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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2009, Number 1

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Rev Invest Clin 2009; 61 (1)

Clinical, epidemiological and treatment aspects of 10 cases of saltwater stingray envenomation

Cazorla D, Loyo J, Lugo L, Acosta M

Language: Spanish
References: 30
Page: 11-17
PDF size: 165.41 Kb.


ABSTRACT

Introduction. Stingrays are cartilaginous elasmobranches fishes that can cause severe and potentially fatal injuries in humans. Objective. A descriptive and prospective survey was conducted to analyze epidemiological, clinical and treatment aspects of injuries caused by marine stingrays in Adicora, Paraguaná peninsula, Falcon State, a northwestern, semiarid region of Venezuela. Methods. Between December 2006 and April 2007, patients with saltwater stingray injuries, attended in the ambulatory emergency service of Adicora, were clinically examined and interrogated. Treatment consisted on the application of a topical antiseptic solution (povidone-iodine), intravenous administration of an anti-inflammatory analgesic, antibiotic therapy per os and tetanus immunization. Results. Ten cases of injures caused by the marine stingray Dasyatis guttata (Dasyatidae) were recorded. 6 (60%) of the envenomation cases occurred in males and 4 (40%) in females, being 8 (80%) adults between 20 and 64 years-old and 2 (2%) above that age. Most of the accidents occurred at December and April holidays (90 %) and during the late part of the day (80%) when bathing or swimming at or near the beach (70%). The time between ambulatory medical assistance and the accident varied from 5 to 7 minutes, with a mean time of 5.6 ± 0.84. Injuries were located at lower limbs in all patients with circular lesions of diameters ranging from 1 to 1.53 cm (X:1.41 ± 0.22); bleeding was observed in 70% of the cases while 20% showed cellulitis and cutaneous necrosis. Other clinical manifestations were intense local and irradiated pain [Visual analog scale (VAS) = X: 9.5 ± 0.71)] and erythema (100%). Systemic symptoms included dyspnea (50%) (VAS = X: 5.4 ± 1.52) and tachycardia (10%). All patients had a satisfactory post-treatment evolution after 20 to 30 minutes (X = 23.1 ± 3.41) with pain and dyspnea VAS mean values significantly lower (X = 0.55 ± 0.44; t = 35.5, p = 0.0001; X = 0.1 ± 0.22; t = 5.57, p = 0.002, respectively). Conclusions. Inju- ries caused by the marine stingray D. guttata are a public health problem, appear to have seasonal pattern, and can produce clinical manifestations of significant severity.


REFERENCES

  1. Botero D, Restrepo M. Parasitosis Humanas. 4a. Ed. Medellín, Colombia: Corporación Para Investigaciones Biológicas; 2003.

  2. Diaz J. The epidemiology, evaluation, and management of stingray injuries. J La State Med Soc 2007; 159: 198-204.

  3. Haddad V. Animais aquáticos de importância médica no Brasil. Rev Soc Bras Med Trop 2003; 36: 591-7.

  4. Auerbach P. Marine envenomations. N Engl J Med 1991; 325: 486-93.

  5. Fenner P. Dangers in the ocean: the traveler and marine envenomation. II. Marine vertebrates. J Travel Med 1998; 5: 213-16.

  6. Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004. Hum Exp Toxicol 2005; 24: 639-42.

  7. De Grado A, Bashirullah A. Algunos atributos de la estructura comunitaria de la ictiofauna de la Laguna Grande de Obispo, Golfo de Cariaco, Venezuela. Act Cient Ven 2001; 52: 3-13.

  8. Rosenberger L. Phylogenetic Relationships within the Stingray Genus Dasyatis (Chondrichthyes: Dasyatidae). Copeia 2001; 615-27.

  9. Thorson T. Observation on the morphology, ecology. And life history of the euryhaline stingray, Dasyatis guttata (Bloch and Schneider) 1801. Acta Biol Venez 1983; 11: 92-125.

