RESUMO
PURPOSE: To describe the ocular findings and the long-term outcomes of patients diagnosed with corneal injury due to little fire ants (LFAs). METHODS: This is a retrospective case series of patients evaluated with corneal injury due to LFAs from October 2015 to January 2018 at the Cornea Clinic in Meir Medical Center. Patients underwent anterior segment optical coherence tomography (AS-OCT) imaging during the follow-up. RESULTS: Four patients reported ocular contact with LFAs and presented to our department with unilateral, scattered, small, dense, round, bright white opacities in the anterior corneal stroma, which remained unchanged in appearance over time, despite topical antibiotic and steroid treatment. No inflammatory signs were noted in the anterior chamber. Follow-up was performed clinically using AS-OCT for periods of 9 to 26 months after the incidents. AS-OCT findings demonstrated small, subepithelial, hyperreflective foci at the level of the anterior stroma to a depth of 145 to 250 µm, with posterior shadowing that remained unchanged over time. These findings were well-correlated with biomicroscopy findings. CONCLUSIONS: LFA bites can cause long-lasting corneal injury in humans with characteristic clinical biomicroscopic findings. The corneal lesions do not respond to conventional topical treatment. AS-OCT imaging can be a useful modality for diagnosis and follow-up. Awareness by both patients and ophthalmologists of this clinical entity may be helpful in diagnosis and management.
Assuntos
Formigas , Lesões da Córnea/diagnóstico por imagem , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Idoso , Animais , Antibacterianos/uso terapêutico , Lesões da Córnea/tratamento farmacológico , Lesões da Córnea/etiologia , Combinação de Medicamentos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Mordeduras e Picadas de Insetos/tratamento farmacológico , Mordeduras e Picadas de Insetos/etiologia , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Tomografia de Coerência ÓpticaAssuntos
Mordeduras e Picadas de Insetos/complicações , Cardiomiopatia de Takotsubo/etiologia , Idoso de 80 Anos ou mais , Animais , Abelhas , Evolução Fatal , Feminino , Humanos , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Imagem Multimodal/métodos , Insuficiência de Múltiplos Órgãos , Cardiomiopatia de Takotsubo/diagnóstico por imagemRESUMO
CONTEXT: Soft tissue calcifications (STCs) were incidentally found in some of the Hymenoptera-stung (HS) children when they underwent computed tomography (CT) scans for evaluating complications of vital organs. Afterwards, a predilection of STCs to the children with severe complications was clinically noticed. A hypothesis was then developed that STCs secondary to HS may correlate with poor outcomes. OBJECTIVE: This study aims to firstly characterize the CT findings of STCs in HS children and to confirm our hypothesis that the occurrence of STCs may act as an indicator of poor outcomes in HS children. MATERIALS AND METHODS: Children who received CT scanning after Hymenoptera sting from January 2011 to October 2016 in our hospital were analyzed retrospectively. Shape, location, and distribution of the STCs were described according to the CT findings. Then the enrolled cases were classified into Soft Tissue Calcification Group (STCG) and non-Soft tissue Calcification Group (non-STCG) to conduct prognostic comparisons of Sequential Organ Failure Assessment (SOFA) scores, incidence of main complications (acute liver failure (ALF), acute kidney injury stage III (AKI-III) and multiple organ failure (MOF)), length of hospital days, and in-hospital death, respectively. Pearson correlation was also utilized between the cumulative volume of STCs and the SOFA score. RESULTS: Sixteen cases were enrolled, and STCs' incidence was 56.25% (9/16). Two STCG cases had diffuse nodular calcifications in their swollen subcutaneous tissue, and another seven had symmetrically stripy or patchy calcifications within or along local muscles. The SOFA scores during the first 3 days were all higher in STCG, and rose to the greatest difference at the third day (9.78 ± 2.17 vs. 2.29 ± 2.06, t = 7.009, p < .001); the incidence of ALF, AKI-III and MOF were significantly higher in STCG (66.67% vs. 0, p = .011), (77.78% vs. 0, p = .003) and (77.78% vs. 14.29%, p = .041); and children in STCG were treated with longer hospital durations (26.33 ± 8.41 days vs. 12.29 ± 7.36 days, t = 3.493, p = .004). One child in STCG died of cardiopulmonary failure, and no deaths occurred in non-STCG. No significant correlations presented between STCs cumulative volumes and SOFA score (rDay1 = 0.096, p = .806; rDay2 = 0.067, p = .863; rDay3 = 0.024, p = .950). CONCLUSION: Soft tissue calcifications detected on CT imaging following multiple Hymenoptera stings in pediatric patients may be a potential prognostic indicator of more severe complications and poorer outcomes.
