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.

This is a descriptive and prospective study on epidemiological and clinical aspects of 72 scorpion accidents admitted to Santarém Municipal Hospital, state of Pará, Brazil, from February 2000 to February 2001. Only 8.3% brought the animal with them, identified as T. cambridgei. The majority of victims were male (83.3%). The mean age and the time of the medical help were respectively 33.6±18.3 years and 4.6±3.2 hours. The parts of the body most affected were the superior members (51.5%). Local symptoms occurred in 91.7% cases and systemic manifestations in 98.6% of the accidents. The local symptoms included: paresthesia in 79.2% cases, pain in 52.8% and edema in 26.4%. Among the systemic manifestations neurological disorders predominated in 97.2%, and the symptom of "electric shock" occurred in 88.9% patients. The most common neurological signs were: myoclonia (93%), dysmetria (86.1%), dysarthria (80.6%), and ataxia (70.8%). The accidents were classified as moderate in 76.4% without any serious cases. The specific anti-venom serum was not administered in 32.7% of the moderate cases, due to non-availability of the anti-venom serum at the time of attendance. The victims of scorpion envenomation notified at Santarém, present a different clinical and regional behavior from previous reports in Brazil and Amazonia regions. The predominantly neurological picture has not previously been described in the Brazilian literature.

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.

Resumo Relatam-se 19 casos de criptococose em crianças, diagnosticados em Belém, PA. Em nove pacientes a variedade do agente etiológico foi estudada e identificada como Cryptococcus neoformans var. gattii. A média de idade destes pacients foi 7,8 anos (variação, 5-13 anos). Havia 5 meninas e 4 meninos (razão, 1,25:1). Cinco foram a óbito em três meses apesar do tratamento com anfotericina B (associada com fluconazol 3 ou fluocitosina 1). São comentados a existência de áreas de alta endemia da infecção por var. gattii no Pará e a gravidade da doença causada por essa variedade fúngica. Palavras-chaves: Criptococose. Cryptococcus neoformans. Cryptococcus neoformans var. gattii. Infância. Meningite. AbstractWe report 19 cases of cryptococcosis in children, diagnosed in Belém, 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 Pará, Brazil and the severity of the disease due to this fungal variety are commented. Cryptococcus neoformans (teleomorfo, Filobasidiella neoformans) é um basidiomiceto, que se apresenta na forma tecidual como levedura encapsulada, corresponde a duas variedades fúngicas, com quatro sorotipos: var. neoformans (sorotipos A e D) e var gattii (sorotipos B e C). É fungo ubíquo, que vive como sapróbio no meio ambiente: em solos contaminados com fezes de pombos (var. neoformans) e junto a eucaliptos (var. gattii), aquela de distribuição universal, esta restrita a zonas de clima tropical e subtropical. A infecção criptococócica mais freqüentemente ocorre em pacientes imunodeprimidos (var. neoformans, fungo oportunista), mas pode ocorrer no hospedeiro nor mal (var. gattii, patógeno primário) 4 .A raridade da ocorrência de criptococose em crianças pré-púberes 4 justifica a apresentação de 19 casos de criptococose na infância, observados num hospital de Belém, Pará.

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