RESUMO
Massive, Africanized honeybee attacks have increased in Brazil over the years. Humans and animals present local and systemic effects after envenomation, and there is no specific treatment for this potentially lethal event. This study evaluated the ability of a new Apilic antivenom, which is composed of F(ab')2 fraction of specific immunoglobulins in heterologous and hyperimmune equine serum, to neutralize A. mellifera venom and melittin, in vitro and in vivo, in mice. Animal experiments were performed in according with local ethics committee license (UFRJ protocol no. DFBCICB072-04/16). Venom dose-dependent lethality was diminished with 0.25-0.5 µL of intravenous Apilic antivenom/µg honeybee venom. In vivo injection of 0.1-1 µg/g bee venom induced myotoxicity, hemoconcentration, paw edema, and increase of vascular permeability which were antagonized by Apilic antivenom. Cytotoxicity, assessed in renal LLC-PK1 cells and challenged with 10 µg/mL honeybee venom or melittin, was neutralized by preincubation with Apilic antivenom, as well the hemolytic activity. Apilic antivenom inhibited phospholipase and hyaluronidase enzymatic activities. In flow cytometry experiments, Apilic antivenom neutralized reduction of cell viability due to necrosis by honeybee venom or melittin. These results showed that this antivenom is effective inhibitor of honeybee venom actions. Thus, this next generation of Apilic antivenom emerges as a new promising immunobiological product for the treatment of massive, Africanized honeybee attacks.
Assuntos
Antivenenos/uso terapêutico , Venenos de Abelha/antagonistas & inibidores , Mordeduras e Picadas/tratamento farmacológico , Meliteno/antagonistas & inibidores , Animais , Anticorpos/sangue , Abelhas , Brasil , Linhagem Celular , Sobrevivência Celular , Relação Dose-Resposta a Droga , Avaliação Pré-Clínica de Medicamentos , Feminino , Hemólise/efeitos dos fármacos , Cavalos , Hialuronoglucosaminidase/antagonistas & inibidores , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Injeções Intradérmicas , Células LLC-PK1 , Dose Letal Mediana , Masculino , Camundongos , Modelos Animais , Testes de Neutralização , Fosfolipases/antagonistas & inibidores , SuínosRESUMO
Apresenta os 32 municípios com Pontos de Atendimentos para a terapia antiveneno, descritos por região de saúde e município no Estado do Tocantins para ações da vigilância de acidentes por animais peçonhentos.
It presents the 32 municipalities with Service Points for antivenom therapy, described by health region and municipality in the State of Tocantins for actions of surveillance of accidents by venomous animals.
Presenta los 32 municipios con Puntos de Servicio para la terapia antiveneno, descritos por región sanitaria y municipio en el Estado de Tocantins para acciones de seguimiento de accidentes por animales venenosos.
Il présente aux 32 communes des points de service pour la thérapie antivenimeuse, décrits par région sanitaire et commune de l'Etat de Tocantins pour des actions de surveillance des accidents par animaux venimeux.
