Envenenamento botrópico natural fatal em equinos no Centro-Oeste do Brasil : caracterização epidemiológica, clínico-patológica e ultraestrutural

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, 2019.A mortalidade decorrente do envenenamento por serpentes nos animais de fazenda tem sido superestimada em áreas rurais na América Latina. A maioria dos casos baseiam-se em hipóteses sem fundamentação técnica. São escassos os relatos de morte por envenenamento botrópico em equinos. Este estudo apresenta os achados epidemiológicos, clínicos e patológicos do envenenamento botrópico fatal em equinos na região Centro-Oeste do Brasil, com o objetivo de melhorar a fundamentação para o diagnóstico dessa condição. Foi realizado um estudo retrospectivo nos registros de necropsias nos Laboratórios de Patologia da Universidade de Brasília, Universidade Federal do Mato Grosso e Universidade Federal do Mato Grosso do Sul, entre janeiro de 2010 a fevereiro de 2018. Foram identificados cinco casos envenenamento por Bothrops spp. em 755 protocolos de necropsias de equinos, correspondendo a 0,66% do total de casos e variando de 0,33% a 0,89%. Os principais achados de necropsia consistem em hemorragia e edema subcutâneo, com maior gravidade no sítio da inoculação, e a identificação das marcas das presas em dois casos. A principal alteração do envenenamento sistêmico são as hemorragias em diversos órgãos e tecidos. Também foram observadas necrose muscular, dermonecrose e degeneração e necrose moderada a acentuada no epitélio tubular renal. O envenenamento botrópico tem baixa ocorrência na região Centro-Oeste. O diagnóstico foi baseado nas alterações clínicas e achados de necropsia e histopatologia. Os achados apresentados devem ser considerados para o estabelecimento do diagnóstico e da terapêutica a ser utilizada em casos de envenenamento.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).Snake bite envenomations in farm animals are generally overestimated as the cause of mortality in rural areas in Latin America. Most cases are based only on anecdotal information andassumptions, and lack diagnostic evidence. There are few proven reports of envenomation and death in horses caused by snakebites from members of the Bothrops genus (lancehead pit vipers). This study presents epidemiological and clinical-pathological findings of fatal bothropic envenomation in horses from Central Western Brazil in order to contribute to the correct diagnosis of this condition. A survey of the records of equine necropsies from the Veterinary Pathology Laboratories of the University of Brasilia, Federal University of Mato Grosso and Federal University of Mato Grosso do Sul, from January 2010 to February 2018, was performed. Five fatal cases of bothropic snakebite were identified in 755 necropsies of horses, corresponding to 0.66% of these cases, ranging annually from 0.33% to 0.89%. The main necropsy findings were marked swelling and diffuse subcutaneous hemorrhage, and identification of the fang marks in 2 out of five horses. Hemorrhage in most organs and tissues was the pathological hallmark of systemic envenomation. Myonecrosis, dermonecrosis, and moderate to severe kidney degeneration and necrosis were also observed. Fatal Bothrops snakebites in horses have a low occurrence in Central Western Brazil and most cases occur in the rainy season. The diagnosis of this condition may be substantiated by clinical signs and pathological findings. Local hemorrhage and necrosis, systemic hemorrhagic disorders and injuries related to acute kidney injury are the predominant clinical signs. These findings should be considered in the diagnosis and therapeutic management of these envenomations

Calcinosis enzoótica en ovinos por Nierembergia veitchii y Nierembergia rivularis

La calcinosis enzoótica es una enfermedad caracterizada por curso crónico, mineralización de tejidos blandos, hipercalcemia, hiperfosfatemia, hipercalcitoninismo, hipoparatiroidismo, osteonecrosis y osteopetrosis. El objetivo de esta tesis fue aportar nuevas informaciones al mecanismo patogénico de la calcinosis enzoótica a partir de casos de intoxicación por Nierembergia veitchii en ovinos y caracterizar regionalmente la ocurrencia de la intoxicación por Nierembergia rivularis en ovinos en Uruguay. El proceso de calcificación arterial en la calcinosis enzoótica presenta características comunes al proceso de osificación. Detectamos la expresión de proteínas estimuladoras del proceso de calcificación, cambios morfológicos de las células musculares lisas arteriales, eventos de migración, y producción de vesículas matriciales y exosomas que son indispensables para el inicio del dicho evento. En conclusión, son necesarias condiciones bioquímicas y celulares adecuadas para el desarrollo del proceso de calcificación. Los resultados inmunohistoquímicos y ultraestructurales encontrados en ovinos intoxicados con N. veitchii pueden ser aplicados al mecanismo patogénico de otras plantas calcinogénicas. En Uruguay, la intoxicación por N. rivularis es actualmente la principal causa de calcinosis enzoótica y afecta principalmente a los ovinos en las épocas de primavera y verano. Los brotes están asociados a áreas húmedas del lago del Rincón del Bonete en los departamentos de Tacuarembó y Durazno. Las tasas de mortalidad varían de 5% a 24%. Son afectados ovinos de todas las edades, excepto lactantes. En un ovino intoxicado por N. rivularis fue observado carcinoma de las células C de las tiroides, que puede estar asociada a hipercalcemia crónica

