Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident

Estudo retrospectivo dos acidentes por serpentes atendidos no Hospital Geral de Palmas-TO, no período de 2010 e 2011.

Os acidentes ofídicos representam um sério problema de saúde pública no Brasil, assim como em outros países de região tropical. A expansão e o crescimento desordenado das cidades acarretam inúmeros impactos como perdas de habitat, predação, falta de abrigo e disponibilidades de recursos. Esses impactos promovem o deslocamento dos diferentes elementos faunísticos para áreas de zona urbana e periurbana, provocando um aumento nos acidentes provocados por serpentes. No Tocantins, são poucos os estudos que avaliam a epidemiologia destes acidentes, sendo este necessário para estabelecer uma conduta adequada para tratamento dos pacientes acometidos por serpentes. Assim, este trabalho teve como objetivo avaliar o perfil dos acidentes por serpentes atendidos no Hospital Geral de Palmas – Tocantins (HGP), nos anos de 2010 e 2011, e elencar as possíveis dificuldades no seu tratamento através da análise dos dados do SINAN e dos prontuários dos pacientes. Nos anos de 2010 e 2011 foram atendidos no HGP 52 pacientes vítimas de acidentes ofídicos. Os acidentes ocorreram em sua maioria com pessoas do sexo masculino, na zona rural, com idade entre 20 a 49 anos, sendo a maioria dos acidentes ocasionados pelo gênero Bothrops. A ocorrência de acidentes com este grupo da população tem sido referida em todas as casuísticas nacionais, o que se deve as atividades do campo, executadas preferencialmente por homens. Portanto, faz se necessário promover ações junto aos moradores das áreas urbanas e rurais para promover medidas que possam reduzir os índices de acidentes com serpentes no município.Palavras chave: Acidente Ofídico, Serpentes, Tocantins.ABSTRACTThe snakebites represent a serious public health problem in Brazil, as well as in other countries of tropical region. The expansion and disordered growth of cities are leading in numerous impacts like loss of habitats, predation, lack of shelter and availability of resources. These impacts promote displacement of different faunal elements for urban areas and peri-urban areas, thus causing an increase in accidents caused by serpents. In Tocantins, there are few studies that assess the epidemiology of these accidents, which is necessary to establish an appropriate conduct for treatment of patients affected by serpents. This work aimed to evaluate the profile of accidents by snakes served in General Hospital of Palmas (GHP) -Tocantins, in the years 2010 and 2011, and list the possible difficulties in its treatment through analysis of data from SINAN and analysis of medical records of patients. In the years 2010 and 2011 were treated in 52 patients HGP victims of snake bites. These Snakebites occurred mostly in males, in rural areas, aged 20-49 years, with the majority of accidents caused by Bothrops. The occurrence of accidents with this group has been referred to in all the studies, national this is field activities in the vast majority being performed by men thus causing a high frequency of accidents with the group. So there is a need to promote actions with the residents of urban and rural areas. These measures can reduce their accident rates with snakes.Keywords: Accident Ophidian, Snakes, Tocantins.

Morphology of the skeletal muscle injury, and regeneration after envenomation by <i>B</i>. <i>atrox</i>.

<p>Groups were envenomated by an i.m. injection of 40 μg (40 μL) of <i>B</i>. <i>atrox</i> venom and treated 45 minutes later with AV (0.2 mL, i.v.), Dexa (1.0 mg/kg, i.p.), or AV + Dexa by the same route and doses. The morphology of the treated groups was compared to that of the untreated control group. The calf muscles of the animals were collected 1, 7 or 21 days after the envenomation and processed as described in Materials and Methods. At 1 day, necrotic areas were observed in all groups (arrows). Seven days after envenomation, some areas of regenerated skeletal muscle cells with central nuclei were observed in all groups (*). At 21 days post-envenomation, regenerated muscle fibers with centrally located nuclei were observed in all groups (*). In all cases, paraffin sections were stained with hematoxylin and eosin.</p

Fibrinogen levels (A) and platelet counts (B) in mice envenomated with <i>B</i>. <i>atrox</i> venom.

<p>Animals (n = 4/group) were injected (i.m.) with <i>B</i>. <i>atrox</i> venom (40 μg/40 μL). Forty-five minutes later, groups were treated with AV (0.2 mL, i.v.), Dexa (1.0 mg/kg), AV + Dexa, or remained untreated, and blood was collected 6 h after the envenomation. The platelets were counted in the whole blood, and fibrinogen was evaluated in citrated plasma as described in Materials and Methods. The results are expressed as the means ± S.E. and the statistically significant (p<0.05) differences from the non-envenomated animals (*) and the untreated group (#) are indicated</p

Myonecrosis induced by <i>B</i>. <i>atrox</i> venom.

<p>The muscle damage was evaluated by measuring the levels of CK in serum, 3 h after the i.m. injection of <i>B</i>. <i>atrox</i> venom (40 μg) into the right calf muscles of the mice. Groups (n = 5/group) were treated with AV (0.2 mL, i. v.), Dexa (1 mg/kg, i. p.) or AV + Dexa by the same routes and doses 10 (A), or 45 minutes (B) after the envenomation. The results are expressed as the means ± S.E., and the statistically significant (p<0.05) differences from the untreated control group are indicated (*).</p

Dermonecrosis induced by <i>B</i>. <i>atrox</i> venom.

<p>Groups of mice (n = 5/group) were treated with AV (0.2 mL, i. v.), Dexa (1 mg/kg, i. p.) or AV + Dexa by the same routes and doses 10 (A), or 45 minutes (B) after i.d. injection of 30 μg of <i>B</i>. <i>atrox</i> venom, and the results were compared to the untreated control group. The dermonecrosis was expressed as the means ± S.E. of the diameters of the spots on the inner surface of the injected skin 48 h after the venom injection. The statistically significant (p < 0.05) differences from the untreated control group (#) or from all other groups (*) are indicated.</p

Kinetics of muscle injury and regeneration after envenomation by <i>B</i>. <i>atrox</i>.

<p>At 1 (A), 4 (B), 7 (C), 14 (D), 21 (E), or 28 (F) days after the i.m. injection of <i>B</i>. <i>atrox</i> venom (40 μg), the CK contents were evaluated in the envenomated and the contralateral saline-injected calf muscles. Groups (n = 5/group) were treated with AV (0.2 mL, i. v.), Dexa (1 mg/kg, i. p.) or AV + Dexa by the same routes and doses 45 minutes after the envenomation. The results are expressed as the means ± S.E. and presented as the percentage of the CK content compared to the saline-injected muscle. The statistically significant (p < 0.05) differences from the untreated control group are indicated (*).</p

Local hemorrhage induced by <i>B</i>. <i>atrox</i> venom.

<p>Groups of mice (n = 5/group) were treated with AV (0.2 mL, i. v.), Dexa (1 mg/kg, i. p.) or AV + Dexa by the same routes and doses 10 (A), or 45 minutes (B) after i.d. injection of 3.3 μg of <i>B</i>. <i>atrox</i> venom, and the results were compared to the untreated control group. The degree of hemorrhage is expressed as the means ± S.E of the diameters of the spots on the inner surface of the injected skin 2 h after the venom injection.</p