Abstract: Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Abstract This review presents the main species of venomous and poisonous arthropods, with commentary on the clinical manifestations provoked by the toxins and therapeutic measures used to treat human envenomations. The groups of arthopods discussed include the class Arachnida (spiders and scorpions, which are responsible for many injuries reported worldwide, including Brazil); the subphylum Myriapoda, with the classes Chilopoda and Diplopoda (centipedes and millipedes); and the subphylum Hexapoda, with the class Insecta and the orders Coleoptera (beetles), Hemiptera (stink bugs, giant water bugs, and cicadas), Hymenoptera (ants, wasps, and bees), and Lepidoptera (butterflies and moths).

AbstractLionfish are venomous fish that belong to the Scorpaenidae family. Individuals of this family and those of the Synanceiidae family comprise most of the existing venomous fish in the world. Lionfish are originally found in the Indo-Pacific, but they have received special attention in the last years for their dissemination in the Atlantic Ocean, with the emergence of large populations in the USA, Caribbean and South America. Because of its beauty, this fish has always been present in private and commercial aquariums around the world. Herein, we describe 15 envenomations in aquarists registered in a period of eighteen years (1997–2014). The stings caused excruciating pain and marked inflammation, with local erythema, edema, heat, paleness and cyanosis. In one case, it was possible to observe vesicles and blisters. There were no skin necroses or marked systemic manifestations. We discuss the possible coming of the fish to South America and the circumstances and clinical impact of the envenomations.

Stingrays are a group of rays – cartilaginous fish related to sharks – that have whiplike tails with barbed, usually venomous spines and are found around the world, especially the marine species. Despite recent reports of accidents involving these fish, they are not aggressive, reacting only when stepped on or improperly handled. Injuries by stingrays are seldom mentioned by historians, although they have always been present in riverine communities of inland waters and in South American coasts. Indeed, envenomations by stingrays are quite common in freshwater and marine fishing communities. Although having high morbidity, such injuries are neglected because they have low lethality and usually occur in remote areas, which favor the use of folk remedies. In the present review article, historical aspects of injuries caused by stingrays in Brazil and their distribution on the coast of São Paulo state and riverine communities of the North, Midwest and Southeast regions were studied. In addition, other aspects were analyzed such as clinical features, therapeutic methods, preventive measures and trends in occurrence of these accidents in the country, particularly in areas in which freshwater stingrays had not been previously registered, being introduced after breaching of natural barriers.

Os autores relatam um envenenamento causado por um cnidário, a caravela (Physalia physalis), em uma mulher de 42 anos. A paciente apresentou uma reação incomum manifestada por pápulas purpúricas surgidas após a fase inicial de envenenamento (cerca de 24 horas depois) quando foram observadas pápulas lineares edematosas e eritematosas. As reações tardias nos acidentes por cnidários comumente apresentam erupções recorrentes e pigmentações locais.

We report the case of a 42-year old woman who was envenomed by a Portuguese man-o'-war (Physalia physalis). She presented an anomalous reaction manifested by purpuric papules that appeared after the initial phase of envenoming (around 24 hours later), when linear erythematous and edematous papules were observed. Late-onset reactions in accidents involving cnidarians commonly include chronic eruptions and local pigmentation.

Um paciente de 24 anos relatou ter pisado em um "piolho de cobra". Ao ser examinado, este apresentava máculas eritêmato-cianóticas, nos três primeiros pododáctilos do pé direito, com queixas de dor local e parestesias, com fluxos arteriais palpáveis. Os diplopodas são artrópodos cilíndricos segmentados que assumem posição enrodilhada - quando ameaçados - liberam quinonas e outros agentes irritativos e pigmentantes. A coloração de aspecto cianótico lembra sofrimento tissular isquêmico, o que pode confundir profissionais em atendimentos de Emergência, quando a história não apresenta clareza e coerência.

A 24 year-old patient reported having stepped on a millipede. When examined the patient presented cyanotic and erythematous macules on the first three toes of his right foot, and also complained of local pain and paresthesia, with palpable arterial flows. Millipedes are cylindrical segmented arthropods that when threatened form into curls and release quinones and other irritant and pigmentary substances. The cyanotic color reminds ischaemic tissular distress fact that may confuse professionals in Emergency Rooms when the clinical report is unclear.

A partir de um acidente causado pela picada de uma formiga falsa tocandira na mão de um pescador amador, os autores descrevem os achados clínicos locais observados, tais como edema, eritema e dor excruciante e a evolução do envenenamento, que cursou com fenômenos sistêmicos imediatos, como sudorese fria, náuseas, vômitos, mal estar, taquicardia e linfadenopatia axilar à esquerda. Após três horas, a dor intensa persistia e o paciente apresentou um episódio de hematoquesia, sem história anterior de enfermidades do trato digestivo, hematológicas ou vasculares. O uso de analgésicos (Tramal® 300 mg/dia), água quente e gelo não melhorou a dor, que arrefeceu em oito horas, tendo permanecido por cerca de 24 horas. São apresentados ainda os aspectos folclóricos, farmacológicos e clínicos relacionados às picadas de tocandiras.

The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world.

