title: Clinical picture and laboratorial evaluation in human loxoscelism.
abstract: Loxosceles spiders are found globally, especially in South and North America. In Brazil, approximately 10,000 cases of Loxosceles spp. spider bites are reported annually. Herein we analyzed 81 patients diagnosed as either cutaneous or cutaneous-hemolytic loxoscelism, in a geographical area where most accidents are caused by Loxosceles gaucho, and we report their clinical and laboratory data obtained during week 1 and 2 after the bite. Massive hemolysis was noticed in only 2 cases, but high serum bilirubin and LDH levels, suggestive of hemolysis, were noticed in 25 cases on admission. Anemia was not frequent (14.7%), and reticulocytosis was particularly noticed during week 2 (in 56% of patients). High D-dimer levels were suggestive of endothelial cell activation and intravascular thrombin generation, but thrombocytopenia was noticed in only 17.6% of patients in week 1. Acute kidney injury (AKI) only occurred in patients with massive hemolysis. The definitive diagnosis of overt disseminated intravascular coagulation (DIC) could not be established on admission. Fever was associated with the presence of hemolysis (p = 0.03). Altogether, these findings provide evidence that mild hemolysis is frequent in loxoscelism and suggest that AKI is uncommon, exclusively occurring in patients with massive hemolysis.
authors: Hospital Vital Brazil, Instituto Butantan, São Paulo-SP, Brazil. cmalaque@butantan.gov.br
authors: Ceila M S
authors: CM
authors: Malaque
authors: Marcelo L
authors: ML
authors: Santoro
authors: João Luiz C
authors: JL
authors: Cardoso
authors: Mayra R
authors: MR
authors: Conde
authors: Christina T G
authors: CT
authors: Novaes
authors: José Y
authors: JY
authors: Risk
authors: Francisco O S
authors: FO
authors: França
authors: Carlos R
authors: CR
authors: de Medeiros
authors: Hui W
authors: HW
authors: Fan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000209:etiology; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000209:etiology; D005260:Female; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010727:Phosphoric Diester Hydrolases / Q000633:toxicity*; D045262:Reticulocytosis / Q000187:drug effects; D012867:Skin / Q000187:drug effects / Q000473:pathology; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D001098:Spider Bites / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013111:Spider Venoms / Q000037:antagonists & inhibitors / Q000633:toxicity*; D013112:Spiders; D055815:Young Adult
chemical_list: D000997:Antivenins; D013111:Spider Venoms; C055161:loxosceles venom; D007770:L-Lactate Dehydrogenase; D010727:Phosphoric Diester Hydrolases; D001663:Bilirubin