocupaçöes mais atingidas, estando os lavradores em primeiro lugar. Foram encontrados 1136 casos de araneismo (41.2%), 680 casos foram picados por Phoneutria (59.8%), 62 casos por Loxosceles (5.4%), 134 por Lycosa (11.9%), 35 casos por outras aranhas (3.08%) e 225 (19.8%) por araneismos provavel. Dos casos de araneismo, 780 foram em adultos (68.7%) e destes, 459 do sexo masculino (58.8%). Foram caracterizados 131 casos de acidentes do trabalho (11.5%), sendo que 6 ocorreram em menores de idade. As atividades de maior risco foram a lavoura, o manuseio e comercio de bananas e a construçäo civil. Dos 390 casos de escorpionismo, 69.3% ocorreram em adultos e destes, 62.7% do sexo masculino. Foram caracterizados 48 casos de acidentes do trabalho, que representam 12.3%, sendo que 5 atingiram menores de idade (8.6%). A atividade de maior risco foi a construçäo civil