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Benzaken Z, Silva LL, Silva-Neto A, Sachett J, Fé N, Guerra MDGVB, Monteiro W. Urbanization and scorpion stings in Manaus, the largest metropolis in the Brazilian Amazon. Toxicon 2024; 247:107823. [PMID: 38914231 DOI: 10.1016/j.toxicon.2024.107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024]
Abstract
This study analyzed a total of 260 confirmed scorpion stings reported in the city of Manaus, in the Brazilian Amazon, from 1990 to 2020. Cases were mapped according to the GPS location of their occurrence and plotted on a satellite image of the city. The stings generally occurred close to green areas, and the hotspots of stings moved north as city grew into that direction over time. Spatial analysis shows that scorpion stings mostly occur in poor, recently urbanized areas. The rapid and unplanned urbanization of originally forested areas, without offering adequate infrastructure and services, creates favorable conditions for infestation by scorpions and increases the risk of scorpion stings.
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Affiliation(s)
- Zehev Benzaken
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Lincoln Luís Silva
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Alexandre Silva-Neto
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Nelson Fé
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Maria das Graças Vale Barbosa Guerra
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Wuelton Monteiro
- School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil; Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil.
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Martins JG, Reis MB, Zuanazzi BA, Bordon KDCF, Zoccal KF, de Lima Procópio RE, Arantes EC. Clinical outcomes in a murine model after envenoming by the Amazonian scorpions Tityus strandi and Tityus dinizi. Toxicon 2024; 246:107797. [PMID: 38852745 DOI: 10.1016/j.toxicon.2024.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
The Brazilian Amazon is home to a rich fauna of scorpion species of medical importance, some of them still poorly characterized regarding their biological actions and range of clinical symptoms after envenoming. The Amazonian scorpion species Tityus strandi and Tityus dinizi constitute some of the scorpions in this group, with few studies in the literature regarding their systemic repercussions. In the present study, we characterized the clinical, inflammatory, and histopathological manifestations of T. strandi and T. dinizi envenoming in a murine model using Balb/c mice. The results show a robust clinical response based on clinical score, hyperglycemia, leukocytosis, increased cytokines, and histopathological changes in the kidneys and lungs. Tityus strandi envenomed mice presented more prominent clinical manifestations when compared to Tityus dinizi, pointing to the relevance of this species in the medical scenario, with both species inducing hyperglycemia, leukocytosis, increased cytokine production in the peritoneal lavage, increased inflammatory infiltrate in the lungs, and acute tubular necrosis after T. strandi envenoming. The results presented in this research can help to understand the systemic manifestations of scorpion accidents in humans caused by the target species of the study and point out therapeutic strategies in cases of scorpionism in remote regions of the Amazon.
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Affiliation(s)
- Jonas Gama Martins
- Graduated Program in Genetics, Conservation, and Evolutionary Biology (PPG GCBEv), National Institute for Amazon Research (INPA), Manaus, AM, Brazil
| | - Mouzarllem Barros Reis
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | - Karla de Castro Figueiredo Bordon
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Karina Furlani Zoccal
- School of Medicine, Centro Universitário Barão de Mauá (CUBM), Ribeirão Preto, SP, Brazil
| | - Rudi Emerson de Lima Procópio
- Graduate Program in Biotechnology and Natural Resources of Amazon, University of the State of Amazonas (UEA), Manaus, AM, Brazil
| | - Eliane Candiani Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
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Araújo KAMD, Torres-Rêgo M, Gurgel-Medeiros T, Silva-Júnior AAD, Leite RDS, Daniele-Silva A, Fernandes-Pedrosa MDF. Epidemiological study in Brazil: Scorpion sting cases in Natal, Rio Grande do Norte. Heliyon 2024; 10:e24190. [PMID: 38293345 PMCID: PMC10826653 DOI: 10.1016/j.heliyon.2024.e24190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Scorpion sting accidents are a public health problem in the state of Rio Grande do Norte, Brazil. The increasing and high incidence of cases in urban areas reveals the importance of studies to determine the epidemiological profile and the spatial distribution of these accidents. This is a retrospective study that describes and analyzes the cases of scorpion stings in the city of Natal, Rio Grande do Norte, Northeast Brazil, from 2007 to 2018. Data from the Information System database of Notifiable Diseases (SINAN) were obtained from the Secretary of Health of Rio Grande do Norte. 31,368 accidents due to scorpion stings were reported, more frequently in urban areas of Natal, whose Human Development Index is low. The cases occurred predominantly in hot and humid regions, mainly affecting women aged between 30 and 60 years. Most individuals sought medical attention within 3 h of the incident. The severity and mortality of the injured individuals varied according to the area of occurrence, age of the patient, and the local and systemic symptoms presented. Pain, numbness, and edema were the most frequent local symptoms, and systemic symptoms were frequently described as headache, hyperthermia and sweating. Therefore, scorpionism in the city of Natal is an environmental and public health problem, with a significant growth trend (p < 0.05). Through the data collected on the spatial distribution and risks, this approach allows the creation of effective control strategies to prevent accidents.
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Affiliation(s)
- Kaliany Adja Medeiros de Araújo
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
| | - Manoela Torres-Rêgo
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
- Graduate Program of Chemistry, Chemistry Institute, Federal University of Rio Grande do Norte, Senador Salgado Filho Avenue, 3000, Lagoa Nova, Natal, 59072-970, Brazil
| | - Thaynara Gurgel-Medeiros
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
| | - Arnóbio Antônio da Silva-Júnior
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
| | - Renner de Souza Leite
- Graduate Program of Physiological Sciences Federal University of Campina Grande, Olho D’água da Bica, S/N, Cuité, Paraíba, 59072-970, Brazil
| | - Alessandra Daniele-Silva
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
| | - Matheus de Freitas Fernandes-Pedrosa
- Laboratory of Technology and Pharmaceutical Biotechnology (Tecbiofar), College of Pharmacy, Federal University of Rio Grande do Norte, General Gustavo Cordeiro de Farias Avenue, S/N, Petrópolis, Natal, 59012-570, Brazil
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Nasr S, Borges A, Sahyoun C, Nasr R, Roufayel R, Legros C, Sabatier JM, Fajloun Z. Scorpion Venom as a Source of Antimicrobial Peptides: Overview of Biomolecule Separation, Analysis and Characterization Methods. Antibiotics (Basel) 2023; 12:1380. [PMID: 37760677 PMCID: PMC10525675 DOI: 10.3390/antibiotics12091380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Scorpion venoms have long captivated scientific researchers, primarily due to the potency and specificity of the mechanism of action of their derived components. Among other molecules, these venoms contain highly active compounds, including antimicrobial peptides (AMPs) and ion channel-specific components that selectively target biological receptors with remarkable affinity. Some of these receptors have emerged as prime therapeutic targets for addressing various human pathologies, including cancer and infectious diseases, and have served as models for designing novel drugs. Consequently, extensive biochemical and proteomic investigations have focused on characterizing scorpion venoms. This review provides a comprehensive overview of the key methodologies used in the extraction, purification, analysis, and characterization of AMPs and other bioactive molecules present in scorpion venoms. Noteworthy techniques such as gel electrophoresis, reverse-phase high-performance liquid chromatography, size exclusion chromatography, and "omics" approaches are explored, along with various combinations of methods that enable bioassay-guided venom fractionation. Furthermore, this review presents four adapted proteomic workflows that lead to the comprehensive dissection of the scorpion venom proteome, with an emphasis on AMPs. These workflows differ based on whether the venom is pre-fractionated using separation techniques or is proteolytically digested directly before further proteomic analyses. Since the composition and functionality of scorpion venoms are species-specific, the selection and sequence of the techniques for venom analyses, including these workflows, should be tailored to the specific parameters of the study.