Assuntos
Humanos , Animais , Pneumonia Viral/prevenção & controle , Mordeduras e Picadas/tratamento farmacológico , Zoonoses/complicações , Animais Peçonhentos/imunologia , Antivenenos/uso terapêutico , Área Programática de Saúde , Instituições de Assistência Ambulatorial/organização & administraçãoRESUMO
Resumen: Introducción: Las mordeduras de animales constituyen un problema sanitario. Pueden producir lesiones de diversa gravedad con riesgo de secuelas estéticas, funcionales y complicaciones infecciosas. El objetivo de este estudio fue describir las características clínicas y epidemiológicas, los tratamientos y las complicaciones de las lesiones por mordeduras de animales en niños hospitalizados en un centro de referencia de Uruguay. Métodos: Estudio descriptivo y retrospectivo. Se incluyeron todos los niños hospitalizados por mordeduras de animales entre 2014 y 2017. Se revisaron las historias clínicas y se registraron el animal involucrado, el tipo de lesiones, los tratamientos, las complicaciones y si el caso se notificó al Ministerio de Salud. Resultados: Se hospitalizaron 106 niños (media de edad: 4.5 años). El animal involucrado más común fue el perro (80.2%), seguido de roedores (8.5%), arácnidos (4.7%) y otros (6.5%). Las lesiones fueron en su mayoría únicas (61.3%) y superficiales (80.2%), y la hospitalización se hizo en cuidados moderados en el 91.5% de los casos. Los tratamientos se centraron en higiene (96.2%), sutura (70.8%) y profilaxis antibiótica (81.1%). Se presentaron complicaciones en el 77.4% de los casos. En tres fue posible el aislamiento del agente etiológico más frecuente: Streptococcus pyogenes. El 20.7% de los casos se notificaron al Ministerio de Salud. No se registró letalidad. Conclusiones: Del total de los niños hospitalizados, los más afectados fueron varones menores de 5 años. Predominaron las lesiones en la cabeza y los miembros, mayoritariamente leves y superficiales. En el 77.4% de los casos hubo complicaciones, principalmente infecciosas y estético-funcionales.
Abstract: Background: Animal bites are a health problem that can produce lesions of varying severity, with the risk of aesthetic and functional sequelae and infectious complications. The objective of the study was to describe the clinical, epidemiological, treatment and complications of lesions caused by animal bites in children hospitalized in a reference center in Uruguay. Method: Descriptive, retrospective study. All children hospitalized for animal bites between 2014 and 2017 were included. Medical records were reviewed and data, such as the animal involved, injuries, treatments, complications, and if the case was notified to the Ministry of Health, were recorded. Results: A total of 106 children were hospitalized, with a mean age 4.5 years. The animals involved were dogs (80.2%), rodents (8.5%), arachnids (4.7%), and others (6.5%). The majority of the lesions were superficial (80.2%), and 91.5% of the cases were hospitalized in moderate care. The treatments were hygiene (96.2%), suture (70.8%), and antibiotic prophylaxis (81.1%). There were complications in 77.4% of the cases. In three cases, the isolation of the most frequent etiological agent was possible: Streptococcus pyogenes. Notification to the Ministry of Health occurred in 20.7% of the cases. No lethality was recorded. Conclusions: A total of 106 children were hospitalized due to animal bites. The most affected were males under 5 years old. Most of them were bitten at home or nearby. Dogs and rodents were the most involved animals. There were predominantly head and limb lesions, mostly mild and superficial. Complications occurred in 77.4% of cases, mainly infectious and aesthetic-functional.
Assuntos
Adolescente , Animais , Criança , Pré-Escolar , Cães , Feminino , Humanos , Lactente , Masculino , Mordeduras e Picadas/epidemiologia , Hospitalização/estatística & dados numéricos , Picada de Aranha/epidemiologia , Roedores , Uruguai/epidemiologia , Mordeduras e Picadas/complicações , Mordeduras e Picadas/tratamento farmacológico , Estudos Transversais , Estudos RetrospectivosRESUMO
BACKGROUND: Approximately 59,000 people die from rabies worldwide annually. Haiti is one of the last remaining countries in the Western Hemisphere with endemic canine rabies. Canine-mediated rabies deaths are preventable with post-exposure prophylaxis (PEP): wound treatment, immunoglobulin, and vaccination. In countries where PEP is available, variability in healthcare seeking behaviors and lack of adherence to recommended treatment guidelines could also contribute to these deaths. Yet, few studies have addressed these issues. METHODS: We examined animal-bite reporting and assessed adherence to treatment guidelines at nine healthcare facilities in Haiti. We analyzed individual-level, de-identified patient data (demographic characteristics, geographic location, healthcare facility type, vaccine administration, and bite injury information) using descriptive analyses and logistic regression to examine factors associated with receiving PEP. FINDINGS: During the 6 month study period, we found 2.5 times more animal-bite case-patients than reported by the national surveillance system (690 versus 274). Of the 690 animal-bite patients identified, 498 (72%) sought care at six PEP providing facilities. Of the case-patients that sought care, 110 (22%) received at least one rabies vaccine. Of the 110 patients, 60 (55%) received all five doses. Delays were observed for three events: when patients presented to a facility after an animal-bite (3.0 days, range: 0-34 days), when patients received their fourth dose (16.1 days, range: 13-52 days), and when patients received their fifth dose (29 days, range: 26-52). When comparing vaccination status and patient characteristics, we found a significant association for bite location (p < .001), severity rank score (p < .001), geographic location (p < .001), and healthcare facility type (p = .002) with vaccination. CONCLUSION: High levels of underreporting identified here are of concern since vaccine distribution may, in part, be based on the number of animal-bite cases reported. Given that the Haitian government provides PEP to the population for free and we found animal-bite victims are seeking care in a timely mannerâ reducing rabies deaths is an achievable goal.
