Caracterización clínica y epidemiológica de 200 pacientes con loxoscelismo cutáneo y cutáneo visceral / Loxoscelism: experience in 200 patients

Background: Loxoscelism is an important public health problem in Chile and South America, due to the higher rate of cutaneous-visceral involvement. The diagnosis of loxoscelism is mostly clinical without established diagnostic criteria. There is little evidence to support any treatment used in this condition. Aim: To characterize the clinical features and epidemiology of loxoscelism among patients consulting at the Emergency and Dermatology Services of a clinical hospital between 2013 and 2017. Material and Methods: Review of medical records of patients registered in the electronic clinical record system with a confirmed diagnosis of loxoscelism. Epidemiological, clinical, laboratory tests and treatment variables were analyzed. Results: We reviewed data from 200 patients. Ninety-four percent presented cutaneous loxoscelism and 5.5% cutaneous-visceral loxoscelism. Systemic symptoms were present in 73% of patients with cutaneous-visceral loxoscelism. Patients who developed systemic symptoms had an 18 times higher risk of developing cutaneous-visceral loxoscelism. Laboratory abnormalities were more common in patients with cutaneous-visceral loxoscelism. Not all patients with hematuria had cutaneous-visceral loxoscelism. Most patients required analgesia. Anti-loxosceles serum was not used in any patient. Conclusions: Many questions remain to be answered regarding the diagnosis and treatment of the disease. Studies are required to validate diagnostic criteria for loxoscelism, predictors for visceral involvement and response to treatment.

Neuroactive venom compounds obtained from Phlogiellus bundokalbo as potential leads for neurodegenerative diseases: insights on their acetylcholinesterase and beta-secretase inhibitory activities in vitro

Spider venom is a rich cocktail of neuroactive compounds designed to prey capture and defense against predators that act on neuronal membrane proteins, in particular, acetylcholinesterases (AChE) that regulate synaptic transmission through acetylcholine (ACh) hydrolysis - an excitatory neurotransmitter - and beta-secretases (BACE) that primarily cleave amyloid precursor proteins (APP), which are, in turn, relevant in the structural integrity of neurons. The present study provides preliminary evidence on the therapeutic potential of Phlogiellus bundokalbo venom against neurodegenerative diseases. Methods Spider venom was extracted by electrostimulation and fractionated by reverse-phase high-performance liquid chromatography (RP-HPLC) and characterized by matrix-assisted laser desorption ionization-time flight mass spectrometry (MALDI-TOF-MS). Neuroactivity of the whole venom was observed by a neurobehavioral response from Terebrio molitor larvae in vivo and fractions were screened for their inhibitory activities against AChE and BACE in vitro. Results The whole venom from P. bundokalbo demonstrated neuroactivity by inducing excitatory movements from T. molitor for 15 min. Sixteen fractions collected produced diverse mass fragments from MALDI-TOF-MS ranging from 900-4500 Da. Eleven of sixteen fractions demonstrated AChE inhibitory activities with 14.34% (± 2.60e-4) to 62.05% (± 6.40e-5) compared with donepezil which has 86.34% (± 3.90e-5) inhibition (p > 0.05), while none of the fractions were observed to exhibit BACE inhibition. Furthermore, three potent fractions against AChE, F1, F3, and F16 displayed competitive and uncompetitive inhibitions compared to donepezil as the positive control. Conclusion The venom of P. bundokalbo contains compounds that demonstrate neuroactivity and anti-AChE activities in vitro, which could comprise possible therapeutic leads for the development of cholinergic compounds against neurological diseases.(AU)

Elaboración y validación de una regla de predicción clinica para identificar compromiso sistemico en casos de loxoscelismo / Preparation And Validation Of A Systemic Loxoscelism Prediction Protocol