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Affiliation(s)
- Sara Nasr
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli 1300, Lebanon; (S.N.); (C.S.)
| | - Adolfo Borges
- Laboratorio de Biología Molecular de Toxinas y Receptores, Instituto de Medicina Experimental, Facultad de Medicina, Universidad Central de Venezuela, Caracas 50587, Venezuela;
- Centro para el Desarrollo de la Investigación Científica, Asunción 1255, Paraguay
| | - Christina Sahyoun
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli 1300, Lebanon; (S.N.); (C.S.)
- Univ Angers, INSERM, CNRS, MITOVASC, Team 2 CarMe, SFR ICAT, 49000 Angers, France
| | - Riad Nasr
- Department of Physical Therapy, Faculty of Public Health 3, Lebanese University, Tripoli 1200, Lebanon;
| | - Rabih Roufayel
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait;
| | - Christian Legros
- Univ Angers, INSERM, CNRS, MITOVASC, Team 2 CarMe, SFR ICAT, 49000 Angers, France
| | - Jean-Marc Sabatier
- Aix-Marseille Université, CNRS, INP, Inst Neurophysiopathol, 13385 Marseille, France
| | - Ziad Fajloun
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli 1300, Lebanon; (S.N.); (C.S.)
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli 1352, Lebanon
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Lacerda MVG, Monteiro W, Hendy A, Guerra MVDF, Guerra MDGVB. The Obituary of the Brazilian Amazon Entomologist: Nelson Ferreira Fé (★1941 †2023). Rev Soc Bras Med Trop 2023; 56:e02602023. [PMID: 37493753 PMCID: PMC10367211 DOI: 10.1590/0037-8682-0260-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, AM, Brasil
- University of Texas Medical Branch, Galveston, TX, USA
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Adam Hendy
- University of Texas Medical Branch, Galveston, TX, USA
| | - Marcus Vinitius de Farias Guerra
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Maria das Graças Vale Barbosa Guerra
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Manaus, AM, Brasil
- Fundação Hospitalar Alfredo da Matta, Manaus, AM, Brasil
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Reis MB, Martins JG, Bordon KDCF, de Campos Fraga-Silva TF, de Lima Procópio RE, de Almeida BRR, Bonato VLD, Arantes EC. Pioneering in vitro characterization of macrophage response induced by scorpion venoms from the Brazilian Amazon. Toxicon 2023; 230:107171. [PMID: 37211059 DOI: 10.1016/j.toxicon.2023.107171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/07/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
There are several scorpion species of medical relevance around the world. Some of them are well characterized by their toxins and clinical outcomes. Brazilian Amazon has a great amount of these arthropods that have an impact in the scorpionism events specifically in this region of Brazil. Recently, several studies pointed out the immune system activation during scorpion envenouming as an important facet of scorpionism, inducing a sepsis-like state that culminates in clinical severity and death. In this work, we characterized the macrophage response of three species of clinical relevance in Brazilian Amazon: Tityus silvestris, T. metuendus and T. obscurus and one specie with no toxic effects to humans, Brotheas amazonicus. All the four species analyzed were able to induce pro- and anti-inflammatory cytokine production in a J774.1 murine macrophage model. This activation was dependent on TLR2/TLR4/MyD88 activation and abolished by TLRs antagonists. These results suggest that the venoms of the four species analyzed were able to induce macrophage response in agreement to the well-established immune activation by T. serrulatus venom. Our findings provide new insights into the clinical repercussions of scorpionism of uncharacterized species and point to new biotechnological applications of these venoms and possible supportive therapies in scorpionism.
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Affiliation(s)
- Mouzarllem Barros Reis
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil; School of Medicine, Centro Universitário Barão de Mauá (CBM), Ribeirão Preto, SP, Brazil
| | - Jonas Gama Martins
- Graduate Program in Genetics, Conservation and Evolutionary Biology (PPG GCBEv), National Institute for Amazon Research (INPA), Manaus, AM, Brazil
| | - Karla de Castro Figueiredo Bordon
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Thais Fernanda de Campos Fraga-Silva
- Program of Basic and Applied Immunology, And Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rudi Emerson de Lima Procópio
- Graduate Program in Biotechnology and Natural Resources of Amazon, University of the State of Amazonas (UEA), Manaus, AM, Brazil
| | | | - Vânia Luiza Deperon Bonato
- Program of Basic and Applied Immunology, And Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Eliane Candiani Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
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Trinidad-Porfirio BE, Morales-Pérez A, Nava-Aguilera E, Flores-Moreno M, Morales-Nava L, García-Leyva J, Silva-Domínguez R, Cortés-Guzmán AJ, Fernández-Salas I, Andersson N. Occurrence of scorpion sting and associated factors in a highly marginalized municipality in Guerrero, Mexico: A cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011271. [PMID: 37126488 PMCID: PMC10150966 DOI: 10.1371/journal.pntd.0011271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Scorpion sting is a neglected public health problem, despite a global estimate of 1.2 million scorpion stings and some 3,250 deaths annually. METHODS This cross-sectional study estimates the occurrence of scorpion stings and identifies associated factors in seven communities in the highly marginalized municipality of Chilapa, in the Mexican state of Guerrero. After informed consent, 1,144 households provided information on 4,985 residents. The questionnaire collated sociodemographic data, characteristics of the dwelling, efforts to avoid scorpion stings, and individual information of scorpion stings suffered in the last year. Cluster-adjusted (acl), bivariate and multivariate analysis relied on the Mantel-Haenszel procedure. RESULTS The overall period prevalence of scorpion stings in the year prior to the study was 4.4% (218/4985), 5.4% in men (126/2320), and 3.5% in women (92/2665), p<0.01. The majority occurred at home 68.3% (149/218), followed by agricultural fields 26.6% (58/218), street 2.8% (6/218), and work 2.3% (5/218). Factors associated with scorpion sting were carrying firewood (OR 2.1; CI95%acl 1.40-3.09), keeping free-range hens around of the home (OR 1.9; CI95%acl 1.19-2.85), residing in a rural area (OR 1.7; CI95%acl 1.04-2.78), being male (OR 1.6; CI95%acl 1.18-2.28), and helping with housework (OR 1.6; CI95%acl 1.04-2.40). CONCLUSION This study confirms scorpion bites are a public health problem in these marginalized communities in Guerrero State, with risk factors related to living conditions and the work process at home and in the fields. Almost all risk factors identified could be reduced with low-cost interventions implemented by the communities themselves.
