Study of defensive behavior of a venomous snake as a new approach to understand snakebite

Snakebites affect millions of people worldwide. The majority of research and management about snakebites focus on venom and antivenom, with less attention given to snake ecology. The fundamental factor in snakebites is the snakes’ defensive biting behavior. Herein we examine the effects of environmental variables (temperature, time of day, and human stimulus) and biological variables (sex and body size) on the biting behavior of a medically significant pit viper species in Brazil, Bothrops jararaca (Viperidae), and associate it with the epidemiology of snakebites. Through experimental simulations of encounters between humans and snakes, we obtained behavioral models applicable to epidemiological situations in the State of São Paulo, Brazil. We found a significant overlap between behavioral, morphological, environmental, and epidemiological data. Variables that increase snakebites in epidemiological data also enhance the tendency of snakes to bite defensively, resulting in snakebites. We propose that snakebite incidents are influenced by environmental and morphological factors, affecting the behavior of snakes and the proportion of incidents. Thus, investigating behavior of snakes related to snakebite incidents is a valuable tool for a better understanding of the epidemiology of these events, helping the prediction and, thus, prevention of snakebites.

Infrared Macrothermoscopy Patterns-A New Category of Dermoscopy.

(1) Background: The authors developed a new non-invasive dermatological infrared macroimaging analysis technique (MacroIR) that evaluates microvascular, inflammatory, and metabolic changes that may be dermoscopy complimentary, by analyzing different skin and mucosal lesions in a combined way-naked eye, polarized light dermatoscopy (PLD), and MacroIR-and comparing results; (2) Methods: ten cases were evaluated using a smartphone coupled with a dermatoscope and a macro lens integrated far-infrared transducer into specific software to capture and organize high-resolution images in different electromagnetic spectra, and then analyzed by a dermatologist; (3) Results: It was possible to identify and compare structures found in two dermoscopic forms. Visual anatomical changes were correlated with MacroIR and aided skin surface dermatological analysis, presenting studied area microvascular, inflammatory, and metabolic data. All MacroIR images correlated with PLD, naked eye examination, and histopathological findings; (4) Conclusion: MacroIR and clinic dermatologist concordance rates were comparable for all dermatological conditions in this study. MacroIR imaging is a promising method that can improve dermatological diseases diagnosis. The observations are preliminary and require further evaluation in larger studies.

Differential diagnosis between venomous (Bothrops jararaca, Serpentes, Viperidae) and “Nonvenomous” (Philodryas olfersii, Serpentes, Dipsadidae) snakebites: is it always possible?

Bites of “nonvenomous” snakes can sometimes be mistaken for the bites of venomous snakes. As an example of this confusion, this report describes confirmed bites by Philodryas olfersii and Bothrops jararaca. In the first case, a 55-y-old man with a history of controlled hypertension was bitten on his right forearm by P olfersii. Physical examination revealed extensive edema, erythema, and widespread ecchymoses throughout his right upper limb. Laboratory tests indicated leukocytosis and high D-dimer levels, but normal coagulation, suggestive of a resolved recent coagulopathy. He received only supportive treatment. In the second case, a healthy 35-y-old man was bitten by B jararaca. Although the anatomic region of the bite and the results of physical examination were similar to those in the first case, laboratory tests showed mild coagulopathy, leukocytosis, and high D-dimer levels. The patient was treated with antivenom. In both cases, the 20-min whole blood clotting test results were normal. Patients bitten by P olfersii may present with local symptoms resembling B jararaca envenomation. Without snake identification and the detection of venom-induced consumption coagulopathy, especially in places where the 20-min whole blood clotting test is the only clotting test available, it is almost impossible to establish an accurate and safe differential diagnosis. In this context, the best alternative is to take the risk of prescribing antivenom for a possible P olfersii bite rather than failing to do so for a real Bothrops bite. Late treatment for Bothrops bite can result in severe complications and sequelae.

