Spider bite (latrodectism) in Mashhad, Iran

Background: Spider (Latrodectus tredecimguttatus) bites are relatively common in North East Iran. They induce morbidity and rarely mortality. We aimed to investigate clinical, electrocardiographic and para-clinical changes in patients with this bite. Methods: All consecutive patients admitted with suspected spider bites between September 2005 and September 2006 were studied prospectively. Results: Spider bites accounted for 56 cases (0.5% of all poisoning, 21% of all admitted envenomated). The patients’ mean (SD) age was 32 (16) years. The most common findings were pain (90%) mainly in their back (45%), stomach (35%), lower limbs (33%), upper limbs (19%) and chest (14%). Other clinical findings included were sweating (55%), chills (29%), dyspnea (25%), flushing (14%), spasm (12%), headache (12%), nausea (12%) and vertigo (12%). On electrocardiograph (ECG); ST segments were depressed in 25% of cases in at least two of the pre-cordial leads. Laboratory findings were in normal ranges. All the patients recovered following supportive and symptomatic treatment (no anti-toxin available in Iran), with a mean hospitalization period of 1.9 (1.3) days. Conclusions: Spider (L. Tredecimguttatus) bite is relatively common in Mashhad, which induces latrodectism with relatively different findings and cardiac toxicity. ECG monitoring should be considered, particularly when specific anti-toxin is not available.

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Comparison of standardised lymphoscintigraphic function test and high resolution sonography of the lymphoedema of legs

Phlebologie ◽

10.1055/s-0037-1622238 ◽

2008 ◽

Vol 37 (05) ◽

pp. 247-252 ◽

Cited By ~ 4

Author(s):

V. S. Brauer ◽

W. J. Brauer

Keyword(s):

Lower Leg ◽

Clinical Findings ◽

Lower Limbs ◽

Fatty Tissue ◽

Qualitative And Quantitative ◽

Function Test ◽

Unreliable Method ◽

Negative Conclusion ◽

Fine Disperse

SummaryPurpose: Comparison of qualitative and quantitative sonography with the lymphoscintigraphic function test and clinical findings in legs. Patients, methods: In 33 patients a lymphoscintigraphic function test of legs combined with measurement of lymph node uptake was performed and subsequently compared with sonography. Sonographic criteria were: Thickness of cutis, thickness of subcutanean fatty tissue and presence of liquid structures or fine disperse tissue structure of lower limbs, foots and toes. Results: In 51 legs uptake values lie in the pathologic area, in four legs in the grey area and in ten legs in the normal area. The cutis thickness in the lower leg shows no significant correlation with the uptake. The determination of the thickness of the subcutanean fatty tissue of the lower leg and of the cutis thickness of the feet turned out to be an unreliable method. In 47% of the medial lower legs and in 57% of the lateral lower legs with clinical lymphoedema sonography is falsely negative. Conclusion: Early lymphoedema is only detectable with the lymphoscintigraphic function test. In the case of clinical lymphoedema clinical examination is more reliable than sonography.

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Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1629824 ◽

1996 ◽

Vol 35 (04) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

G. E Fueger ◽

M. Vejda ◽

R. M. Aigner

Keyword(s):

Bone Scintigraphy ◽

Antibiotic Treatment ◽

Diagnostic Value ◽

Clinical Findings ◽

Laboratory Findings ◽

Radiographic Findings ◽

Serum Parameters ◽

Wbc Count ◽

Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

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Effective Treatment of Neurological Symptoms with Normal Doses of Botulinum Neurotoxin in Wilson’s Disease: Six Cases and Literature Review

Toxins ◽

10.3390/toxins13040241 ◽

2021 ◽

Vol 13 (4) ◽

pp. 241

Author(s):

Harald Hefter ◽

Sara Samadzadeh

Keyword(s):

