Clostridium perfringens α and ß recombinant toxoids in equine immunization / Toxóides recombinantes α e ß de Clostridium perfringens na imunização de equinos

Clostridium perfringens is considered one of the main causative agents of superacute enterocolitis, usually fatal in the equine species, due to the action of the ß toxin, and is responsible for causing severe myonecrosis, by the action of the α toxin. The great importance of this agent in the equine economy is due to high mortality and lack of vaccines, which are the main form of prevention, which guarantee the immunization of this animal species. The aim of this study was to evaluate three different concentrations (100, 200 and 400µg) of C. perfringens α and ß recombinant toxoids in equine immunization and to compare with a group vaccinated with a commercial toxoid. The commercial vaccine was not able to stimulate an immune response and the recombinant vaccine was able to induce satisfactory humoral immune response in vaccinated horses, proving to be an alternative prophylactic for C. perfringens infection.(AU)

Clostridium perfringens é considerado um dos principais agentes causadores de enterocolites superagudas, geralmente fatais na espécie equina, devido à ação da toxina ß, além de ser responsável por causar quadros graves de mionecrose, pela ação da toxina α. A grande importância desses agentes na equinocultura, deve-se a elevada mortalidade e a inexistência de vacinas, principal forma de prevenção, que garantam a imunização dessa espécie animal. O objetivo deste trabalho foi avaliar três diferentes concentrações (100, 200 e 400µg) dos toxóides recombinantes α e ß de C. perfringens na imunização de equinos, bem como comparar com um grupo vacinado com um toxóide comercial. A vacina comercial não se mostrou capaz de estimular uma resposta imune e a vacina recombinante foi capaz de induzir resposta imune humoral satisfatória em equinos vacinados, provando ser uma alternativa profilática para infecção por C. Perfringens.(AU)

Use of EDTA in the treatment of local tissue damage caused by the Bothrops alternatus venom / Utilização do EDTA no tratamento da lesão tecidual local causado pelo veneno de Bothrops alternatus

Twelve adult rabbits were distributed in three groups and received on the femoral biceps region, via intradermal injection (ID), 25µg of Bothrops alternatus venom dissolved in NaCl 0.9% and diluted in 0.25mL of phosphate buffered saline (PBS). Thirty minutes later, the group G1 received 0.25mL of phosphate buffered saline (PBS) ID while to G2 and G3 25mg of ethylenediamine tetraacetic acid (EDTA) dissolved in 0.25mL of PBS were administered via intramuscular (IM) and intravenous (IV) injection, respectively. Evaluations included local lesion and blood profile of all animals, before (time zero) and at 1, 2, 3, 4, 5, 6, 12, 18 and 24h after venom administration. All animal treated with PBS (G1) and EDTA IV (G3) presented increase of nociceptive stimuli at the site of inoculation of the venom, followed by moderate edema that persisted for 24h. Animals treated with IM EDTA (G2) only manifested increase of nociceptive stimuli at the site of injection 1h after treatment with discrete local edema between 12 and 24h. In relation to the local hemorrhagic halo no differences were found amongst the studied groups. Blood profile revealed significant decrease of segmented neutrophils in all groups. There was also increase in triglycerides and decrease in total protein and albumin in all groups. The local lesion was not altered by the treatments.(AU)

