Pedro Pereira de Oliveira Pardal

Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil

The efficacies of specific Bothrops atrox-Lachesis and standard Bothrops-Lachesis antivenoms were compared in the north eastern Amazon region of Brazil. The main aim was to investigate whether a specific antivenom raised against the venom of B. atrox, the most important Amazon snake species from a medical point of view, was necessary for the treatment of patients in this region. Seventy-four patients with local and systemic effects of envenoming by Bothrops or Lachesis snakes were randomly allocated to receive either specific (n = 38) or standard (n = 36) antivenoms. In 46 cases (24 in the standard antivenom group, 22 in the other) the snake was identified either by enzyme immunoassay or by examination of the dead snake, as B. atrox in 45, L. muta in one. Patients were similar in all clinical and epidemiological respects before treatment. Results indicated that both antivenoms were equally effective in reversing all signs of envenoming detected both clinically and in the laboratory. Venom-induced haemostatic abnormalities were resolved within 24 h after the start of antivenom therapy in most patients. The extent of local complications, such as local skin necrosis and secondary infection, was similar in both groups. There were no deaths. The incidence of early anaphylactic reactions was 18% and 19%, respectively for specific and standard antivenoms; none was life-threatening. Measurement of serum venom concentrations by enzyme immunoassay (EIA) confirmed that both antivenoms cleared venom antigenaemia effectively. EIA also revealed that one patient had been bitten by Lachesis muta, although the clinical features in this case were not distinctive.

Criptococose em crianças no Estado do Pará, Brasil

We report 19 cases of cryptococcosis in children, diagnosed in Belem, PA. In nine patients the variety of the etiologic agent was studied and identified as Cryptococcus neoformans var. gattii.The average age of these patients was 7.8 years (range, 5-13 years) There were 5 girls and 4 boys (ratio, 1.25:1). Amphotericin B treatment (associated with fluconazole 3 or fluocytosine 1) was given but five (56%) of these patients died in the following three months. The existence of highly endemic areas of infection by var. gattii in Para, Brazil and the severity of the disease due to this fungal variety are commented.

Paracoccidioidomicose em crianças em Belém do Pará

During the period from January/85 to July/96, 102 cases of paracoccidioidomycosis were observed in a hospital in Belém, PA. Thirteen of these cases were children between 3 and 13 years of age, with a predominance of females (8:5). All patients presented the disseminated subacute form of the mycosis. The high prevalence of the mycosis in children in endemic areas of the Amazon region is discussed.No periodo janeiro de 1985 e julho de 1996 foram observados 102 casos de paracoccidioidomicose em hospital de Belem, PA. Treze pacientes eram criancas entre 3 e 13 anos de idade, com predominio do sexo feminino (8:5). Todos apresentavam a forma disseminada subaguda da micose. E comentada a alta prevalencia da micose em criancas em areas endemicas da Regiao Amazonica.

Clinical aspects of envenomation caused by Tityus obscurus (Gervais, 1843) in two distinct regions of Pará state, Brazilian Amazon basin: a prospective case series

BackgroundScorpion envenomations are a major public health problem in Brazil, whose most dangerous cases are attributable to the genus Tityus. This study was designed to compare the clinical and demographic features of envenomations by Tityus obscurus in two areas of the state of Pará located in the Amazon basin.Were compared demographic findings, local and systemic signs and symptoms of human envenomations caused by T. obscurus that occurred in western and eastern areas of the state.ResultsForty-eight patients with confirmed envenomation by T. obscurus were evaluated from January 2008 to July 2011. Most of them came from the eastern region, where male and female patients were present in similar numbers, while males predominated in the west. Median age groups were also similar in both areas. Most scorpion stings took place during the day and occurred significantly more frequently on the upper limbs. The time between the sting and admission to the health center was less than three hours in both areas. Most eastern patients had local manifestations while in the west, systemic manifestations predominated. Local symptoms were similar in both areas, but systemic signs and symptoms were more common in the west. Symptoms frequently observed at the sting site were local and radiating pain, paresthesia, edema, erythema, sweating, piloerection and burning. The systemic manifestations were significantly higher in patients from the west. Futhermore, neurological symptoms such as general paresthesia, ataxia, dysarthria, myoclonus, dysmetria, and electric shock-like sensations throughout the body were reported only by patients from the west.ConclusionThe present study shows that two regions of Para state differ in the clinical manifestations and severity of confirmed envenomation by T. obscurus which suggests a toxicity variation resulting from the diversity of T. obscurus venom in different areas of the Brazilian Amazon basin, and that T. serrulatus antivenom can be successfully used against T. obscurus.