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Affiliation(s)
| | - Arcadio Morales-Pérez
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Miguel Flores-Moreno
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Liliana Morales-Nava
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Jaime García-Leyva
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Rufino Silva-Domínguez
- Departamento de Epidemiología y Medicina Preventiva, Secretaría de Salud Guerrero, Chilpancingo, Guerrero, México
| | - Antonio Juan Cortés-Guzmán
- Departamento de Epidemiología y Medicina Preventiva, Secretaría de Salud Guerrero, Chilpancingo, Guerrero, México
| | - Ildefonso Fernández-Salas
- Laboratorio de Entomología Médica, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, México
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
- Department of Family Medicine, McGill University, Montreal, Canada
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Scorpion envenomation in Brazil: Current scenario and perspectives for containing an increasing health problem. PLoS Negl Trop Dis 2023; 17:e0011069. [PMID: 36757916 PMCID: PMC9910716 DOI: 10.1371/journal.pntd.0011069] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Opportunistic scorpion species can colonize urban environments, establishing high-density communities that enhance the chances of human accidents. This scenario has been taking place in Brazil, in which some Tityus species have taken city centers, causing an explosion in the number of scorpion envenoming cases. The characteristics of this scorpionism epidemic in Brazil is discussed in the present work. The number of Brazilian scorpion stings has surpassed 120,000 cases in 2017, and has been maintained above this number ever since, representing a more than 3-fold increase in 10 years, which was higher than the number of cases for most of the neglected tropical diseases in the country. The escalation in scorpionism cases is even higher in some regions of Brazil. Fortunately, the proportion of mild cases has also increased in the analyzed period, as well as the number of victims seeking for medical attention within the first hour after the accident. The species Tityus serrulatus, Tityus stigmurus, Tityus bahiensis, and Tityus obscurus are traditionally accountable for most of the scorpion accidents in different regions of Brazil, but other species deserve to be closely watched. Despite scorpionism being a notable health problem in Brazil, accident prevention and pest control regarding this venomous animal have not been properly addressed by the scientific community nor by policy makers. Therefore, this review also aims to point possible fields of research that could help to contain the aggravation of the current scorpionism landscape in Brazil.
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Beck TP, Tupetz A, Farias AS, Silva-Neto A, Rocha T, Smith ER, Murta F, Dourado FS, Cardoso D, Ramos TA, Sachett A, Pinto TS, Pucca MB, Sampaio V, Ramos F, Vissoci JN, Sachett J, Wen FH, Staton CA, Gerardo CJ, Monteiro W. Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon. Toxicon X 2022; 16:100137. [PMID: 36160931 PMCID: PMC9489497 DOI: 10.1016/j.toxcx.2022.100137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon.
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Affiliation(s)
- Timothy P. Beck
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Anna Tupetz
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Altair Seabra Farias
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alexandre Silva-Neto
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Rocha
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Emily R. Smith
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Felipe Murta
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Deugles Cardoso
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - Tatyana A. Ramos
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - André Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Serrão Pinto
- School of Pharmaceutical Sciences, Universidade Federal Do Amazonas, Manaus, Brazil
| | | | - Vanderson Sampaio
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Flavia Ramos
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - João Nickenig Vissoci
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Jacqueline Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Department of Teaching and Research, Fundação Alfredo da Matta, Manaus, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo, São Paulo, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Charles J. Gerardo
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Wuelton Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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10
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de Souza TC, Farias BES, Bernarde PS, Chiaravalotti F, Frade DDR, Brilhante AF, Melchior LAK. Temporal trend and epidemiological profile of accidents involving venomous animals in Brazil, 2007-2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022025. [PMID: 36351057 PMCID: PMC9887982 DOI: 10.1590/s2237-96222022000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. METHODS this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. RESULTS during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". CONCLUSION accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.
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Affiliation(s)
- Tiago Cruz de Souza
- Universidade Federal do Acre, Programa de Pós-Graduação em Ciências
da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil
| | | | - Paulo Sérgio Bernarde
- Universidade Federal do Acre, Laboratório de Herpetologia, Cruzeiro
do Sul, AC, Brazil
| | | | | | - Andreia Fernandes Brilhante
- Universidade Federal do Acre, Programa de Pós-Graduação em Ciências
da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil
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11
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Rebahi H, Ba-M'hamed S, Still ME, Mouaffak Y, Younous S, Bennis M. Clinical features and prognosis of severe scorpion envenomation in children. Pediatr Int 2022; 64:e14687. [PMID: 33682212 DOI: 10.1111/ped.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in the central area is Androctonus mauretanicus (Am) scorpion. Its venom can be lethal, especially for children. This study aimed to determine a clinico-epidemiological profile of severe scorpion envenomation among children and identify risk factors for mortality. METHODS This retrospective cohort study included 606 children admitted for severe scorpion envenomation (SSE) from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital. RESULTS The mean age of envenomed children was 6.3 ± 4.2 years. Seventy-four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 h in 83% of cases. Bivariate analysis indicated that from 1 to 24 months of age (P = 0.001), hyperthermia (P = 0.022), episodes of diarrhea (P < 0.001), tachycardia (P < 0.001), abdominal distention (P < 0.001), skin marbling (P < 0.001), signs of respiratory distress (P < 0.001), irritability (P < 0.001), generalized seizures (P = 0.053), and Glasgow Coma Score (GCS) of 3 to 9 (P < 0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (P = 0.007), skin marbling (P = 0.006), and respiratory distress (P = 0.002), and GCS 3-9 (P = 0.007) were found to be independent risk factors for mortality in our patient population. CONCLUSIONS Children are at high risk of developing serious complications, even death, from severe scorpion envenomation. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.
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Affiliation(s)
- Houssam Rebahi
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Saadia Ba-M'hamed
- Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | | | - Youssef Mouaffak
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Younous
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Bennis
- Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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12
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Borges A, Graham MR, Cândido DM, Pardal PPO. Amazonian scorpions and scorpionism: integrating toxinological, clinical, and phylogenetic data to combat a human health crisis in the world's most diverse rainfores. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20210028. [PMID: 34887908 PMCID: PMC8629433 DOI: 10.1590/1678-9199-jvatitd-2021-0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Venom from Amazonian scorpions of the genus Tityus contains components capable of eliciting a distinct clinical, mostly neurological, syndrome. This contrasts with the mainly autonomic manifestations produced after envenomation by congeneric southern and northern South American species. Herein, we summarize Pan-Amazonian scorpionism by synthesizing available toxinological, clinical, and molecular data gathered from all affected areas in Amazonia, including Brazil, Ecuador, Colombia, Peru, Venezuela, and French Guiana. We searched multiple databases, as well as our own records, for reports of scorpion envenomations in Amazonia by confirmed Tityus spp., and compared the clinical manifestations. To help uncover clinical and venom relationships among problematic species, we explored phylogenetic relationships with a rate-calibrated analysis of mitochondrial COI data from available species. The possible existence of diversity gradients for venom toxic and immunogenic components despite the predicted strong phylogenetic association among species is underscored by discussed clinical and toxinological findings. A multicentric effort, involving all nations affected by this neglected disease, is urgently needed to offer alternatives for treating and understanding this pathology, including the preparation of neutralizing antibodies with a broad range of efficacy.
