Human envenomations caused by Portuguese man-of-war (Physalia physalis) in urban beaches of São Luis City, Maranhão State, Northeast Coast of Brazil

ABSTRACT INTRODUCTION: The clinical and epidemiological aspects associated with Portuguese man-of-war envenomation were investigated and characterized. METHODS: Data from recorded envenomation events between 2005 and 2013 were provided by the GBMar (Group of Firemen Maritime of Maranhão State) and SEMUSC (Municipal Secretary of Security with Citizenship). RESULTS: Most victims were children, and clinical manifestations included intense pain, edema, erythema, and rare systemic manifestations. CONCLUSIONS: The envenomation events were predictable and based on patterns involving multiple factors (environmental and/or human behavior); however, the initially applied measures did not match the current recommendations of the Health Ministry of Brazil.

An outbreak of Portuguese man-of-war (Physalia physalis - Linnaeus, 1758) envenoming in Southeastern Brazil

Introduction Portuguese man-of-war, Physalia physalis (Linnaeus, 1758), are cnidarians capable of discharging intracellular organelles filled with venom, resulting in severe envenomation in humans. Methods We report the clinical and therapeutic aspects of 331 accidents involving Portuguese man-of-war in an outbreak on the coast of the State of São Paulo, Brazil. Results The clinical manifestations of envenomation were rare and mild and mostly local, systemic reactions; there was a low rate of late complications. Conclusions The consequences of envenomation were of moderate severity, and first aid measures were effective in controlling the pain. Outbreaks of accidents involving Portuguese man-of-war occur periodically in the area without a clear explanation. .

Picadura de medusa Olindias sambaquiensis: Análisis de 49 casos

La picadura de la medusa o agua viva Olindia sambaquiensis es de ocurrencia frecuente en las playas de la costa de la provincia de Buenos Aires. Se notifican entre quinientas y mil picaduras de medusas por temporada en la localidad balnearia de Monte Hermoso, al sur de la provincia de Buenos Aires. El daño cutáneo que provoca por su elevada acción urticante plantea un serio inconveniente para el desarrollo del turismo. Durante el mes de enero de 1998, en la localidad de Monte Hermoso se reunieron un total de 49 casos que fueron examinados dentro de la hora posterior a la picadura. Veintiocho eran de sexo masculino (57.1%). La edad promedio fue de 16 ± 4.1 (rango 5-80). El 54% presentó lesiones eritemato-edematosas de configuración lineal, el 28% presentó lesiones predominantemente eritematosas y el 18% presentó placas eritemato-edematosas. En el 73% de los casos las lesiones se localizaron en miembros inferiores. Hemos redefinido la lesión cutánea producida por la medusa O. sambaquiensis, su evolución, sus dimensiones y localizaciones más frecuentes. Además, se ha tipificado y cuantificado el dolor que produce, y otros signos y síntomas que acompañan a la picadura en la hora posterior, a las primeras 24 horas y a los 30 días. Describimos las conductas terapéuticas utilizadas en nuestra costa, evaluamos la efectividad de algunas de ellas en el control del dolor y finalmente proponemos un esquema terapéutico para dicha picadura.

Olindias sambaquiensis jellyfish sting occurs frequently in Buenos Aires province coast beaches. Among five hundred and one thousand stings by jellyfish are reported each season at Monte Hermoso, a beach village in the South of Buenos Aires province. The skin damage provoked because of its highly irritant effect poses a serious issue related to tourism development. A total number of 49 cases that were examined during the first hour after the sting were enrolled in Monte Hermoso during January 1998. Twenty eight were males (57.1%). The average age was 16 ± 4.1 (range 5-80). Of them, 54% showed linear erythema-edematous lesions, 28% showed predominantly erythematous lesions, and in 18% the injuries were erythema-edematous plaques. In 73% of the cases the lesions were located in lower limbs. We had hereby redefined cutaneous lesions produced by O. sambaquiensis, its evolution, its dimensions and most frequent localizations. Besides, it has been typified and quantified the pain it provokes and other signs and symptoms that go with the sting during the posterior hour, during the first 24 hours, and after 30 days. We described the therapeutic conducts used in our coasts and we assessed the effectiveness of some of them in pain control, and finally we propose a therapeutic scheme for this sting.

