title: Tetanus after envenomations caused by freshwater stingrays.
abstract: Injuries caused by freshwater stingray are common in several regions of South America, although they are underreported. The riverside inhabitants are the main victims in the Amazonian and Midwest regions of South America. The fishermen are injured mainly in the new focus of colonization of the rivers by freshwater stingrays. With the increasing population in these regions, where freshwater stingrays are found, there has been a significant increase in injuries within the general population. The highest increase occurred among tourists from other regions, where these animals are not known, when visiting these areas. The envenomations from the stingray causes prolonged and intense pain, both local and regionally. Generally these are associated with other local inflammatory manifestations, such as swelling and erythema. The injury often progresses to necrosis and it is considered potentially tetanogenic. A secondary infection is also a frequent local complication and most frequently is caused by Aeromonas species, usually Aeromonas hydrophila. Herein we report the first 2 cases of tetanus after freshwater stingray injuries: a 51-year-old men who had tetanus and recovered without sequel and the second a 67-year-old men who had severe tetanus and a deep, necrotizing soft-tissue infection with sepsis, septic shock and evolution to death.
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. Electronic address: pasesa2@hotmail.com.
authors.forename: Pasesa P Q
authors.initials: PP
authors.lastname: Torrez
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Mariana M
authors.initials: MM
authors.lastname: Quiroga
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Said
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Paulo A M
authors.initials: PA
authors.lastname: Abati
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Francisco O S
authors.initials: FO
authors.lastname: França
mesh_terms: D000333:Aeromonas; D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000382:microbiology*; D001938:Brazil; D060085:Coinfection / Q000473:pathology*; D017809:Fatal Outcome; D016905:Gram-Negative Bacterial Infections / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012860:Skates, Fish; D013742:Tetanus / Q000473:pathology*
keywords: Amazonia; Myonecrosis; Potamotrygon sp; Stingray; Tetanus; Waterborne infections