Doze coelhos adultos, distribuídos em três grupos, receberam, na região de bíceps femoral, por via intradérmica (ID), 25µg de veneno de Bothrops alternatus, dissolvidos em NaCl 09%, diluído em 0,25mL de tampão salina fosfato (PBS). Trinta minutos após o desafio, o grupo G1 recebeu 0,25mL de (PBS) ID, e os grupos G2 e G3 receberam 25mg de ácido etilenodiamino tetra-acético (EDTA), dissolvidos em mL de PBS por via intramuscular (IM) e intravenosa (IV), respectivamente. Foram avaliados lesão local e perfil sanguíneo de todos os animais, antes - tempo zero, e à uma, às duas, três, quatro, cinco, seis, 12, 18 e 24 horas após a injeção do veneno. Tanto os animais tratados com PBS (G1) como os animais tratados com EDTA IV (G3) apresentaram aumento do estímulo nociceptivo no local da administração do veneno, seguido por moderado edema, que perdurou por 24h. Os animais tratados com EDTA IM (G2) somente manifestaram aumento do estímulo nociceptivo local uma hora após tratamento e discreto edema local entre 12 e 24 horas. Em relação ao halo hemorrágico, não houve diferença entre os três grupos estudados. No perfil hematológico, observou-se diminuição significativa dos neutrófilos segmentados nos três grupos estudados. Da mesma forma, houve aumento dos triglicerídeos e diminuição da proteína total e albumina em todos os grupos. Conclui-se que a lesão local não foi alterada pelos tratamentos.(AU)

Could mesenchymal stem cell therapy help in the treatment of muscle damage caused by Bothrops alternatus venom? / Podem as células tronco mesenquimais auxiliarem no tratamento da lesão muscular causada pelo veneno de Bothrops alternatus?

ABSTRACT: The aim of this study was to evaluate the use of mesenchymal stem cells (MSC) in the treatment of myonecrosis induced by Bothrops alternatus venom in rats. Seventy-five male adult Wistar rats were divided into three experimental groups. G1 and G2 were injected in the gastrocnemius muscle with 120μg of B. alternatus venom, while G3 received 200μL of PBS only. Three days after the venom injection, 12 rats from G1 were treated with 5.0 x 106 MSC in PBS, whereas G2 and G3 rats received PBS. Every three days, blood and muscle samples of five animals from each group were taken for serum biochemical and pathological analyses. Histological examinations showed more intense muscle lesions following MSC treatment, characterized by disorganization and loss of muscle fibers, with focal necrosis and inflammatory infiltration by mononuclear cells. In conclusion, the use of MSC for the treatment of local damage caused by inoculation of B. alternatus venom impaired muscle regeneration and interfered in the healing process.

RESUMO: O objetivo do presente trabalho foi avaliar a utilização das células tronco mesenquimais (MSC) no tratamento da mionecrose induzida pelo veneno de Bothrops alternatus em ratos. 75 ratos Wistar adultos foram distribuídos em três grupos experimentais. G1 e G2 receberam 120μg de veneno de B. alternatus, enquanto o G3 recebeu apenas 200μL de PBS. Três dias após a administração do veneno, os ratos do grupo G1 foram tratados com 5.0 x 106 MSC, enquanto G2 e G3 receberam exclusivamente PBS. A cada três dias, amostras de sangue e tecido muscular foram coletadas de cinco animais de cada grupo para avaliação bioquímica sérica e patológica, respectivamente. A análise histológica revelou lesão muscular mais intensa após a aplicação das MSC, caracterizada pela desorganização e perdas das fibras musculares, com necrose focal e infiltrado inflamatório mononuclear. É possível concluir que a utilização das MSC para o tratamento da lesão local causada pela inoculação do veneno B. alternatus deteriorou a regeneração muscular e interferiu com o processo de cicatrização.

Blackleg in cattle: current understanding and future research needs / Carbúnculo sintomático: compreensão atual e futuras necessidades de pesquisa

ABSTRACT: Blackleg is an endogenous acute infection that principally affects cattle, whose etiologic agent is the anaerobic bacterium Clostridium chauvoei. In recent years, the major virulence factors of C. chauvoei have been discovered and described. However, the pathogenesis of blackleg in cattle, and in particular, the movement of the pathogen from the point of entry to the affected tissues is not yet fully elucidated. Disease control is based on appropriate management and vaccination. This review summarizes the latest research findings that contribute toward the understanding of the disease in cattle, provide a foundation to preventive strategies, and identify future research needs.

