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Severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus
292
Eleventh World Congress
tick-paralysed children occur each year. Often, antitoxin is withheld until the last moment or altogether, because of medical concern that the product, derived from canine hyperimmune serum, may result in anaphylaxis or serum sickness. Anaphylaxis could theoretically occur because of the possibility that humans, who frequently contact dogs, may have become sensitized to canine proteins. Serum sickness is likely because of the heterologous nature of the antiserum which necessarily contains high concentrations of canine serum proteins. Both risks may be reduced by medical procedures on the patient, or during antitoxin manufacture by removal of inactive canine serum proteins. One research approach has been to investigate the separation of toxin-neutralizing IgG from rabbit hyperimmune serum (Stone el al., 1982). Such a product, never commercialized, may be less of a risk. A recent research study, reported here, demonstrates that the serum of the native Australian marsupial, the northern brown bandicoot Isoodon macrourus, has high levels of toxin-neutralizing antibodies after tick-feeding stimulation (Gemmel and Stone, in preparation). Is this serum a possible source of an alternative human antitoxin? Stone, B. F., Neish, A. L. and Wright, I. G. (1982) Aust. J. exp. Biol. med. Sci. 60, 351 358.
Liver dysfunction in patients bitten by Bothrops and Crotalus snakes in Botucatu area (Stale o f S~o Paulo, Brazil). B. Barraviera, K. 1. R. Coelho, P. R. Curi and D. A. Meira (Faculdade de Medicina de Botucatu e Centro de Estudos de Venenos e Animais Peqonhentos, CEVAP, UNESP, Botucatu, S~o Paulo, Brazil). Thirty-two patients bitten by venomous snakes, 16 by Bothrops spp. and 16 by Crotalus durissus terrificus, were studied. The group comprised 30 males and 2 females, aged 8~3 years (mean 33 + 15). Bromsulphalein tests were increased in the majority (P < 0.05) of patients bitten by Crotalus durissus terrificus. The correlation coefficient of Spearman was positive between bromsulphalein tests and alanine aminotransferase levels, and between alanine aminotransferase and aspartate aminotransferase levels only in the Crotalus group. The only patient who died was bitten by Crotalus durissus terrificus and showed hydropic degeneration and mitochondrial injury in the liver. It was concluded that hepatic damage may have been caused by at least two possible mechanisms, venom effects on liver mitochondria and cytokine effects on hepatocyte, especially interleukin-6.
Malpolon monspessulanus bite in Italy: a case report. E. Beer (Omegna, Italy). A case of envenomation by Malpolon monspessulanus, which occurred in Italy some years ago, is reported. Such casualties are very rare in Italy, where this snake is uncommon. In this case symptomatology was only local, and therapy was symptomatic.
Effect of Phoneutria nigriventer spider venom on gastric emptying in liquids in rats. F. Bucaretchi L2 and E. F. Collares ~ (~Department of Pediatrics and Experimental Surgery and Medicine Center, and 2poison Control Center, Faculty of Medical Sciences, Campinas State University, UNICAMP, Campinas, S~o Paulo, Brazil). Gastric emptying (GE) of liquids was studied in young adult rats. Two-hundred and forty animals were tested, eight for each experimental subgroup. Before beginning GE study, Phoneutria nigriventer venom (PNV) was administered: at 30 min, doses of 19, 38 and 76/~g/100 g; at 15, 60 and 120 min, a single dose of 76/~g/100 g; at 30 min, doses of 76/~g/100 g in rats submitted to subdiaphragmatic vagotomy; and at 30 min, doses of 38 and 76 pg/lO0 g in rats previously treated with prazosin, domperidone and propranolol. Each animal received a test meal with 0.9% of sodium chloride solution and phenol red as a marker. Ten minutes after test meal had been orogastrically infused, gastric retention was determined by measuring the residual test meal concentration of the marker after the animal's kill. In a dose-dependent relationship PNV was able to provoke a significant delay on GE of liquids at 15, 30 and 60min after its administration (adequate non-parametric statistical methods). Beta-adrenergic antagonist, propranolol, interfered in the GE of groups of rats that received PNV doses of 38 and 76/tg/100 g. The delay on GE of liquids in severely envenomed rats was probably due to the increase of catecholamines release, provoked by the PNV, which inhibited gastric motility through stimulating beta-adrenergic receptors present in smooth muscle cells.
Severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus. F. Bucaretchi, L2 F. A. D. Zambrone,2 M. R. C. C. Fonseca,2J. L. Douglas 2 and F. S. Tourinho 2(~Department of Pediatrics, and 2Poison Control Center, Faculty of Medical Sciences, Campinas State University, UNICAMP, S~o Paulo, Brazil). From January 1984 to May 1994, 239 patients under 15 years, victims of scorpion stings, with species identification, were admitted to the University Hospital-UNICAMP. Tityus bahiensis was responsible for 84.9%
Eleventh World Congress
293
(3 severe envenomations) and Tit)us serrulatus for 15.1% (14 severe envenomations). Of these 17 severe cases, 13 were children less than 7 years old (median = 26 months), all of them received intravenous scorpion antivenom in intervals of 45 min and 5 hr after the accident (median = 2 hr). On admission, the main clinical manifestations, laboratorial and electrocardiographic alterations were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (6), hypotension (5), tremors (5), hypothermia (4), hyperglycemia ( > 110 mg/dl) (I 7), leukocytosis ( > 10,000 cells/mm 3) (16/16), hypokalemia ( < 3.5 mEq/liter) (13/17), CK-MB increased ( > 6 % total CK) (I 1/12), hyperamylasemia ( > 180 U/dl) (11/14), sinusal tachycardia (16/17) and myocardial infarction-like pattern (11/17). A depressed left ventricular systolic function at echocardiogral~hy was observed in 6 patients stung by Tit)us serrulatus, of these 5 presented pulmonary edema and 4 shock, ;dl of them needed mechanical ventilation and inotropic drugs (dobutamine and digoxine). One 2-year-old child with severe respiratory failure died 65 hr after the sting. In this study, Tityus serrulatus accidents in children were 26.2 times more severe than those determined by Tityus bahiensis (Chi-square P < 0.001).
Tunable solid-state laser system for medical applications. Z. Azar, A. Bank, D. Donskoy and V. Nechitailo (PolyOptics L':d, Nahal-Soreq, Yavne 81800, Israel). The Q-switched Nd:YAG laser is the most recent in a series of pulsed laser systems for various medical procedures. The 532 nm wavelength has been shown to be absorbed by a variety ofchromophores. These include tattoo pigmen:s, oxygenated hemoglobin and melanin-containing epidermal cells. A simple tunable solid state laser module pumped by a double-frequency Q-switched YAG laser will be presented, which enables tuning of the wavelengtl', in the yellow and red visible spectrum to the most suitable wavelengths for dermatology and PDT applications.
Peptide dictionary for cytotoxins, sarafotox#t~ and endothelins. K. E. Yu (Parilis M. Institute of Biochemistry, Tashkent, Uzbekistan). We have intrc~tuced a new method for protein classification using the common conservative fragments. We researched the conservative unique peptide fragments in the unaligned protein family. The presence of fragments in the amino acid sequence is necessary and sufficient for the analysed activity. The method is based on Swiss-Prot Bank v. 14, 1_~409proteins. The conservative fragments were determined for the following families: cytotoxins I (KTCP, CPK, GKNLCY, KRGC, VC, VK, CC), cytotoxins 2 (KTCP, CPK, NLC, RGC, VC, VK, CCNT, KC, NT YK, PK, LK, KY), cytotoxins 3 (KTCP, CPK, NLC, KRGC, V__CC,V__K_K,C CNT, KC, LK, KY), cytotoxins 4 (KTCP, CPK, GKNLCYKM, VPVKRGCI, VCPKNSALVKYVCC, KCNKL, MV): The underlined peptides are common for all the families above. The set of the peptides KTCP, CPK, NLC and RGC is indispensable and enough for cytotoxins isolated from vertebrate. DKECV and CHLDIlW are the conservative fragments for endothelins. Using the Bank we have proved their uniqueness for their function. DMTD, ECL, FCHQD are the three peptides to be conservative for sarafotoxins, FCHQD being unique. The peptide dictionary to classify the proteins according to their function is being created on the basis of the method we prepared. Present results were obtained using the "Protein Adviser' software package.
