ABSTRACT
In Argentina scorpion stings are the leading cause of venom-related injury to human. Since the beginning of the 20th century Tityus trivittatus is found in Buenos Aires. Scorpion envenomation is a neurotoxic syndrome with local symptoms and systemic manifestations. It could develop cardiac failure, acute pulmonary edema, shock and death. Fortunately, most of the scorpion stings in adult people in Buenos Aires are mild envenomations. A retrospective, descriptive and cross sectional study based on data collected from medical records of patients followed between 1982 and 2013 were done. We compiled a total of 141 human scorpion stings and 115 arthropod captures: 88 T. trivittatus, 10 Bothriurus bonariensis and 17 missed data. The accidents occurred more frequently in the eastern and oldest neighborhoods of the city. Eighteen patients had mild systemic manifestation. There was not any death. Twelve patients received scorpion antivenom. Although recently there was a severe case in 5 years old boy and in some provinces in Argentina death have been reported, most of the envenomations are mild. We observed inadequate treatment in some patients; it is important training on the correct management and prevention of this envenomation.
En Argentina el escorpionismo es el principal envenenamiento por animales ponzoñosos. Desde comienzos del siglo XX, Tityus trivittatus ha sido descripto en Buenos Aires. El escorpionismo es una intoxicación que produce un síndrome neurotóxico con síntomas locales y manifestaciones sistémicas. Puede desencadenar insuficiencia cardiaca, edema agudo de pulmón, shock y muerte. Afortunadamente, la mayoría de los accidentes con escorpiones en adultos en Buenos Aires son intoxicaciones leves. Se realizó un estudio retrospectivo, descriptivo y transversal basado en información recolectada de las historias clínicas desde 1982 hasta 2013. Se recolectó información sobre un total de 141 intoxicaciones por escorpiones y 115 capturas de artrópodos: 88 T. trivittatus, 10 Bothriurus bonariensis y 17 sin identificar. Los accidentes sucedieron más frecuentemente en los barrios del este y más antiguos de la ciudad. Dieciocho pacientes tuvieron síntomas sistémicos leves. No hubo ninguna muerte. Doce pacientes recibieron antiveneno. La mayoría de los envenenamientos fueron leves, aunque recientemente se produjo un caso grave en un niño de 5 años y en algunas provincias se han registrado muertes. Hemos observado un tratamiento inadecuado en algunos pacientes por lo que consideramos que sería importante capacitar en el correcto manejo y prevención de este envenenamiento.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Scorpion Stings/epidemiology , Argentina/epidemiology , Urban AreaABSTRACT
Se describe el caso de un paciente de 32 años de edad, residente en Buenos Aires, con manifestaciones dermatológicas compatibles con gnathostomiasis. Había realizado un viaje a Colombia en el mes previo a la aparición de la sintomatología. Allí consumió cebiche (pescado crudo marinado en jugo de limón) en reiteradas oportunidades. El cuadro clínico se presentó como paniculitis eritematosa y migratoria acompañada de eosinofilia sanguínea. Se le realizó biopsia cutánea de una lesión y el diagnóstico anatomopatológico fue "paniculitis eosinofílica". La tríada de paniculitis migratoria, eosinofilia sanguínea y el consumo de pescado crudo durante el viaje a Colombia fue sugestiva de gnathostomiasis por lo que se indicó tratamiento con ivermectina con buena evolución inicial y recaída posterior. Se realizó un nuevo tratamiento con la misma droga con buena evolución y sin recaídas durante tres años de seguimiento. La afección dermatológica es un motivo frecuente de consulta al regreso de un viaje, y representa la tercera causa de morbilidad en viajeros. Es muy importante el reconocimiento de las enfermedades que pueden tener manifestación cutánea, ya que muchas de ellas son potencialmente graves y pueden poner en riesgo la vida del paciente si no son oportunamente diagnosticadas y tratadas.
We describe a case of a 32-year-old man, resident in Buenos Aires, with dermatologic manifestations compatible with gnathostomiasis. The patient had traveled to Colombia in the month prior to the onset of symptoms. There, he repeatedly ate ceviche (raw fish marinated in lemon juice). He presented with an erythematous migratory panniculitis accompanied by eosinophilia. He underwent skin biopsy of a lesion and pathological diagnosis was "eosinophilic panniculitis". The triad of migratory panniculitis, eosinophilia and consume of raw fish during the trip to Colombia was suggestive of gnathostomiasis. Ivermectin treatment started out with good initial response but subsequent relapse. We performed a new treatment with the same drug with good results and no relapses during three years of follow up. The dermatological disease is common upon return from a trip, and is the third leading cause of morbidity in travelers. It is very important to recognize cutaneous manifestations of disease as many of them are potentially serious and may compromise the patient's life if not promptly diagnosed and treated.
Subject(s)
Adult , Animals , Humans , Male , Fishes/parasitology , Foodborne Diseases/parasitology , Gnathostomiasis/parasitology , Skin Diseases, Parasitic/parasitology , Gnathostoma/parasitology , Panniculitis/parasitology , TravelABSTRACT
Despite the great number of spiders in the world, only a small group of them is capable of producing death in humans. In Argentina, there are only three of the four genera of spiders considered of high risk to humans: Latrodectus is present in rural areas, Phoneutria is restricted to small regions while Loxosceles is distributed throughout the country. Accidents by Loxosceles represent around 4 percento of the total number produced by venomous animals in Argentina. The bite is accidental and may produce considerable local necrosis with scar formation and ulcers of slow and difficult healing that may require surgical repair. Some bitten people may suffer from intravascular hemolysis, disseminated coagulation and acute renal insufficiency leading to death. Despite the great number of studies performed on Loxosceles venoms, at present, the physiopathological course of poisoning is not clear and there is not common criteria for its treatment. In this review, biological and epidemiological data of this spider are described as well as the venom composition and the possible participation of its components in the poisoning. These data provide biological and biochemical tools to understand the course of poisoning and to have better criteria for the treatment andon