Picaduras de Insectos y Escorpiones

Epidemiología y Especies

Epidemiología

Picaduras de insectos:

• 9,3 millones de personas sufren picaduras de hormigas cada año.
• > 1 millón de picaduras anuales de otros insectos
• La anafilaxia se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aproximadamente el 3% de los LOS Neisseria casos.
• Aproximadamente 60–70 muertes al AL Amyloidosis año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos

Picaduras de escorpión:

• La mayoría de las picaduras no son letales
  • La mortalidad general es < 1 % con tratamiento oportuno.
  • El envenenamiento grave es más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños menores de 5 años.
• Más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Regiones templadas y tropicales
  • Zonas rurales
  • Meses de verano
  • Durante la noche

Especies clínicamente relevantes

El orden Hymenoptera incluye los LOS Neisseria siguientes insectos urticantes:

• Ápidos: abejas
• Véspidos:
  • Avispas
  • Chaquetas amarillas
  • Avispones
• Formícidos: hormigas coloradas

Los LOS Neisseria escorpiones venenosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos son:

• Centruroides sculpturatus (escorpión de corteza de Arizona)
• C. exilicauda (escorpión de corteza de Baja California)
• C. vittatus (escorpión rayado de la corteza)

Fisiopatología

Características generales del veneno de los LOS Neisseria himenópteros

• Enzimas proteolíticas → degradan el tejido circundante
• Las proteínas actúan como alérgenos → liberación de histamina → vasodilatación e inflamación

Ápidos

• El aguijón punzante se aloja en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel → sólo pica Pica Pica is an eating disorder characterized by a desire or recurrent compulsion to eat substances that are nonnutritive and not food. These compulsions and ingested substances are inappropriate for age or culture. Pica una vez → mata al AL Amyloidosis insecto
• El veneno contiene melitina → que produce dolor Dolor Inflammation y es citolítico

Véspidos

• Los LOS Neisseria aguijones no se quedan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel → permite múltiples picaduras
• El veneno contiene la proteína del antígeno 5 → alergénico

Formícidos

• La hormiga se ancla a la piel → pica Pica Pica is an eating disorder characterized by a desire or recurrent compulsion to eat substances that are nonnutritive and not food. These compulsions and ingested substances are inappropriate for age or culture. Pica repetidamente mientras gira en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum arco
• El veneno está formado por alcaloides → citotóxicos → pústulas estériles características

Escorpiones de corteza

• Puede picar varias veces → el veneno se agota con cada picadura
• Veneno neurotóxico → inactivación incompleta de los LOS Neisseria canales de sodio → despolarización prolongada e hiperexcitabilidad:
  • Disfunción somática y de nervios craneales
  • Liberación excesiva de acetilcolina → disfunción parasimpática
  • Liberación excesiva de epinefrina y norepinefrina → disfunción simpática

Presentación Clínica

Presentación de las picaduras de insectos

Signos y síntomas locales:

• Dolor Dolor Inflammation
• Urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives)
• Enrojecimiento
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Induración
• Aumento de temperatura
• El aguijón puede estar todavía adherido (picadura de abeja).
• Pústulas estériles (picaduras de hormigas coloradas)

Signos y síntomas sistémicos (anafilaxia):

• Urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives) generalizada
• Angioedema Angioedema Angioedema is a localized, self-limited (but potentially life-threatening), nonpitting, asymmetrical edema occurring in the deep layers of the skin and mucosal tissue. The common underlying pathophysiology involves inflammatory mediators triggering significant vasodilation and increased capillary permeability. Angioedema
• Rubor Rubor Inflammation facial (flushing, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
• Sibilancias y dificultad respiratoria
• Hipotensión

Presentación de las picaduras de escorpión

Signos y síntomas locales:

• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema leve
• Aumento de temperatura
• Dolor Dolor Inflammation y sensibilidad
• Parestesias
• Linfadenopatía regional

Signos y síntomas sistémicos (envenenamiento):

• Hallazgos de signos vitales:
  • Hipertensión
  • Taquicardia o bradicardia
  • Taquipnea
• Náuseas y vómitos
• Espasmos y fasciculaciones musculares
• Opistótonos (arqueo de la espalda), y emprostótonos (cuerpo inclinado hacia delante)
• Movimientos anormales:
  • Cuello
  • Cabeza
  • Ojos
• Ansiedad e inquietud
• Sialorrea (salivación excesiva)
• Diaforesis
• Debilidad
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar

Complicaciones:

• Insuficiencia respiratoria
• Anafilaxia
• Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis

Diagnóstico y Tratamiento

Diagnóstico

Las picaduras de insectos y escorpiones son diagnósticos clínicos.

Tratamiento de las picaduras de insectos

Tratamiento general:

• Limpiar con agua y jabón.
• Retire el aguijón (con un movimiento de raspado, no apretando).
• Aplicar compresas frías.
• Terapia médica:
  • AINE o paracetamol paracetamol Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen para la analgesia Analgesia Methods of pain relief that may be used with or in place of analgesics. Anesthesiology: History and Basic Concepts
  • Antihistamínicos
  • Corticoides tópicos
  • Prednisona oral para reacciones grandes y localizadas

Tratamiento de reacciones alérgicas graves y anafilaxia:

• Evaluar y estabilizar la vía aérea.
• Terapia médica:
  • Antihistamínicos (antagonistas H1 y H2)
  • Epinefrina
  • Corticosteroides
  • Líquidos intravenosos

Prevención:

• La inmunoterapia con veneno es eficaz para reducir la posibilidad de anafilaxia recurrente.
• Los LOS Neisseria pacientes con anafilaxia previa a las picaduras deben llevar una jeringa de epinefrina.

