title: A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro) in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?
abstract: Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae), in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. Then antibiotic was suspended; however, after two more days and additional tests, cephalosporin therapy was initiated, and proved successful. Pain worsened despite increasingly powerful analgesics, until debridement of the wound was performed after one month. The wound finally closed ~70 days after the accident, but the patient continued to have problems wearing shoes even eight months later. Chemistry and pharmacology of Potamotrygon venom and mucus, and clinical management of freshwater stingray envenomations are reviewed in light of the present case. Bacterial infections of stingray puncture wounds may account for more long-term morbidity than stingray venom. Simultaneous prophylactic use of multiple antibiotics is recommended for all but the most superficial stingray wounds. Distinguishing relative contributions of venom, mucus, and bacteria will require careful genomic and transcriptomic investigations of stingray tissues and contaminating bacteria.
authors.affiliation: Programa de Pós-Graduação em Ciências Ambientais e Saúde, Pontifícia Universidade Católica de Goiás, Rua 232 nº128 3º andar-Área V. Setor Universitário, CEP 74605-140 Goiânia, Goiás, Brazil. raimundo58@gmail.com.|Departamento de Medicina, Pontifícia Universidade Católica de Goiás, Avenida Universitária, 1069-Setor Universitário, CEP 74605-010 Goiânia, Goiás, Brazil. raimundo58@gmail.com.
authors.forename: Nelson Jorge
authors.initials: NJ
authors.lastname: da Silva
authors.affiliation: Faculdade de Ciências Médicas do Instituto de Pesquisa e Ensino Médico - IPEMED, Rua Dr. Nogueira Martins nº 706, Saúde, CEP 04143-020 São Paulo, São Paulo, Brazil. kalley.ferreira@me.com.
authors.forename: Kalley Ricardo Clementino
authors.initials: KR
authors.lastname: Ferreira
authors.affiliation: Departamento de Medicina, Pontifícia Universidade Católica de Goiás, Avenida Universitária, 1069-Setor Universitário, CEP 74605-010 Goiânia, Goiás, Brazil. raimundo58@gmail.com.|Hospital de Doenças Tropicais Dr. Anuar Auad. Rua SC-1 nº 299, Parque Santa Cruz, CEP 74860-270 Goiânia, Goiás, Brazil. raimundo58@gmail.com.
authors.forename: Raimundo Nonato Leite
authors.initials: RN
authors.lastname: Pinto
authors.affiliation: Evolution and Ecology Unit, Communications and Public Relations Division, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna-son, Kunigami-gun, Okinawa 904-0495, Japan. steven.aird@oist.jp.
authors.forename: Steven Douglas
authors.initials: SD
authors.lastname: Aird
mesh_terms: D000059:Accidents; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001733:Bites and Stings / Q000628:therapy; D001938:Brazil; D003646:Debridement; D005397:Fish Venoms / Q000633:toxicity*; D006801:Humans; D008297:Male; D012860:Skates, Fish
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005397:Fish Venoms
keywords: Potamotrygon motoro; antibiotics; pharmacology; stingray envenomation; treatment; venom chemistry