Envenoming caused by a Portuguese man-o'-war (Physalia physalis) manifesting as purpuric papules / Envenenamento por caravela (Physalia physalis) manifestando-se com erupção papulopurpurica

We report the case of a 42-year old woman who was envenomed by a Portuguese man-o'-war (Physalia physalis). She presented an anomalous reaction manifested by purpuric papules that appeared after the initial phase of envenoming (around 24 hours later), when linear erythematous and edematous papules were observed. Late-onset reactions in accidents involving cnidarians commonly include chronic eruptions and local pigmentation.

Os autores relatam um envenenamento causado por um cnidário, a caravela (Physalia physalis), em uma mulher de 42 anos. A paciente apresentou uma reação incomum manifestada por pápulas purpúricas surgidas após a fase inicial de envenenamento (cerca de 24 horas depois) quando foram observadas pápulas lineares edematosas e eritematosas. As reações tardias nos acidentes por cnidários comumente apresentam erupções recorrentes e pigmentações locais.

Skin lesions in envenoming by cnidarians (Portuguese man-of-war and jellyfish): etiology and severity of accidents on the Brazilian coast / Lesões dermatológicas observadas nos acidentes por cnidários (águas-vivas e caravelas): etiologia e gravidade dos envenenamentos no litoral do Brazil

This work attempts to establish dermatological identification patterns for Brazilian cnidarian species and a probable correlation with envenoming severity. In an observational prospective study, one hundred and twenty-eight patients from the North Coast region of São Paulo State, Brazil were seen between 2002 and 2008. About 80 percent of these showed only local effects (erythema, edema, and pain) with small, less than 20 cm, oval or round skin marks and impressions from small tentacles. Approximately 20 percent of the victims had long, more than 20 cm, linear and crossed marks with frequent systemic phenomena, such as malaise, vomiting, dyspnea, and tachycardia. The former is compatible with the common hydromedusa from Southeast and Southern Brazil (Olindias sambaquiensis). The long linear marks with intense pain and systemic phenomena are compatible with envenoming by the box jellyfish Tamoya haplonema and Chiropsalmus quadrumanus and the hydrozoan Portuguese man-of-war (Physalis physalis). There was an association between skin marks and probable accident etiology. This simple observation rule can be indicative of severity, as the Cubozoa Class (box jellyfish) and Portuguese man-of-war cause the most severe accidents. In such cases, medical attention, including intensive care, is important, as the systemic manifestations can be associated with death.

Cnidários são animais que apresentam no corpo (especialmente nos tentáculos) organelas de defesa chamadas nematocistos, podendo causar graves envenenamentos. Este trabalho procura estabelecer padrões clínicos auxiliares na identificação das espécies de cnidários brasileiros e pesquisar provável correlação das lesões na pele com a gravidade do acidente. Cento e vinte e oito pacientes foram observados no Pronto-Socorro de Ubatuba (Litoral Norte do estado de São Paulo) em período de seis anos (2002-2008). Cerca de 80 por cento dos acidentes mostraram apenas manifestações locais (dor, eritema e edema). Nestes casos, as marcas cutâneas foram pequenas, ovais e arredondadas, algumas vezes com impressões de pequenos tentáculos. As marcas foram menores que 20 cm. Aproximadamente 20 por cento das vítimas tinham lesões longas, lineares e cruzadas, maiores que 20 cm com frequente observação de fenômenos sistêmicos, como mal estar, vômitos, dispnéia e taquicardia. O padrão das marcas arredondadas e curtas é compatível com hidromedusa muito comum nas regiões Sudeste e Sul do Brasil (Olindia sambaquiensis), que causa acidentes de pequena magnitude. As marcas longas e lineares, associadas à dor intensa e fenômenos sistêmicos, são compatíveis com envenenamento pelas cubomedusas Tamoya haplonema e Chiropsalmus quadrumanus e o hidrozoário Physalis physalis, a caravela. Houve associação entre as marcas cutâneas e a provável etiologia do acidente. Esta regra simples de observação clínica pode ter valor clínico, uma vez que a Classe Cubozoa (vespas-do-mar) e as caravelas causam os acidentes mais graves. Nestes casos, a atenção médica deve ser redobrada, incluindo cuidados intensivos, uma vez que fenômenos sistêmicos podem se associar a óbitos.