Bothrops Envenomation in Dogs: Local and Systemic Manifestations:

Background: Snakebite envenoming is a condition that affects humans and domestic animals worldwide. Identification of the snake species involved in the envenomation is infrequent. Bothrops envenomation presents typical clinicopathological features. This report describes epidemiological, clinical, and pathological data of 2 cases of Bothrops envenomation in dogs, including the first case of Bothrops moojeni snake striking a domestic animal in Brazil. Cases: Case 1. A dog was witnessed to have a Bothrops moojeni snakebite on a farm. In the first 24 h, acute lameness, pain, diffuse swelling, focal bleeding at the left forelimb, and increased whole-blood clot­ting time were observed in the envenomed dog. Polyvalent antivenom was administered in addition to fluid therapy, analgesics, corticosteroids, and antibiotics. On the 15th day, the animal presented spontaneous bleeding at the wound site, thrombocytopenia, and increased whole-blood clot­ting time. An additional dose of polyvalent antivenom was administered, and local treatment at the snakebite site was initiated. After 13 days, the dog showed no clinical or laboratory changes and recovered entirely. Case 2. A mongrel dog  was taken for a necropsy to determine the cause of death. Grossly, major findings included swelling in the nasal plane that extended to the neck and dissecting hemorrhage in the subcutaneous tissue and adjacent musculature. Hemorrhages were observed in the heart, parietal pleura, left forelimb, lumbar region, and perirenal tissue. Marked necrosis and disruption of small blood vessels and lymphatics within the deep dermis and subcutaneous tissue were the main microscopic findings close to the snakebite site. Additionally, degeneration and necrosis of muscle fibers and dissecting hemorrhage were observed in the head and neck tissues surrounding the snakebite site. Kidneys showed marked interstitial hemorrhage and acute tubular nephrosis. Discussion: Bothrops envenoming is characterized by local (hemorrhage, dermonecrosis, and myonecrosis) and systemic (coagulative disorders, systemic hemorrhage, and acute kidney injury) changes due to the effect of the main venom components such as phospholipase A2 and metalloproteinases. These changes are hallmarks for the bothropic envenomation, supporting the diagnosis in cases 1 and 2. In case 1, the dog developed a Bothrops moojeni snakebite envenomation, but the immediate treatment with antivenom allowed a favorable outcome. In case 2, gross and microscopic findings supported the presumptive diagnosis of fatal bothropic envenomation. A marked local reaction such as swelling, pain, bleeding, bruising, and tissue necrosis was observed in case 1. In case 2, the most significant local changes were swelling and edema at the head and neck, hemorrhage in the subcutaneous tissue, and adjacent musculature. Systemic effects were observed clinically as spontaneous bleeding, thrombocytopenia, increased whole-blood clot­ting time (Case 1), systemic hemorrhages, and acute tubular nephrosis (Case 2). A proper treatment probably prevented the development of acute renal failure in Case 1. Herein, we show the first case of accidental snakebite envenomation by B. moojeni in a dog in Brazil. Information is scarce on the identification of venomous snake species striking domestic animals. Fast detection of well-determined clinical and pathological findings of Bothrops envenomation is essential for a correct diagnosis, therapeutics, and a good prognosis, even in cases with an unknown history.   Keywords: Bothrops moojeni, venomous, coagulative disorders, canine, snake, snakebite

