Accident caused by Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), native to the Caribbean, in Brazilian airport / Acidente causado por Centruroides testaceus (DeGeer, 1778) (Scorpiones, Buthidae), nativo do Caribe, em aeroporto brasileiro

Describes the case of a 6-year-old girl who was stung by a Centruroides testaceus, a scorpion native to the Lesser Antilles, in the Guarulhos International Airport, São Paulo, Brazil, as she disembarked from a flight coming from the Caribbean. The patient presented only local symptoms (a small area of erythema and pain at the sting site), which were resolved after a few hours with analgesics, without the need for antivenom. Physicians who treat patients stung by scorpions should be alert to the possibility of such accidents being caused by non native species, especially those cases that occur near airports or ports.

Descreve-se um caso de menina de 6 anos de idade picada por um Centruroides testaceus, escorpião nativo das Antilhas, no interior do Aeroporto Internacional de Guarulhos, São Paulo, Brasil, após ter desembarcado de um vôo vindo do Caribe. A paciente apresentou apenas sintomas locais (pequena área de eritema e dor no local da picada), resolvidos em algumas horas com uso de analgésicos, não necessitando receber soro antiveneno. Os médicos que tratam pacientes picados por escorpiões devem estar precavidos quanto à possibilidade dos acidentes serem causados por espécies não-nativas, especialmente nos que ocorrem próximos a aeroportos ou portos.

Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela

The first two cases of scorpion envenoming caused by Tityus neoespartanus (Buthidae) are described. The accidents took place within human environments (one inside a home and the other inside a school), in the village of La Sierra, Margarita Island, State of Nueva Esparta, northeastern Venezuela. Both cases were moderately severe and developed pancreatic involvement and electrocardiographic abnormalities. This report allows inclusion of Margarita Island among the endemic areas of scorpionism in Venezuela.

Descrevem se os dois primeiros casos de escorpionismo por Tityus neoespartanus (Scorpiones, Buthidae). Os acidentes ocorreram no ambiente antrópico (um no domicilio e outro na escola) na aldeia de La Sierra, Ilha de Margarita, Estado de Nueva Esparta, nordeste da Venezuela. Os dois acidentes, moderadamente graves, cursaram com acometimento pancreático e alterações eletrocardiografias. Este reporte permite incluir à Ilha de Margarita entre as áreas endêmicas de escorpionismo na Venezuela.

Síndrome compartamental de extremidad superior: experiencia con el uso de un sistema aspirativo contínuo para el manejo de una herida mayor / Compartmental syndrome of upper extremity

Presentamos a un menor de 9 años de edad quien a raíz de una mordedura de araña de rincón en su extremidad superior derecha (antebrazo) desarrolló un cuadro grave de loxoscelismo cutáneo-visceral rápidamente progresivo, que lo llevó a una insuficiencia renal aguda, además de un síndrome compartamental de la extremidad afectada, donde fue necesario efectuar una fasciotomía de descarga amplia, y varios aseos quirúrgicos con resecciones de tejido necrótico, que dejó una lesión cruenta mayor, la que fue tratada con una curación hermética aspirativa, para finalmente realizar un injerto dermoepidérmico, logrando su recuperación después de 19 días en unidad de cuidados intermedios y de 24 días totales de hospitalización, egresando sin complicaciones precoces.

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

Relato de um caso de latrodectismo ocorrido em Manaus, Amazonas, Brasil / Report of a case of latrodectism occurring in Manaus, Amazonas, Brazil

Em 02/07/1995, foi atendido no Instituto de Medicina Tropical do Amazonas, paciente masculino, 11 anos, acidentado em Manaus, por picada na região retroauricular direita, clínicamente compatível com aquele causado por Latrodectus. Observavam-se abalos musculares, febre, calafrios e sudorese intensa. Instituída terapêutica com neostigmine precedido de atropina, gluconato de cálcio, cimetidina, diazepam e hidrocortisona. No terceiro dia apresentava-se melhorado, consciente, orientado e com diminuição importante do edema palpebral. A despeito de uma melhora progressiva diária, no quinto dia surgiu eritema máculo-pápulo-vesiculoso. Em 14/07/1995 teve alta, assintomático. O caso relatado é o primeiro descrito na região Amazônica, ocorrido na periferia de Manaus e pode ter sido uma consequência da expansão urbana das duas últimas décadas.

In July 2, 1995 arrived at the Instituto de Medicina Tropical do Amazonas as eleven-year-old male with complaining of spider bite on his right retroauricular region, presenting typical findings of latrodectism. The accident was reported as having occurred in the suburbs of Manaus. The patient was given neostigmine preceded by atropine, calcium gluconate, cimetidine, diazepan and hydrocortisone. Within three days the patient showed improvement, and was aware, orientated and with significant palpebral oedema reduction. Muscle spasms are still present, as well as fever, shivering, and intense sweating. In spite of a daily progressive improvement, at the fifth day appeared a spotted papular erythema. The patient was discharged without symptoms after the 13th day. This is the first such reported case which took place in Amazonian region, it might have been happened a consequence of the urban sprawl which has characterized the growth of the city of Manaus, in the last twenty years. It is not possible at this point to evaluate the epidemiological resound of the event, but in any case, it seems plausible to recommend that black widow antivenom become available.

Loxosceles y loxoscelismo en Piura / Loxosceles and loxoscelism in Piura

Los autores presentan dos casos con loxocelismo cutaneo y mordedura de araña del género Loxoceles sp. en la casa de uno de los pacientes. Estos son uno de los primeros caos de loxocelismo y Loxoceles en Piura