Introducción: El loxoscelismo sistémico es la complicación más severa del loxoscelismo. El manejo del cuadro por parte del personal de salud presenta una alta variabilidad por factores que se desconocen actualmente. No se cuenta con un estándar de referencia ni con un modelo de predicción clínica que pueda guiar nuestras decisiones al momento del abordaje de un paciente con mordedura de araña. Objetivo: Elaborar y validar una regla de predicción clínica para loxoscelismo sistémico. Métodos: Se llevó a cabo un estudio observacional de derivación y validación de un modelo de predicción clínica con validación de prueba diagnóstica basada en una cohorte histórica de un solo brazo en pacientes atendidos en el Hospital Vitarte entre los años 2007 al 2016 y reportes clínicos internacionales publicados. Resultados: El loxoscelismo sistémico se presentó solo en el 32,9 % (n=24) de casos. Para el análisis bivariado, las variables que demostraron presentar una asociación estadísticamente significativa (P<0,05) fueron el sexo, mordedura en abdomen independiente en relación a otras partes del cuerpo, mordedura en otras partes del cuerpo que no sea el abdomen, vómito, fiebre y hemoglobinuria. El análisis de regresión incluyó en el análisis a las variables: sexo, vómito, fiebre y hemoglobinuria. El bootstrapping determinó la validez interna del modelo. El área bajo la curva fue de 0,91 (P<0,05) y la sensibilidad, espeficidad, LR+ y LR- fueron de 79,1%, 93,8%, 12,9 y 0,22 respectivamente. Conclusiones: El protocolo de predicción del loxoscelismo sistémico derivado es válido, por el momento.

Introduction: Systemic loxoscelism is the most severe complication of loxoscelism. The management of the cadre by health personnel presents a high variability due to factors that are currently unknown. There is no standard of reference or a clinical prediction model that can guide our decisions when approaching a spider bite patient. Objective: Develop and validate a clinical prediction rule for systemic loxoscelism. Methods: An observational study of derivation and validation of a clinical prediction model was carried out with diagnostic test validation based on a historical single-arm cohort in patients treated at Vitarte Hospital between 2007 and 2016 and international clinical reports published. Results: Systemic loxoscelism occurred only in 32.9% (n = 24) of cases. For the bivariate analysis, the variables that showed a statistically significant association (P <0.05) were sex, bite in an independent abdomen in relation to other parts of the body, bite in other parts of the body than the abdomen, vomiting , fever and hemoglobinuria. The regression analysis included in the analysis the variables: sex, vomit, fever and hemoglobinuria. Bootstrapping determined the internal validity of the model. The area under the curve was 0.91 (P <0.05) and the sensitivity, specificity, LR + and LR- were 79.1%, 93.8%, 12.9 and 0.22 respectively. Conclusions: The protocol of prediction of systemic derived loxoscelism is valid, for the moment.

Acute generalized exanthematous pustulosis associated with spider bite

Abstract: Acute generalized exanthematous pustulosis (AGEP) is an acute febrile rash, usually induced by drugs, which recently has been linked to spider bite. We report a case of a male patient, 48 years old, with an erythematous rash accompanied by fever and small non-follicular pustules. He reported previous pain in the buttock with the onset of a necrotic plaque. The lesion was compatible with spider bite of the genus Loxosceles. According to the EuroSCAR group instrument, the patient scored +10 indicating definite diagnosis of AGEP. As the patient had a compatible lesion and had no other triggers of AGEP, in an Loxosceles endemic area, the AGEP would be associated with spider bite, as described in other publications.

A Case Report of Spider Bite by Tarantula

A total of 631 species of spiders have been reported in Korea. However, there are no spiders with noxious venom such as Latrodectus sp. Because of this, to date, no serious medical problems due to spider bites have been reported in Korea, and only two cases of spider bite were officially reported. However, as the number of earning spiders from other countries is increased, the number of cases of spider bite has also shown a recent increase. A 17-year-old man presented with numbness of both extremities after being bitten by a spider which he had as a pet. The spider is called an Indian ornamental tree spider (Poecilotheria regalis sp.), one kind of tarantula species. Herein, we report on a case of a spider bite by a tarantula.

Progress in research of the spider toxin’s biological activity / 中国药理学通报

There are a wide variety of spiders on the earth and most them can secrete venom,which contains a variety of chemi-cal compositions that have multiple influences on organism be-sides toxic effects.The pharmacological efficiency includes cardi-ovascular and cerebrovascular activities,analgesic activities,an-tibacterial and anticancer activities etc.Ion channels are one of the important targets of spider toxins.They act on different ion channels,such as potassium channel,calcium channel and differ-ent subtypes of sodium channels.Therefore the spider toxins pres-ent different pharmacological activities and potential medicinal value.The venoms of spiders are less well studied than those from other venomous taxa such as conotoxin,scorpions and snakes etc. However,in recent years,spider toxins are turning to a new hot subject in related research areas.This review summarizes the lat-est progress in biological activities of spider toxins as well as its application in medical practice and development.

