Accidents with Animals of Medical Interest in Brazil

1. Alexandre Naime Barbosa MD, PhD
Infectious Diseases Professor
Winter School on Tropical Diseases
Botucatu School of Medicine - UNESP
2016 - Botucatu - SP - Brazil

2. O material que se segue faz parte do projeto didático do
Prof. Dr. Alexandre Naime Barbosa
Objetivos
1. Ensino: Treinamento de Estudantes e Profissionais da Área de Saúde;
2. Extensão: Facilitar o Contato da População em Geral com Conceitos Científicos;
3. Científico: Fomentar a Discussão Científica e Compartilhar Material Didático.
Autoria e Cessão
1. Conteúdo: Os dados contidos estão referenciados, em respeito ao autor original;
2. Uso: Está permitido o uso do material, desde que citada a fonte;
3. Contato: fale com o autor e conheça o seu projeto didático em:

3. The following material is part of the educational project produced by
Prof. Dr. Alexandre Naime Barbosa
Objectives
1. Education: Training for Students & Health Professionals
2. Community: Provide and Translate Scientific Information to the Population;
3. Scientific: Encourage the Scientific Discussion and Share Teaching Materials.
Authorship and Assignment
1. Content: The following data are referenced in respect to the original author;
2. Use: It is allowed to use the material, if the source is mentioned;
3. Contact: Talk to Dr. Barbosa and keep in touch with his project in:

4. 1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

5. • Land area: 5th in the World, 3rd in Americas
• Climate: from equatorial to temperate
• Environment: from rainforests to deserts
• Ecosystems: highly diversified
• Perfect scenario for a huge biodiversity Wikipedia, 2013

6. • Brazil: 1st country in biodiversity
• Mammals: 689; Fish: over 3,000
• Birds: 1,832; Reptiles: 744
• Invertebrates: over 200,000
• Wildlife distribution: Biomes
Brazil Environment Ministry, 2011

7. • Biomes: six main regions
• Amazon: The biggest and most bio-diverse
• Pantanal: World's largest wetland area
• Atlantic Forest: A biodiversity hotspot
• Atlantic Ocean: Marine biodiversity
• Others: Caatinga, Savannah and Lowlands
Embrapa, 2012

9. • Rainforest in the Amazon River Basin
• Equatorial Climate, hot and wet (rain)
• Venom: Snakes, Fish, Frogs and Invertebrates
• Trauma: Mammals, Reptiles, Fish and Invertebrates
WWF, 2014

10. Some Venomous and Poisonous Animals
1. Snakes: Bothrops sp.; Lachesis sp.
2. Fish: Stingrays, Catfishes
3. Frogs: Dendrobatidae Family
4. Invertebrates: Spiders, Scorpions, Bees, Ants, etc.
Haddad Jr et al. JVAT, 2013

11. Venomous Snake: Bothrops sp. (Jararaca, Jararacuçu, Urutu)
- 90% of Snakes Bites; over 60 species
- 70 centimeters to 2 meters
- Throughout Brazil
- Nocturnal, prefers wet places
Anacassia Lima, 2012

12. Venomous Snake: Bothrops sp. (Jararaca, Jararacuçu, Urutu)
- Proteolytic, Coagulant and Hemorrhagic
- Local edema, pain and necrosis
- Coagulopathy, bleeding and renal failure
- Fatality rate (Tx): 0,31 %, AV available
Anacassia Lima, 2012

13. Venomous Snake: Lachesis sp. (Surucucu)
- 1,5 % of Snakes Bites; 3 species
- 2 to 4 meters
- Amazon and Atlantic Forest
- Prefers dense forests
Anacassia Lima, 2012

14. Venomous Snake: Lachesis sp. (Surucucu)
- Proteolytic, Coagulant, Hemorrhagic and Neurotoxic
- Coagulopathy, bleeding and vagal hyperactivity
- Local edema, pain and necrosis
- Fatality rate (Tx): 0,95%, AV available
Anacassia Lima, 2012

15. Venomous Fish: Freshwater Stingrays (Arraia de Água Doce)
- Severe pain, local edema and erythema
- Cutaneous necrosis and secondary infection
- Lytic properties not fully studied
- Supportive therapy (hot water)
Haddad Jr et al. JVAT, 2013

