[Clinical, epidemiological and treatment aspects of 10 cases of saltwater stingray envenomation]

Dalmiro Cazorla, Jesús Loyo, Lusneida Lugo, María Acosta
Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición 2009, 61 (1): 11-7

INTRODUCTION: 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.

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