Micetismo: reporte de dos casos fatales y revisión bibliográfica / Mycetism: Report of two fatal cases and review of the literature

Justificación:El micetismo es la intoxicación producida por la ingestión de setas silvestres, que puede presentarse clínicamente con diferentes síndromes toxicológicos, dependiendo de la especie de hongo involucrada y sus toxinas. Su importancia médicolegal radica en que la ingesta puede ocurrir de manera accidental, homicida o suicida. Objetivo: Revisar aspectos relevantes sobre el micetismo, para el reconocimiento de síndromes toxicológicos asociados a la ingesta de setas. Metodología:Se revisaron diferentes bases de datos utilizando las palabras clave: micetismo, Amanita phalloides, autopsia médicolegal, abordaje diagnóstico. Resultados:A. phalloides, contiene amatoxinas causantes de insuficiencia hepática aguda y las falotoxinas responsables de manifestaciones gastrointestinales 10 horas después de la ingesta, característica del síndrome tóxico faloidiano. Los casos que se describen corresponden a dos femeninas de la misma familia, una mujer adulta 36 años embarazada y su hija de seisaños, procedentes de una comunidad rural en la parte central de Honduras, que fallecieron después de la ingestión de setas silvestres y cuyas autopsias se realizaron en la Dirección de Medicina Forense de Tegucigalpa, para establecer la causa de muerte. En la historia médico legal se consignó que los hongos fueron cocinados por la madre y consumidos por ella y su hija. Conclusión:Es recomendable la capacitación continuade los médicos de emergencia en hospitales, para el reconocimiento de síndromes toxicológicos asociados a la ingesta de setas, con el propósito de tratar oportunamente estos pacientes y ofrecerles mejor oportunidad de sobrevivir...(AU)

Acute and chronic bovine pulmonary edema and emphysema in Uruguay / Edema e enfisema pulmonar agudo e crônico em bovinos do Uruguai

An outbreak of pulmonary edema and emphysema with acute and chronic cases is reported in a farm in Uruguay. In a herd of 40 Hereford steers, 20 died. The deaths began four days after a change of paddock, from an old pasture of Avena sativa to a lush growing pasture of the same grass. Acutely affected animals showed severe dyspnea, sialorrhea, cough, and subcutaneous edema, and died within 72 hours. Chronically affected steers showed dyspnea, respiratory noises, weight loss, and intolerance to exercise. The deaths began four days after the change of paddock. Ten days after the first death, the steers were withdrawn from the pasture, but continued dying throughout the following 40 days. Twenty animals died and six were necropsied. Grossly, the lungs were diffusely armed and glistening, with reddish and crepitant cut surface, and presented alveolar septae sharply distended by edema and emphysema. There was subpleural emphysema with air blebs distributed across the pleural surface. Presence of Dictyocaulus viviparus was observed in three steers. In some animals, the trachea was diffusely reddish with presence of pink foam; in some others, there was bloody liquid in the tracheal lumen. Histologic examination showed severe diffuse alveolar and interstitial emphysema, hyaline membranes adhered to the alveolar wall, thickening of the interlobular septae with proliferation of type II pneumocytes, and moderate-to-severe multifocal histiocytic, neutrophilic and eosinophilic infiltrate. In the trachea, there was submucosal hemorrhage and moderate multifocal eosinophilic and lymphocytic infiltrate. The steers with chronic signs presented similar lung lesions, but multifocal pulmonary fibrosis and cardiac dilatation were also observed. The diagnosis of acute bovine pulmonary emphysema and edema (ABPE) was based on the occurrence of the disease after introduction of the herd in a lush green pasture, on the characteristic gross and histologic lesions, and on the absence of other toxic or infectious agents causing similar lesions. Cattle raisers should be alert to the risks of occurrence of this disease after the introduction of the herds into paddocks with green and lush pastures.(AU)