Botulinum Neurotoxin ◽

Wilson’S Disease ◽

Animal Experiments ◽

Symptomatic Treatment ◽

Wilson's Disease ◽

University Hospital ◽

Laboratory Findings ◽

Dose Information ◽

High Doses ◽

The University

Background: Recent cell-based and animal experiments have demonstrated an effective reduction in botulinum neurotoxin A (BoNT/A) by copper. Aim: We aimed to analyze whether the successful symptomatic BoNT/A treatment of patients with Wilson’s disease (WD) corresponds with unusually high doses per session. Methods: Among the 156 WD patients regularly seen at the outpatient department of the university hospital in Düsseldorf (Germany), only 6 patients had been treated with BoNT/A during the past 5 years. The laboratory findings, indications for BoNT treatment, preparations, and doses per session were extracted retrospectively from the charts. These parameters were compared with those of 13 other patients described in the literature. Results: BoNT/A injection therapy is a rare (<4%) symptomatic treatment in WD, only necessary in exceptional cases, and is often applied only transiently. In those cases for which dose information was available, the dose per session and indication appear to be within usual limits. Conclusion: Despite the evidence that copper can interfere with the botulinum toxin in preclinical models, patients with WD do not require higher doses of the toxin than other patients with dystonia.

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An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

Radiology and Oncology ◽

10.2478/raon-2013-0021 ◽

2013 ◽

Vol 47 (2) ◽

pp. 125-127

Author(s):

Hakan Önder ◽

Faysal Ekici ◽

Emin Adin ◽

Suzan Kuday ◽

Hatice Gümüş ◽

...

Keyword(s):

Case Report ◽

Bile Duct ◽

Magnetic Resonance ◽

Biliary Obstruction ◽

Fasciola Hepatica ◽

Magnetic Resonance Cholangiopancreatography ◽

Clinical Findings ◽

Imaging Studies ◽

Laboratory Findings ◽

Acoustic Shadow

Background. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

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The Relationship between Inflammatory Cytokines and Coagulopathy in Patients with COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10092020 ◽

2021 ◽

Vol 10 (9) ◽

pp. 2020

Author(s):

Fariba Rad ◽

Ali Dabbagh ◽

Akbar Dorgalaleh ◽

Arijit Biswas

Keyword(s):

Inflammatory Cytokines ◽

Interleukin 1 ◽

Clinical Findings ◽

Laboratory Findings ◽

Necrosis Factor Alpha ◽

Coagulation Parameters ◽

Increased Risk ◽

Cytokine Levels ◽

Α Level ◽

High Level

Coronavirus disease 2019 (COVID-19), with a broad range of clinical and laboratory findings, is currently the most prevalent medical challenge worldwide. In this disease, hypercoagulability and hyperinflammation, two common features, are accompanied by a higher rate of morbidity and mortality. We assessed the association between baseline inflammatory cytokine levels and coagulopathy and disease outcome in COVID-19. One hundred and thirty-seven consecutive patients hospitalized with COVID-19 were selected for the study. Baseline interleukin-1 (IL-1), IL-6, and tumor necrosis factor alpha (TNF-α) level were measured at time of admission. At the same time, baseline coagulation parameters were also assessed during the patient’s hospitalization. Clinical findings, including development of thrombosis and clinical outcome, were recorded prospectively. Out of 136 patients, 87 (~64%) had increased cytokine levels (one or more cytokines) or abnormal coagulation parameters. Among them, 58 (~67%) had only increased inflammatory cytokines, 12 (~14%) had only coagulation abnormalities, and 17 (19.5%) had concomitant abnormalities in both systems. It seems that a high level of inflammatory cytokines at admission points to an increased risk of developing coagulopathy, thrombotic events, even death, over the course of COVID-19. Early measurement of these cytokines, and timely co-administration of anti-inflammatories with anticoagulants could decrease thrombotic events and related fatal consequences.