RESUMO: O carbúnculo sintomático é uma infecção endógena, aguda, que acomete principalmente bovinos, cujo agente etiológico é a bactéria anaeróbica Clostridium chauvoei. Recentemente, os principais fatores de virulência do C. chauvoei foram descobertos e descritos. Contudo, a patogênese do carbúnculo sintomático em bovinos, especialmente a circulação do patógeno desde o ponto de entrada até os tecidos acometidos ainda não está completamente elucidada. O controle desta enfermidade é baseado em medidas adequadas de manejo e vacinação. Esta revisão reúne as mais recentes descobertas que contribuíram para o entendimento da doença em bovinos, fornece embasamento para medidas preventivas e aponta futuras necessidades de pesquisa.

Thoracolumbar Paraspinal Myonecrosis after Aortic Dissection / 대한신경손상학회지

Thoracolumbar paraspinal myonecrosis can be developed with various etiologies. It can induce compartment syndrome of spinal muscles and cause elevated pressure on back muscles, resulting in severe back pain. Thoracolumbar paraspinal myonecrosis is a very rare disease. There are only a few studies about paraspinal myonecrosis. Here we report a case of a spontaneous thoracolumbar paraspinal myonecrosis in a patient who had asymptomatic abdominal aortic dissection. Through this case, etiologies, clinical features, radiologic findings, and treatment options for thoracolumbar paraspinal myonecrosis are discussed.

Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis

A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed.

Gangrena gaseosa / Gangrène gazeuse / Gas gangrene

Se presenta un paciente masculino de 29 años, mestizo, recluso, quien 7 días antes de haber sido remitido al servicio de urgencias del Hospital Universitario Amalia Simoni se había inoculado, en autoagresión, heces fecales en la pierna y el muslo derechos. Refirió dolor y presentaba gran toma del estado general. A la exploración física se constató aumento de volumen generalizado del miembro inferior derecho, con zonas de eritema marcado que alternaban con áreas de necrosis que incluso afectaban el abdomen bajo, aumento de la temperatura local; a la palpación, dolor intenso con amplia zona de crepitación subcutánea, además de bulas de contenido serohemático, pútrido, de olor fétido. La radiografía reveló aumento marcado de la opacidad de las partes blandas, bandas de gas a nivel del tejido celular subcutáneo y presencia de numerosas bulas sin toma ósea. Se decidió tratamiento quirúrgico multidisciplinario que incluyó la desarticulación en guillotina del miembro inferior derecho a nivel de la cadera y toilette amplia, medidas de soporte vital, y la combinación de clindamicina, vancomicina y meronem. La gangrena gaseosa es una infección fulminante de los tejidos blandos con una mortalidad elevada; la sospecha diagnóstica y el entendimiento de la fisiopatología mejoran el pronóstico. El soporte vital, el equilibrio del medio interno, el uso de antimicrobianos de amplio espectro y un tratamiento quirúrgico agresivo, disminuyen la mortalidad(AU)

A case of a 29-year convict mestizo male patient is presented here. This patient is referred to the emergency department of Traumatology at Amalia Simoni University Hospital, seven days after having self-inoculated with stool in his right leg and thigh as self-harm. The patient complained of pain and his general was very poor. Physical examination revealed generalized increase in volume of the right lower limb, with marked erythema areas alternating with areas of necrosis that were even affecting the lower abdomen; increased local temperature, tenderness, pain with subcutaneous crepitus in wide area were found, as well as bulls serohematic bulls, putrid, foul-smelling. Radiography reveals marked increase in opacity of the soft tissues, bands of gas at the level of subcutaneous tissue and the presence of numerous bulls without bone involvement. Multidisciplinary surgical treatment was decided including the guillotine disarticulation of the right leg to hip level and wide toilette, life support, and the combination of clindamycin, vancomycin, and meronem. Gas gangrene is a fulminant soft tissue infection with high mortality; the suspected diagnosis and understanding of the pathophysiology improve prognosis. Life support, balance the internal environment, the use of broad-spectrum antimicrobials and aggressive surgical treatment, reduce mortality(AU)