Assuntos
Mordeduras e Picadas/tratamento farmacológico , Cooperação do Paciente , Vacina Antirrábica/administração & dosagem , Raiva/tratamento farmacológico , Adolescente , Adulto , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/prevenção & controle , Mordeduras e Picadas/psicologia , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pós-Exposição , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/psicologia , Adulto JovemRESUMO
Background: Animal bites are a health problem that can produce lesions of varying severity, with the risk of aesthetic and functional sequelae and infectious complications. The objective of the study was to describe the clinical, epidemiological, treatment and complications of lesions caused by animal bites in children hospitalized in a reference center in Uruguay. Method: Descriptive, retrospective study. All children hospitalized for animal bites between 2014 and 2017 were included. Medical records were reviewed and data, such as the animal involved, injuries, treatments, complications, and if the case was notified to the Ministry of Health, were recorded. Results: A total of 106 children were hospitalized, with a mean age 4.5 years. The animals involved were dogs (80.2%), rodents (8.5%), arachnids (4.7%), and others (6.5%). The majority of the lesions were superficial (80.2%), and 91.5% of the cases were hospitalized in moderate care. The treatments were hygiene (96.2%), suture (70.8%), and antibiotic prophylaxis (81.1%). There were complications in 77.4% of the cases. In three cases, the isolation of the most frequent etiological agent was possible: Streptococcus pyogenes. Notification to the Ministry of Health occurred in 20.7% of the cases. No lethality was recorded. Conclusions: A total of 106 children were hospitalized due to animal bites. The most affected were males under 5 years old. Most of them were bitten at home or nearby. Dogs and rodents were the most involved animals. There were predominantly head and limb lesions, mostly mild and superficial. Complications occurred in 77.4% of cases, mainly infectious and aesthetic-functional.
Introducción: Las mordeduras de animales constituyen un problema sanitario. Pueden producir lesiones de diversa gravedad con riesgo de secuelas estéticas, funcionales y complicaciones infecciosas. El objetivo de este estudio fue describir las características clínicas y epidemiológicas, los tratamientos y las complicaciones de las lesiones por mordeduras de animales en niños hospitalizados en un centro de referencia de Uruguay. Métodos: Estudio descriptivo y retrospectivo. Se incluyeron todos los niños hospitalizados por mordeduras de animales entre 2014 y 2017. Se revisaron las historias clínicas y se registraron el animal involucrado, el tipo de lesiones, los tratamientos, las complicaciones y si el caso se notificó al Ministerio de Salud. Resultados: Se hospitalizaron 106 niños (media de edad: 4.5 años). El animal involucrado más común fue el perro (80.2%), seguido de roedores (8.5%), arácnidos (4.7%) y otros (6.5%). Las lesiones fueron en su mayoría únicas (61.3%) y superficiales (80.2%), y la hospitalización se hizo en cuidados moderados en el 91.5% de los casos. Los tratamientos se centraron en higiene (96.2%), sutura (70.8%) y profilaxis antibiótica (81.1%). Se presentaron complicaciones en el 77.4% de los casos. En tres fue posible el aislamiento del agente etiológico más frecuente: Streptococcus pyogenes. El 20.7% de los casos se notificaron al Ministerio de Salud. No se registró letalidad. Conclusiones: Del total de los niños hospitalizados, los más afectados fueron varones menores de 5 años. Predominaron las lesiones en la cabeza y los miembros, mayoritariamente leves y superficiales. En el 77.4% de los casos hubo complicaciones, principalmente infecciosas y estético-funcionales.
