Loxoscelismo cutáneo predominantemente edematoso: a propósito de un caso / Cutaneous loxoscelism mainly edematous: a case report

In Chile, loxoscelism is caused by the bite of the Loxosceles laeta spider. The clinical presentation has two different forms: cutaneous loxoscelism (CL) and vicero-cutaneous loxoscelism, which is less frequent. Cutaneous loxoscelism includes an uncommon clinical variation (4%), called CL with edematous predominance (CLEP). We present a 5-year-old patient with sudden pain and edema on his right eyelid associated with fever, which progressed rapidly involving the right hemifacial area, frontal region, and left eyelid. Angioedema and pre-orbital cellulitis were discarded and CLEP was suspect. Cutaneous loxoscelism with an edematous predominance is self-limited, benign and with little or no necrotic injury due to the edema, which dilutes the toxin-induced enzymatic process causing necrosis. As in the reported cases it usually responds well to medical treatment and does not cause visceral involvement.

El loxoscelismo en Chile es un cuadro producido por la mordedura de la araña Loxosceles laeta. Las formas de presentación son: loxoscelismo cutáneo (LC) y loxoscelismo cutáneo-visceral (LCV), el último menos frecuente. Dentro del LC existe una variante poco común (4%) conocida como loxoscelismo cutáneo predominantemente edematoso (LCPE). Nuestro caso es un paciente de 5 años que consultó por cuadro de inicio súbito de dolor y edema palpebral derecho, asociado a fiebre el cual evolucionó con rápida progresión extendiéndose en la hemicara derecha, región frontal y párpado izquierdo. Se descartó un angioedema y una celulitis periorbitaria, sospechándose un LCPE. Se manejó con hidrocortisona y clorfenamina. El LCPE es un cuadro benigno, autolimitado, en que no está presente la lesión necrótica o ésta es insignificante. Predomina el edema, el cual abortaría la necrosis al diluir el proceso enzimático producido por el veneno. Tiene buena respuesta al tratamiento médico, con ausencia de compromiso visceral.

Accidents caused by Phoneutria nigriventer: diagnosis and nursing interventions / Acidentes causados por Phoneutria nigriventer: diagnósticos e intervenções de enfermagem / Accidentes causados por Phoneutria nigriventer: diagnósticos e intervenciones de enfermería

Objetivo: Identificar os principais rótulos diagnósticos de enfermagem e suas respectivas intervenções de enfermagem, através das principais manifestações clínicas apresentadas pelos indivíduos intoxicados pelo veneno da aranha Phoneutria ningriventer encontradas na literatura. Método: Revisão integrativa da literatura consultada nas bases de dados PubMed e BVS, publicações impressas e sites oficiais relacionados à temática. Os rótulos diagnósticos de enfermagem foram elaborados com base na taxonomia II da North American Nursing Diagnosis Association International e o planejamento das intervenções de enfermagem de acordo com a Classificação das Intervenções de Enfermagem. Resultados: A partir dos achados, foi possível identificar oito rótulos diagnósticos e suas respectivas intervenções de enfermagem. Conclusão: Foram encontrados poucos estudos na literatura abordando as manifestações clínicas apresentadas pelos indivíduos intoxicados pelo veneno da aranha Phoneutria nigriventer e da atuação da enfermagem frente a esses casos.

Objective: To identify the main nursing diagnostic labels and the respective interventions through the main clinical manifestations presented by individuals poisoned by the venom of the spider Phoneutria nigriventer found in the literature. Method: Integrative review of literature consulted in PubMed and BVS databases, printed publications and official websites related to the theme. The nursing diagnostic labels were developed based on taxonomy II from the American Nursing Diagnosis Association International and the planning of nursing interventions in accordance with the Nursing Interventions Classification. Results: From the findings, it was possible to identify eight diagnostic labels and the respective nursing interventions. Conclusion: We found few studies addressing the clinical manifestations presented by individuals poisoned by the venom of the spider Phoneutria nigriventer and nursing performance in these cases.