Bites by Xenodon merremii (Wagler, 1824) and Xenodon neuwiedii (Günther, 1863) (Dipsadidae: Xenodontini) in São Paulo, Brazil: a retrospective observational study of 163 cases

Despite the biological relevance and abundance of non-front-fanged colubroid snakes, little is known about their medical significance. Here, we describe the clinical, epidemiological, and biological aspects of bites by two colubroid species. We retrospectively analyzed cases of Xenodon merremii and Xenodon neuwiedii bites in which the offending snake was clearly identified. Analyses included variables related to the snake and the patient, including demographic data, clinical findings, and treatments. Of the 163 cases, 123 were bites by X. merremii and 40 by X. neuwiedii. Most bites occurred in spring and summer, predominantly during the daytime. Most offending snakes were female. Bites by X. merremii juveniles were more frequent in autumn than in other seasons, whereas those by X. neuwiedii adults were in the summer. Hands and feet were the most frequently affected regions, with no significant difference between upper and lower limbs bitten by either X. merremii or X. neuwiedii. The main clinical findings were pain, transitory bleeding, erythema, and local edema. Local edema was proportionally more frequent with X. neuwiedii bites than with X. merremii bites. No patient had extensive edema or systemic envenomation. A significant association between the snout-vent-length and transitory bleeding in bites by X. merremii, but not in those by X. neuwiedii, was identified. Whole blood clotting tests were normal in all tested patients (62 cases). Sixteen patients were incorrectly treated with anti-Bothrops antivenom. In conclusion, most accidents caused by X. merremii and X. neuwiedii present mild local symptomatology. These snakes can be mistaken for lance-headed vipers, and some bites present symptoms that resemble mild bites by Bothrops sp. Physicians should be aware of X. merremii and X. neuwiedii bites to avoid unnecessary patient distress and overprescription of antivenom.

Bites by Philodryas olfersii (Lichtenstein, 1823) and Philodryas aestiva (Duméril, Bibron and Duméril, 1854) (serpentes, dipsadidae) in São Paulo, Brazil: a retrospective observational study of 155 cases

Despite the biological relevance and abundance of non-front-fanged colubroid snakes, little is known about the medical significance of the majority these species. Herein, we described bites by two green racer species of colubroid snakes, with respect to clinical, epidemiological, and biological features. We retrospectively analyzed proven cases of Philodryas olfersii and Philodryas aestiva bites. Only cases in which the causative animal was brought and identified by an expert were included. Analysis included variables related to the snake, patient demographics, clinical findings, whole blood clotting time (WBCT20), and treatments. Total 155 medical records were analyzed, of which 141 and 14 patients each were bitten by P. olfersii and P. aestiva, respectively. Most bites occurred in spring and summer seasons, predominantly during daytime. Most snakes were female and adult. Bites by P. olfersii adults were more frequent in summer (p < 0.001) and spring (p < 0.001). The hands were most frequently bitten by P. olfersii (59.6%), while the feet and legs (71.4%) were most bitten by P. aestiva. The most common local signs or symptoms observed were pain, edema, erythema, and transitory local bleeding. Severe pain, extensive edema, ecchymosis, and paresthesia were present only in patients bitten by P. olfersii. Significant association was observed between local bleeding and adult snakes (p = 0.019), as well as between the snout-vent-length and pain (p = 0.018), extensive edema (p = 0.024), and erythema (p = 0.047). WBCT20 was normal in the 35 cases in which it was available. Two patients were wrongly treated with anti-Bothrops antivenom. These results indicated that most accidents caused by P. olfersii and P. aestiva present mild local symptomatology. Some bites of P. olfersii bites may present local symptoms, resembling bites by Bothrops-like snakes. Physicians should be informed about these kinds of accidents, to avoid unnecessary distress to the patient and over prescription of antivenom.

The role of travel agents in travel medicine – a study with agencies from Sao Paulo, Brazil

A survey in São Paulo, Brazil, assessed travel agents’ knowledge on travellers’ health. Data were collected using an online questionnaire. Of 200 agencies contacted, 32 answered (34 agents). Most consultants reported discussing personal safety, healt insurance and vaccination. Few provided information on water and food diseases or sexually transmitted infections.

Bites by Tomodon dorsatus (serpentes, dipsadidae): Clinical and epidemiological study of 86 cases.

