Envenoming by the rattlesnake Crotalus durissus ruruima in the state of roraima, Brazil.

The aim of this study was to evaluate the clinical-epidemiological factors associated with victims of rattlesnake envenoming in the state of Roraima, Brazil. In this location, rattlesnake accidents are caused by the subspecies Crotalus durissus ruruima. This is a prospective observational study carried out at the General Hospital of Roraima from april 2017 until july 2018. A total of 37 alleged rattlesnake victims had their medical records evaluated. However only one of them proved to be by C. d. ruruima. All individuals were residents from the savannas (lavrados) of Roraima. The town of Bonfim on the border between Brazil and Guyana had the highest occurrence of rattlesnake bites. The most affected group were males aged 13-20 years and farmers. The highest number of incidents occurred during daytime and lower limbs (feet) were the most major affected part of the body. Tourniquets were used as first aid after snake envenoming in 32.4% of victims. Out of 37 patients, 16.2% were classified as severe cases of snakebite envenoming and in 5.4% dry bites seem to have occurred. Among the symptomatic patients, 100% presented local manifestations and 70.3% presented systemic manifestations. The clinical setting showed local effects such as pain and edema while the systemic effects were blurred vision, myalgias, myasthenic facies, palpebral ptosis, muscle weakness and headache. Laboratory results of aspartate aminotransferase (62.2%), creatine phosphokinase (51.3%), lactic dehydrogenase (37.8%), urea level (32.4%) and serum creatinine (29.7%) were increased significantly in relation to the reference standards. In 16.2% of the cases, the victims presented acute kidney injury. Patients were treated with anticrotalic serum in 70.3% of the cases and antibotropic + anticrotalic serum in 24.3%. The victims of C. d. ruruima in Roraima showed a local symptomatology similar to Bothrops envenoming, while systemic symptoms and laboratory analysis proved kidney and muscular injuries, similar to envenoming by Crotalus d. terrificus in Brazil.

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.

Determination of hyaluronidase activity in Tityus spp. Scorpion venoms and its inhibition by Brazilian antivenoms.

Hyaluronidases (HYALs) are enzymes ubiquitously found in venoms from diverse animals and seem to be related to venom spreading. HYAL activity might be important to Tityus spp. envenoming, since anti-Tityus serrulatus HYAL (TsHYAL) rabbit antibodies neutralize T. serrulatus venom (TsV) lethality. The present work aimed to verify and compare HYAL activity of venoms from other Brazilian Tityus spp. (Tityus bahiensis, Tityus stigmurus and Tityus obscurus) and to test whether anti-TsHYAL antibodies and Brazilian horse therapeutic scorpion antivenom (produced by Fundação Ezequiel Dias (FUNED), Butantan and Vital Brazil Institutes) can recognize and inhibit HYAL activity from these venoms. In ELISA assays, anti-TsHYAL and scorpion antivenoms recognized T. serrulatus, T. bahiensis and T. stigmurus venoms, however, they demonstrated weaker reaction with T. obscurus, which was also observed in Western blotting assay. Epitope mapping by SPOT assay revealed different binding patterns for each antivenom. The assay showed a weaker binding of scorpion antivenom produced by FUNED to peptides recognized by anti-TsHYAL antibodies. Anti-TsHYAL antibodies and antivenoms produced by Butantan and Vital Brazil institutes inhibited HYAL activity of all tested venoms in vitro, whereas FUNED antivenom did not show the same property. These results call attention to the importance of hyaluronidase inhibition, that can aid the improvement of antivenom production.