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Affiliation(s)
- Adolfo Borges
- Center for the Development of Scientific Research (CEDIC), Asunción,
Paraguay
- Laboratory of Molecular Biology of Toxins and Receptors, Institute
of Experimental Medicine, School of Medicine, Central University of Venezuela,
Caracas, Venezuela
| | - Matthew R. Graham
- Department of Biology, Eastern Connecticut State University,
Willimantic, CT, United States
| | | | - Pedro P. O. Pardal
- Laboratory of Medical Entomology and Venomous Animals, Center of
Tropical Medicine, Federal University of Pará (UFPA), Belém, PA, Brazil
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13
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Vaucel JA, Larréché S, Paradis C, Labadie M, Courtois A, Grenet G, Langrand J, Tournoud C, Nisse P, Gallart JC, Schmitt C, Torrents R, Le Roux G, Gil-Jardine C, Kallel H. Relationship Between Scorpion Stings Events and Environmental Conditions in Mainland France. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:2146-2153. [PMID: 34224562 DOI: 10.1093/jme/tjab109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Indexed: 06/13/2023]
Abstract
In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) and 4 Euscorpiidae: Euscorpius concinnus (Koch, 1837), Euscorpius italicus (Herbst, 1800), Euscorpius tergestinus (Koch, 1837), and Tetratrichobothrius flavicaudis (De Geer, 1778). We aimed to describe the impact of environmental conduction on the number of scorpion events. For this, a retrospective multi-center study was conducted with data from the French poison control centers files about scorpion events between 1 January 2011 and 31 December 2020. During the study period, 975 incoming calls for scorpion events were recorded and 574 were related to scorpions native to mainland France and Corsica: B. occitanus (n = 86), Euscorpiidae species (n = 222), B. xambeui (n = 1), and undetermined species (n = 265). Cases were mostly reported along the Mediterranean coast, along rivers, and in cities with a trading port. The number of scorpion events was linked to the rivers' water level, rivers' flow, temperature, sunshine, and pluviometry (P < 0.05 for all variables). B. occitanus need warmest and driest environment than Euscorpiidae spp. A link between the severity of the envenoming and climatic condition or seasonality was not demonstrated.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
- Service des urgences adulte [Emergency Department], Centre hospitalier et universitaire Pellegrin, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Sébastien Larréché
- Département de Biologie Médicale [Medical Biology Department], Hôpital d'Instruction Des Armées Bégin, Saint-Mandé 94160, Ile de France, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Arnaud Courtois
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Guillaume Grenet
- Centre Hospitalier Universitaire de Lyon, Centre Antipoison [Lyon Poison Control Center], Lyon 69000, Auvergne-Rhône-Alpes, France
| | - Jérome Langrand
- Centre Antipoison de Paris [Poison Control Center of Paris], hôpital Fernand-Widal, Paris 75000, Ile de France, France
| | - Christine Tournoud
- Centre Hospitalier Universitaire de Nancy, Centre Antipoison [East Poison Control Center], Nancy 54000, Grand Est, France
| | - Patrick Nisse
- Centre hospitalier Universitaire de Lille, Centre Antipoison [Lille Poison Control Center], Lille 59000, Haut de France, France
| | - Jean-Christophe Gallart
- Centre Hospitalier Universitaire de Toulouse, Centre Antipoison-SAMU 31 [Toulouse Poison Control Center], Toulouse 31000, Occitanie, France
| | - Corinne Schmitt
- Centre Hospitalier Universitaire de Marseille, Centre Antipoison [Marseille Poison Control Center], Marseille 13000, Provence-Alpes-Côte-D'azur, France
| | - Romain Torrents
- Centre Hospitalier Universitaire de Marseille, Centre Antipoison [Marseille Poison Control Center], Marseille 13000, Provence-Alpes-Côte-D'azur, France
| | - Gaël Le Roux
- Centre Hospitalier Universitaire d'Angers, Centre Antipoison [Angers Poison Control Center], Angers 49000, Pays de la Loire, France
| | - Cédric Gil-Jardine
- Service des urgences adulte [Emergency Department], Centre hospitalier et universitaire Pellegrin, Bordeaux 33076, Nouvelle Aquitaine, France
- Bordeaux Population Health Research Center, IETO Team, Université de Bordeaux, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Hatem Kallel
- Service de Réanimation [Intensive Care Unit], Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
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14
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Martins JG, Santos GC, Procópio REDL, Arantes EC, Bordon KDCF. Scorpion species of medical importance in the Brazilian Amazon: a review to identify knowledge gaps. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20210012. [PMID: 34589120 PMCID: PMC8452272 DOI: 10.1590/1678-9199-jvatitd-2021-0012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022] Open
Abstract
Scorpionism is a relevant medical condition in Brazil. It is responsible for most accidents involving venomous animals in the country, which leads to severe symptoms that can evolve to death. In recent years, an increase of almost 50% in the incidence of scorpionism has been observed in the Northern Region, where the highest severity of envenoming has been notified since the beginning of the 21st century. This review aims to provide an in-depth assessment of public data and reports on symptoms and epidemiology of envenoming, ecological aspects of scorpions, and characterization of venoms and toxins to access the gaps that need to be filled in the knowledge of the scorpion species of medical importance from the Brazilian Amazon. A systematic search using the string words "Amazon" and "scorpion" was performed on 11 databases. No restriction on date, language or status of the publication was applied. Reports not related to the Brazilian Amazon were excluded. Therefore, 88 studies remained. It is shown that populations of scorpions of medical importance, even of the same species, may present significant toxic variations peculiar to some regions in the Brazilian Amazon, and commercial scorpion antivenoms were not able to shorten the intensity and duration of neurological manifestations in patients stung by T. silvestris, T. apiacas or T. obscurus. It is also highlighted that the toxins responsible for triggering these alterations have not been elucidated yet and this is a fruitful field for the development of more efficient antivenoms. Furthermore, the geographic distribution of scorpions of the genus Tityus in the Brazilian Amazon was revised and updated. The cumulative and detailed information provided in this review may help physicians and scientists interested in scorpionism in the Brazilian Amazon.
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Affiliation(s)
- Jonas Gama Martins
- Graduate Program in Genetics, Conservation and Evolutionary Biology
(PPG GCBEv), National Institute for Amazon Research (INPA), Manaus, AM,
Brazil
| | - Gabrielle Cristina Santos
- Department of BioMolecular Sciences, School of Pharmaceutical
Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP,
Brazil
| | - Rudi Emerson de Lima Procópio
- Graduate Program in Biotechnology and Natural Resources of Amazon,
University of the State of Amazonas (UEA), Manaus, AM, Brazil
| | - Eliane Candiani Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical
Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP,
Brazil
| | - Karla de Castro Figueiredo Bordon
- Department of BioMolecular Sciences, School of Pharmaceutical
Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP,
Brazil
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15
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Almeida ACC, Carvalho FM, Mise YF. Risk factors for fatal scorpion envenoming among Brazilian children: a case-control study. Trans R Soc Trop Med Hyg 2021; 115:975-983. [PMID: 34352889 DOI: 10.1093/trstmh/trab120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/15/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scorpion envenoming is relatively frequent in tropical and subtropical regions and potentially fatal. We aimed to identify risk factors for fatal scorpion envenoming among Brazilian children. METHODS A case-control study investigated all fatal cases of scorpion envenoming among children up to 10 y old, reported to the Brazilian Diseases Surveillance System between 1 January 2007 and 18 July 2016. Controls were randomly sampled from children who survived the envenoming over this period. Data were analysed using logistic regression. RESULTS Of the 254 cases and 1083 controls investigated, the identified risk factors were age ≤5 y, occurred in a rural area, time-to-treatment ≥3 h, treatment with scorpion antivenom (SAV) but either excessive or insufficient number of vials, treatment with antivenom that was neither SAV nor anti-spider and no antivenom administered compared with the standard recommended treatment. Treatment effectiveness at preventing fatal scorpion envenoming was 77.0% when time-to-treatment was <3 h and 75% in children 9-10 y of age. SAV was 63% effective at preventing death when administered early at the recommended dosage. CONCLUSIONS Fatal scorpion envenoming was associated with younger age, incident occurring in a rural area, late treatment and inadequate antivenom treatment. SAV was effective at preventing death when administered early.
