Informe especial: Envenenamiento por animal ponzoñoso: Alacranismo / Special report: Poisonous by venomous animal: Scorpions

Presentación de un caso, notificado el 9 de enero de 2017, a la Gerencia Operativa de Epidemiología del Gobierno de la Ciudad de Buenos Aires por un efector privado de la Ciudad, de envenenamiento por animal ponzoñoso (Alacranismo) en un paciente residente en la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución del caso, la importancia de distintas acciones de vigilancia epidemiológica, el procedimiento de notificación, medidas de protección, y medidas de prevención y control de accidentes. Incluye datos de centros públicos nacionales y de la Ciudad de Buenos Aires especializados en asistencia y/o in-formación sobre animales venenosos

The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan

Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of...

Epidemiological study of snakebite cases in Brazilian Western Amazonia

Abstract INTRODUCTION Brazil has the largest number of snakebite cases in South America, of which the large majority is concentrated in the Midwest and North. METHODS In this descriptive observational study, we assessed the epidemiological and clinical snakebite cases referred to the Centro de Medicina Tropical de Rondônia from September 2008 to September 2010. RESULTS We followed up 92 cases from admission until discharge, namely 81 (88%) men and 11 (12%) women, with a mean age of 37 years, and mainly from rural areas (91.3%). The snakebites occurred while performing work activities (63%) during the Amazon rainy season (78.3%). The vast majority of individuals presented from the Porto Velho microregion (84.7%). Approximately 95.6% of the snakebites were caused by snakes of the genus Bothrops, followed by two lachetics and two elapidics cases. Surgery was performed in 10 cases (9 fasciotomies in the lower limb and 1 amputation). No deaths were reported in this study, but 4 cases (4.3%) developed sequelae in the lower limb. CONCLUSIONS This study can contribute to a better understanding of envenomation in the state of Rondônia and thus can be useful for identifying real conditions that can increase the incidence of snakebites in this region. Moreover, the study results can serve as a basis for improving educational campaigns designed to prevent these types of snakebites, as well as for preserving snakes.

Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

ABSTRACT Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

Snakebite in Korea: A Guideline to Primary Surgical Management

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.

Quantificação de citocinas no soro e homogenato da pata na intoxicação experimental com veneno de Bothropoides jararaca em ratos Wistar tratados com soroterapia e Mikania glomerata / Quantification of cytokines in serum and paw homogenate of experimental intoxication for venom of the Bothropoides jararaca in Wistar rats treated with antivenom and Mikania glomerata

O presente estudo teve como objetivo quantificar os níveis de citocinas pró-inflamatórias, entre as quais TNF-α, interleucina-1β (IL-1β), IL-6, e anti-inflamatórias, como IL-10, interferon-γ (INF-γ), bem como comparar o efeito do tratamento convencional com o efeito do tratamento complementado pelo extrato da planta Mikania glomerata, na intoxicação experimental por Bothropoides jararaca. Foram usados ratos Wistar,divididos em três grupos: C - controle, VB - veneno botrópico + soro antiofídico e VBM - veneno botrópico + soro antiofídico + Mikania glomerata. As citocinas foram quantificadas, no soro e no homogenato desses animais, pelo teste ELISA, em três momentos (M1 - 30 minutos, M2 - seis horas e M3 - 24 horas após a inoculação do veneno). Os resultados obtidos evidenciaram que a intoxicação por veneno botrópico estimula principalmente a produção de IL-6 no soro e TNF-α, IL-1β, IL-6 no homogenato da pata de animais experimentalmente intoxicados. O tratamento complementar, com o extrato da planta Mikania glomerata, teve influência principalmente na produção de IL-6, IL-10 e IFN-γ no soro e IL-6, IL-1β e IFN-γ no homogenato. Porém, são necessários novos estudos com o extrato de Mikania glomerata para que se possa entender a ação dessa planta sobre a intoxicação botrópica, bem como verificar qual a melhor via para administrá-lo...