A total of 86 proven cases of Tomodon dorsatus bites admitted to Hospital Vital Brazil (HVB) of Butantan Institute, in São Paulo, Brazil, between 1945 and 2018, were retrospectively analyzed. The cases included were those in which the snake was brought to HVB and was correctly identified. Of the 86 cases of snake bites, it was possible to describe the sex of the snake in 52 cases; 31 (59.6%) snakes were male. Only 52 snakes out of 86 could be studied because of their preservation status. The length of snakes (snout-vent length) ranged from 180 to 770 mm. Of the 86 snakes, 72 could be distinguished as adults (n = 63, 87.5%) or juveniles (n = 9, 12.5%). Most bites occurred in the spring and summer seasons (n = 57, 66.3%) and during warmer periods of the day (n = 61, 72.6%), between 9 a.m. and 3 p.m. The mean (±standard deviation) age of the victims was 26.9 ±â€¯17.2 years, and 60 (69.8%) were men. Approximately 90% of the patients sought medical care within 6 h after the bite. Both upper (n = 45, 52.3%) and lower (n = 37, 43.0%) limbs were the most frequently bitten, particularly the feet and hands (n = 54, 62.8%). The local clinical manifestations were pain (n = 55, 64.0%), transitory bleeding (n = 23, 26.7%), erythema (n = 22, 25.6%), edema (n = 14, 16.3%), paresthesia (n = 9, 10.5%), and ecchymosis (n = 3, 3.5%). Only 10 (11.6%) patients reported non-specific systemic symptoms characterized by transient dizziness or mild headache, and 21 (24.4%) patients showed no evidence of envenomation. A 20 min whole blood clotting test was performed in 31 (36.0%) patients on admission and all of them had coagulable blood. Supportive treatment was offered to 38 (44.2%) patients, namely, antiseptic (n = 20, 23.3%), antihistamines (n = 12, 14.0%), and analgesics (n = 9, 10.5%). Four (4.7%) patients were inappropriately treated with Bothrops antivenom before their admission to HVB. No sequelae or relevant complications were observed in patients, and the prognosis was benign. Therefore, although T. dorsatus bites can cause mild local symptomatology, it is important that health professionals know how to make the correct diagnosis to avoid unnecessary use of antivenom.

Use of infrared thermography in a case of systemic envenomation by the coral snake Micrurus frontalis (Duméril et al., 1854) in Sao Paulo, Brazil.

Infrared thermography is a technique that quantifies the thermal (infrared) radiation emitted by an object and produces a high-resolution, digital thermal image of it. Medically, this technique is used to visualize the body's surface temperature distribution in a non-invasive, safe, and convenient fashion. However, to the best of our knowledge, the use of infrared thermography for assessing the systemic effects of envenomation by coral snakes has not been reported. In this case report, we describe the use of this technique in the management of a case of snakebite in Sao Paulo, Brazil. A 51-year-old woman was bitten on the back of the right hand by Micrurus frontalis, a species of coral snake, 10 min prior to her arrival at the hospital. Infrared imaging performed at admission revealed elevated temperatures at the bite site and in the elbow, as well as the preservation of a normal distal thermal gradient in both hands. A few minutes later, the patient developed muscle weakness in the upper limbs and in the eyelids, and infrared imaging showed an alteration of the thermal gradient in both hands, reflecting the systemic action of the venom. Following these observations, the patient was treated with the specific antivenom and was discharged 48 h post admission. At the two-week follow-up, the thermal image obtained showed no anomalies, indicating the recovery of the patient. Hence, infrared thermography can be very useful in the early identification of systemic neurotoxicity in cases of Micrurus snake bites, facilitating the decision to prescribe the antivenom.

Use of infrared thermography in a case of systemic envenomation by the coral snake Micrurus frontalis (Duméril et al., 1854) in Sao Paulo, Brazil