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Affiliation(s)
- Ana Caroline C Almeida
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Salvador, 40110-040, Brazil
| | - Fernando M Carvalho
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Largo do Terreiro de Jesus, s/n Centro Histórico, Salvador, 40026-010, Brazil
| | - Yukari F Mise
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Salvador, 40110-040, Brazil
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16
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Ghorbani A, Mansouri B, Baradaran M. Effects of climate variables on the incidence of scorpion stings in Iran for five years. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200110. [PMID: 34262606 PMCID: PMC8252957 DOI: 10.1590/1678-9199-jvatitd-2020-0110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/04/2021] [Indexed: 12/08/2023] Open
Abstract
Background: Although scorpionism is recorded worldwide, some regions such as Iran
present a higher incidence. Due to the great prevalence of scorpion stings
in Khuzestan province, southwestern Iran, the present study examined the
relationship between different climate parameters and the scorpion sting
rate in this area from April 2010 to March 2015. Methods: In this cross-sectional descriptive-analytical study, we considered all
scorpion sting cases recorded in the Department of Infectious Diseases,
Ahvaz Jundishapur University of Medical Sciences. Data were analyzed using
statistics, frequency distribution and Pearson’s correlation
coefficient. Results: A total of 104,197 cases of scorpion stings was recorded from 2010 to 2015.
The cumulative incidence of scorpion sting was 2.23%. The spatial
distribution of scorpion stings showed that most cases occurred in the
Dehdez district (4,504 scorpion stings/100,000 inhabitants) and the Masjed
Soleyman county (4,069 scorpion stings/100,000 inhabitants). A significant
association was found between climate factors (temperature, evaporation
rate, sunshine duration, humidity, and precipitation) and the scorpion sting
rate. An increase in rainfall and humidity coincided with a reduction in
scorpion stings whereas an increase in temperature, evaporation, and
sunshine duration was accompanied by a growth of scorpion stings. No
significant correlation was found between wind velocity/direction and the
incidence rate of stings. Moreover, the seasonal peak incidence of scorpion
stings was recorded in summer (an average of 8,838 cases) and the lowest
incidence was recorded during winter (an average of 1,286 cases). The annual
trend of scorpion sting cases decreased during the period from 2010 to
2015. Conclusion: Climate variables can be a good index for predicting the incidence of
scorpion stings in endemic regions. Since they occur mostly in the hot
season, designing preventive measures in the counties and districts with a
high incidence of scorpion stings such as Dehdez and Masjed Soleyman can
minimize mortality and other burdens.
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Affiliation(s)
- Ahmad Ghorbani
- Toxicology Research Center, Medical Basic Sciences Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Toxicology Research Center Medical Basic Sciences Institute Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Behzad Mansouri
- Department of Statistics, Shahid Chamran University of Ahvaz, Ahvaz, Iran. Department of Statistics Shahid Chamran University of Ahvaz Ahvaz Iran
| | - Masoumeh Baradaran
- Toxicology Research Center, Medical Basic Sciences Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Toxicology Research Center Medical Basic Sciences Institute Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
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Amado TF, Moura TA, Riul P, Lira AFDA, Badillo-Montaño R, Martinez PA. Vulnerable areas to accidents with scorpions in Brazil. Trop Med Int Health 2021; 26:591-601. [PMID: 33560566 DOI: 10.1111/tmi.13561] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify areas that present a higher risk of exposure to accidents with scorpions in Brazil. METHODS We used techniques of spatial prioritisation to determine the most vulnerable localities to envenomation by four scorpion species. Our prioritisation integrated ecological niche models with health investment, antivenin availability, access to health care facilities and metrics of human impact data. RESULTS The ecological niche models indicated that three scorpion species (Tityus bahiensis, Tityus serrulatus, and Tityus stigmurus) are more associated with human population density, while T. obscurus demonstrated a strong association with temperature variations during the year. Spatial prioritisation indicated that the areas with higher risk exposure to accidents with scorpions are in northern and northeastern Brazil. Alternatively, more isolated but densely populated areas in the southeastern and central regions also emerged as a priority. CONCLUSION Mapping areas where humans are more likely to interact with scorpions can assist in the design of efficient public health policies.
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Affiliation(s)
- Talita Ferreira Amado
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil.,Biodiversity and Macroecology Lab, Universidad Rey Juan Carlos, Madrid, Spain
| | - Thais Andrade Moura
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | - Pablo Riul
- Departamento de Sistemática e Ecologia, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - André Felipe de Araujo Lira
- Programa de Pós-Graduação em Ciência Animal Tropical, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - Raúl Badillo-Montaño
- Red de Estudios Moleculares Avanzados, Instituto de Ecologia A, C, Xalapa-Enríquez, Mexico
| | - Pablo Ariel Martinez
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil
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18
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Abhilash KP, Rao R. Animal bites presenting to the emergency department: Spectrum, seasonal variation, and outcome. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmgims.jmgims_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Gomes JV, Fé NF, Santos HLR, Jung B, Bisneto PF, Sachett A, de Moura VM, Mendonça da Silva I, Cardoso de Melo G, Pereira de Oliveira Pardal P, Lacerda M, Sampaio V, Wen FH, de Almeida Gonçalves Sachett J, Monteiro WM. Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon. Toxicon 2020; 187:245-254. [PMID: 32991937 DOI: 10.1016/j.toxicon.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a 'sensation of receiving an electric shock' throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.
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Affiliation(s)
- Jacimara Vasques Gomes
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Nelson Ferreira Fé
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Hildegard Loren Rebouças Santos
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Bruna Jung
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Pedro Ferreira Bisneto
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-Graduação em Zoologia, Universidade Federal do Amazonas, Manaus, Brazil
| | - André Sachett
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Valéria Mourão de Moura
- Programa de Pós-graduação em Recursos Naturais da Amazônia, Universidade Federal do Oeste do Pará, Santarém, Pará, Brazil
| | - Iran Mendonça da Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gisely Cardoso de Melo
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Manaus, Brazil
| | - Vanderson Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton M Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
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Vaucel J, Mutricy R, Hoarau M, Pujo JM, Elenga N, Labadie M, Kallel H. Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects. J Venom Anim Toxins Incl Trop Dis 2020; 26:e202000038. [PMID: 32973890 PMCID: PMC7485965 DOI: 10.1590/1678-9199-jvatitd-2020-0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The Amazon basin is one of the seven major geographical areas where
scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants
are registered per year. As the severity of cases is higher in children,
descriptive studies are needed to have a better understanding of this
pathology. The aim of the present study is to describe pediatric scorpionism
in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion
stings in all pediatric patients admitted to Cayenne General Hospital from
January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients
with general signs of envenomation were younger and lighter (p = 0.04). The
picture was “one sting” (95.3%) by a “big” (47.6%), “black” (60%) and “small
pincer” (58%) scorpion on the extremity of the body (84%). Stings occurred
mainly during the day, while patients changed clothes. There was no
envenomation during night. The monthly evaluation highlights that the number
of stings and percentage of general signs of envenomation were closely
connected to a composite variable including the variation of the level of
rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with
general signs of envenomation. The presence of pulmonary; ear, nose, and
throat (ENT); or gastrointestinal symptoms are related to major envenomation
(p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia
increased according to the envenomation grade whereas serum potassium and
alkaline reserve decreased. Forty-six patients needed hospitalization and
seven of them required intensive care. No patient died nor presented
sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child
activities and climatic conditions. Severe envenomation presented most of
the time with cardiac, pulmonary, and gastrointestinal symptoms.
