Infrared thermography to diagnose and manage venomous animal bites and stings

Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation.

METHODS

This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera.

RESULTS

In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation.

CONCLUSIONS

IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Keywords:
Infrared thermography; Envenomation; Venomous animals

Authorship

Carlos Roberto de Medeiros

Hospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil. Instituto ButantanBrazilSão Paulo, SP, BrazilHospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil.

Marcos Leal Brioschi

Divisão de Neurologia e Neurocirurgia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, São Paulo, Brasil.Universidade de São PauloBrazilSão Paulo, SP, BrazilDivisão de Neurologia e Neurocirurgia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, São Paulo, Brasil.

Solange Nogueira de Souza

Hospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil. Instituto ButantanBrazilSão Paulo, SP, BrazilHospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil.

Manoel Jacobsen Teixeira

Corresponding author: Dr. Carlos Roberto de Medeiros. e-mail:carlos.medeiros@butantan.gov.br

Conflicts of interest: The authors declare that there is no conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Hospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil. Instituto ButantanBrazilSão Paulo, SP, BrazilHospital Vital Brazil, Instituto Butantan, São Paulo, SP, Brasil.

Figures

Figures (3)

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FIGURE 1
Snakebites. Case 1: A 28-year-old man was bitten on his right middle finger by a lance-headed viper identified as Bothrops moojeni (A) 15 minutes prior to arrival at the hospital. Erythema, marked edema, and two fang marks could be observed at the bite site (B). Infrared imaging (IR) conducted one day after the snakebite showed a significant asymmetry between the temperatures observed in both the bitten and the healthy upper limbs (ΔT=1.8ºC) (C). Case 2: A 28-year-old healthy man was bitten by a rattlesnake (Crotalus durissus terrificus) (D) on his right index finger an hour and a half prior to arriving at the hospital. On arrival, he reported mild pain at the bite site, generalized myalgia, and visual impairment. He had a small erythematous lesion on his right index finger without swelling, (E) and pronounced ptosis. The IR conducted ten hours after the snakebite showed a significant temperature rise at the bite site, as confirmed by the difference between the temperatures of the fingertips of the index and little fingers (ΔT=3.6ºC) (F). Case 3: A 27-years-old woman was bitten on her left fourth toe by a lance-headed viper identified as Bothrops jararaca (G) about two hours prior to admission to the hospital. On arrival, she reported only pain at the bite site, with two localized fang marks, but without localized erythema, edema, ecchymosis, or systemic symptoms (H). Results of routine laboratory tests, including her coagulation profile, were normal. After 18 hours of observation, the patient showed no other symptoms, the diagnosis was considered to be dry bite, and she was discharged without the use of antivenom. The IR performed at admission showed no asymmetry between the temperatures observed in both lower limbs (ΔT=0 ºC) (I).

Thumbnail

FIGURE 2
Scorpion stings. Case 4: A 16-year-old girl was stung by a scorpion identified as Tityus serrulatus (A) about two hours prior to admission to the hospital. Clinical examination on admission revealed a severe, localized, burning pain with a small area of erythema on the left scapular region (B). The infrared imaging (IR) performed on admission showed a significant temperature rise at the sting site (ΔT=1.5ºC) (C). Case 4: A 49-year-old man was admitted with a Tityus bahiensis (D) scorpion sting on his right middle finger one hour before admission. He complained of local pain radiating to the whole forearm. He had a small area of erythema on the distal phalanx of the affected finger (E). The IR performed on admission showed a region with decreased temperature extending from the sting site to the elbow (ΔT=-1.8ºC) (F).

Thumbnail

FIGURE 3
Spider bites. Case 6: A 56-year-old man was admitted to our hospital two hours and a half after being bitten on his right hallux by a Brazilian wandering spider identified as Phoneutria nigriventer (A). Clinical examination showed local severe burning pain radiating to the knee and a small area with erythema involving his right hallux (B). The infrared imaging (IR) performed on admission showed a region with increased temperature extending from the bite site to the knee (ΔT=7.4ºC) (C). Case 7: A 71-year-old woman was bitten on her neck by a brown spider identified as Loxosceles gaucho (D). She visited the hospital about 19 hours after being bitten. She presented with an erythematous area of 4×2cm in the right cervical region (E). There was no local necrosis. The IR performed on admission showed a significant increase in temperature at the bite region (ΔT=2.2ºC) (F). Case 8: A 32-year-old man visited the hospital three days after being bitten by a brown spider (Loxosceles sp) on his right popliteal region. Clinical examination showed an erythematous area of approximately 8×4 cm with a central brownish-crimson area of 5×6 cm with thin dark blisters (G). After 21 days of evolution, the wound had become a well-defined ulcer (H). The IR carried out at this time (I) showed significant asymmetry between the temperatures observed in both lower limbs (ΔT=1.2ºC). In the affected leg, a central area with decreased temperature was observed, corresponding to the necrotic wound.