Amino acid sequence of two cytolytic sea anemone toxins. D. Mebs, ~M. Yanagisawa 2 and Y. Samejima 2 (~Zentrum der Rechtsmedizin, University of Frankfurt, Frankfurt, F.R.G.; and 2Institute of Medical Chemistry, Hoshi University, Tokyo, Japan). Sea anemones produce either toxins that affect nervous structures, e.g. ion channels, or toxins that damage membranes by forming pores or channels. One toxin each causing lysis of human erythrocytes was isolated from the sea anemone species Heteractis magnifica (Madang, Papua New Guinea) and Entacmaea quadricolor (Gulf of Aqaba, Red Sea). Their cytolytic activity correlates to their ability to kill freshwater as well as marine fish (ichthyotoxicity) by damaging the gill filament and lamella structure. Both toxins exhibit a tool. mass of about 20 kDa and consist of a single chain of 178 and 187 amino acids, respectively, which is not cross-linked by disulfide bridges. There exists considerable homology in the amino acid sequence of these and of other sea anemone cytolytic toxins.
Effect of the 5permicidal compound from Leiurus quinquestriatus (H&E) venom on the testes of rat: electron microscopic stttdy. M. F. EI-Asmar, I N. M. EI-Shakaa, 2 A. S. EI-Moursy, 2 J. P. Camillerie, 3 N. Z. Swelam 2 and
Eleventh World Congress
tick-paralysed children occur each year. Often, antitoxin is withheld until the last moment or altogether, because of medical concern that the product, derived from canine hyperimmune serum, may result in anaphylaxis or serum sickness. Anaphylaxis could theoretically occur because of the possibility that humans, who frequently contact dogs, may have become sensitized to canine proteins. Serum sickness is likely because of the heterologous nature of the antiserum which necessarily contains high concentrations of canine serum proteins. Both risks may be reduced by medical procedures on the patient, or during antitoxin manufacture by removal of inactive canine serum proteins. One research approach has been to investigate the separation of toxin-neutralizing IgG from rabbit hyperimmune serum (Stone el al., 1982). Such a product, never commercialized, may be less of a risk. A recent research study, reported here, demonstrates that the serum of the native Australian marsupial, the northern brown bandicoot Isoodon macrourus, has high levels of toxin-neutralizing antibodies after tick-feeding stimulation (Gemmel and Stone, in preparation). Is this serum a possible source of an alternative human antitoxin? Stone, B. F., Neish, A. L. and Wright, I. G. (1982) Aust. J. exp. Biol. med. Sci. 60, 351 358.
Liver dysfunction in patients bitten by Bothrops and Crotalus snakes in Botucatu area (Stale o f S~o Paulo, Brazil). B. Barraviera, K. 1. R. Coelho, P. R. Curi and D. A. Meira (Faculdade de Medicina de Botucatu e Centro de Estudos de Venenos e Animais Peqonhentos, CEVAP, UNESP, Botucatu, S~o Paulo, Brazil). Thirty-two patients bitten by venomous snakes, 16 by Bothrops spp. and 16 by Crotalus durissus terrificus, were studied. The group comprised 30 males and 2 females, aged 8~3 years (mean 33 + 15). Bromsulphalein tests were increased in the majority (P < 0.05) of patients bitten by Crotalus durissus terrificus. The correlation coefficient of Spearman was positive between bromsulphalein tests and alanine aminotransferase levels, and between alanine aminotransferase and aspartate aminotransferase levels only in the Crotalus group. The only patient who died was bitten by Crotalus durissus terrificus and showed hydropic degeneration and mitochondrial injury in the liver. It was concluded that hepatic damage may have been caused by at least two possible mechanisms, venom effects on liver mitochondria and cytokine effects on hepatocyte, especially interleukin-6.
