Accident involving a 2-year-old child and Lonomia obliqua venom: clinical and coagulation abnormalities

Epidemiological characterization of lonomism in South America

Lonomism is the envenomation caused by accidental contact with Lonomia caterpillars, and this is a public health priority in South America since it is relatively common but remains underestimated. This study presents an updated and integrative analysis of reliable global data from 1960 to 2020 on the epidemiology of this envenomation in the whole continent. A total of 13,186 notifications were recorded for South America: 13,056 (99.01%) in Brazil, 49 (0.37%) in Argentina, 43 (0.33%) in Colombia, 29 (0.22%) in Venezuela, 6 (0.05%) in Peru and 3 (0.02%) in French Guiana. The number of new locations reporting accidents has increased since the first formally notifications at the middle of the last century. Most of these locations are situated in Brazil, the pioneer in deeply researching the Lonomia genus and its impacts in public health. Most victims were males, in the economically productive age group, and accidental contact occurred more frequently in the upper limbs while doing activities outdoors in urban/rural areas. Regarding the determinants of clinical outcome, countries where patients received delayed medical care were associated with a higher number of moderate and/or severe cases, as well as a higher chance of progressing to death. Additionally, the longer the delay for accessing medical care, the higher the risk of developing systemic complications, thereby increasing the need for specific treatment. Our study also shows that accidents globally occurred more frequently in the summer months and in the beginning of autumn. Although having identified several shortcomings in the documents selected and verified that notifications are strongly biased by public policies adopted by each South American country, this study provides the first comprehensive assessment of lonomism in South America, demonstrating the increase in the number of accidents, and their expansion to other areas of the continent over time. Our findings will undoubtedly help guide the appropriate allocation of resources and implementation of prevention strategies and define priority criteria for epidemiological surveillance of this neglected tropical disease.

Lonomia envenomation in Brazil: an epidemiological overview for the period 2007-2018

BACKGROUND

Among the Lepidoptera with medical importance in Brazil, larvae of Lonomia moth (Saturniidae: Hemileucinae) stand out by being the etiological agent of the lonomism, a form of erucism in which the most troubling symptoms include systemic hemorrhage that can lead to death.

METHODS

This study provides an epidemiological overview of accident notifications with Lonomia registered by the Brazilian Reportable Disease Information System (SINAN) between 2007 and 2018. The categories of sociodemographic aspects of the victim, accident characteristics, and clinical data (6,636 records) were analysed by the chi-square test for goodness of fit (α=0.05). By the same test, accident frequencies by month, year, and state were also compared. To explore the spatial distribution of notifications and to identify significant space-time and purely spatial clusters, a spatial scan statistic (SaTScan) was used.

RESULTS

The epidemiological profile of most of the victims had at least one of the following characteristics: male, >50 y of age, ethnically classified as white, and with a low level of education. Accidents in urban areas were as frequent as in rural areas. A higher frequency of non-work-related accidents was detected. Victims were mostly stung on the upper limbs. Most victims received medical care within the first 3 h after the accident. Most cases were classified as mild, although 12 deaths were reported. The south states of Brazil concentrate the highest frequencies of notifications. Summer was the season with the greatest number of cases, and the majority of the notifications occurred between 2017 and 2018.

CONCLUSION

These results provide an overall and current situation assessment of the lonomism in Brazil, and they should enable health authorities to improve the management of this envenomation in states/regions that share the high epidemiological risk of exposure to Lonomia.