Objetivo: Identificar las principales etiquetas diagnósticas de enfermería y sus respectivas intervenciones a través de las principales manifestaciones clínicas que presentan las personas intoxicadas por el veneno de la araña Phoneutria nigriventer encontradas en la literatura. Método: Revisión Integral de la literatura consultada en los bancos de datos PubMEed y BVS, publicaciones impresas y sitios web oficiales sobre el tema. Las etiquetas diagnósticas de enfermería fueron elaboradas con base en la taxonomía II de la North American Nursing Diagnosis Association International y planeamiento de las intervenciones de enfermería de acuerdo con la Clasificación de Intervenciones de Enfermería. Resultados: A través de los resultados fue posible identificar ocho etiquetas de diagnóstico y las respectivas intervenciones de enfermería. Conclusión: Se encontraron pocos los estudios de las manifestaciones clínicas que presentan las personas envenenadas por el veneno de la araña Phoneutria nigriventer y la actuación de enfermería en estos casos.

Expressão do fator de crescimento endotelial vascular (VEGF) e seus receptores Flt-1 e Flk-1 após envenenamento pela aranha Phoneutria nigriventer em ratos / Expression of vascular endothelial growth factor (VEGF) and its receptors Flt-1 and Flk-1 after envenoming by Phoneutria nigriventer spider in rats

O fator de crescimento endotelial vascular (VEGF), o principal regulador da angiogênese e da permeabilidade vascular, foi recentemente reconhecido como neurotrófico, neurogênico e neuroprotetor, sendo, portanto, regulado positivamente em muitos processos neuropatológicos. Neste modelo experimental de quebra da barreira hematoencefálica (BHE) pelo veneno da aranha Phoneutria nigriventer (PNV), a expressão do VEGF e seus receptores tirosina-quinase, Flt-1 e Flk-1 e de seus RNAs mensageiros foi investigada no hipocampo e cerebelo de ratos Wistar (Rattus norvegicus) por imunohistoquímica (IHQ), western blotting (WB) e reação em cadeia da polimerase em tempo real (qPCR). Paralelamente, a integridade da BHE foi avaliada através da expressão das proteínas da via paracelular, Ocludina e β-catenina, e da principal proteína da membrana basal, a Laminina, que estão presentes no endotélio na interface sangue-cérebro. O estudo foi realizado em ratos de 14 dias (neonatos) e de 8-10 semanas (adultos jovens) para avaliar diferenças em função da idade na funcionalidade da BHE e na possível mediação dos efeitos neurotóxicos do PNV pelo VEGF. A via escolhida para administração de PNV (1,7 mg/kg em 0,5ml de salina 0,9%) foi intraperitoneal, devido sua administração mais favorável nos animais neonatos. Os tempos de 2, 5 e 24 horas após a administração de PNV visaram investigar a expressão das proteínas, RNAs mensageiros e uma possível mediação pelo VEGF na fase aguda do envenenamento. A administração do PNV provocou sinais imediatos de intoxicação nos animais, os quais foram mais severos e imediatos nos neonatos do que nos adultos.

Vascular endothelial growth factor (VEGF), a major regulator of developmental angiogenesis and vascular permeability, was recently recognized as neurotrophic, neurogenic and neuroprotector, hence being upregulated in many neuropathological processes. In this experimental model of blood brain barrier (BBB) breakdown by the Phoneutria nigriventer spider venom (PNV), the expression of VEGF and its receptor tyrosine kinases, Flt-1 and Flk-1 and their mRNAs was investigated in the hippocampus and cerebellum of Wistar rats (Rattus norvegicus) by immunohistochemistry (IHC), western blotting (WB) and real time polymerase chain reaction (qPCR). Simultaneously, the BBB integrity was assessed through expression of paracellular pathway proteins, β- catenin and Occludin, and the main basement membrane protein, Laminin, which are present in the endothelium blood-brain interface. The study was performed in rats by 14 days (neonates) and 8-10 weeks (young adults) to assess differences related to age in the BBB functionality and the possible mediation of the PNV neurotoxic effects by VEGF. The via chosen for PNV administration (1.7 mg/kg in 0.5 ml of 0.9% saline) was intraperitoneally, due to more favorable application in neonate animals. The times of 2, 5 and 24 hours after PNV administration aimed to investigate the expression of proteins, mRNAs, and possible mediation by VEGF in acute envenomation. The PNV administration provoked immediate signs of intoxication in animals, which were more severe and immediate in neonates than in adults. In hippocampus, the WB data showed increased expression of VEGF, Flt-1 and Flk-1 and their mRNAs, which were concomitant with the development of perivascular edema, and decreased expression of Occludin, β-catenin and Laminin. IHC data show that VEGF immunoreactivity occurred in the bodies and dendrites of pyramidal neurons in the subfield CA1, CA2, CA3 and dentate gyrus of the hippocampus, in contrast with nuclear staining of Flt-1 and Flk-1.