This experiment aimed to quantify the pro-inflammatory cytokine levels, including TNF-α, interleukin-1β (IL-1β) and IL-6 as well as the anti-inflammatory ones such as IL-10 and INF-γ. It was also proposed to compare the effect of the conventional treatment to a treatment in which was added the Mikania glomerata plant in the experimental intoxication using Bothropoides jararaca venom. It was used Wistar rats that were randomly divided into 3 groups: C - control; VB - Bothrops venom + antivenom serum; and VBM - Bothrops venom + antivenom serum + Mikania glomerata. Cytokines were quantified in the serum and paw homogenate using ELISA test in three different moments (M1- 30 minutes, M2- 6 hours and M3- 24 hours after venom injection). The intoxication by Bothropoides jararaca venoms mainly stimulated the production of IL-6 in the serum and TNF-α, IL-1β, IL-6 in paw homogenate of animals experimentally intoxicated. Adjunctive treatment with the extract of the Mikania glomerata plant mainly influenced the production of IL-6, IL-10 and IFN-γ in the serum and IL-6, IL1β and IFN-γ in paw homogenate. Further research is necessary with the extract of Mikania glomerata in order to understand the action of this plant on the Bothropoides poisoning and also to verify the best way to manage it...

Envenenamento crotálico em cães / Crotalic envenomation in dogs

No Brasil, foram notificados no ano de 2011 30.826 casos de acidentes ofídicos em seres humanos, sendo que destes, 71,9% foram serpentes do gênero Bothrops. Todavia, dados do Serviço de Toxicologia do Hospital João XXIII (Belo Horizonte, MG) reportam que a maior parte dos acidentes por serpentes são decorrentes da espécie Caudisona durissa (Crotalus durissus) (ANDRADE FILHO et al., 2013). Do mesmo modo, no Hospital Veterinário da Escola de Veterinária da Universidade Federal de Minas Gerais (UFMG), o percentual de atendimentos decorrentes de picadas com serpentes da espécie C. durissa no ano de 2012 até maio de 2013 foi de 90% (foi atendido um total de 10 animais envenenados por serpentes neste período e apenas um animal foi serpente Bothrops). Os diagnósticos caninos foram realizados com base na identificação da serpente, nas manifestações clínicas e achados laboratoriais.

Acidente ofídico em um cão - relato de caso / g - case report

As serpentes peçonhentas dos gêneros Bothrops (jararacas), Micrurus (corais), Crotalus (cascavéis) e Lachesis (surucucus) são as mais importantes em acidentes ofídicos no Brasil. A maior incidência destes acidentes na Medicina Veterinária é causada por serpentes do gênero Bothrops. Os cães são altamente suscetíveis a acidentes botrópicos devido ao seu comportamento curioso, e os locais comumente atingidos no ataque da serpente são o focinho e o pescoço. Cães e gatos são geralmente tratados algumas horas após a picada, quando os sintomas já são bem evidentes. Devido à atividade proteolítica, hipotensora e coagulante do veneno, o tratamento imediato é um fator decisivo para o prognóstico do paciente. O objetivo deste resumo é descrever o caso de um acidente ofídico em um cão atendido em hospital universitário.

Acidente ofídico em um cão - relato de caso / Ophidian accident in a dog - case report

Foi atendido no Hospital Veterinário da Universidade Federal do Rio Grande do Sul, um canino, da raça Bulldog, de oito anos, pesando 32 kg, o qual habitava em um sítio. Foi relatado que o animal havia sofrido um acidente ofídico há duas horas e recebeu soro antiofídico em doses não conhecidas, por via subcutânea, cerca de uma hora após o acidente. A cobra foi descrita como da espécie Bothrops alternatus. O exame clínico mostrou edema acentuado na região submandibular direita, hematoma e lesões com sangramento no ponto de inoculação no pescoço. O animal foi hospitalizado e foram realizados hemograma e exames bioquímicos (ALT, creatinina, ureia), os quais não tiveram alterações, além de testes de coagulação (TP, TTPa), os quais se mostraram incoaguláveis (acima de 30s).

