Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study.
Background Spiders of the genus Loxosceles are distributed throughout tropical and temperate regions worldwide. Loxosceles spp. bites may evolve to necrosis, with or without intravascular hemolysis. There is no consensus regarding the best treatment to prevent necrosis. The objective of this study w...
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ftdoajarticles:oai:doaj.org/article:53fe574269d14211b2b6fa318f79a65b 2023-05-15T15:14:53+02:00 Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. Ceila M S Malaque Christina T G Novaes Roberta O Piorelli Jose Y Risk Jefferson C Murad Amanda N Lara Cristiana C Virgulino Karina T Miyaji Marcelo L Santoro 2022-10-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0010842 https://doaj.org/article/53fe574269d14211b2b6fa318f79a65b EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0010842 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0010842 https://doaj.org/article/53fe574269d14211b2b6fa318f79a65b PLoS Neglected Tropical Diseases, Vol 16, Iss 10, p e0010842 (2022) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2022 ftdoajarticles https://doi.org/10.1371/journal.pntd.0010842 2022-12-30T19:39:34Z Background Spiders of the genus Loxosceles are distributed throughout tropical and temperate regions worldwide. Loxosceles spp. bites may evolve to necrosis, with or without intravascular hemolysis. There is no consensus regarding the best treatment to prevent necrosis. The objective of this study was to evaluate the factors associated with the development of necrosis and the impact that antivenom administration has on the evolution of cutaneous loxoscelism. Methodology/principal findings This was a prospective observational study carried out at a referral center for envenoming. Over a 6-year period, we included 146 patients with a presumptive or definitive diagnosis of loxoscelism. Depending on the symptom severity, a polyvalent anti-arachnid antivenom was administered or not-in 74 cases (50.7%) and 72 cases (49.3%), respectively. Cutaneous and systemic manifestations were assessed at admission and weekly thereafter. Adverse reactions to the antivenom were also evaluated. Cutaneous loxoscelism was observed in 141 cases (96.6%), and the spider was identified in 29 (19.9%). The mean time from bite to antivenom administration was 41.6 ± 27.4 h. After discharge, 130 patients (90.9%) were treated with corticosteroids, antihistamines and analgesics being prescribed as needed. The probability of developing necrosis was significantly lower among the patients who were admitted earlier, as well as among those who received antivenom (p = 0.0245). Among the 74 patients receiving antivenom, early and delayed adverse reactions occurred in seven (9.5%) and four (5.4%), respectively. Local infection was observed only in three (2.3%) of the 128 patients for whom that information was available. Conclusions/significance Necrosis after a Loxosceles sp. bite appears to more common when hospital admission is delayed or when antivenom is not administered. In addition, the administration of a polyvalent anti-arachnid antivenom appears to be safe, with a relatively low rate of adverse reactions. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 16 10 e0010842 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Ceila M S Malaque Christina T G Novaes Roberta O Piorelli Jose Y Risk Jefferson C Murad Amanda N Lara Cristiana C Virgulino Karina T Miyaji Marcelo L Santoro Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Spiders of the genus Loxosceles are distributed throughout tropical and temperate regions worldwide. Loxosceles spp. bites may evolve to necrosis, with or without intravascular hemolysis. There is no consensus regarding the best treatment to prevent necrosis. The objective of this study was to evaluate the factors associated with the development of necrosis and the impact that antivenom administration has on the evolution of cutaneous loxoscelism. Methodology/principal findings This was a prospective observational study carried out at a referral center for envenoming. Over a 6-year period, we included 146 patients with a presumptive or definitive diagnosis of loxoscelism. Depending on the symptom severity, a polyvalent anti-arachnid antivenom was administered or not-in 74 cases (50.7%) and 72 cases (49.3%), respectively. Cutaneous and systemic manifestations were assessed at admission and weekly thereafter. Adverse reactions to the antivenom were also evaluated. Cutaneous loxoscelism was observed in 141 cases (96.6%), and the spider was identified in 29 (19.9%). The mean time from bite to antivenom administration was 41.6 ± 27.4 h. After discharge, 130 patients (90.9%) were treated with corticosteroids, antihistamines and analgesics being prescribed as needed. The probability of developing necrosis was significantly lower among the patients who were admitted earlier, as well as among those who received antivenom (p = 0.0245). Among the 74 patients receiving antivenom, early and delayed adverse reactions occurred in seven (9.5%) and four (5.4%), respectively. Local infection was observed only in three (2.3%) of the 128 patients for whom that information was available. Conclusions/significance Necrosis after a Loxosceles sp. bite appears to more common when hospital admission is delayed or when antivenom is not administered. In addition, the administration of a polyvalent anti-arachnid antivenom appears to be safe, with a relatively low rate of adverse reactions. |
format |
Article in Journal/Newspaper |
author |
Ceila M S Malaque Christina T G Novaes Roberta O Piorelli Jose Y Risk Jefferson C Murad Amanda N Lara Cristiana C Virgulino Karina T Miyaji Marcelo L Santoro |
author_facet |
Ceila M S Malaque Christina T G Novaes Roberta O Piorelli Jose Y Risk Jefferson C Murad Amanda N Lara Cristiana C Virgulino Karina T Miyaji Marcelo L Santoro |
author_sort |
Ceila M S Malaque |
title |
Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
title_short |
Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
title_full |
Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
title_fullStr |
Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
title_full_unstemmed |
Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. |
title_sort |
impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: a prospective observational study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2022 |
url |
https://doi.org/10.1371/journal.pntd.0010842 https://doaj.org/article/53fe574269d14211b2b6fa318f79a65b |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 16, Iss 10, p e0010842 (2022) |
op_relation |
https://doi.org/10.1371/journal.pntd.0010842 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0010842 https://doaj.org/article/53fe574269d14211b2b6fa318f79a65b |
op_doi |
https://doi.org/10.1371/journal.pntd.0010842 |
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PLOS Neglected Tropical Diseases |
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16 |
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10 |
container_start_page |
e0010842 |
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