Cerebral Vascular Hamartoma In a Campeiro Bulldog

Background: Vascular hamartomas (VH) are rare or simply underdiagnosed injuries in veterinary medicine and represent a non-neoplastic developmental anomaly disorganization and proliferation of endothelial tissue. VH occur in any region of the body, however in the brain present clinical relevance related with the potential for spontaneous bleeding, adjacent tissue compression and convulsive activity. The aim of these report is to describe clinical, pathological and immunohistochemical features of a case of cerebrovascular hamartoma and highlight the diagnosis of these rare brain disorder in dogs.Case: A 10-year-old male dog, a Campeiro Bulldog breed presented convulsions episodes and died before an elective surgical procedure for eyelid nodule removal. Three red nodules were observed in the brain, one between the parietal lobe and the left occipital lobe (in the medium suprasylviam sulcus), the other in the caudal region of the corpus callosum and the third one in the cerebellar cortex. Central nervous system, eyelids and most organs and tissues samples were collected, fixed in 10% formaldehyde and processed for histopathological analysis. Histologically, in the eyelid was detected a sebaceous adenoma. The nervous system samples revealed well-differentiated different sizes vascular structures with thin-walled and blood-filled, promoting compression of the brain. Normal neuropile was detected between the vascular structures substantiating cerebral vascular hamartoma diagnosis in the dog. Immunohistochemical assay was conducted with CD31 (monoclonal mouse antibody anti-CD31, Clone JC70A, Dako Corp.) and Von Willebrand factor (monoclonal mouse antibody anti-Von Willebrand factor, Clone F8/86, Dako Corp.) using the biotin–peroxidase–streptavidin method (PolyDetector Plus DAB–HRP, Bio SB) on CNS sections to confirm the vascular origin of the lining cells in the mass. Discussion: Hamartomas are rarely reported in domestic animals and mostly are of vascular origin. VH in nervous tissues can trigger clinical signs related to hemorrhage, brain space occupation, compression and obstructive secondary hydrocephalus. In general, cerebral VH have a slow progression and usually affected animals are asymptomatic. On the other hand, cerebral vascular hamartomas may also cause clinical signs in very young animals about 15 to 16 months old. In humans, clinical presentation of VH may be related with acquired lesions such as trauma, ionizing radiation, and other central nervous system injuries. In the present case, the dog presented convulsion episode only at 10 years old during pre-chirurgical procedures. The morphological features of the vascular hamartoma we observed in the Campeiro bulldog is classified as capillary teleangiectasia composed by well differentiated capillaries lined with well differentiated endothelial cells interspaced by normal neuronal tissue. Histopathological and immunohistochemical assay are extremely important to differentiate hamartoma from other tumors, since they may be macroscopically similar. The immunolabeling of endotelial cells by anti-CD31 and anti-Von Willebrand factor antibodies in the cerebral VH, highlight the vascular origin of the masses detected. However, it is also important to perform systematic gross examination of the brain in detail to detect even the smallest injuries in asymptomatic animals avoiding underdiagnoses of cerebral VH

Immunopathological findings in a cat with auricular chondritis

At clinical examination, a 5-year-old male domestic short-haired cat exhibited painful swelling and erythema of the pinnae of both ears. Microscopically, the lesions on both pinnae were composed of diffuse granulomatous chondritis with degeneration and necrosis of the pinnal cartilage. Numerous mast cells were also observed within and surrounding the inflammatory lesion. Immunohistochemistry showed a mixed inflammatory infiltrate characterised by the predominance of macrophages (CD68+, MAC 387+ and Lysozyme+), T lymphocytes (CD3+), some B lymphocytes (CD79α+) and neutrophils. Immunopathological characterisation of the lesion showed a granulomatous inflammation profile and suggests that the morphological changes and immunopathogenesis of auricular chondritis in cats presents a similarity with relapsing polychondritis in humans

South American Rattlesnake (Crotalus durissus spp.) Envenomation in Dogs in the Semiarid Region of Brazil