16. Poisonous Frog: Dendrobatidae Family (Sapos/Rãs)
- Not venomous, but poisonous (skin)
- Toxicity through the consumption of small insects
- Produce one of the most lethal toxins
- Exposure: intentional, in rituals
The Sapo Diaries, 2013

17. Some Trauma Injuries by Animals
1. Mammals: Panthera onca, Tapirus terrestris, Myrmecophaga tridactyla
2. Fish: Vandellia cirrhosa, Electrophorus electricus
3. Reptiles: Eunectes sp., Black Caiman
4. Invertebrates: Blatella germanica
Voz do Acre Journal, 2012

18. Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
- Mainly in the Amazon and Pantanal
- Recently new cases in Brazil
- Ecotourism and Fishing tourism
- “Onça-seeing” tourism
Campos Neto et al. WEM 2011

19. Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
Predatory Attack 1: Non Fatal
- Fishermen boat, 17y/o man
- cranial-encephalic trauma
- brain and bone tissue loss, memory deficit
Campos Neto et al. WEM 2011

20. Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
Predatory Attack 2: Fatal
- Fisherman tent, 21y/o man
- cervical transection of the spinal cord
- cervical and brain tissue and bone loss
Campos Neto et al. WEM 2011

21. Trauma Mammal: Myrmecophaga tridactyla (Anteater or Tamanduá)
- Tamanduá: 2 meters, 40 kg
- Rare accidents
- 47y/o male hunter attacked by defense
- Death due to wounds in femural artery
Haddad et al. WEM 2014

22. Trauma Fish: Vandellia cirrhosa (Candiru)
- Small parasitic freshwater catfish, 12 cm
- Attracted by urine, enter through the urethra
- Umbrella-like spines, only removed after surgery
- Symptoms: pain and urethra bleeding FUNASA

23. Trauma Fish: Electrophorus electricus (Poraquê)
- Big freshwater knifefish, 2 - 3 meters
- Powerful electric shocks of up to 600 volts
- Shocks used hunting and self-defense
- 4,2% of all aquatic animals accident in a fishermen cohort
GarroneNeto et al. CSP 2005

24. Trauma Reptile: Eunectes sp. (Anaconda, Sucuri)
- One of the biggest snakes; 2 to 10 meters
- Non venomous
- Several reports of attacks to humans
- Only accidental attacks
The NYC, 2010
Google

25. Trauma Reptile: Black Caiman (Jacaré-açu)
- Not common, accidental
- 11y/o girl bathing on a river was attacked
- Many wounds and femur fracture
- Death due to drowning
Haddad Jr et al. WEM, 2011

26. Ueida et al. IJD 2013
Trauma Invertebrate: Blatella germanica (Cockroach, barata)
- Cockroach bites in massive infestation
- Poor sanitary conditions, indigenous people
- Secondary infections, allergy
- Cockroach can enter the ear, nose or mouth

28. • Wetland in the Paraguay River Basin
• Tropical Climate, dry or rainy season
• Venom: Snakes, Fish and Invertebrates
• Trauma: Mammals, Reptiles, Fish and Invertebrates
IBAMA, 2013

29. Some Venomous Animals
1. Snakes: Bothrops sp.
2. Fish: Stingrays, Freshwater Catfish
3. Invertebrates: Spiders, Scorpions, Bees, etc.
Haddad Jr et al. RSBMT, 2012

30. Venomous Fish: Freshwater Catfish
P. Maculatus (mandijuba) and P. corruscans (surubim)
- Venomous stingers
- Pain, inflammation and bleeding
- Ulcer can be a complication
Haddad Jr et al. RSBMT, 2012

31. Some Trauma Animals
1. Mammals: Panthera onca, Tapirus terrestris, etc.
2. Fish: Serrasalmus sp.
3. Reptiles: Eunectes sp, Caiman sp.
Haddad Jr et al. RSBMT, 2012

32. Trauma Fish: Serrasalmus sp. (Piranha)
- No report of massive attack to humans
- Generally 1 single bite per person
- Outbreaks related to bathing
- Circular wound, laceration of tissues
Haddad Jr et al. WEM 2003