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Pituitary abscess in an HIV-1-infected patient

SAGE Open Medical Case Reports ◽

10.1177/2050313x17701374 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1770137

Author(s):

Hiroyuki Yamazaki ◽

Masayuki Kobayashi ◽

Anamaria Daniela Sarca ◽

Akifumi Takaori-Kondo

Keyword(s):

Central Nervous System Infection ◽

Clinical Findings ◽

Endocrine Function ◽

Visual Field Defects ◽

Magnetic Resonance Imaging Scan ◽

Pituitary Abscess ◽

Laboratory Findings ◽

Cell Counts ◽

Disturbance Of Consciousness ◽

Hiv 1

Objectives: Pituitary abscess is a rare occurrence among pituitary conditions, but one which carries life-threatening potential. An immunocompromised status is a risk factor for the development of a pituitary abscess; however, literature describes only one case among HIV-infected patients. Methods and results: We present here a case of pituitary abscess in an HIV-1-positive patient, who demonstrated a shock status, disturbance of consciousness and generalized skin rash with laboratory findings of hypovolemia, acute inflammatory reaction and blood electrolyte abnormality. We first diagnosed the dermal manifestation as atypical generalized zoster, however, the other clinical findings could not be explained by VZV infection only. Combination with anamnesis, head magnetic resonance imaging scan and endocrine function test helped us to diagnose pituitary abscess. Although the etiology of the pituitary abscess could not be detected, the patient was successfully treated with antibiotics but followed by panhypopituitarism as sequela. Conclusion: A pituitary abscess should be considered in HIV-infected patients with endocrinological abnormalities, visual field defects, and central nervous system infection signs or symptoms, regardless of CD4 T-cell counts.

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Arterial Thrombosis and Gangrene Secondary to Arachnidism

Vascular ◽

10.2310/6670.2009.00022 ◽

2009 ◽

Vol 17 (4) ◽

pp. 239-242

Author(s):

Jan M. Eckermann ◽

Theodore H. Teruya ◽

Christian Bianchi ◽

Ahmed M. Abou-Zamzam

Keyword(s):

Case Report ◽

Lower Extremity ◽

Vascular Disease ◽

Tissue Damage ◽

Arterial Thrombosis ◽

Progressive Necrosis ◽

Life Threatening ◽

History Of ◽

Spider Bites ◽

Spider Bite

Spider bites can cause local tissue damage as well as life-threatening complications. This is a case report of a female with no history of lower extremity vascular disease who presented with a spider bite on the dorsum of her foot. She developed progressive necrosis and eventually suffered limb loss despite attempts at revascularization.

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A two year study of verified spider bites in Switzerland and a review of the European spider bite literature

Toxicon ◽

10.1016/j.toxicon.2013.07.010 ◽

2013 ◽

Vol 73 ◽

pp. 104-110 ◽

Cited By ~ 27

Author(s):

Wolfgang Nentwig ◽

Markus Gnädinger ◽

Joan Fuchs ◽

Alessandro Ceschi

Keyword(s):

Spider Bites ◽

Spider Bite

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Animais Venenosos em Território Português: Abordagem Clínica de Picadas e Mordeduras

Acta Médica Portuguesa ◽

10.20344/amp.15589 ◽

2021 ◽

Vol 34 (11) ◽

pp. 784

Author(s):

Sofia R. Valdoleiros ◽

Inês Correia Gonçalves ◽

Carolina Silva ◽

Diogo Guerra ◽

Lino André Silva ◽

...

Keyword(s):