Assuntos
Mordeduras e Picadas/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Animais , Mordeduras e Picadas/complicações , Mordeduras e Picadas/tratamento farmacológico , Criança , Pré-Escolar , Estudos Transversais , Cães , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Roedores , Picada de Aranha/epidemiologia , Uruguai/epidemiologiaRESUMO
Three adult birds of the species Ara chloropterus and five of the species Ara ararauna from a conservation breeding facility suffered a massive attack by honeybees. The A. chloropterus birds presented swollen puncture lesions with stingers (mainly in the facial regions without feathers), swelling of the eyelids and subcutaneous tissue, and respiratory distress, and they were treated with intramuscular injections of 1.67 mg/kg of promethazine and 10 mg/kg of hydrocortisone followed by removal of the stingers. Complete remission of the clinical signs occurred 48 hours after start of treatment. The five A. ararauna birds died before they arrived at the veterinary hospital, and the necropsies found stingers in the areas of the face without feathers and the subcutaneous tissue, which were associated with erythema, bruising, and swelling. Food content from the crop was found in the oral cavity and the tracheal lumen, and marked congestion was observed in the heart, liver, spleen, lungs, kidneys, brain, and cerebellum. Among the histopathological findings, significant swelling of the myocytes in the endocardium and vascular dilation with erythroid repletion were observed, and there were multifocal areas of centrilobular necrosis associated with severe congestion and hemorrhaging in the hepatic tissue. Severe acute tubular necrosis and hydropic-vacuolar degeneration were observed in the kidneys. The clinical signs and pathological findings suggest envenomation due to a massive bee attack, the first such report for Psittacidae.
Assuntos
Venenos de Artrópodes/toxicidade , Abelhas , Doenças das Aves/fisiopatologia , Mordeduras e Picadas/veterinária , Papagaios , Animais , Comportamento Animal , Doenças das Aves/tratamento farmacológico , Mordeduras e Picadas/tratamento farmacológico , Mordeduras e Picadas/mortalidade , Mordeduras e Picadas/fisiopatologia , Brasil , Hidrocortisona/uso terapêutico , Prometazina/uso terapêuticoRESUMO
Las heridas por mordida en la región maxilofacial son relativamentecomunes y se consideran de tratamiento complejo; son contaminadas con una flora oral bacteriana única y, en ocasiones, tienen resultados estéticos devastadores. Las heridas pueden ser ocasionadas por animales domésticos, salvajes y humanos. El clínico debe tener una comprensión multidisciplinaria del manejo de las mismas, incluyendo el abordaje médico, quirúrgico, viral, bacteriológico y la secuencia propia del tratamiento. Se presenta una revisión de la literatura, así como casos clínicos para el tratamiento integral de este tipo de trauma.
Bite wounds in the maxillofacial region are relatively common and are regarded as diffi cult to treat given the associated contamination with what is a unique polymicrobial inoculum. The aesthetic consequences can occasionally prove devastating. The wounds can be caused by both domestic and wild animals, as well as by humans. Clinicians need to have a multidisciplinary understanding of how to manage such wounds, including surgical, medical, virological, and bacteriological aspects, and the proper sequence of treatment. We present a review of the literature and a number of clinical cases for the comprehensive management of this type of trauma.