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Affiliation(s)
- Jules Vaucel
- Poison Control Center (Centre Antipoison) Nouvelle Aquitaine, Centre Hospitalier et Universitaire Pellegrin, Bordeaux 33076, Aquitaine, France.,Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Remi Mutricy
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Maëlle Hoarau
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Jean-Marc Pujo
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Narcisse Elenga
- Emergency Pediatric Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Magali Labadie
- Poison Control Center (Centre Antipoison) Nouvelle Aquitaine, Centre Hospitalier et Universitaire Pellegrin, Bordeaux 33076, Aquitaine, France
| | - Hatem Kallel
- Intensive Care Unit, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
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21
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Feola A, Perrone MA, Piscopo A, Casella F, Della Pietra B, Di Mizio G. Autopsy Findings in Case of Fatal Scorpion Sting: A Systematic Review of the Literature. Healthcare (Basel) 2020; 8:healthcare8030325. [PMID: 32899951 PMCID: PMC7551928 DOI: 10.3390/healthcare8030325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending in a terminal bulbous (telson) containing paired venom glands and the stinger. There are 19 known families of scorpions and more than 2200 species, of which about 50 from the families of Buthidae, Hemiscorpiidae and Scorpionidae are harmful to humans. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins and organic compounds, thereby having neurologic, cardiovascular, hematologic and renal side effects, in addition to local effects such as redness, pain, burning and swelling. When the sting is fatal, the mechanism of death is often related to cardiotoxicity with terminal pulmonary edema. However, the cholinergic excess or the neuromuscular excitation can provoke respiratory failure. Sometimes, death is due to an anaphylactic reaction to the envenoming. The purpose of this literature review is to evaluate the autopsy findings in scorpion sting-related deaths in order to better understand the pathophysiological mechanisms underlying them, thus helping pathologists in defining the correct diagnosis.
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Affiliation(s)
- Alessandro Feola
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-5666-018
| | | | - Amalia Piscopo
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (A.P.); (G.D.M.)
| | - Filomena Casella
- Unit of Legal Medicine, AORN “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy;
| | - Bruno Della Pietra
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (A.P.); (G.D.M.)
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22
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Sachett JDAG, Val FF, Alcântara JA, Cubas-Vega N, Montenegro CS, da Silva IM, de Souza TG, Santana MF, Ferreira LCL, Monteiro WM. Bothrops atrox Snakebite: How a Bad Decision May Lead to a Chronic Disability: A Case Report. Wilderness Environ Med 2020; 31:317-323. [PMID: 32456876 DOI: 10.1016/j.wem.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.
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Affiliation(s)
| | - Fernando F Val
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - João A Alcântara
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Nadia Cubas-Vega
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Iran M da Silva
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Monique F Santana
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Luiz C L Ferreira
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton M Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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23
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Borges A, Lomonte B, Angulo Y, Acosta de Patiño H, Pascale JM, Otero R, Miranda RJ, De Sousa L, Graham MR, Gómez A, Pardal PP, Ishikawa E, Bonilla F, Castillo A, de Avila RAM, Gómez JP, Caro-López JA. Venom diversity in the Neotropical scorpion genus Tityus: Implications for antivenom design emerging from molecular and immunochemical analyses across endemic areas of scorpionism. Acta Trop 2020; 204:105346. [PMID: 31982434 DOI: 10.1016/j.actatropica.2020.105346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
Scorpions of the Neotropical genus Tityus are responsible for most severe envenomations in the Caribbean, South America, and Lower Central America (LCA). Although Tityus is taxonomically complex, contains high toxin polymorphism, and produces variable clinical manifestations, treatment is limited to antivenoms produced against species with restricted distributions. In this study, we explored the compositional and antigenic diversity of Tityus venoms to provide improved guidelines for the use of available antivenoms at a broader geographic scale. We used immunoblotting, competitive ELISA, and in vivo studies to compare reactivity against commercial antivenoms from Brazil, Venezuela, and Mexico, as well as MALDI-TOF mass spectrometry, cDNA sequencing, and phylogenetic analyses to assess venom sodium channel-active toxin (NaTx) content from medically important Tityus populations inhabiting Brazil, Colombia, Costa Rica, Ecuador, Panama, Trinidad and Tobago, and Venezuela. Additionally, we raised rabbit antibodies against Tityus venoms from LCA to test for cross-reactivity with congeneric species. The results suggest that Tityus spp. possess high venom antigenic diversity, underlying the existence of four toxinological regions in Tropical America, based on venom composition and immunochemical criteria: LCA/Colombia/Amazonia (Region I), Venezuela (Region II), southeast South America (Region III), and a fourth region encompassing species related to toxinologically divergent Tityus cerroazul. Importantly, our molecular and cross-reactivity results highlight the need for new antivenoms against species inhabiting Region I, where scorpions may produce venoms that are not significantly reactive against available antivenoms.
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24
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Fan HW, Natal Vigilato MA, Augusto Pompei JC, Gutiérrez JM. [Situation of public laboratories manufacturing antivenoms in Latin AmericaA situação dos laboratórios públicos produtores de soros antivenenos na América Latina]. Rev Panam Salud Publica 2019; 43:e92. [PMID: 31772565 PMCID: PMC6863067 DOI: 10.26633/rpsp.2019.92] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022] Open
Abstract
Se analiza la situación de los laboratorios públicos productores de antivenenos en América Latina, con base a los resultados de en un taller coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA) de la Organización Panamericana de la Salud (OPS). Nueve países en la región poseen doce laboratorios públicos que producen y distribuyen antivenenos contra venenos de diferentes animales ponzoñosos. Se discutió la situación de cada laboratorio, se analizó el escenario actual caracterizado por las crecientes demandas regulatorias y la heterogeneidad de estos en términos de infraestructura y capacidad productiva y se planteó la necesidad de concertar procesos de cooperación regional dirigidos a mejorar la disponibilidad de antivenenos, incluyendo proyectos de investigación y desarrollo para el mejoramiento de los procesos y las tecnologías; estudios del perfil de la capacidad neutralizante de los antivenenos contra diferentes venenos, y programas de capacitación técnica de profesionales y personal técnico. En el contexto actual, en el que la Organización Mundial de la Salud elaboró una estrategia global para la prevención y el control de los envenenamientos ofídicos, el Centro PANAFTOSA de la OPS ha asumido la coordinación de estas acciones en las Américas, mejorar la disponibilidad de antivenenos es prioritaria. Como resultado de ese taller, se creó la Red de Laboratorios Públicos Productores de Antivenenos de América Latina (RELAPA), con el objetivo de fortalecer estos laboratorios y de aumentar la disponibilidad y accesibilidad de antivenenos eficaces y seguros a toda América Latina.