33. Trauma Reptiles: Caiman sp. (Jacaré do Pantanal)
- Very rare, accidental
- Fisherman 61y/o, only bite on hand
- Pain, blending, edema and secondary infection
- Trauma and hand fracture
Campos Neto et al. DT 2013

35. • Tropical Forest in the Atlantic Coast
• Tropical and Subtropical Climate
• Venom: Snakes, Fish and Invertebrates
• Trauma: Mammals, Fish and Invertebrates
IBAMA 2013

36. Some Venomous Animals
1. Snakes: Bothrops sp.; Crotalus sp.; Micrurus sp
2. Fish: Stingrays, Freshwater Catfish
3. Invertebrates: Spiders, Scorpions, Bees, etc.
Butantan Institute

37. Venomous Snakes: Crotalus sp. (Cascavel)
- 7,7 % of Snakes Bites; 32 species (1Br)
- 50 centimeters to 1,5 meters
- Atlantic Forest, Cerrado, Caatinga
- Prefers rocky and dry places
Anacassia Lima, 2012

38. Venomous Snakes: Crotalus sp. (Cascavel)
- Coagulant, Miotoxic and Neurotoxic
- Bleeding, dark urine and myalgia
- Ptosis, myasthenic face and renal failure
- Fatality rate (Tx): 1,85%, AV available
CEVAP, 2011

39. Venomous Snakes: Micrurus sp (Coral)
- 0,4 % of Snakes Bites; 65 species
- 90 centimeters to 1,5 meters
- Thoughout Brazil
- Reclusive behavior, beneath the ground
M. M. Moura, 2012

40. Venomous Snakes: Micrurus sp (Coral)
- Neurotoxic only, but very potent
- Acute progressive myasthenic syndrome
- Paralysis of respiratory muscles, death
- Fatality rate: 0,36%; AV available Anacassia Lima, 2012

41. Venomous Invertebrates: Spiders
Phoneutria sp. (Armadeira)
- Agressive, 17 centimeters
- Neurotoxic venom, but in low dose
- Painful, dangerous to children, AV available
Funasa, 2009

42. Venomous Invertebrates: Spiders
Loxosceles sp. (Aranha marrom)
- Not agressive, 4 centimeters
- Necrotic venom
- Without acute symptoms, AV available
Funasa, 2009

43. Venomous Invertebrates: Scorpions
Tityus serrulatus (yellow) and T. bahiensis (brown)
- Local pain and inflammation
- Potential Neurotoxic Venom
- Dangerous to children, AV available
Funasa, 2009

44. Venomous Invertebrates: Caterpillar
Lonomia sp.
- Local pain and inflammation
- Hemorrhagic syndrome and Renal Failure
- Rare but possible deaths, AV available
SMS Curitiba, 2012

45. Venomous Invertebrates: Bees
Apis Mellifera (Africanized honey bees)
- 9,000 accidents/y, 26 deaths (2011)
- Complex venom, and allergic reaction
- No specific antivenom, supportive therapy
CEVAP, 2011

46. Some Trauma Animals
1. Mammals: Tapirus terrestris, Porcupines, etc.
2. Fish: Serrasalmus sp, etc.
Google

47. Trauma Mammals: Tapirus terrestris (Anta)
- Tapir: 2 meters, 200 kg
- Rare accidents
- 55y/o male farmer bitten three times
- Death due to bite in the cervical region Haddad Jr et al. WEM, 2005

48. Trauma Mammals: Porcupines (Ouriços-cacheiros)
- Porcupines: small rodent
- Rare accidents, non aggressive behavior
- 34y/o male tourist tried to capture
- After spines removed, the pain stopped
Haddad Jr et al. JVAT 2010

50. • Extension: 9.198 km
• Climate: from equatorial to temperate
• Venom: Fish and Invertebrates
• Trauma: Fish and Invertebrates
Google

51. Some Venomous Animals
1. Fish: Stingrays, Marine Catfish and Scorpionfish.
2. Invertebrates: Sponges, Man-of-war, Jellyfish, Octopus and Sea Urchin
Google