Un patient âgé de 29 ans, métis, reclus, référé au service d'urgences à l'hôpital universitaire "Amalia Simoni" dû à une automutilation (inoculation de selle dans la jambe et la cuisse droites), est présenté. Il a exprimé une douleur et une sensation de mal-être. Dans l'examen physique, on a pu constater une inflammation du membre inférieur droit; des zones érythémateuses très marquées alternant avec des zones nécrosées, même arrivant à l'abdomen bas; une augmentation de la température locale; une douleur violente avec une zone de crépitements à la palpation, et des bulles à contenu séro-hématique, putréfié et fétide. La radiographie a révélé une augmentation significative de l'opacité des parties molles, des bandes gazeuses au niveau du tissu cellulaire sous-cutané, et une présence de nombreuses bulles sans prise osseuse. On a décidé un traitement chirurgical pluridisciplinaire consistant à une désarticulation en guillotine du membre inférieur droit au niveau de la hanche et un curettage profond; des soins intensifs, et une combinaison de clindamycine, vancomycine et méropénème. La gangrène gazeuse est une infection fulminante des tissus mous avec un taux de mortalité très haut. Le diagnostic suspecté et la compréhension de la physiopathologie améliorent le pronostic. Les soins intensifs, l'équilibre du milieu intérieur, l'emploi d'antimicrobiens à large spectre et un traitement chirurgical agressif font réduire le taux de mortalité(AU)

Infecciones necrotizantes de tejidos blandos: Mionecrosis por Clostridium

Las infecciones necrotizantes de los tejidos blandos varían en su presentación clínica, pero en general son de curso grave y alta mortalidad. El cuadro clínico incluye: fiebre, celulitis, edema, crepitación, bulas, necrosis y sepsis; con frecuencia existe un antecedente traumático o quirúrgico. Como hallazgo operatorio se encuentra necrosis de la piel y tejido subcutáneo, con o sin mionecrosis. El tratamiento debe ir dirigido a compensar el estado general de los pacientes aunado al temprano desbridamiento y remoción de tejido necrótico y contaminado y cobertura antibiótica de amplio espectro. Se expone el caso clínico de un paciente indígena de 2 años, sin antecedentes patológicos previos que desarrolló un proceso compatible con una infección necrotizante de partes blandas (INPB) en miembro superior e inferior izquierdo. Se realizó de urgencia una fasciotomía de miembro superior Derecho y desarticulación de cadera izquierda y se instauró tratamiento antibiótico con meropenem y vancomicina, sesiones con oxígenos hiperbárico.

Necrotizing soft tissue infections vary in their clinical presentation, but are generally severe course and high mortality. The clinical picture includes fever, cellulitis, edema, crepitus, bullae, necrosis and sepsis; there is often a traumatic or surgical history. As surgical finding is necrosis of the skin and subcutaneous tissue, with or without myonecrosis. Treatment should be directed to compensate the general state of patients coupled with early debridement and removal of necrotic tissue and contaminated and broad-spectrum antibiotics.The clinical case of an patient two years, without previous pathological antecedents who developed a process compatible with necrotizing soft tissue infection into upper and lower left limb is exposed. Performed emergency fasciotomy of right upper limb and left hip disarticulation and antibiotic treatment was started with meropenem and vancomycin, hyperbaric oxygen sessions.

Histopathological, immunohistochemical and biomolecular diagnosis of myocarditis due to Clostridium chauvoei in a bovine / Diagnóstico anatomopatológico, imuno-histoquímico e biomolecular de um caso de miocardite por Clostridium chauvoei em um bovino

The aim of this study was to report a case of clostridial myocarditis in a bovine in Brazil with emphasis on the pathological findings, isolation and molecular identification associated with the in situ localization of C. chauvoei. The animal, a male Brangus bull with nine months of age, was found dead without prior clinical signs. Multifocal and coalescent areas of necrosis were observed in the myocardium. Rod cells in the cardiac muscle fibers were positive immunostaining for C. chauvoei, while this bacterium was also isolated and identified by polymerase chain reaction (PCR).