Envenoming by coral snakes (Micrurus) in Argentina, during the period between 1979-2003 / Envenenamento por cobras corais na Argentina durante o período 1979-2003

Envenomation by coral snakes (Micrurus sp.) is one of the most dangerous injuries in America and it is considered as a serious medical emergency, however bites by these snakes appear to be rare. We analyzed epidemiological data, clinical signs and antivenom use in Argentina during the period between 1979-2003. During this period of study 46 non-fatal Micrurus bites were reported. The majority of cases were men from 31 to 40 years old. Bites occurred primarily in spring and summer. Most cases were reported from the northeast and northwest provinces of the country. The bites were mostly located on hands or feet and occurred mostly during agricultural activities and so mainly involved farmers. Only four cases occurred as a result of handling snakes. The median time it took for antivenom to be administrated was 60 minutes after the bite, and the median number of vials applied was 2. Local pain was mentioned and edema was reported in 41% of patients. All patients recovered without sequelae. This study showed a low incidence of Micrurus bites and low severity of envenomation. However, although no deaths have been reported during the last 30 years, given the toxicity of the venom of Micrurus snakes, the risk of severe envenomation should be considered.

O envenenamento por corais (Micrurus sp.) é um dos mais perigosos na América e considerado uma emergência médica grave ainda que acidentes por estas serpentes pareçam raros. Analisamos dados epidemiológicos e clínicos e o uso de soro antiofídico, durante o período de 1979-2003. As comunicações indicam 46 acidentes por Micrurus, aproximadamente dois casos anuais, sem registro. A maioria dos casos ocorreu em homens de idade entre 31 e 40 anos, principalmente no período de primavera e verão e provenientes do noroeste e nordeste do país. Os acidentes na sua maioria ocorreram em mãos e pés, durante atividades agrícolas envolvendo trabalhadores rurais. Apenas quatro acidentes foram relacionados a manejo dos animais. Em todos os casos analisados houve descrição de dor local e em 41% dos pacientes houve edema. Por paciente foram administradas, em média, duas ampolas. O tempo médio de aplicação do soro foi de 60 minutos. Em todos os casos a recuperação foi favorável sem presença de sequelas. Neste estudo foi possível observar uma baixa incidência de acidentes e baixa severidade nos envenenamentos. Apesar de que não aconteceram mortes nos últimos 30 anos, dado a toxicidade do veneno das cobras corais, o risco de envenenamento severo deveria ser considerado.

Preparation and in vitro characterization of chitosan nanoparticles containing Mesobuthus eupeus scorpion venom as an antigen delivery system

Hydrophilic nanoparticles have been widely investigated in recent years as delivery systems for therapeutic macromolecules such as antigens. In the present study Mesobuthus eupeus venom-loaded chitosan nanoparticles were prepared via ionic gelation of tripolyphosphate (TPP) and chitosan. The optimum encapsulation efficiency (91.1 percent) and loading capacity (76.3 percent) were obtained by a chitosan concentration of 2 mg/mL, chitosan-to-TPP mass ratio of 2 and M. eupeus venom concentration of 500 µg/mL. The average nanoparticle size at optimum conditions was determined by Zetasizer (Malvern Instruments, UK). The nanoparticle size was about 370 nm (polydispersity index: 0.429) while the zeta potential was positive. Transmission electron microscope (TEM) imaging showed a spherical, smooth and almost homogenous structure for nanoparticles. Fourier transform infrared (FTIR) spectroscopy confirmed tripolyphosphoric groups of TPP linked with ammonium groups of chitosan in the nanoparticles. The in vitro release of nanoparticles showed an initial burst release of approximately 60 percent in the first ten hours, followed by a slow and much reduced additional release for about 60 hours. It is suggested that the chitosan nanoparticles fabricated in our study may provide a suitable alternative to traditional adjuvant systems.(AU)

Neutralization of bitis parviocula (Ethiopian mountain adder) venom by the south african institute of medical research (SAIMR) antivenom / Neutralização do veneno de Bitis parviocula (serpente da Montanha da Etiópia) pelo antiveneno do Instituto Africano de Pesquisa Médica (SAIMR)