  10. Halstead B, Vinci J. Venomous fish stings (ichthyoacanthotoxicoses). Clin Dermatol 1987; 5: 29-35.

  11. Haddad V, Neto D, de Paula Neto J, de Luna Marques F, Barbaro K. Freshwater stingrays: Study of epidemiologic, clinic and therapeutic aspects based on 84 envenomings in humans and some enzymatic activities of the venom. Toxicon 2004; 43: 287-94.

  12. Machado-Allison A, Rodríguez-Acosta A. Animales venenosos y ponzoñosos de Venezuela. 1a. Ed. Caracas, Venezuela: Ediciones del CDCH Universidad Central de Venezuela; 1997.

  13. Pedroso C, Jared C, Charvet-Almeida P, Almeida M, Garrone Neto D, Lira M, et al. Morphological characterization of the venom secretory epidermal cells in the stinger of marine and freshwater stingrays. Toxicon 2007; 50: 688-97.

  14. Barbaro K, Lira M, Malta M, Soares S, Garrone Neto D, et al. Comparative study on extracts from the tissue covering the stingers of freshwater (Potamotrygon falkneri) and marine (Dasyatis guttata) stingrays. Toxicon 2007; 50: 676-87.

  15. Magalhães K, Lima C, Piran-Soares A, Marques E, Hiruma- Lima C, Lopes-Ferreira M. Biological and biochemical properties of the Brazilian Potamotrygon stingrays: Potamotrygon cf. scobina and Potamotrygon gr. orbignyi. Toxicon 2006; 47: 575-83.

  16. Perkins R, Morgan S. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician 2004; 69: 885-90.

  17. Russell F, Fairchild M, Michaelson J. Some properties of the venom of the stingray. Med Art Sci 1958; 12: 78-86.

  18. Cermeño J, Cermeño J, Salazar N, De Salazar N. Rayismo: aspectos epidemiológicos y clínicos. Estado Bolívar, Venezuela. Km 2005; 33: 46-50.

  19. Dao L. Lesions produced by Potamotrygonidae in venezuelan rivers. Dermatol Int 1965; 4: 219-24.

  20. Gutiérrez J, Benítez-Guerra I, Benítez-Guerra G. Envenenamiento por rayas de agua dulce. RFM 2004; 27: 131-4.

  21. Rodríguez-Acosta A. Análisis clínico y epidemiológico de accidentes por rayas de río (Potamotrygonidae). Arch Venez Med Tropical 1997; 1: 64-6.

  22. Acosta M, Cazorla D, Garvett M. Enterobiasis en escolares de una población rural del Estado Falcón, Venezuela y su relación con el nivel socio-económico. Invest Clin 2002; 43: 173-81.

  23. Aitken R. Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62: 989-93.

  24. Atkinson P, Boyle A, Hartin D, McAuley, D. Is hot water immersion an effective treatment for marine envenomation? Emerg Med J 2006; 23: 503-8.

  25. Taylor D, Ashby K, Winkel K. An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia. Wilderness Environ Med 2002; 13: 106-12.

  26. Fenner P, Williamson S, Skinner R. Fatal and non fatal stingray envenomation. Med J Aust 1989; 151: 621-5.

  27. Auerbach P, Yajko D, Nassos P, Kizer K, McCosker J, Geehr E, et al. Bacteriology of the marine environment: implications for clinical therapy. Ann Emerg Med 1987; 16: 643-9.

  28. Bendt R, Auerbach P. Foreign body reaction following stingray envenomation. J Wilderness Med 1991; 2: 298-303.

  29. Baldinger P. Treatment of stingray injury with topical becaplermin gel. J Am Podiatr Med Assoc 1999; 89: 531-3.

  30. Rocca A, Moran E, Lippert F. III. Hyperbaric oxygen therapy in the treatment of soft tissue necrosis resulting from a stingray puncture. Foot Ankle Int 2001; 22: 318-23.




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