Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

Abstract

Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident.

Acute Kidney Injury Secondary to Lonomia envenomation. Case Report and Literature Review

“…With the production and implementation of ALS, not only a rapid and evident resolution of the clinical manifestations was observed, but a clear reversal of the effect of the venom toxins due to its main component, which is a heterologous immunoglobulin specific to the L. obliqua venom. (11), as long as the treatment was started within 48 hours after exposure to the venom (12). As previously mentioned, not all patients received ALS.…”

“…Finally, regarding the prognosis of patients with lomonic accident associated with AKI, it has been seen that the degree of morbidity and mortality is related to the severity of the clinical involvement and the alterations in the paraclinical tests at the time of hospitalization (12). Regarding the associated kidney condition, the follow-up of some of these patients was done with periodic controls of serum creatinine levels to define the condition's progression or improvement, given that some patients developed chronic kidney disease after the lomonic accident.…”

“…However, the main mechanisms described for progression to acute kidney failure are the hemodynamic changes caused by the hemorrhagic syndrome, which decrease the mean arterial pressure, and therefore the renal perfusion pressure, which leads to a decrease in the glomerular filtration rate; hemolysis, which generates waste products that alter kidney function; alteration of vascular permeability, which causes edema, tubular obstruction and glomerular fibrin deposition, which contributes even more to tissue damage and becomes a postrenal etiology of this acute kidney failure; and last but not least, the direct nephrotoxicity of the venom produced by the action of metalloproteinases, serine proteinases, C-type lectin, phospholipases A2 and different oxidases (12,19,20).…”

“…After 6 hours of exposure to the venom, massive proteinuria is observed. Histologically, there is acute tubular necrosis with tubule dilatation, cytoplasmic vacuolization, degeneration and desquamation of the necrotic epithelium, which causes an intense inflammatory response with tissue fibrosis at 48-96 hours (12,14,17).…”

Effectiveness of Lonomia antivenom in recovery from the coagulopathy induced by Lonomia orientoandensis and Lonomia casanarensis caterpillars in rats

“…Symptoms of the envenomation that results from contacting Lonomia caterpillars can vary from intense local pain or a burning sensation at the site of contact, to renal failure and intracerebral and intraperitoneal hemorrhages that can lead to death [ 7 – 10 ]. Several studies of the composition of the scolus extract and toxicity have been conducted in Brazil and Venezuela.…”