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Affiliation(s)
- Hui Wen Fan
- Instituto Butantan Instituto Butantan São Paulo Brazil Instituto Butantan, São Paulo. Brazil
| | - Marco Antonio Natal Vigilato
- Centro Panamericano de Fiebre Aftosa Organización Panamericana de la Salud Rio de Janeiro Brasil Centro Panamericano de Fiebre Aftosa, Organización Panamericana de la Salud, Rio de Janeiro. Brasil
| | - Julio Cesar Augusto Pompei
- Centro Panamericano de Fiebre Aftosa Organización Panamericana de la Salud Rio de Janeiro Brasil Centro Panamericano de Fiebre Aftosa, Organización Panamericana de la Salud, Rio de Janeiro. Brasil
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología Universidad de Costa Rica San José Costa Rica Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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25
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Monteiro WM, Gomes J, Fé N, Mendonça da Silva I, Lacerda M, Alencar A, Seabra de Farias A, Val F, de Souza Sampaio V, Cardoso de Melo G, Pardal P, Mota da Silva A, Bernarde PS, Carlos de Lima Ferreira L, Gutierrez JM, de Almeida Gonçalves Sachett J, Fan HW. Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review. Toxicon 2019; 169:68-80. [DOI: 10.1016/j.toxicon.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 01/01/2023]
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26
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Batista C, Martins J, Restano-Cassulini R, Coronas F, Zamudio F, Procópio R, Possani L. Venom characterization of the Amazonian scorpion Tityus metuendus. Toxicon 2018; 143:51-58. [DOI: 10.1016/j.toxicon.2018.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/09/2023]
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27
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Román JP, García F, Medina D, Vásquez M, García J, Graham MR, Romero-Alvarez D, Pardal PPDO, Ishikawa EAY, Borges A. Scorpion envenoming in Morona Santiago, Amazonian Ecuador: Molecular phylogenetics confirms involvement of the Tityus obscurus group. Acta Trop 2018; 178:1-9. [PMID: 29079184 DOI: 10.1016/j.actatropica.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
Scorpion envenoming by species in the genus Tityus is hereby reported from rural locations in the Amazonian province of Morona Santiago, southeastern Ecuador. Twenty envenoming cases (18 patients under 15 years of age) including one death (a 4-year-old male) were recorded at the Macas General Hospital, Morona Santiago, between January 2015 and December 2016 from the counties of Taisha (n=17), Huamboyo (n=1), Palora (n=1), and Logroño (n=1). An additional fatality from 2014 (a 3-year-old female from Nayantza, Taisha county) is also reported. Leukocytosis and low serum potassium levels were detected in most patients. We observed a significant negative correlation between leukocytosis and hypokalemia. Scorpions involved in three accidents from Macuma, Taisha County, were identified as genetically related to Tityus obscurus from the Brazilian Amazonian region based on comparison of mitochondrial DNA sequences encoding cytochrome oxidase subunit I. These cases, along with previously reported envenoming from northern Manabí, reinforce the notion that scorpionism is a health hazard for children in Ecuador and emphasizes the need to supply effective antivenoms against local species, which are not currently available. The genetic affinity of the Ecuadorian specimens with T. obscurus may underlay toxinological, clinical, and venom antigenic relationships among Amazonian scorpions that deserves further exploration for designing therapeutic strategies to treat scorpionism in the region.
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Affiliation(s)
- Juan P Román
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | | | - Doris Medina
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - Manolo Vásquez
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - José García
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - Matthew R Graham
- Department of Biology, Eastern Connecticut State University, 83 Windham St., Willimantic, CT 06226, USA
| | - Daniel Romero-Alvarez
- Biodiversity Institute and Department of Ecology and Evolutionary Biology, University of Kansas, Lawrence, KS 66045, USA
| | - Pedro P de Oliveira Pardal
- Laboratory of Medical Entomology and Venomous Animals, Center of Tropical Medicine, Pará Federal University, Av. Generalíssimo Deodoro 92, Umarizal, 66055-240 Belém, Pará State, Brazil
| | - Edna A Y Ishikawa
- Laboratory of Medical Entomology and Venomous Animals, Center of Tropical Medicine, Pará Federal University, Av. Generalíssimo Deodoro 92, Umarizal, 66055-240 Belém, Pará State, Brazil
| | - Adolfo Borges
- Carrera de Biotecnología, Facultad de Ingenierías y Ciencias Agropecuarias, Universidad de Las Américas, Quito, Ecuador; Laboratorio de Biología Molecular de Toxinas y Receptores, Instituto de Medicina Experimental, Facultad de Medicina, Universidad Central de Venezuela, Caracas 1051, Venezuela.
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Nencioni ALA, Neto EB, de Freitas LA, Dorce VAC. Effects of Brazilian scorpion venoms on the central nervous system. J Venom Anim Toxins Incl Trop Dis 2018; 24:3. [PMID: 29410679 PMCID: PMC5781280 DOI: 10.1186/s40409-018-0139-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022] Open
Abstract
In Brazil, the scorpion species responsible for most severe incidents belong to the Tityus genus and, among this group, T. serrulatus, T. bahiensis, T. stigmurus and T. obscurus are the most dangerous ones. Other species such as T. metuendus, T. silvestres, T. brazilae, T. confluens, T. costatus, T. fasciolatus and T. neglectus are also found in the country, but the incidence and severity of accidents caused by them are lower. The main effects caused by scorpion venoms - such as myocardial damage, cardiac arrhythmias, pulmonary edema and shock - are mainly due to the release of mediators from the autonomic nervous system. On the other hand, some evidence show the participation of the central nervous system and inflammatory response in the process. The participation of the central nervous system in envenoming has always been questioned. Some authors claim that the central effects would be a consequence of peripheral stimulation and would be the result, not the cause, of the envenoming process. Because, they say, at least in adult individuals, the venom would be unable to cross the blood-brain barrier. In contrast, there is some evidence showing the direct participation of the central nervous system in the envenoming process. This review summarizes the major findings on the effects of Brazilian scorpion venoms on the central nervous system, both clinically and experimentally. Most of the studies have been performed with T. serrulatus and T. bahiensis. Little information is available regarding the other Brazilian Tityus species.
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Affiliation(s)
| | - Emidio Beraldo Neto
- Laboratory of Pharmacology, Butantan Institute, Av. Dr. Vital Brasil, 1500, São Paulo, SP 05503-900 Brazil
- Graduation Program in Sciences – Toxinology, Butantan Institute, São Paulo, SP Brazil
| | - Lucas Alves de Freitas
- Laboratory of Pharmacology, Butantan Institute, Av. Dr. Vital Brasil, 1500, São Paulo, SP 05503-900 Brazil
- Graduation Program in Sciences – Toxinology, Butantan Institute, São Paulo, SP Brazil
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Ebrahimi V, Hamdami E, Moemenbellah-Fard MD, Ezzatzadegan Jahromi S. Predictive determinants of scorpion stings in a tropical zone of south Iran: use of mixed seasonal autoregressive moving average model. J Venom Anim Toxins Incl Trop Dis 2017; 23:39. [PMID: 28852405 PMCID: PMC5569496 DOI: 10.1186/s40409-017-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background More than 1.2 million scorpion stings occur annually worldwide, particularly in tropical regions. In the absence of proper medical care, mortality due to venomous scorpion stings is an important public health issue. The aim of the present study is to explore the temporal trend of scorpionism with time series models and determine the effective factors on this event using regression models. Methods A retrospective cross sectional study was conducted on 853 scorpion stung patients. They were referred to Haji-Abad Hospital of Hormozgan University of Medical Sciences (HUMS), south Iran, from May 2012 to July 2016. A linear model to describe and predict the monthly trend of scorpion sting cases is fit with autoregressive moving average (ARMA) model. Results Of 853 victims, 384 (45%) patients were female and 30.2% of them lived in urban areas. The mean (± SD) age of patients was 30.1 (± 19.6) years and the most affected age group was 20-29 years (21.8%). Most victims were unemployed people and farmers (54.7%) followed by housewives (30.2%). The majority of the stings occurred indoors (53.7%), between midnight and 6 a.m. (29.2%), in the summer (44.2%), and the most affected limbs were hands and legs (81.2%). Patient genders and occasions of being stung by scorpions were significantly different between outdoors and indoors (p < 0.001). Scorpion stings due to Odontobuthus doriae were significantly higher than due to other species in urban and rural patients (p = 0.04). Mixed seasonal ARMA at lag 12, ARMA (1, 1) × (0, 1), was selected as the best process for monthly trend of data. Regression results indicated that significant climate factors associated with scorpion stings are temperature (p < 0.001) and relative humidity (p = 0.002). Conclusions Scorpion stings have a noticeable effect on tropical rural populations, mainly farmers. Two effective climate factors associated positively and negatively with scorpion sting cases are temperature and relative humidity, respectively. The results of time series and regression models to predict the trends and determinants of scorpion stings are almost the same.