Background:  South American rattlesnake (Crotalus durissus spp.) envenomation is rarely reported in small animals and livestock in Brazil. Minor swelling at the snakebite site, skeletal muscle, and renal damage, and severe neurological signs characterize the crotalic envenomation. This case report aims to present epidemiological, clinical, and pathological data of two cases of Crotalus durissus spp envenomation in dogs in the Northeast of Brazil.Cases: Envenomation by Crotalus durissus spp. was recorded in two dogs in Patos, State of Paraíba, Brazil. In Case 1, the dog presented flaccid paralysis, hyporeflexia, a deficit of cranial nerves, epistaxis, and gingival hemorrhages. Laboratory assay showed proteinuria, myoglobinuria, regenerative thrombocytopenia, and increased serum activities of creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). The dog was medicated with crotalic antivenom and wholly recovered from local and systemic clinical signs. In Case 2, the dog died and was detected fang marks at the ventral region of the left mandible (two small parallel perforations spaced 2.0 cm apart) at the snakebite site. Cyanosis of the oral cavity, congestion, and hemorrhages in several organs were observed at necropsy. Tubular nephrosis, muscular necrosis, hepatocytes swelling were observed. The owners witnessed snakebites, and the rattlesnakes (Crotalus durissus spp.) identified by the rattle at the end portion of the tail in both cases. Discussion: Natural South American rattlesnake envenomation presents complex clinical signs that makes diagnosis a challenge for veterinary practitioners. The criteria for the correct diagnosis and observed in the two dogs include witness of the snakebite, identification of the snake, detection of fang marks, clinical-pathological findings, and therapeutic response to treatment with specific anti-venom. The dog’s owners did not identify the subspecies of rattlesnakes; however, Crotalus durissus cascavella and Crotalus durissus collilineatus are the only species found in the Northeast region of Brazil. Crotoxin is the primary toxic component of South American rattlesnake, which induces neuromuscular blockage, and neurological signs (skeletal muscle flaccid paralysis, apathy, hyporeflexia, cranial nerve deficits). These clinical signs are similar to those observed in the two dogs. Respiratory distress, cyanosis, pulmonary edema, and hemorrhage are secondary to respiratory muscle paralysis and also detected in a dog (Case 2) with crotalic envenomation. Minor local swelling at the snakebite site,  myotoxicity observed in both dogs (high serum activities of CK and AST - Case 1), degeneration and necrosis of muscle fibers - Case 2), and fang marks observed in Case 2, strengthen the diagnosis of Crotalus durissus envenomation. Nephrotoxicity was also detected in both dogs (increased specific gravity of urine - Case 1 and myoglobin deposition and degeneration of renal epithelial tubular cells - Case 2). Coagulative disorders and hepatotoxicity are infrequently in domestic animals and humans with crotalic envenomation. High serum activities of ALP and ALT in Case 1, and swelling of hepatocytes in Case 2, suggest liver damage associated with the crotalic envenomation. The differential diagnosis of South American rattlesnake envenomation should be included in dogs with acute neuromuscular flaccid paralysis, associated or not with bleeding disorders, myoglobinuria, and acute kidney injury

RELATIONSHIP BETWEEN HEALTH-DISEASE PROCESS AND CROSS-CULTURAL CARE:CONTRIBUTIONS TO NURSING CARE

A visão sobre o que o indivíduo percebe como saúde é de suma importância para a lógica assistencial. Leininger percebeu que a cultura estava intimamente interligada ao processo de adoecer do indivíduo. Objetivo: este estudo teve como objetivo refletir sobre a relação entre a teoria do cuidado transcultural de Madeleine Leininger com o processo saúde-doença, como possível benefício à assistência de enfermagem. Métodos: trata-se de um estudo descritivo, exploratório, que utilizou a revisão de bibliografia como fonte de informações. Resultados: a discussão da temática priorizou a divisão em categorias que relacionassem o cuidar transcultural ao processo de saúde-doença, buscando subsídios à assistência de saúde. Conclusão: a teoria transcultural aliada ao conhecimento das esferas subjetivas do cliente e suas vertentes culturais, pode tornar o cuidado de enfermagem mais efetivo. Descritores: ”Enfermagem transcultural”,”processo saúde-doença”, “cuidado”