First case of human latrodectism in Venezuela / Primeiro caso de latrodectismo humano na Venezuela

The first case of envenoming by Latrodectus geometricus in Venezuela is described. The accident occurred at the victim’s home, in Aragua de Barcelona, Anzoátegui State. The 31-year-old female victim was bitten twice on the left scapular region, in quick succession (within seconds). She developed a hyperactive state of the central, autonomic and peripheral nervous systems with minor local symptoms.

Descreve-se o primeiro caso de envenenamento por Latrodectus geometricus na Venezuela. O acidente ocorreu na residência, em Aragua de Barcelona, Estado Anzoátegui. A paciente de 31 anos de idade foi picada, consecutivamente duas vezes, em segundos, na região escapular esquerda. Ela desenvolveu um quadro de hiperatividade do sistema nervoso central, autonômico e periférico com escassa sintomatologia local.

Parasitosis cutáneas y loxoscelismo / Cutaneous parasitosis and loxoscelism

Ectoparasitosis are skin disorders caused by animal parasites living on the body surface. Scabies, pediculosis capitis, phthiriasis and demodecidosis are common skin infections in Chile. Worldwide, they are among the most frequent dermatoses, particularly in infancy and childhood. At present, effective treatments are available, however, some of the present drugsare toxic and some parasites are becoming resistant to common antiparasitic treatment. Loxoscelism, on the other hand, is caused by the bite of Loxosceles spiders, world-widedistributed, affects individuals of all ages, it may present two clinical forms cutaneous loxoscelism (CL) and viscerocutaneous loxoscelism (VCL). The cutaneous surface of limbs and face are the most frequently affected areas by CL. Local clinical manifestations are pain, edema and livedoid plaque, most of wich evolve into a necrotic scar in CL, whereas hematuria, hemoglobinuria, jaundice, fever and sensorial involvement characterise VCL. Spider bite continues to be a controversial subject worldwide and its treatment may be controversial. Physicians should be aware of this disease entity and its complications. This article summarises the therapeutically approach against these infections.

Nitroglycerine in scorpion sting with decompensated shock.

This study was designed to examine the effect of nitroglycerine infusion in children hospitalized for scorpion sting with severe myocardial dysfunction and decompensated shock. Children satisfying the inclusion criteria were started on nitroglycerine infusion under hemodynamic monitoring and other supportive measures. The effects of nitroglycerine, including improvement in oxygenation and decrease in pulmonary congestion and liver size were recorded. Seven out of 11 children responded well to nitroglycerine therapy and the clinical response was evident within 30 to 60 minutes. The first parameter to improve was oxygen saturation, followed by an improvement in the blood pressure and respiratory rate. Heart rate was the last parameter to improve after nitroglycerine infusion. The average duration of nitroglycerine infusion was 25 hours (12 - 36 hours). It was seen that the non-survivors had significant tachycardia at admission, and a greater need for assisted ventilation compared to the survivors. We conclude that nitroglycerine therapy could bring about significant improvement in myocardial function and hemodynamic parameters with a potential for improved survival.

Bilateral cerebellar infarction: a rare complication of scorpion sting.