Tratamiento de la picadura de escorpión

La mayoría de las picaduras sólo requieren cuidados de soporte. Los LOS Neisseria cuidados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de escorpiones venenosos pueden incluir:

• Observación durante al AL Amyloidosis menos 4 horas
• Intubación por insuficiencia respiratoria inminente
• Terapia médica:
  • AINE u opioides para el dolor Dolor Inflammation
  • Benzodiacepinas para los LOS Neisseria espasmos musculares
  • Antihipertensivos intravenosos, según sea necesario
• Antiveneno para la disfunción músculo esquelética y/o de nervios craneales

Diagnóstico Diferencial

• Picaduras de arañas: la araña reclusa parda contiene un veneno necrotizante que puede provocar una herida dolorosa, ampollosa y necrótica, fiebres, mialgias, hemólisis, convulsiones e insuficiencia renal. El veneno neurotóxico de la araña viuda negra puede provocar calambres y rigidez muscular, inestabilidad de los LOS Neisseria signos vitales, lagrimeo, salivación, ptosis Ptosis Cranial Nerve Palsies y dificultad respiratoria. El diagnóstico es clínico. El tratamiento incluye el cuidado de las heridas, el tratamiento del dolor Dolor Inflammation, el antiveneno para las picaduras de araña viuda negra y el desbridamiento retardado del tejido necrótico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las picaduras de reclusa parda.
• Mordedura de ofidio: La evidencia de envenenamiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el lugar de la mordedura incluye edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, eritema, calor Calor Inflammation, ampollas y necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage. Pueden presentarse síntomas sistémicos como náuseas, diaforesis, parestesias y alteración del sensorio. Además, el veneno de la serpiente coral puede provocar la flacidez de los LOS Neisseria músculos. El diagnóstico es clínico. El tratamiento incluye cuidados de soporte, control del dolor Dolor Inflammation, hidratación y antiveneno. Los LOS Neisseria pacientes son monitorizados estrechamente para detectar shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock, coagulopatía, insuficiencia respiratoria e insuficiencia renal.
• Asma ASMA Autoimmune Hepatitis: enfermedad inflamatoria crónica que provoca hiperreactividad bronquial y obstrucción del flujo de aire. Los LOS Neisseria pacientes suelen presentar sibilancias, tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome y disnea. Generalmente no se observa urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives) ni hipotensión. El diagnóstico se confirma con una prueba de función pulmonar que evidencia un patrón obstructivo reversible. El tratamiento se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gravedad de los LOS Neisseria síntomas y puede incluir oxigenoterapia, broncodilatadores, corticoides inhalados, esteroides sistémicos e intubación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de insuficiencia respiratoria.
• Angioedema Angioedema Angioedema is a localized, self-limited (but potentially life-threatening), nonpitting, asymmetrical edema occurring in the deep layers of the skin and mucosal tissue. The common underlying pathophysiology involves inflammatory mediators triggering significant vasodilation and increased capillary permeability. Angioedema hereditario: trastorno autosómico dominante caracterizado por episodios recurrentes de edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema grave ( angioedema Angioedema Angioedema is a localized, self-limited (but potentially life-threatening), nonpitting, asymmetrical edema occurring in the deep layers of the skin and mucosal tissue. The common underlying pathophysiology involves inflammatory mediators triggering significant vasodilation and increased capillary permeability. Angioedema). La inflamación de la vía aérea puede restringir la respiración y provocar una obstrucción de la vía aérea potencialmente mortal. El diagnóstico se realiza mediante la evaluación de los LOS Neisseria niveles del inhibidor de C1 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sangre. El tratamiento incluye danazol Danazol A synthetic steroid with antigonadotropic and anti-estrogenic activities that acts as an anterior pituitary suppressant by inhibiting the pituitary output of gonadotropins. It possesses some androgenic properties. Danazol has been used in the treatment of endometriosis and some benign breast disorders. Antiestrogens, inhibidores de la calicreína e inhibidores de C1.
• Botulismo: intoxicación por la toxina del Clostridium botulinum Clostridium botulinum A species of anaerobic, gram-positive, rod-shaped bacteria in the family clostridiaceae that produces proteins with characteristic neurotoxicity. It is the etiologic agent of botulism in humans, wild fowl, horses; and cattle. Seven subtypes (sometimes called antigenic types, or strains) exist, each producing a different botulinum toxin (botulinum toxins). The organism and its spores are widely distributed in nature. Clostridia que puede provocar parálisis simétrica de los LOS Neisseria nervios craneales y parálisis muscular descendente. En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico pueden utilizarse la electromiografía y los LOS Neisseria ensayos de toxinas. El tratamiento incluye terapia de soporte, intubación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de deterioro respiratorio y administración de antitoxinas.