Infrared thermography is a technique that quantifies the thermal (infrared) radiation emitted by an object and produces a high-resolution, digital thermal image of it. Medically, this technique is used to visualize the body's surface temperature distribution in a non-invasive, safe, and convenient fashion. However, to the best of our knowledge, the use of infrared thermography for assessing the systemic effects of envenomation by coral snakes has not been reported. In this case report, we describe the use of this technique in the management of a case of snakebite in Sao Paulo, Brazil. A 51-year-old woman was bitten on the back of the right hand by Micrurus frontalis, a species of coral snake, 10 min prior to her arrival at the hospital. Infrared imaging performed at admission revealed elevated temperatures at the bite site and in the elbow, as well as the preservation of a normal distal thermal gradient in both hands. A few minutes later, the patient developed muscle weakness in the upper limbs and in the eyelids, and infrared imaging showed an alteration of the thermal gradient in both hands, reflecting the systemic action of the venom. Following these observations, the patient was treated with the specific antivenom and was discharged 48 h post admission. At the two-week follow-up, the thermal image obtained showed no anomalies, indicating the recovery of the patient. Hence, infrared thermography can be very useful in the early identification of systemic neurotoxicity in cases of Micrurus snake bites, facilitating the decision to prescribe the antivenom.

Bites by Tomodon dorsatus (serpentes, dipsadidae): clinical and epidemiological study of 86 cases

A total of 86 proven cases ofTomodon dorsatusbites admitted to Hospital Vital Brazil (HVB) of ButantanInstitute, in São Paulo, Brazil, between 1945 and 2018, were retrospectively analyzed. The cases included werethose in which the snake was brought to HVB and was correctly identified. Of the 86 cases of snake bites, it waspossible to describe the sex of the snake in 52 cases; 31 (59.6%) snakes were male. Only 52 snakes out of 86could be studied because of their preservation status. The length of snakes (snout–vent length) ranged from 180to 770 mm. Of the 86 snakes, 72 could be distinguished as adults (n = 63, 87.5%) or juveniles (n = 9, 12.5%).Most bites occurred in the spring and summer seasons (n = 57, 66.3%) and during warmer periods of the day(n = 61, 72.6%), between 9A.M. and 3P.M. The mean ( ± standard deviation) age of the victims was 26.9 ± 17.2 years, and 60 (69.8%) were men.Approximately 90% of the patients sought medical care within 6 h after the bite. Both upper (n = 45, 52.3%)and lower (n = 37, 43.0%) limbs were the most frequently bitten, particularly the feet and hands (n = 54,62.8%). The local clinical manifestations were pain (n = 55, 64.0%), transitory bleeding (n = 23, 26.7%), er-ythema (n = 22, 25.6%), edema (n = 14, 16.3%), paresthesia (n = 9, 10.5%), and ecchymosis (n = 3, 3.5%).Only 10 (11.6%) patients reported non-specific systemic symptoms characterized by transient dizziness or mildheadache, and 21 (24.4%) patients showed no evidence of envenomation. A 20 min whole blood clotting test wasperformed in 31 (36.0%) patients on admission and all of them had coagulable blood. Supportive treatment wasoffered to 38 (44.2%) patients, namely, antiseptic (n = 20, 23.3%), antihistamines (n = 12, 14.0%), and an-algesics (n = 9, 10.5%). Four (4.7%) patients were inappropriately treated withBothropsantivenom before theiradmission to HVB. No sequelae or relevant complications were observed in patients, and the prognosis wasbenign. Therefore, althoughT. dorsatusbites can cause mild local symptomatology, it is important that healthprofessionals know how to make the correct diagnosis to avoid unnecessary use of antivenom.

Use of infrared thermography in a case of systemic envenomation by the coral snake Micrurus frontalis (Duméril et al., 1854) in Sao Paulo, Brazil

Infrared thermography is a technique that quantifies the thermal (infrared) radiation emitted by an object and produces a high-resolution, digital thermal image of it. Medically, this technique is used to visualize the body's surface temperature distribution in a non-invasive, safe, and convenient fashion. However, to the best of our knowledge, the use of infrared thermography for assessing the systemic effects of envenomation by coral snakes has not been reported. In this case report, we describe the use of this technique in the management of a case of snakebite in Sao Paulo, Brazil. A 51-year-old woman was bitten on the back of the right hand by Micrurus frontalis, a species of coral snake, 10 min prior to her arrival at the hospital. Infrared imaging performed at admission revealed elevated temperatures at the bite site and in the elbow, as well as the preservation of a normal distal thermal gradient in both hands. A few minutes later, the patient developed muscle weakness in the upper limbs and in the eyelids, and infrared imaging showed an alteration of the thermal gradient in both hands, reflecting the systemic action of the venom. Following these observations, the patient was treated with the specific antivenom and was discharged 48 h post admission. At the two-week follow-up, the thermal image obtained showed no anomalies, indicating the recovery of the patient. Hence, infrared thermography can be very useful in the early identification of systemic neurotoxicity in cases of Micrurus snake bites, facilitating the decision to prescribe the antivenom.