52. Venomous Fish: Scorpionfish
Scorpaena sp. (Mangangá)
- Venomous stings in fin
- Strong and long pain
- Necrosis can be a complication
Brasil Reef

53. Venomous Invertebrates: Sponges
Tedania, Neofibularia and Microciona
- Irritating slime and spikes
- Allergic symptoms
Haddad, 2013

54. Venomous Invertebrates: Man-of-war
Physalia physalis, Caravela
- Small distal spicules
- Toxic and an allergic action
- Severe pain (like burning)
- Systemic repercussion
Haddad, 2013
Google

55. Venomous Invertebrates: Jellyfish
Medusa, Água Viva
- Small distal spicules
- Toxic and an allergic action
- Severe pain (like burning)
- Systemic repercussion
Haddad, 2013
Google

56. Some Trauma Animals
1. Fish: Moray eels (Muraenidae), Sharks, etc.
2. Invertebrates: Sea Urchin, Crabs, etc.
Haddad, 2015Google

57. Trauma Invertebrates: Sea Urchin
Ouriço do Mar
- Spine penetration and breaking
- Pain and Inflammation
- Granuloma and Secondary Infection
- Most common injury Haddad, 2013

58. • 1927-2015: 143 attacks (official data)
• Systematic report: only after 1992
• Main concentration in the Northeast Region
• Metropolitan area of Recife is the most affected
• Main species: Bull, Tiger, Sand Tiger and Great White

59. • 1927-1992: only 6 attacks in Pernambuco (official data)
• Systematic report: only after 1992
• 1992-2015: 60 attacks (until July 2015)
• Metropolitan area of Recife is the most affected
• Main species: Bull (cabeça chata) and Tiger (tigre)
Pernambuco State
CEMIT, 2013

60. • Shark Attacks in beaches
- Boa Viagem and Piedade: 69.4%
- Urban and crowded beaches
CEMIT, 2013
Google

61. • Deaths between 1992-2015:
- 24 deaths from 60 attacks reported
- Mortality rate: 40%
- Deaths by Exposure Category: Bathers = 83.3%
- 2012-2015 (until August): 5 attacks (4 fatal), 4 males, all bathers
- Cause of death: massive trauma injuries
CEMIT, 2013
Google

62. • The most recent death, case report:
- 07/21/2013, Monday, 1:20 p.m.
- Boa Viagem beach, tourists in the water
- Two girls were taken by sea current to a deeper area
- Lifeguard was called due to drowning risk
- Trying to swim, an 18 y/o female was bitten by a shark Globo TV, 2013
OESP, 2013

63. • The most recent death, case report:
- Rescued from the water and taken to the hospital, 2 episodes of CRA
- Hypovolemic sock, BP: 0x0, unconscious
- Trauma lesion on the left leg
- Extensive blood, musculature and bone loss
- Amputation of the leg and all supportive therapies were performed
- Death after 10 hours of the attack
OESP, 2013
Restauração Hospital Archive

64. • Why are these attacks so frequent? General Reasons
- Same habitat: high population densities of sharks and humans
- Public warnings are constantly ignored, mainly by tourists
- Sea sports and other activities are increasing (e.g. surf)
- Splashing of arms and legs can attract sharks
- An occasional attack can be considered normal

65. • Why are these attacks so frequent? Specific Reasons
- High frequency of aggressive shark species
OESP, 2013

66. • Why are these attacks so frequent? Specific Reasons
- Topography: a deep channel, 100 meters of the shore
OESP, 2013

67. • Why are these attacks so frequent? Specific Reasons
1. Changes in the Suape
bay, a natural nursery of
aquatic life, in order to
build the port (1980) could
have dislodged the sharks.
2. Sharks usually follow the
ships
3. Waste and blood from a
slaughterhouse were thrown
into a close river.OESP, 2013

68. Biodiversity: Brazilian Coins

69. • In a continental country, huge biodiversity
• Many animal can be dangerous to humans
• Disturbs to the ecological balance = Accidents
• Research and learn with animals biology and behavior
• Fight against predatory exploration of the wildlife

70. Obrigado pela Atenção!