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PLoS Neglected Tropical Diseases Dec 2021The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings... (Review)
Review
The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel-binding toxins and potassium channel-binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.
Topics: Africa, Northern; Animals; Antivenins; Humans; Middle East; Scorpion Stings; Scorpion Venoms; Scorpions; Snake Bites; Snake Venoms; Snakes
PubMed: 34855751
DOI: 10.1371/journal.pntd.0009880 -
Revista Medica de Chile May 2021Loxoscelism is an important public health problem in Chile and South America, due to the higher rate of cutaneous-visceral involvement. The diagnosis of loxoscelism is...
BACKGROUND
Loxoscelism is an important public health problem in Chile and South America, due to the higher rate of cutaneous-visceral involvement. The diagnosis of loxoscelism is mostly clinical without established diagnostic criteria. There is little evidence to support any treatment used in this condition.
AIM
To characterize the clinical features and epidemiology of loxoscelism among patients consulting at the Emergency and Dermatology Services of a clinical hospital between 2013 and 2017.
MATERIAL AND METHODS
Review of medical records of patients registered in the electronic clinical record system with a confirmed diagnosis of loxoscelism. Epidemiological, clinical, laboratory tests and treatment variables were analyzed.
RESULTS
We reviewed data from 200 patients. Ninety-four percent presented cutaneous loxoscelism and 5.5% cutaneous-visceral loxoscelism. Systemic symptoms were present in 73% of patients with cutaneous-visceral loxoscelism. Patients who developed systemic symptoms had an 18 times higher risk of developing cutaneous-visceral loxoscelism. Laboratory abnormalities were more common in patients with cutaneous-visceral loxoscelism. Not all patients with hematuria had cutaneous-visceral loxoscelism. Most patients required analgesia. Anti-loxosceles serum was not used in any patient.
CONCLUSIONS
Many questions remain to be answered regarding the diagnosis and treatment of the disease. Studies are required to validate diagnostic criteria for loxoscelism, predictors for visceral involvement and response to treatment.
Topics: Animals; Chile; Humans; Pain; Spider Bites; Spider Venoms; Spiders
PubMed: 34751320
DOI: 10.4067/s0034-98872021000500682 -
Scientific Reports Oct 2021Mistaken beliefs about danger posed by feared stimuli are considered a key factor causing and maintaining fears. Such beliefs are intriguing because many fearful people...
Mistaken beliefs about danger posed by feared stimuli are considered a key factor causing and maintaining fears. Such beliefs are intriguing because many fearful people express them, but acknowledge they are untrue in reality. While previous research indicates fearful individuals may not wholly endorse their beliefs about objective threats (e.g., the spider will bite), expectations of negative subjective consequences (e.g., I will feel terrible) are also likely to be important. We investigated the extent to which participants' expectations of objective and subjective threats were sensitive to manipulations that encouraged them to consider whether their expectations were likely to happen in reality. Across five online experiments (N = 560, or 727 with more liberal inclusion criteria), such manipulations produced lower expectancy ratings for objective but not subjective threats (versus participants who gave ratings without the manipulation). Most participants reported that anticipation of negative feelings was more concerning than actual danger. Hence, numerous fear-relevant expectations about objective threat-considered central in understanding why people are irrationally afraid-respond to small cognitive manipulations. Additionally, expectations of negative subjective experiences during fear-provoking encounters appear to be more consistently endorsed, and feature prominently in fearful individuals' concerns about what will happen in a fear-relevant situation.
Topics: Adult; Aged; Animals; Fear; Female; Humans; Male; Middle Aged; Needles; Phobic Disorders; Snakes; Spiders; Young Adult
PubMed: 34675285
DOI: 10.1038/s41598-021-00317-3 -
Journal of Education & Teaching in... Oct 2021This game is appropriate for medical students, interns, junior and senior residents.
AUDIENCE
This game is appropriate for medical students, interns, junior and senior residents.
INTRODUCTION
The COVID-19 pandemic has forced a transition from in-person to virtual learning, and educators must innovate and adapt to keep learners engaged. One way to achieve this is through gamification.1 The authors employed a novel approach to gamification of virtual learning which engaged not only learners' computers but also their mobile phones. Learners worked in teams communicating by text message to answer ABEM board-style questions and occupy sites on the virtual board.
EDUCATIONAL OBJECTIVES
By the end of this didactic, the learner will:1. Describe the basics of the presentation of each topic listed above2. Recall the basics of management of each topic listed above3. Improve learners' preparedness for the Emergency Medicine Inservice Exam and Written Board Examination.
EDUCATIONAL METHODS
Wilderness and environmental medicine topics were selected from the list of topics covered on the ABEM boards. Questions were then written by the authors teaching these concepts.
