Infrared thermography to diagnose and manage venomous animal bites and stings

Medeiros, Carlos Roberto de; Brioschi, Marcos Leal; Souza, Solange Nogueira de; Teixeira, Manoel Jacobsen

doi:10.1590/0037-8682-0390-2016

Cited by 11 publications

(5 citation statements)

References 16 publications

(27 reference statements)

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“…However, the evaluation of the efficacy of therapeutic approaches for the prevention of local complications has been neglected. The information on the efficacy of anti-inflammatory drugs, PBMT, and toxin inhibitors in SBEs is restricted to the results of preclinical studies. PBMT has shown efficacy in reducing myonecrosis, inflammatory response, pain, and edema in preclinical studies but, to our knowledge, has never been tested on patients with SBE.…”

Section: Discussionmentioning

confidence: 99%

“…This image is made visible through a color scale in which the warmest areas are represented in white or red, while the coldest areas appear in blue or black. The venom induces local inflammatory reactions, and, in thermography, a white area represents where the inflammation is most intense . In this study, LLLT was applied to the white areas (eFigure 2 in Supplement 2).…”

Section: Methodsmentioning

confidence: 99%

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Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Carvalho,

Souza,

Melo

et al. 2024

JAMA Intern Med

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ImportanceBothrops venom acts almost immediately at the bite site and causes tissue damage.ObjectiveTo investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations.Design, Setting, and ParticipantsThis was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022.InterventionThe intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point.Main Outcomes and MeasuresFeasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients’ acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients’ discharge. P values for outcomes were adjusted with Bonferroni correction.ResultsA total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P &lt; .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed.Conclusions and RelevanceThe data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations.Trial RegistrationBrazilian Registry of Clinical Trials Identifier: RBR-4qw4vf

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Carvalho,

Souza,

Melo

et al. 2024

JAMA Intern Med

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“…Infrared thermography has been studied and used as a diagnostic and monitoring tool in many situations, 13,14 including local envenomation. The device used was an FLIR E8 camera with an image resolution of 320×240 pixels and a thermal sensitivity of <0.05 • C (0.09 • F)×<50 mK.…”

Section: Discussionmentioning

confidence: 99%

A Tropical Kiss by a Malabar Pit Viper

Sirur

Lath

Chethana

et al. 2022

Wilderness & Environmental Medicine

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Snakebite in India is often attributed to the "big 4," for which polyvalent anti-snake venom is effective. Also significant and less known is the burden of other venomous snakes, one of which is Trimeresurus malabaricus. We report a bite to the face of a tree climber by Trimeresurus malabaricus in the Western Ghats of India, which caused severe local envenomation in the form of facial edema and systemic signs of envenomation, including coagulopathy and hypotension. We discuss the role of thromboelastogram, infrared thermography, and routine diagnostics in this case, which led to the administration of Indianmade polyvalent anti-snake venom. The patient recovered and was discharged without any clinically evident physiological or physical dysfunction.

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“…The infrared thermography was proposed to aid in the diagnosis of loxoscelism, since it detects and quantifies the body surface temperature, which may reflect the presence of a huge inflammatory response at the site of the accident [116]. Although it is a non-invasive technique, the simple detection of an inflammatory response at the injured site does not necessarily reflect specifically accidents with Brown spiders and exposure to PLDs.…”

Section: Diagnosis Of Loxoscelism Based On the Identification Of Pldsmentioning

confidence: 99%

“…Although it is a non-invasive technique, the simple detection of an inflammatory response at the injured site does not necessarily reflect specifically accidents with Brown spiders and exposure to PLDs. There are reports of an increase in body surface temperature in several other medical conditions, including accidents with other venomous animals [116]. However, together with other signs and epidemiology of loxoscelism, this can be an interesting strategy, since it is a non-invasive method and there is a clinical correlation with injured victims.…”

Section: Diagnosis Of Loxoscelism Based On the Identification Of Pldsmentioning

confidence: 99%

Forty Years of the Description of Brown Spider Venom Phospholipases-D

Gremski

Justa

Silva

et al. 2020

Toxins

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Spiders of the genus Loxosceles, popularly known as Brown spiders, are considered a serious public health issue, especially in regions of hot or temperate climates, such as parts of North and South America. Although the venoms of these arachnids are complex in molecular composition, often containing proteins with distinct biochemical characteristics, the literature has primarily described a family of toxins, the Phospholipases-D (PLDs), which are highly conserved in all Loxosceles species. PLDs trigger most of the major clinical symptoms of loxoscelism i.e., dermonecrosis, thrombocytopenia, hemolysis, and acute renal failure. The key role played by PLDs in the symptomatology of loxoscelism was first described 40 years ago, when researches purified a hemolytic toxin that cleaved sphingomyelin and generated choline, and was referred to as a Sphingomyelinase-D, which was subsequently changed to Phospholipase-D when it was demonstrated that the enzyme also cleaved other cellular phospholipids. In this review, we present the information gleaned over the last 40 years about PLDs from Loxosceles venoms especially with regard to the production and characterization of recombinant isoforms. The history of obtaining these toxins is discussed, as well as their molecular organization and mechanisms of interaction with their substrates. We will address cellular biology aspects of these toxins and how they can be used in the development of drugs to address inflammatory processes and loxoscelism. Present and future aspects of loxoscelism diagnosis will be discussed, as well as their biotechnological applications and actions expected for the future in this field.

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Infrared thermography to diagnose and manage venomous animal bites and stings

Cited by 11 publications

References 16 publications

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

A Tropical Kiss by a Malabar Pit Viper

Forty Years of the Description of Brown Spider Venom Phospholipases-D

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