Descreve-se um surto de edema e enfisema pulmonar com casos agudos e crônicos em bovinos em uma criação semi-intensiva no Uruguai. De um lote de 40 novilhos da raça Hereford morreram 20. As mortes começaram quatro dias após uma mudança de alimentação, de uma pastagem mais velha de Avena sativa, para uma pastagem recentemente plantada de aveia que estava em brotação. Os animais afetados apresentaram sinais clínicos agudos de dispneia, sialorreia, tosse e alguns desenvolveram edema subcutâneo, morrendo em até 72 horas. Outros novilhos mais cronicamente afetados apresentaram dispneia, ruídos respiratórios, perda de peso e intolerância ao exercício. As mortes começaram quatro dias após a mudança de pastagens. Dez dias após a primeira morte, os novilhos foram retirados do pasto, mas morreram ainda durante 40 dias mais. Ao total, morreram vinte animais e seis foram necropsiados. Nas necropsias dos animais mortos na fase aguda os pulmões estavam difusamente armados e brilhosos e ao corte de coloração avermelhada e crepitante, com os septos alveolares acentuadamente distendidos por edema e enfisema. Havia enfisema subpleural caracterizado por bolhas de ar distribuídas pela superfície pleural. Em três bovinos havia ainda presença de Dictyocaulus viviparus. Alguns animais apresentaram a traqueia difusamente avermelhada com espuma de coloração rósea ou liquido sanguinolento livre na luz traqueal. Histologicamente havia edema e enfisema alveolar e intersticial difuso severo, membranas hialinas espessas aderidas à parede alveolar, espessamento dos septos interlobulares com proliferação de pneumócitos tipo II e infiltrado inflamatório histiocítico, neutrofílico e eosinofílico multifocal moderado a severo. Na traqueia havia hemorragias na submucosa e infiltrado eosinofílico e linfocítico multifocal. Os novilhos com sinais crônicos apresentaram lesões pulmonares semelhantes, entretanto, foram observadas também, fibrose pulmonar multifocal e dilatação cardíaca. O diagnóstico de EEPAB baseou-se na ocorrência da doença após a introdução do rebanho em uma pastagem viçosa em brotação, nas características macroscópicas e histológicas e na ausência de outros agentes tóxicos ou infecciosos que causam lesões semelhantes. Se alerta para os riscos da ocorrência desta enfermidade, quando houver mudanças de pastagens.(AU)

La implementación de procedimientos estandarizados en la prevención de enfermedades transmitidas por los alimentos. Conteo microbiológico del Staphylococcus aureus en quesos frescos / Implementation of standardized procedures to prevent diseases transmitted by foodstuffs. Microbiological count of Staphylococcus aureus in freshcheese

Introducción: las enfermedades transmitidas por alimentos son una problemática mundial a la que la Organización Mundial de la Salud y los países brindan una atención especial. Dentro de los grupos de alto riesgo se encuentran los productos de origen animal, como la leche y sus derivados. Staphylococcus aureus es un microorganismo causante de brotes de las enfermedades transmitidas por alimentos, lo que genera la necesidad de estudiar la carga microbiana y establecer los controles adecuados. Objetivo: evaluar la calidad microbiológica en el proceso manufacturero en el área de producción de la Cooperativa de Producción Agropecuaria Chone LTDA, con el fin de asegurar la ausencia del Staphylococcus aureus en el queso fresco 100% chonero. Materiales y métodos: Se realizó un estudio de evaluación de la calidad en cuatro fases. Se realizaron exámenes microbiológicos iniciales, se identificaron las causas esenciales de contaminación identificadas por observación directa, revisión de documentos y entrevistas, como base para la elaboración e implementación de POE (Procedimientos Operativos Estandarizados) y POES (Procedimientos Operativos Estandarizados de Saneamiento). Se cumplieron los requerimientos éticos y se realizaron los análisis estadísticos utilizando porcentaje e índices como medida resumen y con el uso de IBM SPSS, versión libre, realizándose regresión logística binaria para determinar la probabilidad de éxito al aplicar dichos procedimientos. Resultados: los análisis microbiológicos iniciales (antes de implementación de POE y POES), dieron como resultado: 98, 116, 79, 120 y 13 UFC/g para las muestras: DiQ1, DiQ2, DiQ3, DiQ4 y DiQ5, respectivamente. Las causas esenciales de contaminación fueron falta de control microbiológico, falta de control del aspecto del personal y falta de control del agua) Una vez implementados los POE y POES, el análisis mostró ausencia en todas las muestras analizadas. Conclusiones: se concluye que la aplicación de POE y POES tiene un efecto significativo sobre la ausencia del Staphylococcus aureus, con probabilidad de éxito del 100% (AU).

