Accidente lonómico leve atribuido a la oruga de la especie Lonomia obliqua en el departamento de Santander, Colombia, 2021

Las orugas del género Lonomia, del orden Lepidoptera y familia Saturnidae, son de interés médico en Sudamérica por ser causantes del lonomismo, tipo de envenenamiento que aumenta cada vez más en Colombia, con tasas de mortalidad de 2,5 %. La severidad es variable y los casos no son de notificación obligatoria, lo que lleva a un subregistro de estos eventos. Se presenta el caso de una mujer adulta joven, quien acude a urgencias por la picadura de 20 orugas Lonomia en la palma de la mano izquierda; presentó signos locales inflamatorios, dolor y limitación de la movilidad de la mano. Se hospitalizó por tres días, se clasificó como leve y se trató con analgesia y antihistamínico endovenoso, lo que logró favorable evolución. El envenenamiento por oruga Lonomia es una urgencia que puede ser mortal, por tanto, es importante que se conozcan estos eventos en la literatura para su adecuado abordaje.

Caterpillars of the genus Lonomia, of the order Lepidoptera, family Saturnidae are of medical interest in South America for being the cause of lonomism, poisoning that is increasing more and more in Colombia, with mortality rates of 2.5%, the severity is variable and they are not mandatory notification, which leads to an underreporting of these events. We present the case of a young adult woman, who went to the emergency room due to the bite of 20 Lonomia caterpillars in the palm of her left hand, generating local inflammatory signs, pain and limitation of hand mobility. She was hospitalized for 3 days, classified as mild and treated with analgesia and intravenous antihistamine; which achieved favorable evolution. Therefore, it was concluded that Lonomia caterpillar poisoning is an emergency, which can be fatal. It is important that these events are known in the literature for their proper approach.

The specific impact of uremic toxins upon cognitive domains: a review / O impacto específico de toxinas urêmicas em domínios cognitivos: uma revisão

ABSTRACT One of the mechanisms proposed for chronic kidney disease (CKD)-related cognitive impairment is the accumulation of uremic toxins due to the deterioration of the renal clearance function. Cognition can be categorized into five major domains according to its information processing functions: memory, attention, language, visual-spatial, and executive. We performed a review using the terms 'uric acid', 'indoxyl sulfate', 'p-cresyl sulfate', 'homocysteine', 'interleukins' and 'parathyroid hormone'. These are the compounds that were found to be strongly associated with cognitive impairment in CKD in the literature. The 26 selected articles point towards an association between higher levels of uric acid, homocysteine, and interleukin 6 with lower cognitive performance in executive, attentional, and memory domains. We also reviewed the hemodialysis effects on cognition. Hemodialysis seems to contribute to an amelioration of CKD-related encephalopathic dysfunction, although this improvement occurs more in some cognitive domains than in others.

RESUMO Um dos mecanismos propostos para explicar o comprometimento cognitivo relacionado à doença renal crônica (DRC) é o acúmulo de toxinas urêmicas devido à deterioração da função de depuração renal. A cognição pode ser categorizada em cinco domínios principais de acordo com suas funções de processamento de informações: memória, atenção, linguagem, visual-espacial e executiva. Realizamos uma revisão usando os termos "ácido úrico", "indoxil sulfato", "p-cresil sulfato", "homocisteína", "interleucinas" e "paratormônio". Estes são os compostos que se mostraram fortemente associados ao comprometimento cognitivo na DRC na literatura. Os 26 artigos selecionados apontam para uma associação entre níveis mais elevados de ácido úrico, homocisteína e interleucina-6 com menor desempenho cognitivo nos domínios executivo, atenção e de memória. Também revisamos os efeitos da hemodiálise na cognição. A hemodiálise parece contribuir para uma melhoria da disfunção encefalopática relacionada à DRC, embora essa melhora ocorra mais em alguns domínios cognitivos do que em outros.

Lepidopterismoy erucismo en Colombia / Lepidopteism andd erucism in Cloombia

El accidente por mariposa se le conoce como erucismo y lepidopterismo dependiendo del tipo de caso. Las familias de lepidópteros que tienen importancia sanitaria en Colombia son Megalopygidae, Arctiidae, Saturniidae y dentro de esta la subfamilia Hemileucinae es la que presenta los casos más graves con síndromes hemorrágicos graves, principalmente por las orugas del género Lonomia. Las larvas contienen enzimas que actúan sobre diferentes componentes, Lonomia actúa sobre el sistema hemostático provocando hemorragias que pueden conducir a la muerte. Son de especial atención los accidentes por Lonomia aquelonus (Saturniidae), que en los últimos años fue motivo de numerosos casos de erucismo en el sur de Colombia, algunos mortales. En los últimos años en Colombia se ha observado un aumento de casos de erucismo, pero el subregistro sigue siendo muy alto y el conocimiento de la temática es exiguo; en general, el grupo poblacional que más se ve afectado por los casos de erucismo son personas jóvenes de entre 15 y 45 años de edad, principalmente personas trabajadoras del campo. A causa del riesgo potencial que esto representa, sumado a la falta de conocimiento general sobre la patología que producen los venenos de Lepidoptera en humanos y en especial sobre la historia natural de las especies causantes de los envenenamientos, y de los aspectos eco-epidemiológicos, se pretende con este artículo contextualizar el impacto de estos animales venenosos en la salud de los Colombianos, dando valoración de conceptos y presentando fundamentos teóricos que aporten a esta temática.

The injuries caused by butterflies are known as lepidopterism and erucism depending on each case. The Lepidoptera families with the most public health importance in Colombia are Megalopygidae, Arctiidae, and Saturniidae and in this last one, the Hemileucinae subfamily presents the most serious cases with severe hemorrhagic syndromes, mainly because of caterpillars from the Lonomia genus. The larvae contain enzymes which act on different components; Lonomia aquelonus (Saturniidae) acts on the hemostatic system causing hemorrhage that can cause death. Accidents by Lonomia aquelonus (Saturniidae) deserve special attention since they have been the cause of numerous cases of erucism in southern Colombia, some of them fatal. An increased number of Lonomia cases have been observed in Colombia in recent years but the under-registration continues to be very high and the knowledge about the topic is meager; in general the population groups mostly affected by eurcism are young people between 15 and 45 years old, mainly farmworkers. Because of the potential risk this represents, added to the. general lack of knowledge about the pathology produced by poisons Lepidoptera in humans and specially about the natural history of the species causing poisoning and the eco-epidiomogical aspects, this article intends to contextualze the impact of these poisonous animals on the Colombian population health through concept assessment and presenting theoretical foundations that contribute to this issue.