BACKGROUND: The Ethiopian mountain adder (Bitis parviocula) is a viperid known only from a few locations in southwestern Ethiopia. METHODS: a total of 30 µg of B. arietans and B. parviocula venoms were run on a 10-20 percent Tricine gel. To assay lethality dose fifty (LD50), five groups of eight mice for each venom were used. Hemorrhagic activity for crude venom was tested. Fibrinogenolytic activity of crude venom was measured using (2.5 mg/mL) of fibrinogen solution and (0.03 mg/mL) of crude venom. Gelatinase activity of the venom was tested on a Kodak X-OMAT TM film. Crude venoms of B. parviocula and B. arietans were tested for their abilities to affect clotting time, clotting rate and platelet function on whole human blood. RESULTS: The (SAIMR) antivenom was confirmed in this study to neutralize the lethal activity of venom from Bitis parviocula. The ED50s of SAIMR antivenom on B. parviocula and B. arietans neutralized half of 18.2 and 66.7 mg of venom, respectively. The hemorrhagic activities (MHDs) of B. parviocula and B. arietans were 0.88 and 1.7 µg, respectively. Bitis arietans and B. parviocula venoms degradated α and β chains at different times. The γ chains remained unaffected. Bitis parviocula venom did not exhibit gelatinase activity, while B. arietans had a MGD of 6.9 µg. At 3 mg/mL, the crude venoms of B. parviocula and B. arietans did not significantly affect clotting time or clotting rate. CONCLUSIONS: The SAIMR antivenom is very effective in neutralizing the venom of B. parviocula and should be considered in treating envenomations by these snakes.

BACKGROUND: Serpente das Montanhas da Etiópia (Bitis parviocula) é um viperídeo conhecido somente em poucas localizações do sudoeste da Etiópia. MÉTODOS: Um total de 30 µg de veneno de B. arietans e B. parviocula foram corridos em gel de 10 a 20 por cento de tricina. Para se estabelecer a quinquagésima dose de letalidade (LD50) foram usados cinco grupos de oito camundongos para cada veneno. A atividade hemorrágica para o veneno cru foi testada. A atividade fibrogenolítica do veneno cru foi medida usando 2,5 mg/mL de solução de fibrinogênio e 0,03 mg/mL de veneno cru. A atividade de gelatinase do veneno foi testada em um filme KODAK X-OMAT TM. Venenos crus de B. parviocula e B. arietans foram testados no que diz respeito à sua capacidade de afetar o tempo de coagulação, a velocidade de coagulação e a função plaquetogênica em sangue humano total. RESULTADO: o antiveneno SAIMR foi confirmado neste estudo no que diz respeito à neutralização da atividade letal do veneno de Bitis parviocula. ED50s do antiveneno SAIMR sobre a B. parviocula e B. arietans neutralizou metade de 18,2 e 66,7 mg respectivamente do veneno. As atividades hemorrágicas (MHDs) de B. parviocula e B. arietans foram respectivamente 0,88 e 1,7 µg. Os venenos de B. arietans e B. parviocula degradaram cadeias α e β em tempos diferentes. A cadeia Γ permaneceu não afetada. O veneno da B. parviocula não mostrou atividade de gelatinase, enquanto o de B. arietans teve um MGD de 6,9 µg. A nível de 3 mg/mL os venenos crus de B. parviocula e B. arietans não afetaram significantemente o tempo e a velocidade de coagulação. CONCLUSÕES: O antiveneno SAIMR é bastante efetivo para neutralizar o veneno da B. parviocula e deveria ser considerado para o tratamento de envenenamentos por estas serpentes.

Escorpionismo: presentación de un posible caso grave ocurrido en la Ciudad Autónoma de Buenos Aires / Scorpionism: presentation of a possible serious case occurred in Ciudad Autónoma de Buenos Aires

El escorpionismo, en su aspecto clínico es un envenenamiento de causa accidental producido por la inoculación del veneno de un alacrán o escorpión, que en Argentina ocurre predominantemente en áreas urbanas, en el ámbito domiciliario o peridomiciliario. En nuestro país son tres las especies de escorpiones de interés médico-sanitario: Tityus (T.) trivittatus, T. confluens y T. bahiensis. El cuadro clínico se caracteriza por presentar dolor agudo con escaso compromiso cutáneo y manifestaciones sistémicas que, sin tratamiento pueden provocar la muerte, principalmente en niños. El objetivo de esta comunicación es dar a conocer el primer caso de escorpionismo grave, ocurrido en la Ciudad Autónoma de Buenos Aires, en una niña de 4 años de edad y describir el cuadro clínico característico y la necesidad del tratamiento precoz en los casos moderados y severos.