The venomous toadfish Thalassophryne nattereri (niquim or miquim): report of 43 injuries provoked in fishermen of Salinópolis (Pará State) and Aracaju (Sergipe State), Brazil

Fishes of family Batrachoididae are responsible for great number of injuries in fishermen in North and Northeast regions of Brazil. The genus Thalassophryne presents various venomous species of fishes found in the Brazilian coast, T. nattereri being the most common of them. The venom is ejected through two hollow spines on the dorsal fin and two on pre-opercular regions, which present a venomous gland in the base and can be erected or depressed by the fish. The manifestations of the envenoming were intense local pain, edema and erythema in 43 patients observed in Salinópolis (Pará State) and Aracaju (Sergipe State). There were no systemic manifestations, but necrosis was detected in eight and bacterial infection in ten injured fishermen. The circumstances of the contacts and therapeutic aspects are discussed. Envenoming by the genus Thalassophryne is important and frequent and should be considered of moderate severity grade, since there are not the excruciating pain or the massive local necrosis provoked by scorpionfishes (Scorpaena) or stingrays injuries nor the systemic manifestations that are the most important marker of severe envenoming.

Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.

Hemorrhagic stroke related to snakebite by bothrops genus: a case report

This research reports a clinical case of hemorrhagic stroke due to envenomation by bothrops snakebite associated with severe hypertension. Although bothrops snakebites are frequent in the State of Pará, such associations are uncommon, requiring specialized and early management to avoid severe complications.

Acidentes por centopéia notificados pelo "Centro de Informações Toxicológicas de Belém", num período de dois anos

Centipedes are arthropods of the class Chilopoda. The objective of this work was to study the incidence of accidents involving centipedes at “Centro de Informacoes Toxicologicas de Belem“ (CIT-Belem) over a two-year period. Seventy-six patients were studied from March 30, 1998 until March 30, 2000. Centipede accidents occurred in 16.8% of all accidents by venomous animals at Centro de Informacoes Toxicologicas de Belem; compared to snake accidents, 44.4 % and scorpion accidents, 20.5%. The majority of cases occurred in the residence (86.8%). The most important age group was 20-49 years old (64.4%). The part of human body mostly affected was the superior members (47.4 %). Local pain and edema were found in 95.8% and 52.1% of the patients, respectively. Treatment was symptomatic. Healing occurred in 94.7%, although the outcome of 5.3% of cases was unknown. Centipede accidents are a benign accident, occurring within the residence and treatment consists of measures to decrease the pain. Key-words: Centipedes. Accidents. Arthropods. Venomous animals. 1.Universidade Federal do Para; Prefeitura Municipal de Belem; Hospital Universitario Joao de Barros Barreto/Centro de Informacoes Toxicologicas de Belem, PA, Brasil. Endereco para correspondencia: Dr. Pedro Pereira de Oliveira Pardal. Hospital Universitario Joao de Barros Barreto/CIT-Belem. R. dos Mundurucus 4487, Guama, 66073-000 Belem, PA, Brasil. Tel: 91 249-6370; Fax: 91 259-3748 e-mail: citbelem@yahoo.com Recebido para publicacao em 8/2/2001. As centopeias ou lacraias sao animais invertebrados, pertencentes a classe Chilopoda do filo dos artropodes6, que apresentam um par de patas por segmento do corpo e exibem um corpo achatado, filiforme ou redondo, dividido em cabeca e numerosos segmentos (de 15 a mais de 170)1 3 6 7 13. Na cabeca das lacraias ha um par de antenas articuladas, dois pares de maxilas, um par de forcipulas onde estao as glândulas de peconha o aguilhao aparelho inoculador de veneno e um conjunto de olhos simples ou ocelos laterais, que ajudam a diferenciar os generos per tencentes a familia Scolopendridea (Scolopendra e Ostostigmus) e a familia Criptopidae, em que estao ausentes 5 6 . No ultimo segmento do corpo estao localizados o aparelho genital masculino ou feminino e um par de apendices anais. As centopeias geralmente tem coloracao marrom, mas podem apresentar uma ampla variedade de cores, incluindo tonalidades claras de vermelho, preto, amarelo e verde ou ate mesmo faixas azuis transversais em seu dorso6 7 8. Sao animais terrestres, de habitos noturnos, passando a maior parte do dia escondida sob entulhos umidos, folhas e cascas de arvores, sendo ocasionalmente encontradas dentro das casas. Alimentam-se basicamente de larvas de besouros, minhocas, vermes, entre outros, que sao capturados vivos, imobilizados e inoculados por peconha3 6 7 13. No Brasil, existem cerca de dez especies cuja picada e temida, sendo as principais a Scolopendra viridicornis,