INTRODUCTION: Complications following scorpion sting are common in India and can be fatal. Stroke following scorpion sting is a rare complication and can occur by various mechanisms such as hypertension, hypotension, DIC, myocarditis and venom-induced vasculitis. We present a rare case of extensive cerebellar infarction following scorpion sting, which has rarely been reported in medical literature. OBJECTIVES: To study the clinical profile of two patients presenting with an acute onset of cerebellar symptoms following a scorpion sting. To evaluate the possible causes of the stroke and to study the relation of their symptoms to the scorpion sting. METHODS: Two young women presented with a history of acute onset of dysarthria, ataxia and incoordination following scorpion sting. They did not have any known risk factors for stroke. They had cerebellar type of dysarthria and cerebellar signs on both sides along with incoordination. A CT-scan of the brain showed bilateral extensive cerebellar infarctions. They were investigated for other causes of stroke without any positive results. With treatment the patients made a gradual but complete recovery. CONCLUSION: Since there was no evidence of hypertension, hypotension, myocarditis or disseminated intravascular coagulation, we can conclude that the patients had suffered a thrombotic stroke caused by the vasculotoxic action of the scorpion venom.

Myocarditis and multiple cerebral and cerebellar infarction following scorpion sting.

An unusual case of scorpion sting followed by multiple cerebral and cerebellar watershed infarctions is being reported. Myocarditis, hypotension and hypoperfusion infarction is being considered as the possible explanation for this pathology. Hypoperfusion leading to parieto-occipital infarction has been reported earlier, however cerebellar infarction in this context is extremely rare.

Desenlace fatal por loxoscelismo cutáneo visceral / Severe loxoscelism with lethal outcome. Report of one case

Loxoscelism, is caused by the bite of Loxosceles laeta spiders. It has two clinical forms: cutaneous loxoscelism (CL) and viscerocutaneous loxoscelism (VCL). VCL is characterized by hematuria, hemoglobinuria, jaundice, fever and sensorial involvement. In severes cases there is massive hemolysis and renal failure, with high letality. We report a 71 year-old man, brought to the hospital five days after suffering a spider bite. The patient was admitted with a severe kidney failure, hemolysis, metabolic acidosis and clotting disorder. The patient was managed with adrenal steroids and dialisys but died five weeks after hospital admission. This particualr patient consulted late and had multiple factors of poor prognosis.

Loxoscelismo en pediatría: Región Metropolitana Chile / Loxoscelism in paediatrics: Región Metropolitana Chile

Loxoscelismo es el cuadro tóxico producido por veneno que arañas del género Loxosceles L. Iaeta, en Chile, inyectan en el momento de la mordedura. Puede presentarse en dos formas clínica: loxoscelismo cutáneo-visceral (LCV). El objetivo del presente trabajo es exponer y analizar los aspectos clínico-epidemiológicos de 56 casos pediátrico -38 LC y 18 LCV- atendidos en la Región Metropolitana. En los últimos 45 años se ha encontrado una mayor incidencia de ambas formas en primavera-verano, en dormitorios cuando el niño dormía o se estaba vistiendo, siendo las áreas cutáneas más frecuentemente afectadas las extremidades y cara, con sensación de lancetazo urente como síntoma inicial. Manifestaciones clínicas más frecuentes: dolor, edema y placa livedoide que derivó a escara necrótica. Manifestaciones clínicas del LCV fueron hematuria, hemoglobinuria, ictericia, fiebre y compromiso de conciencia; letalidad 22,2 por ciento. El LCV no tuvo relación con el sitio de mordedura, extensión de la lesión local ni época del año. Si el compromiso visceral no aparece en las primeras 24 h es muy probable que se trate de un LC cuyo pronóstico es bueno. Si el paciente con LCV ha sobrepasado las 48 h, sus posibilidades de recuperación son altas. El tratamiento fue parental: antihistamínicos o corticoides en LC y corticoides en LCV. Conclusiones: En esta serie se observa una predominancia en el sexo femenino, sin diferencias estacionales ni de edad. En su gran mayoría los casos se originaron en el domicilio, afectando en especial las extremidades. El LCV fue más frecuente en mujeres, y sus principales manifestaciones fueron la hematuria y hemoglobinuria, y la precocidad del diagnóstico y su manejo son factores fundamentales en el pronóstico