Introduction: Diseases transmitted by foodstuffs (DTF) are a worldwide problem that receives special attention by WHO and different countries. High risk groups include foodstuff of animal origin, like milk and its by-products. Staphylococcus aureus is a microorganism responsible for DTF outbreaks which generates the necessity of studying its microbial burden and establishing the adequate controls. Objective: to evaluate the microbiological quality of the manufacturing process in the production area of the Farming and Stockbreeding Cooperative Chone LTDA, to assure the absence of Staphylococcus aureus in the manufacturing process of fresh cheese. Materials and methods: A study to assess the quality in four stages was carried out: initial microbiological tests, identification of the essential contamination causes by direct observation, documental review and inquires. They were used to elaborate and implement the Standardized Operational Procedures (SOP) and the Standardized Operational Procedures of Sanitation (SOPS). The ethical requirements were fulfilled and the statistical tests were performed using percentages and indexes as summary measures through IBM SPSS, free version; binary logistic regression was made to determine the success when applying those procedures. Results: initial microbiological controls (before implementing SOP and SOPS) gave these results 98, 116, 79, 120, and 13 UFC/g for samples DiQ1, DiQ2, DiQ3, DiQ4 and DiQ5 respectively. The main contamination causes were lack of microbiological control, lack of control on the staff's cleanliness and lack of control on the water. After implementing SOP and SOPS microbiological control found particularly clean samples. Conclusions: SOP and SOPS have a significant effect on the amount of Staphylococcus aureus, with 100% success probability (AU).

Surto de doença trasmitida por alimentos nos municipios de Mauá e Ribeirão Pires - SP / Outbreak of foodborne diseases in the municipalities of Maua and Ribeirao Pires - SP

Doenças de transmissão hídrica e alimentar (DTHA) acarretam importantes problemas econômicos e de saúde pública no mundo atual. Este estudo relata um surto de Doença Transmitida por Alimento - DTA que envolveu 12 pessoas de duas residências localizadas na Região do ABC paulista em dezembro de 2012. Quatro pessoas de uma residência tiveram sintomas de diarreia, cólica abdominal, náusea, vômito, febre e prostração, sendo que apenas duas consumiram o bolo preparado em Ribeirão Pires, SP - Brasil. Outras oito pessoas consumiram o mesmo alimento no município de Mauá e, além dos sintomas citados, houve também registro de insuficiência renal e parada cardiorrespiratória. Dentre os envolvidos, uma menina de oito anos veio a óbito após convulsão e bronco-aspiração. O período variou entre 2 e 22 horas após o consumo do alimento. A amostra de bolo foi analisada segundo a metodologia preconizada pelo BAM-FDA e teve como resultados: Coliformes termotolerantes (NMP = 4,6x104/g); Bacillus cereus (1,5x105 U.F.C./g) e presença de Salmonella Enteritidis em 25 gramas. Clostridium perfringens, Staphylococcus aureus e Listeria monocytogenes não foram isolados. Foram realizadas duas coproculturas que apresentaram resultados positivos para Salmonella Enteritidis. As cepas de Salmonella spp isoladas, tanto no alimento como nas fezes dos pacientes, apresentaram similaridade genética e mesmo perfil de suscetibilidade aos antimicrobianos. Assim, foi constatado o envolvimento do bolo como veiculador de patógenos e ressaltada a importância do trabalho em conjunto das vigilâncias sanitárias e epidemiológicas de ambos os municípios e o laboratório de referência em saúde pública, fundamental na elucidação deste surto.

Assessment of effects on health due to consumption of bitter bottle gourd (Lagenaria siceraria) juice.