Assuntos
Calcificação Fisiológica/fisiologia , Himenópteros , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Mordeduras e Picadas de Insetos/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Tomografia Computadorizada Quadridimensional , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Medição de RiscoAssuntos
Imageamento Tridimensional , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Rabdomiossarcoma/diagnóstico por imagem , Imagem Corporal Total , Brasil , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Estadiamento de Neoplasias , Rabdomiossarcoma/patologiaAssuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Anafilaxia/diagnóstico por imagem , Abelhas , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/terapia , Anafilaxia/etiologia , Anafilaxia/terapia , Animais , Feminino , Humanos , Mordeduras e Picadas de Insetos/complicações , Mordeduras e Picadas de Insetos/terapia , Pessoa de Meia-Idade , Radiografia , Recidiva , Fatores de Tempo , Resultado do TratamentoAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Doença da Artéria Coronariana/induzido quimicamente , Hipersensibilidade a Drogas/diagnóstico por imagem , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Hipersensibilidade a Drogas/complicações , Feminino , Humanos , Mordeduras e Picadas de Insetos/complicações , Pessoa de Meia-Idade , Radiografia , SíndromeRESUMO
Soft tissue infections and angioedema from insect bites and stings may be difficult to differentiate by inspection. We present sonographic findings of 4 cases of soft tissue swelling from insect bites and stings suggestive of angioedema. Sonographic features of soft tissue angioedema consist of thickened subcutaneous tissue layers with multiple linear, horizontal, striated, and hypoechoic lines following the tissue planes between soft tissue layers. In addition to the history and physical examination, sonographic findings may assist in differentiating between local allergic reactions and cellulitis in patients with insect bites and stings. Further study is warranted for clinical application.
Assuntos
Angioedema/diagnóstico por imagem , Angioedema/etiologia , Hipersensibilidade/diagnóstico por imagem , Hipersensibilidade/etiologia , Mordeduras e Picadas de Insetos/complicações , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Criança , Pré-Escolar , Pálpebras/diagnóstico por imagem , Feminino , Pé/diagnóstico por imagem , Mãos/diagnóstico por imagem , Humanos , Masculino , UltrassonografiaRESUMO
A 12-year-old girl with a history of papillary thyroid cancer underwent radioiodine remnant ablation using (131)I. Posttherapy whole-body (131)I scintigraphy revealed not only the known activity in the neck but also increased activity in the superficial posterior right upper thigh. On further clinical evaluation, the patient was found to have a mosquito bite with surrounding hyperemia at the site of the abnormal activity.
Assuntos
Culicidae/fisiologia , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Iodo , Animais , Carcinoma/diagnóstico por imagem , Carcinoma Papilar , Criança , Feminino , Humanos , Radioisótopos do Iodo , Cintilografia , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/diagnóstico por imagemRESUMO
We present the case of a 45-year-old man with clinical features of acute coronary syndrome with persistent ST segment elevation following an anaphylactic reaction to a wasp sting treated with adrenaline. A thrombolysis is performed with no effect on clinical signs, leading to an emergency cardiac catheterization which reveals a non-occlusive thrombosis of the right coronary artery. The pathophysiology and clinical implications of this association are discussed.
Assuntos
Anafilaxia/diagnóstico por imagem , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Vespas , Anafilaxia/etiologia , Animais , Humanos , Mordeduras e Picadas de Insetos/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , RadiografiaAssuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Adulto , Animais , Diagnóstico Diferencial , Reações Falso-Positivas , Feminino , Fluordesoxiglucose F18 , Humanos , Himenópteros , Compostos RadiofarmacêuticosAssuntos
Tromboflebite/diagnóstico por imagem , Adulto , Artefatos , Diagnóstico Diferencial , Corpos Estranhos/diagnóstico por imagem , Humanos , Mordeduras e Picadas de Insetos/diagnóstico por imagem , Perna (Membro) , Masculino , Músculo Esquelético/diagnóstico por imagem , Agulhas , UltrassonografiaRESUMO
On several occasions, we have been asked to locate bee stingers so that they could be removed. The studies were negative, and we did not know if identification was even possible. An experiment was done using both film screen studies and xerograms at various techniques to attempt to locate a honey bee stinger. The stinger could not be identified.