Use of infrared thermography in a case of systemic envenomation by the coral snake Micrurus frontalis (Duméril et al., 1854) in Sao Paulo, Brazil

Infrared thermography is a technique that quantifies the thermal (infrared) radiation emitted by an object and produces a high-resolution, digital thermal image of it. Medically, this technique is used to visualize the body's surface temperature distribution in a non-invasive, safe, and convenient fashion. However, to the best of our knowledge, the use of infrared thermography for assessing the systemic effects of envenomation by coral snakes has not been reported. In this case report, we describe the use of this technique in the management of a case of snakebite in Sao Paulo, Brazil. A 51-year-old woman was bitten on the back of the right hand by Micrurus frontalis, a species of coral snake, 10 min prior to her arrival at the hospital. Infrared imaging performed at admission revealed elevated temperatures at the bite site and in the elbow, as well as the preservation of a normal distal thermal gradient in both hands. A few minutes later, the patient developed muscle weakness in the upper limbs and in the eyelids, and infrared imaging showed an alteration of the thermal gradient in both hands, reflecting the systemic action of the venom. Following these observations, the patient was treated with the specific antivenom and was discharged 48 h post admission. At the two-week follow-up, the thermal image obtained showed no anomalies, indicating the recovery of the patient. Hence, infrared thermography can be very useful in the early identification of systemic neurotoxicity in cases of Micrurus snake bites, facilitating the decision to prescribe the antivenom.

Bites by Tomodon dorsatus (serpentes, dipsadidae): clinical and epidemiological study of 86 cases

A total of 86 proven cases ofTomodon dorsatusbites admitted to Hospital Vital Brazil (HVB) of ButantanInstitute, in São Paulo, Brazil, between 1945 and 2018, were retrospectively analyzed. The cases included werethose in which the snake was brought to HVB and was correctly identified. Of the 86 cases of snake bites, it waspossible to describe the sex of the snake in 52 cases; 31 (59.6%) snakes were male. Only 52 snakes out of 86could be studied because of their preservation status. The length of snakes (snout–vent length) ranged from 180to 770 mm. Of the 86 snakes, 72 could be distinguished as adults (n = 63, 87.5%) or juveniles (n = 9, 12.5%).Most bites occurred in the spring and summer seasons (n = 57, 66.3%) and during warmer periods of the day(n = 61, 72.6%), between 9A.M. and 3P.M. The mean ( ± standard deviation) age of the victims was 26.9 ± 17.2 years, and 60 (69.8%) were men.Approximately 90% of the patients sought medical care within 6 h after the bite. Both upper (n = 45, 52.3%)and lower (n = 37, 43.0%) limbs were the most frequently bitten, particularly the feet and hands (n = 54,62.8%). The local clinical manifestations were pain (n = 55, 64.0%), transitory bleeding (n = 23, 26.7%), er-ythema (n = 22, 25.6%), edema (n = 14, 16.3%), paresthesia (n = 9, 10.5%), and ecchymosis (n = 3, 3.5%).Only 10 (11.6%) patients reported non-specific systemic symptoms characterized by transient dizziness or mildheadache, and 21 (24.4%) patients showed no evidence of envenomation. A 20 min whole blood clotting test wasperformed in 31 (36.0%) patients on admission and all of them had coagulable blood. Supportive treatment wasoffered to 38 (44.2%) patients, namely, antiseptic (n = 20, 23.3%), antihistamines (n = 12, 14.0%), and an-algesics (n = 9, 10.5%). Four (4.7%) patients were inappropriately treated withBothropsantivenom before theiradmission to HVB. No sequelae or relevant complications were observed in patients, and the prognosis wasbenign. Therefore, althoughT. dorsatusbites can cause mild local symptomatology, it is important that healthprofessionals know how to make the correct diagnosis to avoid unnecessary use of antivenom.