Native Species ◽

Severe Disease ◽

Clinical Manifestations ◽

Specific Treatment ◽

Hospital Setting ◽

Marine Species ◽

Symptomatic Treatment ◽

Thaumetopoea Pityocampa ◽

Hermodice Carunculata ◽

Spider Bites

There are many native species of animals with the potential to cause severe disease in Portugal. Of the four clinically relevant snake species, the vipers (Vipera latastei and Vipera seoanei) are the most concerning. They can cause severe disease and require in-hospital management, monitoring and specific treatment, including the administration of anti-snake venom serum. The Malpolon monspessulanus and Macroprotodon brevis snakes cause mostly localized clinical manifestations, which do not require specific treatment. Only a minority of the spider species in Portugal possess chelicerae (mouthparts of the Chelicerata, shaped as either articulated fangs or pincers, which may contain venom or be connected to the venom glands and are used for predation or capture of food) long enough to perforate the human skin. Nevertheless, Latrodectus tredecimguttatus and Loxosceles rufescens spider bites may require specialized treatment in a hospital setting, as well as careful active symptom surveillance. Diversely, the treatment for Scolopendra cingulata and Scolopendra oraniensis centipedes’ bites is merely symptomatic. The only existing scorpion species in Portugal is the Buthus ibericus; its sting typically causes local symptoms with intense pain, and its treatment consists essentially of analgesia. The insects of the Hymenoptera order, such as bees and wasps, have the ability to inject venom into the skin. Most people present only with local or regional inflammatory response, and symptomatic treatment is usually effective. Even so, individuals with hypersensitivity to bee venom may develop anaphylaxis. Several marine species in the Portuguese coast are venomous to humans, including weeverfish (Trachinidae family), stingrays (Dasyatis pastinaca, Taeniura grabata, Myliobatis aquila), red scorpion fish (Scorpaena scrofa), cnidaria (Pelagia noctiluca, Chrysaora hysoscella, Physalia physalis) and bearded fireworm (Hermodice carunculata); treatment is symptomatic. Contact with the larvae or bristles (chitinous structures with locomotor or tactile functions) of Thaumetopoea pityocampa (pine processionary) can cause cutaneous, ocular and, rarely, respiratory reactions; its management is also symptomatic.

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SARS-COV-2 transmission among family members

Naucni casopis urgentne medicine - Halo 194 ◽

10.5937/halo26-28178 ◽

2020 ◽

Vol 26 (3) ◽

pp. 143-148

Author(s):

Gordana Todorović ◽

Aleksandar Joldžić ◽

Slađana Anđelić ◽

Darko Nedeljković

Keyword(s):

Case Reports ◽

Family Members ◽

Clinical Findings ◽

Rt Pcr ◽

Laboratory Findings ◽

Indirect Contact ◽

Protein Levels ◽

The World ◽

High Erythrocyte Sedimentation Rate ◽

Loss Of Appetite

Introduction/Objective Severe acute respiratory distress syndrome caused by coronavirus 2 (SARS-COV-2) is a new respiratory disease -COVID-19. A virus from the Coronaviridae family, highly contagious and virulent took over the world in a very short time causing the 2019/2020 pandemic. We are presenting the case of COVID-19 transmission among family members, patients of various ages, sex, clinical presentation and findings, who have been infected in different ways. Case reports Three patients are described, all with different coronavirus-specific symptomatology. Symptoms ranged from fatigue and loss of appetite with no other, more prominent symptoms in the youngest patient, to fever, high temperature, diarrhoea, muscle ache and chest pain during inspiration in the oldest patient. The third patient's dominant symptoms were dry, non-productive cough, lack of oxygen, shortness of breath and perspiration on exertion, headache and normal temperature, with radiographically confirmed bilateral pneumonia. Laboratory findings (leukopenia, lymphocytopenia with elevated C-reactive protein levels, high erythrocyte sedimentation rate and lactate dehydrogenase levels) were consistent with a viral infection, highly suspicious of SARS-COV-2, which was confirmed with a real-time RT-PCR test in all three patients. After being hospitalized in the Clinical Hospital Center "Zemun" Department of Pulmonology and treated with symptomatic, antiviral and antibiotic therapy, the disease regressed and the RT-PCR tests became negative. Conclusion SARS-COV-2 is a very aggressive and potent cause of the coronavirus disease. The presented cases confirm the possibility of quick transmission within a family through direct and indirect contact, as well as the diversity of symptoms, laboratory and clinical findings. Our clinical examples are similar in symptomatology and available results to cases from other parts of the world hit with the pandemic.

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