Perfil dos acidentes causados por aranhas na área de abrangência sanitáriado município de juiz de fora - MG / Parachnidism epidemiology in Juiz de Fora, Minas Gerais, Brazil

= 348), com evolução para a cura em 82,3% (n = 357) doscasos. Os indivíduos acometidos eram, frequentemente,O araneísmo constitui um problema de saúde pública. Osgêneros Phoneutria, Loxosceles e Latrodectus são referenciadosna literatura como responsáveis por cerca de 81,0% dosacidentes causados por animais peçonhentos que ocorremem nosso país, representando cerca de 5000 acidentes/ano. O município de Juiz de Fora/MG situa-se em áreaendêmica para estes animais. Assim, o objetivo deste estudofoi verificar o perfil dos acidentes causados por aranhasna área de abrangência sanitária do município de Juiz deFora. Tratou-se de um estudo descritivo e retrospectivodo araneísmo entre janeiro de 2002 e dezembro de 2007.Os dados foram obtidos a partir do Sistema de Informaçãode Agravos de Notificação (SINAN), disponíveis noDepartamento de Vigilância Epidemiológica de Juiz deFora e analisados com o auxílio do Programa StatisticalPackage for the Social Sciences, versão 14.0. Foram registradas1500 notificações de acidentes causados por animaispeçonhentos, dos quais 28,9% (n = 434) foram provocadospor aranhas. O gênero Phoneutria foi responsável por 45,4%(n = 197) dos casos e Loxosceles, por 5,1% (n = 22) e, em39,2% dos casos, o gênero do animal foi ignorado. A maioriados acidentes (80,2%) ocorreu no município sede, compredominância da zona urbana (50,0%, n = 217) sobre arural (46,5%; n = 202). A maior parte das vítimas (52,1%;n = 226) foi atendida em até 3 horas após o acidente. Osmembros superiores foram os mais atingidos (44,6%; n =193), com destaque para os dedos da mão (24,7%; n = 107).A soroterapia foi realizada em apenas 3,2% (n = 14) doscasos. Os acidentes leves foram mais frequentes (80,2%, ndo sexo masculino (66,6%; n = 289), raça branca (23,7%;n = 103) e possuíam de 4 a 7 anos de estudo em 8,1% (n= 348), com evolução para a cura em 82,3% (n = 357) doscasos. Os indivíduos acometidos eram, frequentemente,= 35) das notificações. Indivíduos com idades entre 16 e60 anos foram acometidos em 72,6% (n = 315) dos envenenamentos.O número de acidentes por aracnídeos naregião indica a necessidade de elaboração de estratégias decontrole e programas de prevenção de acidentes.

Factores asociados a la presentación víscero-hemolítica de loxoscelismo en el Hospital Nacional Cayetano Heredia, entre el 2000 y 2008 / Factors associated with visceral-hemolytic loxoscelism in Hospital Nacional Cayetano Heredia between 2000 and 2008

Objetivos: Determinar los factores asociados a la forma víscero hemolítica de loxoscelismo en pacientes admitidos al Hospital Nacional Cayetano Heredia y describir las características clínico epidemiológicas de esta enfermedad. Material y método: Estudio de casos y controles que incluyó a los pacientes hospitalizados en la institución indicada entre el 2000 y 2008 por loxoscelismo víscero-hemolítico (casos) y loxoscelismo cutáneo (controles), de acuerdo a definiciones operativas. Las variables fueron analizadas en un modelo de regresión logística ajustado por potenciales factores de confusión. Resultados: Se incluyeron 48 casos y 89 controles; no se encontraron diferencias en la media de las edades (33 años +/- 18 vs. 31 años +/- 20, p=0,27). En el análisis multivariado, la presentación víscero-hemolítica se asoció con la presencia de mordedura en el tórax (ORa 6,6; IC95% 1,5 a 28,7) y de manifestaciones sistémicas en las primeras 24 horas de la admisión, incluyendo fiebre (ORa 3,2; IC95% 1,3 a 8,1) y mal estado general (ORa 3,3; IC95% 1,3 a 8,1). La mortalidad fue de 18% en los casos y 0% en los controles. Conclusiones: La mordedura en tórax y la presencia de fiebre y malestado general durante las primeras 24 horas están asociadas al desarrollo de la forma víscero-hemolítica de loxoscelismo en este escenario.