Os peixes da família Batrachoididae causam um grande número de acidentes em pescadores das regiões Norte e Nordeste do Brasil. O gênero Thalassophryne apresenta várias espécies no Brasil e a espécie Thalassophryne nattereri é a mais comum, todas apresentando veneno. O veneno é inoculado por duas espículas ocas na nadadeira dorsal e duas nas regiões pré-operculares, ligadas a uma glândula de veneno na base. Os envenenamentos causaram dor intensa, edema e eritema iniciais em 43 pescadores observados em Salinópolis (Pará) e Aracaju (Sergipe). Em todos os casos, não ocorreram fenômenos sistêmicos dignos de nota, mas ocorreu necrose local em oito pacientes e infecção bacteriana em dez. As circunstâncias dos acidentes são comentadas, assim como aspectos terapêuticos. Nossa conclusão foi que o envenenamento por Thalassophryne é importante e freqüente e deve ser considerado de média gravidade, em função de não haverem fenômenos sistêmicos, como observado nos acidentes por peixes-escorpião (Scorpaena) ou arraias marinhas e fluviais.

Fishes of family Batrachoididae are responsible for great number of injuries in fishermen in North and Northeast regions of Brazil. The genus Thalassophryne presents various venomous species of fishes found in the Brazilian coast, T. nattereri being the most common of them. The venom is ejected through two hollow spines on the dorsal fin and two on pre-opercular regions, which present a venomous gland in the base and can be erected or depressed by the fish. The manifestations of the envenoming were intense local pain, edema and erythema in 43 patients observed in Salinópolis (Pará State) and Aracaju (Sergipe State). There were no systemic manifestations, but necrosis was detected in eight and bacterial infection in ten injured fishermen. The circumstances of the contacts and therapeutic aspects are discussed. Envenoming by the genus Thalassophryne is important and frequent and should be considered of moderate severity grade, since there are not the excruciating pain or the massive local necrosis provoked by scorpionfishes (Scorpaena) or stingrays injuries nor the systemic manifestations that are the most important marker of severe envenoming.

Foram analisados, em um estudo retrospectivo, 359 casos de loxoscelismo comprovados ou presumidos, acompanhados no Hospital Vital Brazil, Instituto Butantan, São Paulo, Brasil, entre 1985 e 1996. A aranha foi identificada em 14% dos casos. Os acidentes predominaram nas áreas urbanas (73%), entre setembro e fevereiro. Pacientes maiores de 14 anos foram mais freqüentemente atingidos (92%) e 41% foram picados ao se vestir. Apenas 11% procuraram o serviço médico nas primeiras horas após a picada. A forma cutânea foi a mais freqüente (96%), sendo as principais manifestações descritas: dor (76%), eritema (72%), edema com enduração (66%), equimose (39%). Necrose cutânea ocorreu em 53% dos pacientes, sendo mais freqüentemente observada no tronco, coxa e braço, e naqueles que procuraram atendimento médico mais de 72 horas após o acidente. Infecção local foi detectada em 12 pacientes (3%). A hemólise foi confirmada em 4 casos (1,1%). Exantema generalizado, febre e cefaléia foram observados em 48% dos pacientes. Não se verificou insuficiência renal ou óbito. O antiveneno foi administrado em 66% dos casos, associado a corticosteróide em 47% ou a dapsona em 30%. O diagnóstico presuntivo de loxoscelismo pode ser estabelecido baseado em achados clínicos e epidemiológicos. Maiores investigações são necessárias para se comprovar o valor do antiveneno e outras drogas.

A retrospective study analysed 359 proven or presume cases of loxoscelism seen at the Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1985 and 1996. The spider was identified in 14%. The bites occurred predominantly in the urban areas (73%) between September and February. Patients > 14 years were commonest inflicted (92%) and 41% were bitten while getting dressed. Only 11% sought medical care within the first 12 hours post bite. Cutaneous loxoscelism was the commonest form presenting (96%); commonest manifestations were: pain (76%), erythema (72%), edema with enduration (66%), ecchymosis (39%). Skin necrosis occurred in 53% of patients, most frequently seen on trunk, tigh and upper arm, and when patients seek medical care more than 72 hours after bite. Local infection was detected in 12 patients (3%). Hemolysis was confirmed in 4 cases (1.1%). Generalised cutaneous rash, fever and headache were also observed in 48% of the total of patients. None of them had acute renal failure or died. Treatment usually involved antivenom administration (66%), being associated with corticosteroids (47%) or dapsone (30%). Presumptive diagnosis of loxoscelism may be established based on clinical and epidemiological findings. Further investigations are required to prove the value of antivenom and other treatment schedules.

Os autores relatam cinco acidentes de "seabather's eruption" ou prurido do traje de banho, uma erupção típica associada na maioria das vezes à água-viva Linuche unguiculata (Cnidaria), que causa um "rash" pápulo-eritematoso extremamente pruriginoso em áreas cobertas por trajes de banho. O quadro cutâneo é característico e a erupção é comum no Caribe, Flórida, México e estados americanos do Golfo. Os casos são os primeiros relatados no Brasil e larvas de Linuche unguiculata estão presentes nas águas onde ocorreram os acidentes.

The authors report five cases of seabather's eruption, a typical dermatitis associated predominantly to the jellyfish Linuche unguiculata (Cnidaria), that causes erythematous and pruriginous papules on areas of the skin of bathers covered by swimsuits. The rash is characteristic and the eruption is commom in the Caribbean, Florida, Mexico and Gulf States of USA. The cases are the first reported in Brazil and larvae of the jellyfish are present in the waters where the accidents happened.