Infrared thermography to diagnose and manage venomous animal bites and stings.

INTRODUCTION: Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. METHODS: This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. RESULTS: In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. CONCLUSIONS: IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Prevalence and titers of yellow fever virus neutralizing antibodies in previously vaccinated adults.

INTRODUCTION:: The World Health Organization (WHO) recommends one single dose of the Yellow Fever (YF) vaccine based on studies of antibody persistency in healthy adults. We assessed the prevalence and titers of YF virus neutralizing antibodies in previously vaccinated persons aged  60 years, in comparison to younger adults. We also evaluated the correlation between antibody titers and the time since vaccination among participants who received one vaccine dose, and the seropositivity among participants vaccinated prior to or within the past 10 years. METHODS:: previously vaccinated healthy persons aged  18 years were included. YF virus neutralizing antibody titers were determined by means of the 50% Plaque Reduction Neutralization Test. RESULTS:: 46 persons aged  60 years and 48 persons aged 18 to 59 years were enrolled. There was no significant difference in the prevalence of YF virus neutralizing antibodies between the two groups (p = 0.263). However, titers were significantly lower in the elderly (p = 0.022). There was no correlation between YF virus neutralizing antibody titers and the time since vaccination. There was no significant difference in seropositivity among participants vaccinated prior to or within the past 10 years. CONCLUSIONS:: the clinical relevance of the observed difference in YF virus neutralizing antibody titers between the two groups is not clear.

Infrared thermography to diagnose and manage venomous animal bites and stings

Abstract INTRODUCTION Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. METHODS This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. RESULTS In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. CONCLUSIONS IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Prevalence and titers of yellow fever virus neutralizing antibodies in previously vaccinated adults

Introduction: The World Health Organization (WHO) recommends one single dose of the Yellow Fever (YF) vaccine based on studies of antibody persistency in healthy adults. We assessed the prevalence and titers of YF virus neutralizing antibodies in previously vaccinated persons aged = 60 years, in comparison to younger adults. We also evaluated the correlation between antibody titers and the time since vaccination among participants who received one vaccine dose, and the seropositivity among participants vaccinated prior to or within the past 10 years. Methods previously vaccinated healthy persons aged = 18 years were included. YF virus neutralizing antibody titers were determined by means of the 50% Plaque Reduction Neutralization Test. Results: 46 persons aged = 60 years and 48 persons aged 18 to 59 years were enrolled. There was no significant difference in the prevalence of YF virus neutralizing antibodies between the two groups (p = 0.263). However, titers were significantly lower in the elderly (p = 0.022). There was no correlation between YF virus neutralizing antibody titers and the time since vaccination. There was no significant difference in seropositivity among participants vaccinated prior to or within the past 10 years. Conclusions: the clinical relevance of the observed difference in YF virus neutralizing antibody titers between the two groups is not clear.

Infrared thermography to diagnose and manage venomous animal bites and stings

Introduction: Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. Methods: This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. Results: In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. Conclusions: IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Prevalence and titers of yellow fever virus neutralizing antibodies in previously vaccinated adults

ABSTRACT Introduction: The World Health Organization (WHO) recommends one single dose of the Yellow Fever (YF) vaccine based on studies of antibody persistency in healthy adults. We assessed the prevalence and titers of YF virus neutralizing antibodies in previously vaccinated persons aged ≥ 60 years, in comparison to younger adults. We also evaluated the correlation between antibody titers and the time since vaccination among participants who received one vaccine dose, and the seropositivity among participants vaccinated prior to or within the past 10 years. Methods: previously vaccinated healthy persons aged ≥ 18 years were included. YF virus neutralizing antibody titers were determined by means of the 50% Plaque Reduction Neutralization Test. Results: 46 persons aged ≥ 60 years and 48 persons aged 18 to 59 years were enrolled. There was no significant difference in the prevalence of YF virus neutralizing antibodies between the two groups (p = 0.263). However, titers were significantly lower in the elderly (p = 0.022). There was no correlation between YF virus neutralizing antibody titers and the time since vaccination. There was no significant difference in seropositivity among participants vaccinated prior to or within the past 10 years. Conclusions: the clinical relevance of the observed difference in YF virus neutralizing antibody titers between the two groups is not clear.

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.