Scorpionism in its clinical aspect is an envenoming caused by accidental sting and inoculation of venom from a scorpion, which in Argentina occurs predominantly in urban areas, in the home environment or peridomiciliary. In our country there are three species of scorpions of medical-health concern: Tityus (T.) trivittatus, T. confluens and T. bahiensis. The clinical picture is characterized by severe pain with limited cutaneous and systemic manifestations, that without treatment can cause death, especially in children. The aim of this communication is to present the first case of severe scorpionism occurred in the City of Buenos Aires, in a 4 years old girl, and to describe the characteristic clinical picture and the need for early treatment in moderate and severe cases of scorpionism.

Plant-antivenom: database of anti-venom medicinal plants

Plant-antivenom is a computational Websystem about medicinal plants with anti-venom properties. The system consists of a database of these plants, including scientific publications on this subject and amino acid sequences of active principles from venomous animals. The system relates these data allowing their integration through different search applications. For the development of the system, the first surveys were conducted in scientific literature, allowing the creation of a publication database in a library for reading and user interaction. Then, classes of categories were created, allowing the use of tags and the organization of content. This database on medicinal plants has information such as family, species, isolated compounds, activity, inhibited animal venoms, among others. Provision is made for submission of new information by registered users, by the use of wiki tools. Content submitted is released in accordance to permission rules defined by the system. The database on biological venom protein amino acid sequences was structured from the essential information from National Center for Biotechnology Information (NCBI). Plant-antivenom's interface is simple, contributing to a fast and functional access to the system and the integration of different data registered on it. Plant-antivenom system is available on the Internet at http://gbi.fmrp.usp.br/plantantivenom.

Humoral immune response of patients bitten by the snake Bothrops erythromelas / Resposta imune humoral em pacientes picados pela serpente Bothrops erythromelas

INTRODUCTION: Snake envenomings are a health problem in rural areas of tropical and subtropical countries, but little is known regarding the immune response presented by bitten individuals. The IgM production of patients bitten by Bothrops erythromelas snake was analyzed to identify the effectiveness of treatment in this type of envenomation. METHODS: Bothrops erythromelas venom was submitted to electrophoresis and transferred to a nitrocellulose sheet, following incubation with patients' sera. RESULTS: A 38 KDa protein was detected before and 24 h after therapy. CONCLUSIONS: The result suggests that this protein could be used as a marker for individuals envenomed by Bothrops. erythromelas.

INTRODUÇÃO: Envenenamentos ofídicos consistem problema de saúde pública em áreas rurais de países tropicais e subtropicais, mas pouco sabe-se sobre a resposta imune apresentada pelos indivíduos picados, por isso a avaliação da produção de IgM por pacientes picados por Bothrops erythromelas identificando a eficácia do tratamento nesse tipo de envenenamento. MÉTODOS: O veneno de Bothrops erythromelas foi submetido a eletroforese e transferido para nitrocelulose, seguindo incubação com soro de pacientes. RESULTADOS: Foi observada proteína de 38KDa antes e 24 horas após o tratamento. CONCLUSÕES: Os resultados sugerem que essa proteína poderia ser utilizada como marcador para indivíduos envenenados pela serpente Bothrops erythromelas.

Effect of Mikania glomerata (Asteraceae) leaf extract combined with anti-venom serum on experimental Crotalus durissus (Squamata: Viperidae) envenomation in rats

Crotalic envenomation represents the highest number of deaths when compared to other snakebite envenomations of medical interest. Crotalic venom has important characteristics such as neurotoxicity, myotoxicity, nephrotoxicity, and clotting and hemolytic action. We evaluated the clinical and laboratory aspects of Crotalus durissus terrificus experimental envenomation in Wistar rats treated with antivenom and the aqueous extract of the plant Mikania glomerata. The animals were divided into three groups: Group C (control); Group VS-venom and antivenom; Group VSM-venom, antivenom and aqueous extract of M. glomerata. Crotalic poison caused clinical and laboratory alterations in Wistar mice. Significant linical alterations were: temperature decrease, edema in the venom inoculated member, sedation and a locomotion decrease in groups VS and VSM when compared with group C. A faster recovery from sedation was observed only for animals of group VSM when compared to VS. There was an increase in the number of leukocytes, neutrophils and creatine kinase in the VS and VSM groups, compared to group C. Wistar rats showed a high resistance to crotalic venom. Additional studies with different doses, time of treatment, different administration methods and histopathological and immunological studies are necessary to understand the action of M. glomerata in crotalic accidents. Rev. Biol. Trop. 57 (4): 929-937. Epub 2009 December 01.