O objetivo deste estudo foi relatar um caso de miocardite clostridial em um bovino no Brasil, com ênfase nos achados patológicos, isolamento e identificação molecular do agente e visualização in situ de C. chauvoei. O animal, um macho da raça Brangus com nove meses de idade, foi encontrado morto sem sinais clínicos prévios. Foram observadas áreas de necrose multifocal e coalescente no miocárdio, com a presença de bastonetes imunomarcados para C. chauvoei nas fibras musculares cardíacas. Uma estirpe de C. chauvoei foi isolada do tecido e sua identidade foi confirmada por reação em cadeia da polimeras (PCR).

Identification of two novel cytolysins from the hydrozoan Olindias sambaquiensis (Cnidaria)

Although the hydrozoan Olindias sambaquiensis is the most common jellyfish associated with human envenomation in southeastern and southern Brazil, information about the composition of its venom is rare. Thus, the present study aimed to analyze pharmacological aspects of O. sambaquiensis venom as well as clinical manifestations observed in affected patients. Crude protein extracts were prepared from the tentacles of animals; peptides and proteins were sequenced and submitted to circular dichroism spectroscopy. Creatine kinase, cytotoxicity and hemolytic activity were evaluated by specific methods.

Identification of two novel cytolysins from the hydrozoan Olindias sambaquiensis (Cnidaria)

Although the hydrozoan Olindias sambaquiensis is the most common jellyfish associated with human envenomation in southeastern and southern Brazil, information about the composition of its venom is rare. Thus, the present study aimed to analyze pharmacological aspects of O. sambaquiensis venom as well as clinical manifestations observed in affected patients. Crude protein extracts were prepared from the tentacles of animals; peptides and proteins were sequenced and submitted to circular dichroism spectroscopy. Creatine kinase, cytotoxicity and hemolytic activity were evaluated by specific methods.

Recurrent diabetic myonecrosis: A rare complication of a common disease.

Spontaneous aseptic diabetic muscle infarction (DMI) is one of the rare complications of diabetes. We report a case of type 2 diabetes mellitus with advanced microvascular complications presenting with severe muscular pain. She was diagnosed as DMI on the basis of clinical presentation, radiological and histopathological investigations. She was managed conservatively. During 18 months of follow up, she had good improvement but subsequently other muscle groups were involved suggesting recurrent DMI.

Mionecrose aguda por Clostridium septicum em equinos / Acute myonecrosis by Clostridium septicum in horses

Descrevem-se dois casos de miosite necrosante causada por Clostridium septicum em equinos. Os dois equinos apresentavam aumento de volume no membro pélvico direito e que se estendia para a região abdominal ventral. Ao corte, essa área era formada por edema sanguinolento e bolhas de gás. Os músculos esqueléticos da região caudal da coxa apresentavam áreas vermelho-escuras, crepitantes, com edema sanguinolento e, ao corte, as áreas mais profundas da musculatura tinham aspecto seco. As principais alterações histopatológicas observadas foram tumefação, vacuolização, necrose hialina e necrose flocular de fibras musculares esqueléticas. Entre as fibras, havia hemorragia, edema e grande quantidade de bacilos com tamanho de 3-6μm. Na coloração de Gram, os bacilos se apresentavam roxos (gram-positivos); quando impregnados pela prata (Warthin-Starry), se mostraram enegrecidos. Nos dois casos, C. septicum foi isolado, em ambiente anaeróbio, do líquido de edema das lesões musculares.