Systemic Toxic Reaction Due Bee Stings in Dogs

Background: Toxic reactions due bee stings in human, companion animals, food animals and wild animals are sporadically reported. Accidents involving bees have been occurring in urban and rural areas since 1956, when African bees were introduced in Brazil, forming populations of aggressive hybrid Africanized bees. Their sting cause local and systemicreactions, which include dermatologic reactions, anaphylactic reactions and toxic systemic reactions before death. The aim of this article is to describe the clinical and pathological aspects of the toxic systemic reactions of two dogs that suffered a massive bee attack in the Federal District, Brazil.Cases: A 8-year-old female Brazilian mastiff, and one female 6-year-old Belgian shepherd were locked in the kennel when they suffered a massive bee attack. The dogs presented ‘apathy, congested mucous membranes, dyspnea, epistaxis, hemoglobinuria, icterus (one of them) and convulsions. Clinical pathology results showed a strong hemolyzed plasma, azotemia, leukocytosis with neutrophilia and monocytosis. Both animals were euthanized due to their critical conditions. At necropsy the dogs showed severe subcutaneous edema in the face, moderate congestion of mucous membranes, hematochezia and hematuria. Both dogs presented kidneys dark brown to blackened colored, urinary bladder replete with dark red fluid, lungs severely congested, intestines with severe mural edema and hyperemia containing bloody fecal matter inside, and the liverof one of the dog moderately icteric. The main histologic findings were the moderate diffuse degeneration of the kidney tubular epithelium with small focal areas of necrosis, countless casts of hemoglobin, granular and hyaline casts inside the renal tubules. The skin affected showed stingers inserted, dissociation of the collagen fibers by edema and multifocal areasof hemorrhage, neutrophils and eosinophils, and the muscular tissue underneath had intense necrosis, with hyalinization and moderate multifocal fragmentation of myocytes.Discussion: Africanized bees are well established in rural areas and can adapt to urban areas and, given their marked aggressiveness, cause accidents with animals and humans. Clinical and hematological changes presented by dogs in the DF are similar to those previously reported in this species, which are usually observed in hemolytic anemias and tissuedamage caused by the acute inflammatory response due multiple bee stings. Nephrosis can be considered one of the most important toxic effects, due severe intravascular hemolytic disturbance and rhabdomyolysis, along with acute renal failure caused by the toxin components in the tubules and the toxic-isquemic condition, causing azotemia. Hemolysin proteins such as fosfolipase A and melitina cause rhabdomyolysis, intravascular hemolysis, and hemoglobinemia, which trigger the process of diffuse nephrosis and acute renal failure. The main pathologic changes were observed in the kidneys and skin of the dogs in the DF and were similar to that previously reported in dogs with severe bee stings. The count of inserted bee stingers in the skin and history is considered important to establish a presumptive diagnosis and initiate immediate treatment for the affected animals. The epidemiologic and clinical-pathologic findings presented in these cases are similarto those observed in humans who had suffered systemic toxicity by bee stings and aggravates the general condition of the patient even leading to death. Based on these findings, it was possible to establish the diagnosis of systemic toxic reaction in dogs secondary to poisoning by Africanized bee stings.Keywords: poisonous arthropods, Africanized bees, systemic toxic reaction, toxicology

RELATIONSHIP BETWEEN HEALTH-DISEASE PROCESS AND CROSS-CULTURAL CARE:CONTRIBUTIONS TO NURSING CARE

A visão sobre o que o indivíduo percebe como saúde é de suma importância para a lógica assistencial. Leininger percebeu que a cultura estava intimamente interligada ao processo de adoecer do indivíduo. Objetivo: este estudo teve como objetivo refletir sobre a relação entre a teoria do cuidado transcultural de Madeleine Leininger com o processo saúde-doença, como possível benefício à assistência de enfermagem. Métodos: trata-se de um estudo descritivo, exploratório, que utilizou a revisão de bibliografia como fonte de informações. Resultados: a discussão da temática priorizou a divisão em categorias que relacionassem o cuidar transcultural ao processo de saúde-doença, buscando subsídios à assistência de saúde. Conclusão: a teoria transcultural aliada ao conhecimento das esferas subjetivas do cliente e suas vertentes culturais, pode tornar o cuidado de enfermagem mais efetivo. Descritores: ”Enfermagem transcultural”,”processo saúde-doença”, “cuidado”

Relationship between health-disease process and cross-cultural care: contributions to nursing care

Objective: This study aimed to reflect on the relationship between the theory of transcultural care of Madeleine Leininger with the health-disease as a possible benefit to nursing care. Method: This is a descriptive, exploratory study, which used the review of literature as a source of information. Results: The discussion of the prioritized thematic division into categories that related to transcultural caring health disease process of seeking grants to health care. Conclusion: The Transcultural Nursing theory coupled with the knowledge of the client's subjective spheres and its cultural aspects can make nursing care more effective