RESEARCH METHODS
Learners were surveyed immediately following the session using an evaluation tool containing both Likert-scale questions on quality and applicability as well as open-ended questions on strengths and areas for improvement. The response rate to this survey was 100%.
RESULTS
Feedback was overwhelmingly positive, with 19/20 respondents rating the sessions 5/5 for effectiveness and value of teaching compared with other sessions, and 1/20 rating the session 4/5. Nineteen out of twenty respondents rated the content as "highly relevant"; 1/20 rated it as "mostly relevant." Nineteen out of twenty respondents rated the session 5/5 for being engaging and holding their attention; 1/20 rated it as somewhat engaging.
DISCUSSION
Learners rated the session as highly relevant and engaging. We hypothesize that by engaging two screens and forcing learners to work together by text message, we were able to turn what would normally be a distraction (texting co-residents during resident conference) into a tool for learning.
TOPICS
Electrical injury, lightning strike, thermal burns, inhalational injury, chemical burns, acute radiation syndrome, snake bites, scorpion envenomation, stingray envenomation, jellyfish stings, black widow spider bites, mammalian bites, rabies, murine typhus, bear encounters, decompression sickness, arterial gas embolism, drowning, dehydration, heat stroke, exercise-associated hyponatremia, frostbite, hypothermia, CO poisoning, hydrogen sulfide poisoning, giardia.
PubMed: 37465264
DOI: 10.21980/J8J343 -
Journal of Wound Care Sep 2021Spider bites are common worldwide. Frequently symptoms resolve without any adverse outcome, but in rare cases the bite can cause severe morbidity. The most typical...
INTRODUCTION
Spider bites are common worldwide. Frequently symptoms resolve without any adverse outcome, but in rare cases the bite can cause severe morbidity. The most typical presentation of Mediterranean recluse spider () bite is a dermatonecrotic lesion of the skin (skin loxoscelism). When the only manifestation of a spider bite is an ulcerated skin lesion, clinical suspicion and differential diagnosis strongly depend on its site. We present the case of an ulcerated wound of the breast, diagnosed as a Mediterranean recluse spider bite.
CASE PRESENTATION
A 79-year-old woman presented a 10cm-wide soft tissue ulceration of her left breast. At first, the diagnostic hypothesis of an ulcerated cancer was ruled out. Two family members revealed a recent history of Mediterranean recluse spider bite and the same clinical diagnosis was made for our patient. A wide excision was performed, with complete resolution of symptoms.
DISCUSSION
No specific diagnostic criteria for spider bites are available. Diagnosis is usually clinical. Skin loxoscelism could be easily mistaken for cellulitis, various types of skin infections, cutaneous anthrax, vasculitis, scorpion sting, pyoderma gangrenosum, erythema migrans of Lyme disease or prurigo nodularis. A thorough anamnestic interview is fundamental to raise the diagnostic hypothesis. When possible, a biopsy is recommended and it is extremely important when the ulcer can mimic a cancer, as is the case in breast tissue.
CONCLUSION
We recommend a wide excision of the wound after failure of conservative treatment, in order to obtain local control and to perform histological examination on a more representative specimen.
Topics: Aged; Breast; Diagnosis, Differential; Female; Humans; Pyoderma Gangrenosum; Skin; Ulcer
PubMed: 34597171
DOI: 10.12968/jowc.2021.30.Sup9a.XII -
World Journal of Emergency Medicine 2021
PubMed: 34512830
DOI: 10.5847/wjem.j.1920-8642.2021.04.011 -
Cureus Jul 2021Brown recluse spider is a spider of the genus also known as violin spider or fiddle-back spider. Brown recluse spider is characterized by having six eyes, with a pair...
Brown recluse spider is a spider of the genus also known as violin spider or fiddle-back spider. Brown recluse spider is characterized by having six eyes, with a pair in front, a pair on both sides, and a gap between the pairs. The other spiders have eight eyes in two rows of four. Brown recluse spider bites are challenging to verify but may be clinically diagnosed with consideration of geographic location, seasonality, and clinical characteristics. We present a case that involves a brown recluse spider bite in a 59-year-old female with malnutrition and polysubstance use who developed systemic symptoms and a dermonecrotic wound. Local wound care and intravenous (IV) antibiotics lead to clinical improvement by hospital day three, at which time the patient left against medical advice. The case highlights the challenges of diagnosing a brown recluse spider bites, particularly in a patient with multiple risk factors for necrotizing soft tissue infection. Furthermore, the present case represents one of the few case reports of a brown recluse spider bite in Michigan.
PubMed: 34458049
DOI: 10.7759/cureus.16663 -
The American Journal of Case Reports Aug 2021BACKGROUND Envenomation from the brown recluse spider (Loxosceles reclusa) is described to cause both local and systemic symptoms. We report a case of an adolescent boy...