Assuntos
Humanos , Masculino , Adolescente , Animais , Feminino , Criança , Adulto Jovem , Animais Domésticos , Mordeduras e Picadas/cirurgia , Mordeduras e Picadas/complicações , Mordeduras e Picadas/tratamento farmacológico , Antibacterianos/administração & dosagem , Cicatrização/fisiologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Infecção dos Ferimentos/prevenção & controle , Mordeduras e Picadas/classificação , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/epidemiologia , Procedimentos Cirúrgicos Bucais/métodosRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: The high frequency of poisoning by sting or bite from venomous animals has begun to be a serious public health problem in Mexico where scorpion sting is the most common. Because of this, there is the need to seek active substances in plant species with an antagonistic effect against neurotropic activity of scorpion venom. The aim of this work was to demonstrate which of the compounds contained in the n-hexane extract from Aristolochia elegans roots display activity against scorpion venom. MATERIAL AND METHODS: Antagonist activity displayed by extract, fractions and isolated compounds obtained from Aristolochia elegans was guided by the inhibition of smooth muscle contraction induced by scorpion venom (Centruroides limpidus limpidus) in a model of isolated guinea pig ileum. The neolignans obtained from this extract were isolated and analyzed by chromatographic methods including HPLC. The chemical characterization of these compounds was performed by the analysis of (1)H and (13)C NMR spectra. RESULTS: The bio-guided chromatographic fractionation allowed us to isolate 4 known neolignans: Eupomatenoid-7 (1), licarin A (2), licarin B (3), eupomatenoid-1 (4) and other new neolignan which was characterized as 2-(3'-hydroxy-4'-methoxyphenyl)-3-methyl-5-[(E)-α-propen-γ-al]-7-methoxy-benzo [b] furan (5). This compound was named as eleganal. Compounds 1 and 2 were purified from the most active fraction AeF3 (EC50 of 149.9µg/mL, Emax of 65.66%). A doses-response analysis of eupomatenoid-7(1) and licarin A(2) allowed us to establish EC50 values (65.96µg/mL and 51.96µg/mL) respectively. CONCLUSIONS: The antagonistic effect against Centuroides limpidus limpidus scorpion venom displayed by the n-hexane extract from Aristolochia elegans roots is due to the presence of neolignans 1-2 contained in the fraction AeF3. Chemical analysis of fraction AeF2 allowed the isolation of a new compound which was identified as 2-(3'-hydroxy-4'-methoxyphenyl)-3-methyl-5-[(E)-α-propen-γ-al]-7-methoxy-benzo[b]furan (5), denominated as eleganal.
Assuntos
Antivenenos/farmacologia , Aristolochia/química , Lignanas/farmacologia , Venenos de Escorpião/antagonistas & inibidores , Animais , Antivenenos/administração & dosagem , Antivenenos/isolamento & purificação , Mordeduras e Picadas/tratamento farmacológico , Cromatografia Líquida de Alta Pressão/métodos , Relação Dose-Resposta a Droga , Cobaias , Lignanas/administração & dosagem , Lignanas/isolamento & purificação , Espectroscopia de Ressonância Magnética , Masculino , México , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/metabolismo , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Raízes de Plantas , EscorpiõesAssuntos
Mordeduras e Picadas/fisiopatologia , Venenos de Cnidários/efeitos adversos , Edema/etiologia , Eritema/etiologia , Traumatismos da Mão/fisiopatologia , Hidrozoários , Dor/etiologia , Corticosteroides/uso terapêutico , Adulto , Animais , Mordeduras e Picadas/tratamento farmacológico , Mordeduras e Picadas/etiologia , Progressão da Doença , Feminino , Guadalupe , Traumatismos da Mão/tratamento farmacológico , Traumatismos da Mão/etiologia , Humanos , Hidrozoários/crescimento & desenvolvimento , Estágios do Ciclo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. METHODS: A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. RESULTS: Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. CONCLUSIONS: Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.