Medusas en Chile: a propósito de un caso / Jellyfish in Chile: a case report

Las medusas son organismos acuáticos marinos del reino animal que aumentan en frecuencia en ciertas condiciones de temperatura del agua, conllevando el riesgo de picar a los seres humanos, pudiendo llegar a ser mortal. La liberación de estructuras llamadas neumatocistos favorece la expulsión de un veneno o toxina ponzoñosa fabricada con el objetivo de atrapar a su presa, todo lo cual produce una serie de reacciones cutáneas locales y/o sistémicas características. Se presenta una revisión acabada de la epidemiología, sintomatología y diagnóstico de esta enfermedad para su adecuado manejo y tratamiento, dado que últimamente se ha advertido un aumento en su presencia en las costas de nuestro país.

Picaduras de medusas: actualización / Jellyfish sting: an update

Jellyfishes are aquatic organisms, whose number increases under certain conditions of water temperature. They can sting humans, which can be fatal. The liberation of structures known as nematocysts induces the extrusion of the poison, to attack their victims. The poison produces characteristic local and systemic reactions. Since an increased number of these organisms has been detected in our coastline, we review the epidemiology, symptoms and diagnosis of the syndrome produced by the bite, to improve its management.

Picadura por mantarraya y aguamala / Ray and jellyfish stings

El objetivo de este artículo es presentar la información biológica de los organismos marinos venenosos más comunes, el tratamiento médico de algunos de los investigadores más notables en el tema y las medidas más recientes de primeros auxilios para disminuir los efectos de estos venenos, ya que el hecho de que un médico haya empleado una dosis y un tipo de fármaco, no es indicación de que otro pueda emplearlo en una situación similar

Sobre el emponzoñamiento producido por las corales ponzoñosas del trópico americano, especialmente en Venezuela / Poisoning produced by Coral snakes of the American tropic , specially in Venezuela

Los autores presentan un trabajo sobre el emponzoñamiento producido por las Corales ponzoñosas del trópico americano, especialmente en Venezuela, en dondo se han comprobado las siguientes especies: Micrurus carinicauda, micrurus circinalis, Micrurus disoleucus, Micrurus hemiprichi, Micrurus isozonus, Micrurus lemniscatus, Micrurus mipartitus, Micrurus psyches, Micrurus spixi y Micrurus surinamensis. Algunas sub-especies descritas para las especies mencionadas requieren revisión. Micrurus isozonus solamente ha sido encontrada hasta el presente en Venezuela y se la confundió durante mucho tiempo con el Micrurus lemniscatus. Micrurus isozonus, Micrurus disoleucus y Micrusus mipartitus tienen una extensa distribución geográfica en el país y presumiblemente son las responsables de los pocos casos de emponzoñamiento elapídico que se han registrado en Venezuela. La ponzoña elapídica es fuertemente neurotóxica y produce una curarización progresiva actuando por mecanismo enzimático inhibiendo la conducción neuromuscular en la placa motora, especialmente en los músculos respiratorios (diafragma e intercostales), además de una poderosa y temible acción sobre los núcleos mesencefálicos con cuadriplejia flácida y parálisis de los músculos controlados por todos los pares craneanos. Se presenta un caso de severo emponzoñamiento elapídico en un niño de 12 años de edad, producido por la mordedura de una Coral ponzoñosa el país presumiblemente el Micrurus isozonus muy frecuente en el área de proveniencia del paciente, tratado con el suero Anti-elapídico del Instituto Butantan de Säo Paulo y que no obstante su elaboración mediante inmunizaciones de caballos con las elaboración mediante inmunizaciones de caballos con las ponzoñas de Micrurus corallinus y Micrurus frontalis, frecuentes en el Brasil, demostró una acción favorable parcial sobre la evolución clínica del caso mencionado aunque se aplicó tardíamente; y que se complementó con la asistencia ventilatoria mecánica a cargo de un personal especializado a la que fue sometido el paciente en la Unidad de Cuidados Intensivos del Hospital Universitario de Caracas...