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Affiliation(s)
- Vahid Ebrahimi
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Esmael Hamdami
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, 79391-83417 Iran
| | - Mohammad Djaefar Moemenbellah-Fard
- Research Center for Health Sciences, Institute of Health, Department of Medical Entomology and Vector Control, School of Health, Shiraz University of Medical Sciences, Shiraz, 71645 Iran
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30
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Araújo KAMD, Tavares AV, Marques MRDV, Vieira AA, Leite RDS. Epidemiological study of scorpion stings in the Rio Grande do Norte State, Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2017; 59:e58. [PMID: 28793026 PMCID: PMC5553945 DOI: 10.1590/s1678-9946201759058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/11/2017] [Indexed: 11/21/2022] Open
Abstract
This communication is a retrospective epidemiological study of the scorpion sting cases recorded from 2007 to 2014 in the Rio Grande do Norte State, Northeastern Brazil. The data was collected from the Injury Notification Information System database of the Health Department of Rio Grande do Norte State. A total of 20,555 cases were studied. The cases were distributed over all months of the period studied and occurred mainly in urban areas. Victims were predominantly 20-29 year-old women. Most victims were stung on the foot and received medical care within 1-3 h after being stung. The cases were mostly classified as mild and progressed to cure. Scorpion stings in Rio Grande do Norte State are an environmental public health problem that needs to be monitored and controlled throughout the year.
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Affiliation(s)
- Kaliany Adja Medeiros de Araújo
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Unidade Acadêmica de Saúde, Programa de Pós-Graduação em Biotecnologia e Ciências Naturais, campus Cuité, Paraíba, Brazil
| | - Aluska Vieira Tavares
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Unidade Acadêmica de Saúde, Programa de Pós-Graduação em Biotecnologia e Ciências Naturais, campus Cuité, Paraíba, Brazil
| | - Michael Radan de Vasconcelos Marques
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Unidade Acadêmica de Saúde, Programa de Pós-Graduação em Biotecnologia e Ciências Naturais, campus Cuité, Paraíba, Brazil
| | - Alecxandro Alves Vieira
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Unidade Acadêmica de Saúde, Programa de Pós-Graduação em Biotecnologia e Ciências Naturais, campus Cuité, Paraíba, Brazil
| | - Renner de Souza Leite
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Unidade Acadêmica de Saúde, Programa de Pós-Graduação em Biotecnologia e Ciências Naturais, campus Cuité, Paraíba, Brazil
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Silva BAJD, Fé NF, Gomes AADS, Souza ADS, Sachett JDAG, Fan HW, Melo GCD, Monteiro WM. Implication of Tityus apiacas (Lourenco, 2002) in scorpion envenomations in the Southern Amazon border, Brazil. Rev Soc Bras Med Trop 2017; 50:427-430. [DOI: 10.1590/0037-8682-0490-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brazil
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Monteiro WM, de Oliveira SS, Pivoto G, Alves EC, de Almeida Gonçalves Sachett J, Alexandre CN, Fé NF, Barbosa Guerra MDGV, da Silva IM, Tavares AM, Ferreira LCDL, Lacerda MVG. Scorpion envenoming caused by Tityus cf. silvestris evolving with severe muscle spasms in the Brazilian Amazon. Toxicon 2016; 119:266-9. [DOI: 10.1016/j.toxicon.2016.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/20/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022]
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Scorpionism by Tityus silvestris in eastern Brazilian Amazon. J Venom Anim Toxins Incl Trop Dis 2016; 22:24. [PMID: 27570532 PMCID: PMC5000479 DOI: 10.1186/s40409-016-0079-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scorpionism is a serious public health problem in Brazil. Although cases of envenomation by scorpions are frequent in Brazil, Tityus silvestris - found throughout the Amazon region - is considered of minor medical significance and with only a few descriptions in the literature. This article aims to describe for the first time the epidemiological characteristics and clinical manifestations of scorpion stings by T. silvestris that occurred in eastern Brazilian Amazon. METHODS A prospective and observational study was carried out on 13 confirmed cases of T. silvestris envenomation registered from 2007 to 2011 in the cities of Belém and Ananindeua, Pará state, Brazil. RESULTS The stings occurred mainly during daytime, at domiciliary environment, and the scorpions were found in clothing, fruits or vegetables. Envenomation was more frequent in the age group between 21 and 30 years old, upper limbs were more affected and medical aid was usually provided within two hours. Men and women were equally affected. Regarding severity, ten patients were classified as Class I and three patients as Class II according to the Scorpion Consensus Expert Group. Local manifestations were present in all patients, being pain the most common symptom. Mild systemic manifestations including nausea, vomiting, somnolence, malaise and prostration were observed in three victims. Symptomatic treatment of pain was offered to all patients, and only one received specific antivenom. All victims had a favorable outcome. CONCLUSIONS To the best of our knowledge, this study is the first to report the systemic symptomatology of envenomation by T. silvestris in the Brazilian Amazon, highlighting the medical relevance of the species in this region. Further research on the venom and clinical manifestations of envenomation by T. silvestris should be conducted in order to verify the relevance of this species to public health.
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Sampaio VS, Gomes AA, Silva IM, Sachett J, Ferreira LCL, Oliveira S, Sabidò M, Chalkidis H, Barbosa Guerra MGV, Salinas JL, Wen FH, Lacerda MVG, Monteiro WM. Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon. PLoS One 2016; 11:e0156386. [PMID: 27227455 PMCID: PMC4881914 DOI: 10.1371/journal.pone.0156386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. Methodology/Principal Findings We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95%CI = 0.30–0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI >median [OR = 0.64 (95%CI = 0.39–0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95%CI = 1.49–2.94; p<0.001)], Indigenous status [OR = 2.15 (95%CI = 1.19–3.86; p = 0.011)] and living in a municipality located >300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28–2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located >300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15–2.02; p = 0.003)] and living in a municipality with a MHSPI <median [OR = 1.91 (95%CI = 1.28–2.47; p = 0.002)] increased the odds of antivenom underdosage. Conclusions Spider bites is prevalent across the study region with a higher incidence in the rainy season in rural areas. Spider bites can be painful and lead to local manifestations but rarely result in life-threatening envenoming. Major local complications were dermonecrosis and secondary infection in cases diagnosed as Loxosceles bites. Based on the correlations shown here, envenomings occurring in remote rural areas, Indigenous status and living in a municipality located >300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage.
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Affiliation(s)
- Vanderson Souza Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Núcleo de Sistemas de Informação, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - André Alexandre Gomes
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Iran Mendonça Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Luiz Carlos Lima Ferreira
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Sâmella Oliveira
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Meritxell Sabidò
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Catalunya, Spain
| | - Hipócrates Chalkidis
- Curso de Ciências Biológicas, Faculdades Integradas do Tapajós, Santarém, Pará, Brazil
| | - Maria Graças Vale Barbosa Guerra
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Jorge Luis Salinas
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Fan Hui Wen
- Instituto Butantan, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- * E-mail:
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