Objectives: To determine clinical factors associated with the occurrence of visceral-hemolytic loxoscelism in patients admitted to Hospital Nacional Cayetano Heredia, and to describe both clinical and epidemiological features of this condition. Material and method: We conducted a case-control study including patients admitted to Hospital Nacional Cayetano Heredia in Lima, Peru, with a diagnosis of visceral-hemolytic loxoscelism (cases) and cutaneous loxoscelism (controls), between years 2000 and 2008. Variable were analyzed using a logistic regression model adjusting for potential confounding factors. Results: Forty-nine cases and 89 controls were included. Age of patients was similar in both groups (33 +/- 18 years vs. 31 +/- 20 years, p= 0,27). Visceral-hemolytic loxoscelism was associated with spider bites located in the thorax (OR: 7.3; 95% CI: 1.3-41.0) and with systemic manifestations, including fever (OR: 3.2, 95% CI: 1.3-8,1) and a poor general condition (OR: 3.3; 95% CI: 1.3-8.1). Mortality rates were 18% in cases and 0% in controls. Conclusions: Spider bites located in the thoracic area and the presence of fever and a poor general condition during the first 24 hours of hospitalization are associated with the occurrence of visceral-hemolyticloxoscelism.

Evaluación experimental de la eficiencia de una pintura repelente para arañas del género Loxosceles / Effectiveness of a repellent paint against the spider Loxosceles laeta

Background: Loxoscelism is a severe reaction to the bite of the spider Loxosceles laeta. In recent years, a paint with repellent properties has been promoted in the commerce. However, there are no reports of experiments evaluating its effectiveness. Aim: To evaluate experimentally the repellent properties of a paint against Loxosceles laeta. Material and methods: Males, females and nymphs of L laeta were deposited in cockpits that allow the free displacement of the spider. Half of the cockpit was covered with repellent paint. Daily observations during one week, determined how frequently the spiders occupied the space covered with repellent paint. The experiments were run in triplicate. Results: No statisticaldifferences in the occupancy of spaces covered with repellent paint or not covered with it were observed for nymphs (87% and 67%, respectively), males (72% and 77%, respectively) orfemales (91% and 84%, respectively). Conclusions: The tested paint does not have a repellent action against the spider Loxosceles laeta.

Caracterización clínico-epidemiológica telefónica de la mordedura por araña de rincón, en un centro de información toxicológica de Chile, durante el año 2005 / Prevalence and epidemiology of Loxosceles laeta bite. Analysis of consultations to a poison control center

Background: Loxoscelism is caused by the bite of spider Loxosceles laeta. It can cause a cutaneous or systemic syndrome. Aim: To determine the epidemiol¢gica! and clinical features of patients bitten by the Chilean recluse spider (Loxosceles laeta). Material and Methods: All communications received at a telephonic orientation center for intoxications during 2005 were analyzed, selecting those who involved patients with symptoms that suggested loxoscelism (i.e., pain, burning sensation, blue area, hematuria, fever or myalgia). These were derived to the emergency room for confirmation of the diagnosis. Forty-eight hours after the initial communication, patients were contacted by phone to find out about the definitive diagnosis. The variables analyzed were: gender, age, geographical location, time since exposure, part of the body involved, clinical signs and definitive diagnosis. Results: Of 2,831 telephonic consultations with suspected loxoscelism, the diagnosis was confirmed in 287. All of these patients had cutaneous loxoscelism and only 7.3 percent of them developed visceral loxoscelism. Fifty six percent of patients with loxoscelism presented two or more clinical signs. The most common were a blue area, pain and a burning sensation, in 69 percent, 58 percent and 38 percent of patients, respectively. Fifty-one percent of patients developed signs within the first 12 hours. All patients with visceral syndrome presented with hemoglobinuria. No cases of loxoscelism were registered in areas located southern than the Xth region of Chile. There were no fatalities attributed to loxoscelism. Conclusions: Most cases of loxoscelism of this series were cutaneous. The population must be educated about the clinical signs of spider bite to seek early and adequate medical treatment.