Viscerocutaneous form of loxoscelism and erythrocyte glucose-6-phosphate deficiency

Barretto, Orlando César de Oliveira; Cardoso, João Luiz Costa; Cillo, Domingos De

doi:10.1590/s0036-46651985000500006

Cited by 36 publications

(11 citation statements)

References 10 publications

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“…Additionally, in Colombia, an association between haemolysis and physical exercise was observed in individuals with reduced G6PD activity [117]. In Brazil, G6PDd was suggested to contribute to haemolysis in patients with the viscerocutaneous form of loxoscelism, a condition produced by the bite of the recluse spiders of genus Loxosceles [118]. In Brazil, there have been reports of recurrent infections in children diagnosed with G6PDd [119,120].…”

Section: Resultsmentioning

confidence: 99%

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Monteiro

Franca

Queiroz

et al. 2014

Malar J

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BackgroundAlthough G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review.MethodsA systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent.ResultsThe Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent.ConclusionHaemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.

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Section: Resultsmentioning

confidence: 99%

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Monteiro

Franca

Queiroz

et al. 2014

Malar J

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“…In Santa Catarina State, Brazil, where L. laeta is frequently found, hemolysis was described in 13% 28 ; a similar proportion of viscerocutaneous form were found in Chile, where L. laeta is also a prevalent species 27 . Certain characteristics of the patient, such as age 15 and genetic variations 4 may also be implicated in the severity of envenomation. In some of our patients, jaundice was observed more than one week after bite, which highlights for the possibility of late hemolysis, not impaired by antivenom.…”

Section: Discussionmentioning

confidence: 99%

Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo, Brazil

Málaque

Castro-Valencia

Cardoso

et al. 2002

Rev. Inst. Med. trop. S. Paulo

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A retrospective study analysed 359 proven or presume cases of loxoscelism seen at the Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1985 and 1996. The spider was identified in 14%. The bites occurred predominantly in the urban areas (73%) between September and February. Patients > 14 years were commonest inflicted (92%) and 41% were bitten while getting dressed. Only 11% sought medical care within the first 12 hours post bite. Cutaneous loxoscelism was the commonest form presenting (96%); commonest manifestations were: pain (76%), erythema (72%), edema with enduration (66%), ecchymosis (39%). Skin necrosis occurred in 53% of patients, most frequently seen on trunk, tigh and upper arm, and when patients seek medical care more than 72 hours after bite. Local infection was detected in 12 patients (3%). Hemolysis was confirmed in 4 cases (1.1%). Generalised cutaneous rash, fever and headache were also observed in 48% of the total of patients. None of them had acute renal failure or died. Treatment usually involved antivenom administration (66%), being associated with corticosteroids (47%) or dapsone (30%). Presumptive diagnosis of loxoscelism may be established based on clinical and epidemiological findings. Further investigations are required to prove the value of antivenom and other treatment schedules.

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“…Envenomation by spiders belonging to the genus Loxosceles , found in temperate and tropical regions of America, Africa and Europe, commonly results in impressive local necrotic skin lesions. Mild systemic effects induced by envenomation, such as fever, malaise, pruritus and exanthema, are common, while intravascular haemolysis and coagulation, sometimes accompanied by thrombocytopenia and renal failure, occur in approximately 16% of victims 1–7 …”

Section: Introductionmentioning

confidence: 99%

Mechanism of induction of complement susceptibility of erythrocytes by spider and bacterial sphingomyelinases

et al. 2002

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SUMMARYWe have recently shown that the sphingomyelinase toxins P1 and P2 from the venom of the spider Loxosceles intermedia induce complement (C)-dependent lysis of autologous erythrocytes by induction of the cleavage of cell surface glycophorins through activation of an endogenous metalloproteinase facilitating the activation of the alternative pathway of C. Phospholipase D (PLD) from Corynebacterium pseudotuberculosis shows some degree of homology with the spider sphingomyelinases and can induce similar clinical symptoms to those observed after spider envenomation. The aim of this study was to investigate if the bacterial PLD-induced haemolysis of human erythrocytes was C dependent and if cleavage of glycophorins occurred. We show here that haemolysis of both PLD-and P1-treated human erythrocytes was C dependent, but while PLD-mediated haemolysis was dependent on activation of the classical pathway of C, P1 induced lysis via both the classical and alternative pathways. P1, but not PLD, induced cleavage of glycophorins and no change in expression of complement regulators was induced by either of the toxins. In both cases, annexin V binding sites were exposed, suggesting that the membrane asymmetry had been disturbed causing exposure of phosphatidylserine to the cell surface. Our results suggest that C susceptibility induced by L. intermedia and C. pseudotuberculosis PLD is a result of exposure of phosphatidylserine, and the higher potency of P1 toxin can be explained by its additional effect of cleavage of glycophorins.

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Viscerocutaneous form of loxoscelism and erythrocyte glucose-6-phosphate deficiency

Cited by 36 publications

References 10 publications

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo, Brazil

Mechanism of induction of complement susceptibility of erythrocytes by spider and bacterial sphingomyelinases

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