BACKGROUND Envenomation from the brown recluse spider (Loxosceles reclusa) is described to cause both local and systemic symptoms. We report a case of an adolescent boy who developed severe systemic loxoscelism, and his clinical course was complicated by myocarditis, which has not been previously reported in association with loxoscelism. CASE REPORT A 16-year-old boy presented with non-specific symptoms and forearm pain following a suspected spider bite, which subsequently evolved into a necrotic skin lesion. During his clinical course, he developed a characteristic syndrome of systemic loxoscelism with hemolysis, disseminated intravascular coagulopathy, and severe systemic inflammatory response syndrome, necessitating transfer to the Intensive Care Unit. The diagnosis was confirmed with an enzyme-linked immunosorbent assay that detected Loxosceles venom in the wound. Additionally, he developed pulmonary edema and cardiogenic shock secondary to myocarditis, which was confirmed with cardiac magnetic resonance imaging. Steroids and plasmapheresis were initiated to manage the severe inflammatory syndrome, and the myocarditis was treated with intravenous immunoglobulins, resulting in resolution of symptoms and improvement of cardiac function. CONCLUSIONS This is the first reported case of myocarditis associated with loxoscelism, providing evidence for Loxosceles toxin-associated cardiac injury, which has been previously described in animal models only. Furthermore, this case provides further support for the use of confirmatory testing in the clinical diagnosis of loxoscelism.
Topics: Adolescent; Animals; Brown Recluse Spider; Hemolysis; Humans; Male; Myocarditis; Skin Diseases; Spider Bites
PubMed: 34453029
DOI: 10.12659/AJCR.932378 -
Journal of Investigative Medicine High... 2021Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of...
Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of clinical manifestations, anywhere from a painless papular lesion to life-threatening reactions. We report a possible spider bite presenting as leukostasis initially suspected to be acute leukemia. A 22-year-old female patient presented to the emergency department with confusion and right upper arm pain, redness, and swelling after a suspected spider bite. Initial labs showed WBC count of 103.5x10e3/µL, hemoglobin of 3.3 g/dL, positive Direct Coombs' test, creatinine of 1.8 mg/dL, transaminitis, and lactic acid of 20 mmol/L. Acute leukemia with leukostasis was suspected. She was started emergently on hydroxyurea in conjunction with prophylaxis for tumor lysis syndrome. However, peripheral smear showed left-shifted granulocytosis with lymphocytosis, monocytosis, and no blast cells or evidence of myelodysplasia. Bone marrow aspirate showed mildly hypercellular marrow with myeloid hyperplasia and no myelodysplasia. Flow cytometry analysis confirmed a left-shifted myeloid maturation pattern with 0.3% myeloblasts. BCR-ABL1 and JAK2 testing was negative. Hence, she had no evidence of leukemia but rather had leukostasis from a spider bite. Hydroxyurea was stopped and follow-up labs normalized. Sphingomyelinase D in the brown recluse spider venom is unique to Loxosceles and Sicarius and may be responsible for the unique clinical presentation of loxoscelism. The presentation of hyperleukocytosis complicated by shock with an unclear history poses a diagnostic challenge. In diagnostic uncertainty, consider delaying chemotherapy until a diagnosis can be confirmed to avoid potential harm.
Topics: Adult; Animals; Brown Recluse Spider; Female; Humans; Leukostasis; Spider Bites; Young Adult
PubMed: 34404267
DOI: 10.1177/23247096211039949 -
The Journal of Venomous Animals and... 2021Accidents caused by the bites of brown spiders () generate a clinical condition that often includes a threatening necrotic skin lesion near the bite site along with a...
Accidents caused by the bites of brown spiders () generate a clinical condition that often includes a threatening necrotic skin lesion near the bite site along with a remarkable inflammatory response. Systemic disorders such as hemolysis, thrombocytopenia, and acute renal failure may occur, but are much less frequent than the local damage. It is already known that phospholipases D, highly expressed toxins in venom, can induce most of these injuries. However, this spider venom has a great range of toxins that probably act synergistically to enhance toxicity. The other protein classes remain poorly explored due to the difficulty in obtaining sufficient amounts of them for a thorough investigation. They include astacins (metalloproteases), serine proteases, knottins, translationally controlled tumor proteins (TCTP), hyaluronidases, allergens and serpins. It has already been shown that some of them, according to their characteristics, may participate to some extent in the development of loxoscelism. In addition, all of these toxins present potential application in several areas. The present review article summarizes information regarding some functional aspects of the protein classes listed above, discusses the directions that could be taken to materialize a comprehensive investigation on each of these toxins as well as highlights the importance of exploring the full venom repertoire.
PubMed: 34377142
DOI: 10.1590/1678-9199-JVATITD-2020-0188