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Introduction: Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. Methods: This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. Results: In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. Conclusions: IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.Keywords: Infrared thermography. Envenomation. Venomous animals. . IR has been used to study diseases in which skin temperature can reflect the presence of inflammation in underlying tissues, or those in which blood flow is increased or decreased because of a clinical abnormality Infrared imaging (IR) is a noninvasive technique thatIt is widely known that animal venoms are capable of inducing localized reactions involving inflammation and pain 3 . One of the challenges that clinicians face when treating patients envenomed by venomous animals is a lack of suitable clinical tools for accurate assessment of the localized effects caused by different venoms in order to provide refined criteria for choosing the best therapeutic option, especially the most efficacious use of antivenom. IR has great potential for use as such a clinical tool because it is a non-invasive method that has no biological side effects, requires no sedation or anesthesia, and can be repeated as desired for follow-ups 1,2. To the best of our knowledge, no study has investigated the use of IR with high-resolution thermograms for assessing the local effects of envenomation by venomous animals. The aim of this observational pilot study was to evaluate the feasibility of this new potential clinical application of IR for the diagnosis and management of venomous animal bites and stings.Eight patients envenomed by snakes (three cases), spiders (three cases), and scorpions (two cases) were studied. The study sample represents a convenience sample where a research investigator was present and the equipment was available. Only cases in which the causative animal was identified (Laboratório Especial de Coleções Zoológicas, Instituto Butantan, São Paulo, Brazil) were included.Infrared imaging examinations were conducted in compliance with international recommendations 2 by using a FLIR T650sc camera (FLIR Systems AB, Taby, Sweden). This infrared system has an image resolution of 640×480 pixels and thermal sensitivity of <20mK at 30ºC. The camera produced quantitative and qualitative temperature maps of surface temperature (thermograms), and results were analyzed using the rainbow palette, with white/red as hot and blue/black as cold. Image acquisition and storage was carried out with the Flir Tools ® software (V 5.3.15320.1002, 2015, FLIR Systems AB, Danderyd, Sweden). Emissivity of ...

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Bites of "nonvenomous" snakes can sometimes be mistaken for the bites of venomous snakes. As an example of this confusion, this report describes confirmed bites by Philodryas olfersii and Bothrops jararaca. In the first case, a 55-y-old man with a history of controlled hypertension was bitten on his right forearm by P olfersii. Physical examination revealed extensive edema, erythema, and widespread ecchymoses throughout his right upper limb. Laboratory tests indicated leukocytosis and high D-dimer levels, but normal coagulation, suggestive of a resolved recent coagulopathy. He received only supportive treatment. In the second case, a healthy 35-y-old man was bitten by B jararaca. Although the anatomic region of the bite and the results of physical examination were similar to those in the first case, laboratory tests showed mild coagulopathy, leukocytosis, and high D-dimer levels. The patient was treated with antivenom. In both cases, the 20-min whole blood clotting test results were normal. Patients bitten by P olfersii may present with local symptoms resembling B jararaca envenomation. Without snake identification and the detection of venom-induced consumption coagulopathy, especially in places where the 20-min whole blood clotting test is the only clotting test available, it is almost impossible to establish an accurate and safe differential diagnosis. In this context, the best alternative is to take the risk of prescribing antivenom for a possible P olfersii bite rather than failing to do so for a real Bothrops bite. Late treatment for Bothrops bite can result in severe complications and sequelae.

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