Two cases of acute necrotizing myositis caused by Clostridium septicum in horses are described. Both horses presented swelling of the right pelvic limb extending to the ventral abdominal region. The cut surface of the affected area revealed blood-stained edema and gas bubbles. The skeletal muscles of the caudal region of the thigh of the affect limbs had dark red discolored areas of blood-stained edema and crepitation; the deep musculature was dry. The main histopathological findings were swelling, vacuolation and hyaline and floccular necrosis of skeletal myofibers; in between myofibers there were hemorrhage, edema and large amounts of bacilli. In both cases, C. septicum was isolated from the edema fluid of muscular lesions.

Low-level laser therapy decreases local effects induced by myotoxins isolated from bothrops jararacussu snake venom

The prominent myotoxic effects induced by Bothrops jararacussu crude venom are due, in part, to its polycationic myotoxins, BthTX-I and BthTX-II. Both myotoxins have a phospholipase A2 structure: BthTX-II is an active enzyme Asp-49 PLA2, while BthTX-I is a Lys-49 PLA2 devoid of enzymatic activity. In this study, the effect of low-level laser therapy (LLLT), 685 nm laser at a dose of 4.2 J/cm2 on edema formation, leukocyte influx and myonecrosis caused by BthTX-I and BthTX-II, isolated from Bothrops jararacussu snake venom, was analyzed. BthTX-I and BthTX-II caused a significant edema formation, a prominent leukocyte infiltrate composed predominantly by neutrophils and myonecrosis in envenomed gastrocnemius muscle. LLLT significantly reduced the edema formation, neutrophil accumulation and myonecrosis induced by both myotoxins 24 hours after the injection. LLLT reduced the myonecrosis caused by BthTX-I and BthTX-II, respectively, by 60 and 43 percent; the edema formation, by 41 and 60.7 percent; and the leukocyte influx, by 57.5 and 51.6 percent. In conclusion, LLLT significantly reduced the effect of these snake toxins on the inflammatory response and myonecrosis. These results suggest that LLLT should be considered a potential therapeutic approach for treatment of local effects of Bothrops species venom.

Calcific Myonecrosis of the Antetibial Area

Calcific myonecrosis is a rare late post-traumatic condition, in which a single muscle is replaced by a fusiform mass with central liquefaction and peripheral calcification. Compartment syndrome is suggested to be the underlying cause. The resulting mass may expand with time due to recurrent intralesional hemorrhage into the chronic calcified mass. A diagnosis may be difficult due to the long time between the original trauma and the symptoms of calcific myonecrosis. We encountered a 53-year-old male patient diagnosed with calcific myonecrosis in the lower leg. We report the case with a review of the relevant literature.

The effects of low-level laser on muscle damage caused by Bothrops neuwiedi venom

The present study aimed to assess the effects of low-level laser (660 nm) on myonecrosis caused by the insertion of Bothrops neuwiedi venom in the gastrocnemius muscle of rats. Male Wistar rats were divided into three groups (n equal 24 each): Group S (0.9 percent saline solution); Group V (venom) and Group VLLL (venom plus low-level laser). These categories were subdivided into four additional groups (n equal 6) based on the euthanasia timing (3 hours, 24 hours, 3 days and 7 days). The groups V and VLLL were inoculated with 100 miL of concentrated venom (40 mig/mL) in the gastrocnemius muscle. The muscle was irradiated using a gallium-aluminum-arsenide laser (GaAlAs) at 35 mW power and 4 J/cm² energy density for 3 hours, 24 hours, 3 days or 7 days after venom inoculation. To evaluate the myotoxic activity of the venom, CK activity was measured and the muscle was histologically analyzed. The low-level laser reduced venom-induced CK activity in the groups euthanized at 3 hours, 24 hours and 3 days (p smaller that 0.0001). Histological analysis revealed that low-level laser reduced neutrophilic inflammation as well as myofibrillar edema, hemorrhage and myonecrosis following B. neuwiedi envenomation. These results suggest that low-level laser can be useful as an adjunct therapy following B. neuwiedi envenomation.