Malpolon monspessulanus bite in Italy: a case report. E. Beer (Omegna, Italy). A case of envenomation by Malpolon monspessulanus, which occurred in Italy some years ago, is reported. Such casualties are very rare in Italy, where this snake is uncommon. In this case symptomatology was only local, and therapy was symptomatic.
Effect of Phoneutria nigriventer spider venom on gastric emptying in liquids in rats. F. Bucaretchi L2 and E. F. Collares ~ (~Department of Pediatrics and Experimental Surgery and Medicine Center, and 2poison Control Center, Faculty of Medical Sciences, Campinas State University, UNICAMP, Campinas, S~o Paulo, Brazil). Gastric emptying (GE) of liquids was studied in young adult rats. Two-hundred and forty animals were tested, eight for each experimental subgroup. Before beginning GE study, Phoneutria nigriventer venom (PNV) was administered: at 30 min, doses of 19, 38 and 76/~g/100 g; at 15, 60 and 120 min, a single dose of 76/~g/100 g; at 30 min, doses of 76/~g/100 g in rats submitted to subdiaphragmatic vagotomy; and at 30 min, doses of 38 and 76 pg/lO0 g in rats previously treated with prazosin, domperidone and propranolol. Each animal received a test meal with 0.9% of sodium chloride solution and phenol red as a marker. Ten minutes after test meal had been orogastrically infused, gastric retention was determined by measuring the residual test meal concentration of the marker after the animal's kill. In a dose-dependent relationship PNV was able to provoke a significant delay on GE of liquids at 15, 30 and 60min after its administration (adequate non-parametric statistical methods). Beta-adrenergic antagonist, propranolol, interfered in the GE of groups of rats that received PNV doses of 38 and 76/tg/100 g. The delay on GE of liquids in severely envenomed rats was probably due to the increase of catecholamines release, provoked by the PNV, which inhibited gastric motility through stimulating beta-adrenergic receptors present in smooth muscle cells.
Severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus. F. Bucaretchi, L2 F. A. D. Zambrone,2 M. R. C. C. Fonseca,2J. L. Douglas 2 and F. S. Tourinho 2(~Department of Pediatrics, and 2Poison Control Center, Faculty of Medical Sciences, Campinas State University, UNICAMP, S~o Paulo, Brazil). From January 1984 to May 1994, 239 patients under 15 years, victims of scorpion stings, with species identification, were admitted to the University Hospital-UNICAMP. Tityus bahiensis was responsible for 84.9%
Eleventh World Congress
293
(3 severe envenomations) and Tit)us serrulatus for 15.1% (14 severe envenomations). Of these 17 severe cases, 13 were children less than 7 years old (median = 26 months), all of them received intravenous scorpion antivenom in intervals of 45 min and 5 hr after the accident (median = 2 hr). On admission, the main clinical manifestations, laboratorial and electrocardiographic alterations were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (6), hypotension (5), tremors (5), hypothermia (4), hyperglycemia ( > 110 mg/dl) (I 7), leukocytosis ( > 10,000 cells/mm 3) (16/16), hypokalemia ( < 3.5 mEq/liter) (13/17), CK-MB increased ( > 6 % total CK) (I 1/12), hyperamylasemia ( > 180 U/dl) (11/14), sinusal tachycardia (16/17) and myocardial infarction-like pattern (11/17). A depressed left ventricular systolic function at echocardiogral~hy was observed in 6 patients stung by Tit)us serrulatus, of these 5 presented pulmonary edema and 4 shock, ;dl of them needed mechanical ventilation and inotropic drugs (dobutamine and digoxine). One 2-year-old child with severe respiratory failure died 65 hr after the sting. In this study, Tityus serrulatus accidents in children were 26.2 times more severe than those determined by Tityus bahiensis (Chi-square P < 0.001).
