[Clinical, epidemiological and treatment aspects of 10 cases of saltwater stingray envenomation].
BACKGROUND
Stingrays are cartilaginous elasmobranches fishes that can cause severe and potentially fatal injuries in humans.


OBJECTIVE
A descriptive and prospective survey was conducted to analyze epidemiological, clinical and treatment aspects of injuries caused by marine stingrays in Adicora, Paraguaná peninsula, Falcon State, a northwestern, semiarid region of Venezuela.


METHODS
Between December 2006 and April 2007, patients with saltwater stingray injuries, attended in the ambulatory emergency service of Adicora, were clinically examined and interrogated. Treatment consisted on the application of a topical antiseptic solution (povidone-iodine), intravenous administration of an anti-inflammatory analgesic, antibiotic therapy per os and tetanus immunization.


RESULTS
Ten cases of injures caused by the marine stingray Dasyatis guttata (Dasyatidae) were recorded. 6 (60%) of the envenomation cases occurred in males and 4 (40%) in females, being 8 (80%) adults between 20 and 64 years-old and 2 (2%) above that age. Most of the accidents occurred at December and April holidays (90%) and during the late part of the day (80%) when bathing or swimming at or near the beach (70%). The time between ambulatory medical assistance and the accident varied from 5 to 7 minutes, with a mean time of 5.6 +/- 0.84. Injuries were located at lower limbs in all patients with circular lesions of diameters ranging from 1 to 1.53 cm (X: 1.41 +/- 0.22); bleeding was observed in 70% of the cases while 20% showed cellulitis and cutaneous necrosis. Other clinical manifestations were intense local and irradiated pain [Visual analog scale (VAS) = X: 9.5 +/- 0.71)] and erythema (100%). Systemic symptoms included dyspnea (50%) (VAS = X: 5.4 +/- 1.52) and tachycardia (10%). All patients had a satisfactory post-treatment evolution after 20 to 30 minutes (X = 23.1 +/- 3.41) with pain and dyspnea VAS mean values significantly lower (X = 0.55 +/- 0.44; t = 35.5, p = 0.0001; X = 0.1 +/- 0.22; t = 5.57, p = 0.002, respectively). CONCLUSIONS. Injuries caused by the marine stingray D. guttata are a public health problem, appear to have seasonal pattern, and can produce clinical manifestations of significant severity.
Cazorla
Dalmiro
D
Laboratorio de Entomología, Parasitologia y Medicina Tropical, Centro de Investigaciones Biomédicas, Decanato de Investigaciones, Universidad Nacional Experimental Francisco de Miranda. Lutzomyia@hotmail.com
Loyo
Jesús
J
Lugo
Lusneida
L
Acosta
María
M
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001733:Bites and Stings / Q000188:drug therapy / Q000453:epidemiology*; D002481:Cellulitis / Q000188:drug therapy / Q000209:etiology; D003625:Data Collection; D004417:Dyspnea / Q000209:etiology; D004630:Emergencies; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000628:therapy; D008297:Male; D008387:Marine Toxins / Q000506:poisoning*; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D012860:Skates, Fish; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology; D013610:Tachycardia / Q000209:etiology; D013745:Tetanus Toxoid; D014687:Venezuela / Q000453:epidemiology; D014945:Wound Healing; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D008387:Marine Toxins; D013745:Tetanus Toxoid