Detection of several clostridia by a direct fluorescent antibody test in formalin-fixed, paraffin-embedded tissues

Descreve-se a aplicabilidade de uma técnica de imunofluorescência direta, para o diagnóstico de mionecroses causadas por clostrídios, a partir de tecidos fixados em formol e incluídos em parafina. Essa técnica pode auxiliar no diagnóstico do carbúnculo sintomático e da gangrena gasosa, contribuindo para determinar a real prevalência dessas doenças no país

Rectus Sheath Hematoma Complicated by Rectus Abdominus Myonecrosis in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Rectus sheath hematoma is an uncommon cause of acute abdomen, caused by a tear in deep epigastric vessels or its branches. It occurs spontaneously, after trauma or surgery. Rectus abdominus myonecrosis is a life threatening complication of rectus sheath hematoma. We report a case with fatal rectus sheath hematoma complicated by rectus abdominus myonecrosis caused by ischial fracture in a chronic active rheumatoid arthritis patient.

Myonecrosis induced in rat by a myotoxin isolated from the venom of Bothrops neuwiedifrom Alfenas, MG

Bothrops venoms are composed by several protein fractions. Among these fractions there are myotoxins which induce an important muscle lesion. The purification of this component involves some steps, although providing a pure material, is time consuming. In the present study, we describe a quick method for myotoxin fraction isolation from the venom of Bolhrops nsuwiedi using one-step high performance liquid chromatography (HPLC). The complete procedure took 30 min. The pur6+y of the two myotoxic fractions isolated was assessed by SDS-PAGE. Upon i.m. injection into rat tibialis anterior, both toxins induced early morphological changes, indicating that the plasma membrane was the first cellular structure affected. Afterwards, the lesion was typically myonecrotic and inflammatory infiltrate was present.

Os venenos de Bolhrops são compostos por várias frações protéicas. Dentre elas, as miotoxinas induzem lesões musculares importantes. A purificação deste componente envolve várias etapas e, embora forneça frações puras, é muito trabalhosa. Neste trabalho foi descrito um método rápido para o isolamento da fração miotóxica do veneno de Bothrops neuwiedi (jararaca pintada), utilizando-se uma etapa única de purificação por Cromatografia Liquida de Alta Eficiência (CLAE). O procedimento completo demorou apenas 30 min. Foram isoladas duas frações com atividade miotóxica, cuja pureza foi verificada por eletroforese em gel de poliacrilamida-SDS. A injeção intramuscular no músculo tibial anterior de ratos induziu alterações morfológicas precoces, indicando que a membrana plasmática foi a primeira estrutura celular afetada pela fração miotóxica. A lesão muscular obtida foi tipicamente mionecrótica e foi observado infiltrado inflamatório.

A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis / 감염

Invasive infections by group A streptococci have reemerged as a global public health problem since the middle of the 1980s. Streptococcal toxic shock syndrome (StrepTSS) is one manifestation of invasive streptococcal infections, and it is characterized by necrotic infection of soft tissue. Myonecrosis can occur in StrepTSS, but the clinical features of this subset of StrepTSS are not clearly defined. A previously healthy 38-year-old woman was hospitalized because of pain and edema of both legs, which had developed one day prior to admission. Six hours after admission, the swelling of the patient's left leg became more severe and areas of well-demarcated violescent discoloration of the skin and hemorrhagic bullae developed. A further ten hours later, she was in shock and exhibited signs of disseminated intravascular coagulation and multiple organ failure. Gram stain of an aspirate from the bulla revealed short chains of gram-positive cocci. Streptococcus pyogenes was isolated from blood culture and the presence of streptococcal exotoxins (speA gene) and M-protein type 3 were confirmed using the polymerase chain reaction. Muscle biopsy showed extensive myonecrosis and hemorrhage without infiltration of leukocytes. Despite intensive treatment with antibiotics (including clindamycin), debridement, and intravenous gamma globulin, the patient died four days after admission to the hospital.