Tunable solid-state laser system for medical applications. Z. Azar, A. Bank, D. Donskoy and V. Nechitailo (PolyOptics L':d, Nahal-Soreq, Yavne 81800, Israel). The Q-switched Nd:YAG laser is the most recent in a series of pulsed laser systems for various medical procedures. The 532 nm wavelength has been shown to be absorbed by a variety ofchromophores. These include tattoo pigmen:s, oxygenated hemoglobin and melanin-containing epidermal cells. A simple tunable solid state laser module pumped by a double-frequency Q-switched YAG laser will be presented, which enables tuning of the wavelengtl', in the yellow and red visible spectrum to the most suitable wavelengths for dermatology and PDT applications.
Peptide dictionary for cytotoxins, sarafotox#t~ and endothelins. K. E. Yu (Parilis M. Institute of Biochemistry, Tashkent, Uzbekistan). We have intrc~tuced a new method for protein classification using the common conservative fragments. We researched the conservative unique peptide fragments in the unaligned protein family. The presence of fragments in the amino acid sequence is necessary and sufficient for the analysed activity. The method is based on Swiss-Prot Bank v. 14, 1_~409proteins. The conservative fragments were determined for the following families: cytotoxins I (KTCP, CPK, GKNLCY, KRGC, VC, VK, CC), cytotoxins 2 (KTCP, CPK, NLC, RGC, VC, VK, CCNT, KC, NT YK, PK, LK, KY), cytotoxins 3 (KTCP, CPK, NLC, KRGC, V__CC,V__K_K,C CNT, KC, LK, KY), cytotoxins 4 (KTCP, CPK, GKNLCYKM, VPVKRGCI, VCPKNSALVKYVCC, KCNKL, MV): The underlined peptides are common for all the families above. The set of the peptides KTCP, CPK, NLC and RGC is indispensable and enough for cytotoxins isolated from vertebrate. DKECV and CHLDIlW are the conservative fragments for endothelins. Using the Bank we have proved their uniqueness for their function. DMTD, ECL, FCHQD are the three peptides to be conservative for sarafotoxins, FCHQD being unique. The peptide dictionary to classify the proteins according to their function is being created on the basis of the method we prepared. Present results were obtained using the "Protein Adviser' software package.
Amino acid sequence of two cytolytic sea anemone toxins. D. Mebs, ~M. Yanagisawa 2 and Y. Samejima 2 (~Zentrum der Rechtsmedizin, University of Frankfurt, Frankfurt, F.R.G.; and 2Institute of Medical Chemistry, Hoshi University, Tokyo, Japan). Sea anemones produce either toxins that affect nervous structures, e.g. ion channels, or toxins that damage membranes by forming pores or channels. One toxin each causing lysis of human erythrocytes was isolated from the sea anemone species Heteractis magnifica (Madang, Papua New Guinea) and Entacmaea quadricolor (Gulf of Aqaba, Red Sea). Their cytolytic activity correlates to their ability to kill freshwater as well as marine fish (ichthyotoxicity) by damaging the gill filament and lamella structure. Both toxins exhibit a tool. mass of about 20 kDa and consist of a single chain of 178 and 187 amino acids, respectively, which is not cross-linked by disulfide bridges. There exists considerable homology in the amino acid sequence of these and of other sea anemone cytolytic toxins.
Effect of the 5permicidal compound from Leiurus quinquestriatus (H&E) venom on the testes of rat: electron microscopic stttdy. M. F. EI-Asmar, I N. M. EI-Shakaa, 2 A. S. EI-Moursy, 2 J. P. Camillerie, 3 N. Z. Swelam 2 and