FIGURE 1 Snakebites. Case 1: A 28-year-old man was bitten on his right middle finger by a lance-headed viper identified as Bothrops moojeni (A) 15 minutes prior to arrival at the hospital. Erythema, marked edema, and two fang marks could be observed at the bite site (B). Infrared imaging (IR) conducted one day after the snakebite showed a significant asymmetry between the temperatures observed in both the bitten and the healthy upper limbs (ΔT=1.8ºC) (C). Case 2: A 28-year-old healthy man was bitten by a rattlesnake (Crotalus durissus terrificus) (D) on his right index finger an hour and a half prior to arriving at the hospital. On arrival, he reported mild pain at the bite site, generalized myalgia, and visual impairment. He had a small erythematous lesion on his right index finger without swelling, (E) and pronounced ptosis. The IR conducted ten hours after the snakebite showed a significant temperature rise at the bite site, as confirmed by the difference between the temperatures of the fingertips of the index and little fingers (ΔT=3.6ºC) (F). Case 3: A 27-years-old woman was bitten on her left fourth toe by a lance-headed viper identified as Bothrops jararaca (G) about two hours prior to admission to the hospital. On arrival, she reported only pain at the bite site, with two localized fang marks, but without localized erythema, edema, ecchymosis, or systemic symptoms (H). Results of routine laboratory tests, including her coagulation profile, were normal. After 18 hours of observation, the patient showed no other symptoms, the diagnosis was considered to be dry bite, and she was discharged without the use of antivenom. The IR performed at admission showed no asymmetry between the temperatures observed in both lower limbs (ΔT=0 ºC) (I).

FIGURE 2 Scorpion stings. Case 4: A 16-year-old girl was stung by a scorpion identified as Tityus serrulatus (A) about two hours prior to admission to the hospital. Clinical examination on admission revealed a severe, localized, burning pain with a small area of erythema on the left scapular region (B). The infrared imaging (IR) performed on admission showed a significant temperature rise at the sting site (ΔT=1.5ºC) (C). Case 4: A 49-year-old man was admitted with a Tityus bahiensis (D) scorpion sting on his right middle finger one hour before admission. He complained of local pain radiating to the whole forearm. He had a small area of erythema on the distal phalanx of the affected finger (E). The IR performed on admission showed a region with decreased temperature extending from the sting site to the elbow (ΔT=-1.8ºC) (F).

FIGURE 3 Spider bites. Case 6: A 56-year-old man was admitted to our hospital two hours and a half after being bitten on his right hallux by a Brazilian wandering spider identified as Phoneutria nigriventer (A). Clinical examination showed local severe burning pain radiating to the knee and a small area with erythema involving his right hallux (B). The infrared imaging (IR) performed on admission showed a region with increased temperature extending from the bite site to the knee (ΔT=7.4ºC) (C). Case 7: A 71-year-old woman was bitten on her neck by a brown spider identified as Loxosceles gaucho (D). She visited the hospital about 19 hours after being bitten. She presented with an erythematous area of 4×2cm in the right cervical region (E). There was no local necrosis. The IR performed on admission showed a significant increase in temperature at the bite region (ΔT=2.2ºC) (F). Case 8: A 32-year-old man visited the hospital three days after being bitten by a brown spider (Loxosceles sp) on his right popliteal region. Clinical examination showed an erythematous area of approximately 8×4 cm with a central brownish-crimson area of 5×6 cm with thin dark blisters (G). After 21 days of evolution, the wound had become a well-defined ulcer (H). The IR carried out at this time (I) showed significant asymmetry between the temperatures observed in both lower limbs (ΔT=1.2ºC). In the affected leg, a central area with decreased temperature was observed, corresponding to the necrotic wound.

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Infrared thermography to diagnose and manage venomous animal bites and stings

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Mensagem

[1] Corresponding author: Dr. Carlos Roberto de Medeiros. e-mail:carlos.medeiros@butantan.gov.br