Karyotype diversity and chromosomal organization of repetitive DNA in Tityus obscurus (Scorpiones, Buthidae)

BackgroundHolocentric chromosomes occur in approximately 750 species of eukaryotes. Among them, the genus Tityus (Scorpiones, Buthidae) has a labile karyotype that shows complex multivalent associations during male meiosis. Thus, taking advantage of the excellent model provided by the Buthidae scorpions, here we analyzed the chromosomal distribution of several repetitive DNA classes on the holocentric chromosomes of different populations of the species Tityus obscurus Gervais, 1843, highlighting their involvement in the karyotypic differences found among them.ResultsThis species shows inter- and intrapopulational karyotype variation, with seven distinct cytotypes: A (2n = 16), B (2n = 14), C (2n = 13), D (2n = 13), E (2n = 12), F (2n = 12) and G (2n = 11). Furthermore, exhibits achiasmatic male meiosis and lacks heteromorphic sex chromosomes. Trivalent and quadrivalent meiotic associations were found in some cytotypes. In them, 45S rDNAs were found in the terminal portions of two pairs, while TTAGG repeats were found only at the end of the chromosomes. In the cytotype A (2n = 16), the U2 snRNA gene mapped to pair 1, while the H3 histone cluster and C0t-1 DNA fraction was terminally distributed on all pairs. Mariner transposons were found throughout the chromosomes, with the exception of one individual of cytotype A (2n = 16), in which it was concentrated in heterochromatic regions.ConclusionsChromosomal variability found in T. obscurus are due to rearrangements of the type fusion/fission and reciprocal translocations in heterozygous. These karyotype differences follow a geographical pattern and may be contributing to reproductive isolation between populations analyzed. Our results also demonstrate high mobility of histone H3 genes. In contrast, other multigene families (45S rDNA and U2 snRNA) have conserved distribution among individuals. The accumulation of repetitive sequences in distal regions of T. obscurus chromosomes, suggests that end of chromosome are not covered by the kinetochore.

First report of an accident with the speckled forest pit viper (Bothriopsis taeniata) in Brazil

The first reported case of an accident with Bothriopsis taeniata in Brazil is described. The victim, a 43-year-old man, was bitten just above his right heel and presented a clinical condition compatible with mild Bothrops poisoning: local edema with hemorrhage at the bite site and pain, although without coagulopathy.