El envenamiento crotálico representa el número más alto de muertes cuando es comparado con envenenamientos por mordeduras de otras serpientes de interés médico. El veneno crotálico tiene importantes características de acción neurotóxica, miotoxicidad, nefrotoxicidad, coagulación y acción hemolítica. Este trabajo evaluó los aspectos clínicos y de laboratorio del envenenamiento experimental con el veneno de la serpiente Crotalus durissus terrificus en las ratas Wistar tratadas con suero antiofídico y extracto acuoso de M. glomerata. Los animales fueron separados en tres diferentes grupos: grupo control (C); grupo veneno+suero (VS), grupo veneno+suero+extracto acuoso de M. glomerata (VSM). El veneno crotálico causó alteraciones clínicas y diferencias en los análisis sanguíneos practicados a los ratones Wistar evaluados. Las alteraciones clínicas más importantes fueron una disminución de la temperatura, edema en el miembro inoculado de veneno, la sedación y una disminución de la locomoción en los grupos VS y VSM comparado con el grupo C. Una rápida recuperación de la sedación estadísticamente significativa fue observada en los animales del grupo VSM al compararse con los del grupo VS. Los análisis sanguíneos mostraron un aumento en el número de leucocitos, neutrofilos y creatina quinasa en los grupos VS y VSM comparados con el grupo C. Los ratones Wistar mostraron una alta resistencia al veneno del crótalo. Estudios adicionales con variación en las dosis, tiempo de tratamiento, y métodos de administración, así como la realización de estudios histopatológicos e inmunológicos son importantes para comprender la acción de M. glomerata en accidentes crotálicos.

Appropriate antivenom doses for six types of envenomations caused by snakes in taiwan

Six of the 15 species of venomous snakes found in Taiwan are responsible for most of the clinically significant envenomations in the country. These species are: Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Naja atra, Bungarus multicinctus, Deinagkistrodon acutus and Daboia russelii siamensis, which together can be subdivided into three groups based on their venom effects. Primary treatment consists of rapid administration of appropriate antivenoms. The present study aimed to identify a proper dose of antivenom for each snake group as well as to describe hemorrhagic, neurotoxic, and mixed effects of their venoms. A retrospective chart review identified 72 snakebite cases referred to an emergency department. Data on epidemiology, examination findings, snake identification, treatment, antivenom dose and complications were collected. After excluding 14 patients, data from 58 victims were analyzed. Most studied cases were male (86 percent). Significantly higher doses of antivenom were administered against neurotoxic envenomations (mean dose: three vials) compared with the other two (p < 0.05). Moreover, patients affected by neurotoxic bites were more likely to develop blurred vision and other complications (p < 0.05). Multivariate logistic regression analysis indicated that neurotoxic envenomation was a risk factor for complications (OR: 8.84, 95 percent CI: 1.06-73.73). Neurotoxic envenomations and complication occurrence were positively correlated with antivenom dosage. In conclusion, patients affected by neurotoxic envenomations received higher doses of antivenom than others whereas incidence of complications was associated with higher antivenom doses.

Un caso de mordedura de una taya equis / A case of bothrops asper bite

En la madrugada del 25 de Abril fui llamado á prestarle los servicios profesionales á Moisés Uquira quien el día anterior por la tarde había sufrido la mordedura de una taya equis. El animal, que fue muerto, pocos momentos después de haber ocasionado la herida, medía 140 centímetros de longitud. Al momento que recibió la herida, sintió el enfermo un dolor agudísimo en el punto de la inoculación, el cual en breves instantes se extendió á todo el miembro. La herida fue hecha en la parte superior y externa de la pierna derecha. Inmediatamente el compañero tuvo la feliz idea de evitar la circulación devuelta, colocando un lío circular en la parte media del muslo y comprimiendo bastante. Cuando el amigo terminaba la operación, yá Moisés había perdido totalmente el conocimiento y era presa de ligeras convulsiones; pocos momentos después aparecieron vómitos que, biliosos al principio, se hicieron sanguinolentos en seguida; las conjuntivas se inyectaron, lágrimas mezcladas con sangre salían por el ángulo interno de la hendedura parpebral. Como medicación dieronle al enfermo una cierta cantidad de aguardiente.