Loxoscelismo cutáneo de predominio edematoso / Cutaneous loxoscelism with edema predominance

Loxoscelism in the clinical condition produced by the venom of spiders belonging to the genus loxosceles, human cases of loxoscelism have been observed in diverse countries of different continents in temperate and tropical regions. In Chile loxoscelism is caused by loxosceles laeta, spider with domestic habits. Loxoscelism can be observed into two well definited clinical variants: cutaneous loxoscelism (CL) and systemic or viscerocutaneous loxoscelism (VCL) which occur in around 83,3 and 16,7 percent cases respectively. Within the universe of CL patients a clinical modality in which necrotic lesion is not present or is insignificant, but presenting a remarkable edema, particularly when the bite is on the face, which as received the name of CL with an edematous predominance (CLEP). In this paper the individual description and the assambled analysis of 10 cases, four males and six females, age ranging from 6 to 68 years, of CLEP are presented. Nine cases occurred in warm periods spring through fall and one in winter. In six cases the accident causing spider was seen and two of these were identified as L. laeta adult females. In all cases the patients went or were transported to emergency medical services 4-24 h after the bite. The predominant initial symptom was a burning stinging sensation at the site of the bite, followed by intensive pain which expanded the neighbour areas concomitantly with the emerging and progressive edema. In four of the nine patients in who the bite was on the face, the edema envolved all of it, closed both eyelids and expanded to the neck and upper part of the thorax. In three cases the enormous edema was the only signicant clinical manifestation, whereas in the remaining seven conjunctly with the edema, a small violaceous plaque or a blister of serous content gave place to a little livedoid plaque (diameter 0,3-0,8 cm) which evolved to desquamation without leaving any scarring. The edema was characterized by its brilliant rose color, painful and hard which is not accompanied by regional adenopathy. Treatment of the 10 patients depended on the moment in they were seen by us. It consisted on parenteral administration, according to age and weight, of 5-10 mg of chloroprofenpyridamine maleate every 8 hours for be continued every 12-24 hours until the patient was discharged. Parenteral route was preferred in order that it was going to be adequately absorbed

La dapsona (D.D.S.) en el loxoscelismo cutáneo / Dapsone in cutaneous loxoscelism

Desde Noviembre 1984 - Agosto 1986, se realizó un estudio abierto y prospectivo en 16 pacientes con cuadro de Loxoscelismo cutáneo, las cuales recibieron como terapia única Diamino Definil Sulfona (DDS). La dosis administrada fue de 100 mg/día vía oral; 10/16 pacientes completaron 10 días; 2/16, 15 días; 2/16, 20 días; 1/16, 5 días; 1/16, 5 días (doble de la dosis). La evolución de 10/16 pacientes con lesión predominantemente del tipo placa liveloide, fue como sigue: 1/10 curó sin secuela alguna; 8/10 formaron crosta sin úlcera; 1/10 persistió con úlcera inicial. Además en estos 10 pacientes 3/10 tuvieron leve necrosis inicial asociada, y una vez terminada la terapia con DDS, desapareció la necrosis sin progrear a la úlcera, en 5/16 pacientes con lesión violácea predominantement, la evolución post-terapia fue: 2/5 curó sin secuela alguna; 3/5 hicieron costra que luego cayó sin dejar úlcera 1/15 de los pacientes tuvo además leve necrosis inicial que con el tratamiento no progresó y desapareció. El único paciente (1/16) con gran edema y eritema, evolucionó bien con el tratamiento, sin dejar secuela alguna. No se tuvo ningún efecto secundario de la DDS durante el tratamiento, que nos obligara a descontinuarla. Sólo al finalizar la terapia un paciente (1/16) presentó una erupción dérmica leve en las palmas de las manos, que tratada con cremas corticoides y antihistamínicos orales evolucionó favorablemente