Background & objectives: The bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other associated benefits. However, in last few years there have been reports of suspected toxicity due to consumption of its juice. This led to the constitution of an Expert Committee by Department of Health Research at Indian Council of Medical Research (ICMR), Ministry of Health & Family Welfare, Government of India in October 2010. The committee looked into the issues related to safety of consumption of bottle gourd juice, and this paper presents the findings. Methods: Information on cases of suspected toxicity due to consumption of bottle gourd juice was collected by internet search, advertising on website of ICMR and by writing to State and district health authorities as well as to medical colleges, hospitals and private nursing homes across the country. Results: Three deaths were reported, one from Delhi and two from Uttar Pradesh after consumption of extremely bitter bottle gourd juice. Three persons who died after consumption of freshly prepared bottle gourd juice or juice mixed with bitter gourd (karela) juice were over 59 years of age and had diabetes since last 20 years. This juice was reported to be extremely bitter by all three. Twenty six persons were admitted to various hospitals of the country on complaint of abdominal pain and vomiting following consumption of freshly prepared bottle gourd juice. Diarrhoea and vomiting of blood (haematemesis) was reported in 18 (69.2%) and 19 (73.1%) patients, respectively. Biochemical investigations revealed elevated levels of liver enzymes. More than 50 per cent patients had hypotension. Endoscopic findings showed profusely bleeding stomach with excessive ulceration seen in distal oesophagus, stomach and duodenum in most of the cases. All these patients recovered fully and no sequeale was recorded for any of the cases. Interpretation & conclusions: Cucurbitaceae family, of which bottle gourd is a member contains the toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste. There is no known antidote for this toxicity and clinicians treat such cases symptomatically only. The Committee made the following recommendations: (i) The community needs to be educated that bitter tasting bottle gourd juice should not be consumed and in case there is any discomfort, nausea, vomiting, diarrhoea or any feeling of uneasiness after consumption of juice, the person should immediately be taken to a nearby hospital. (ii) Clinicians are suggested that patients coming with symptoms (discomfort, nausea, vomiting, diarrhoea, gastrointestinal bleeding after consumption of juice) should immediately be attended to and general supportive care should be provided, i.e. IV fluids/crystalloids/blood products/ fresh frozen plasma to maintain the haemodynamics and electrolyte balance; Ryle’s tube to be put in for gastric lavage and to assess gastrointestinal (GI) bleed- aspirate to be preserved; Proton pump inhibitors should be given for management of GI bleed and appropriate treatment for other complications should be given. (iii) The possible research areas identified are chemical composition studies on bitter and normal bottle gourd and other members of cucurbitaceae family; animal toxicity studies and studies on interaction between bottle gourd juice and other drugs.

La increíble empresa de Sarmiento de Gamboa y su triste fin: Posibles causas de la tragedia en el Estrecho de Magallanes en el siglo XVI / The possible causes of the tragedy of “Port Famine” in the Strait of Magellan

The attempts to colonize the Strait of Magellan soon followed the discovery of this route. PeDro Sarmiento de Gamboa, a Spanish sailor, established human settlements to fortify those lands and control the transit of vessels, especially those of English corsairs, which devastated Chilean and Peruvian coasts. During the summer of 1584, approximately 500 soldiers, artisans, priests, women and children established two villages called “Nombre de Jesús” and “Rey Don Felipe”. From the beginning, these settlers had leadership and communication problems and difficulties to obtain food. After three winters only 17 to 18 people survived according to the testimony of one of the survivors, that was rescued by an English sailor named Cavendish, which renamed the village “Rey Don Felipe” as “Port Famine”. When he observed the scenes of abandonment and death, he supposed that the settlers died due to lack of food. Other factors that facilitated the desolation were hypothermia, execution, anthropophagy and lesions caused by natives. There is also a possibility that intoxication by red tide (harmful algal bloom) could explain in part the finding of unburied corpses in the strait beaches.

Tetrodotoxin poisoning following ingestion of the toxic eggs of the horseshoe crab Carcinoscorpius rotundicauda, a case series from 1994 through 2006.

Between 1994 and 2006, a total of 280 cases of varying degrees of tetrodotoxin poisoning following ingestion of the toxic eggs of the horseshoe crab, Carcinoscorpius rotundicauda, were admitted to the medical service of Chon Buri Hospital. The severity of the poisoning was classified into four stages based on clinical signs and symptoms of human tetrodotoxication. Of 245 available medical records; 100 were in stage 1, 74 were in stage 2, 3 were in stage 3 and 68 were in stage 4. The frequencies of symptoms and signs included the following : circumoral and lingual numbness (98%), hands and feet numbness (94.7%), weakness (59.6%), dizziness and vertigo (54.3%), nausea and vomiting (52.6%), transient hypertension (39.6%), respiratory paralysis (27.7%), fixed dilated pupils (14.7%), ophthalmoplegia (12.2%), blood pressure lower than 90/60 mmHg (5.7%), and polyuria (0.4%). All patients received symptomatic and supportive treatment. Endotracheal intubation and mechanical ventilation were considered when paralysis was progressing rapidly. The results of treatment are as follows: 239 patients (97.5%) showed complete recovery, 5 patients (2%) died, and 1 patient (0.4%) suffered anoxic brain damage. Horseshoe crab poisoning occurs both sporadically and epidemically in Chon Buri. Seasonal variation in the number of cases of poisoning was observed with a peak from December through March.