RESUMO
The efficacy of prophylactic antibiotics for preventing infectious complications at the site of pit viper envenomation has not been well studied. We undertook a prospective, controlled trial of antibiotic treatment versus no antibiotic treatment among 114 victims of crotalid envenomation in Ecuador's Amazon rain forest. A group of 59 patients received intravenous gentamicin and chloramphenicol, and 55 patients did not. All other aspects of care were identical. There were no statistically significant differences between antibiotic-treated and untreated patients with regard to demographics, delay in treatment, clinical and laboratory evidence of severity of envenomation, or use of antivenin. Nine abscesses occurred, six in the antibiotic-treated group and three in the untreated group. The results of this study did not show any statistically significant differences in outcome in terms of the number of abscesses that occurred between antibiotic-treated and untreated patients. Based on this lack of differences, routine use of prophylactic antibiotics for prevention of infectious complications of crotalid envenomation cannot be recommended.
Assuntos
Antibioticoprofilaxia , Crotalus , Mordeduras de Serpentes/tratamento farmacológico , Infecção dos Ferimentos/prevenção & controle , Abscesso/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cloranfenicol/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Equador , Feminino , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Venenos de VíborasRESUMO
Thirty-eight cases of abscess secondary to pit viper envenomation are reviewed. The incidence of abscess formation was 9%. Results of aerobic cultures revealed growth of enteric, coliform organisms in 22 of 25 isolates obtained from previously unopened abscesses. Clinical evidence for co-existent anaerobic infection is presented. No cases of tetanus were encountered. Clinical and laboratory findings of patients in the study are correlated with a review of bacteriologic investigations of the oral flora of venomous snakes. Use of antibiotics effective against aerobic coliforms and histotoxic anaerobic organisms for prophylaxis and/or treatment of infectious complications of pit viper envenomation are recommended.
Assuntos
Abscesso/microbiologia , Mordeduras de Serpentes/microbiologia , Abscesso/tratamento farmacológico , Abscesso/etiologia , Antibacterianos/uso terapêutico , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/tratamento farmacológicoRESUMO
In the ten year period 1980-1989, 97 patients were treated for tropical pyomyositis at Hospital Vozandes Oriente in eastern Ecuador, accounting for 2.2% of surgical admissions. Operation records from an affiliated hospital in Quito showed that, high on the Andean plateau, pyomyositis accounted for only 0.1% of surgical admissions. Among the patient population of Ecuador's eastern tropical rain forest, persons who were members of an indigenous ethnic group were affected with pyomyositis twice as often as would be expected from their representation in the general population.
Assuntos
Miosite/epidemiologia , Abscesso/etiologia , Adolescente , Adulto , Criança , Equador/epidemiologia , Feminino , Humanos , Masculino , Miosite/etiologia , Infecções Estafilocócicas/complicações , Clima TropicalRESUMO
Treatment outcome of 294 hospitalized victims of snakebite injuries in Eastern Ecuador are reported, documenting high rates of morbidity and mortality. One or more major complications occurred in 25% of patients. Complications included blood loss severe enough to require transfusion (29 patients), abscess (26 patients), intracranial hemorrhage (15 patients) and major tissue loss (10 patients). Sixteen patients died, yielding a mortality rate of 5.4%. Death resulted from intracranial hemorrhage in 12 patients and from sequelae of hypovolemic shock in 4 patients.
Assuntos
Mordeduras de Serpentes/epidemiologia , Abscesso/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Antivenenos/uso terapêutico , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Criança , Pré-Escolar , Equador/epidemiologia , Etnicidade , Feminino , Primeiros Socorros , Gangrena/etiologia , Hemorragia/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estações do Ano , Fatores Sexuais , Choque/etiologia , Choque/mortalidade , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/mortalidade , Mordeduras de Serpentes/terapia , Toxoide Tetânico/uso terapêuticoRESUMO
A prevalence of 4.3% (52) groin hernias were observed in 10 communities in the hyperendemic areas of onchocerciasis in Ecuador. Of the 31 patients in whom herniorrhaphy was performed, 87.1% presented with the acquired type of hernias; 15 (48.4%) with direct inguinal and 12 (38.7%) with femoral hernias, while only 12.9% (4) presented with indirect inguinal or the congenital type of hernias. This is in sharp contrast to the usual preponderance of indirect inguinal hernias reported in surveys of other population groups. Mechanisms for this association are discussed.