Ação neuro-muscular do veneno crotálico: dados preliminares

Silva, Maria Dorvalina; Resende, Luiz Antônio L.; Ueda, Anete Kimuni; Barraviera, Benedito; Mendes, R.P.; Montenegro, Mário Rubens G.

doi:10.1590/S0004-282X1996000100001

Resumos

Estudamos 6 pacientes, 2 cães e um coelho com intoxicação crotálica. Avaliamos a condução nervosa periférica sensitiva e motora, a transmissão neuromuscular e eletromiografias. As biópsias de músculo foram processadas por histoquímica. Os 6 pacientes apresentaram mononeuropatia sensitiva no nervo periférico adjacente ao local da inoculação do veneno e encontramos evidências histoquímicas de miopatia mitocondrial. Os defeitos da transmissão neuromuscular foram mínimos. A maioria dos autores admite que veneno crotálico determina síndrome miastênica. Nossos achados indicam que ptose palpebral, facies miastênico e fraqueza muscular observados após acidente crotálico, correspondem provavelmente a miopatia mitocondrial, muitas vezes transitória e reversível.

veneno crotálico; mononeuropatia sensitiva; miopatia mitocondrial

We studied 6 patients and 2 dogs that have been bitten by South American rattlesnake Crotalus durissus terrificus and one rabbit inoculated with crotalid venom. We analized sensory and motor peripheral nerve conduction, repetitive stimulation for studying neuromuscular transmission and electromyographies. Muscle biopsies were processed by histochemistry. All patients had peripheral mononeuropathy of the closest sensitive nerve to the area of snakebite. The neuromuscular transmission alterations were minimal. Muscle histochemistry of 4 patients, 2 dogs and 1 rabbit showed findings of mitochondrial myopathy. The majority of authors admit that crotalid venom causes myastenic syndrome. Our findings suggest that palpebral ptosis, myastenic facies and muscular weakness observed after crotalid poisoning are, probably, due to transient and reversible mitochondrial myopathy. As far as we know, this is the first report on the ability of the venom of this rattlesnake to cause local sensitive mononeuropathy and the first muscle histochemistry showing mitochondrial myopathy in humans poisoned by crotalid venom.

crotalid venom; sensory mononeuropathy; mitochondrial myopathy

Ação neuro-muscular do veneno crotálico: dados preliminares

Neuromuscular action of crotalid venom: preliminar data

Maria Dorvalina Silva^I; Luiz Antônio L. Resende^II; Anete Kimuni Ueda^III; Benedito Barraviera^IV; R.P. Mendes^V; Mário Rubens G. Montenegro^VI

^IDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Médica Assistente do Setor de Eletroneuromiografia

^IIDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Professor Assistente-Doutor de Neurologia

^IIIDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Professora Assistente-Doutora

^IVDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Professor Adjunto de Moléstias Infecciosas

^VDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Professor Titular de Moléstias Infecciosas

^VIDepartamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP: Professor Emérito de Patologia

RESUMO

Estudamos 6 pacientes, 2 cães e um coelho com intoxicação crotálica. Avaliamos a condução nervosa periférica sensitiva e motora, a transmissão neuromuscular e eletromiografias. As biópsias de músculo foram processadas por histoquímica. Os 6 pacientes apresentaram mononeuropatia sensitiva no nervo periférico adjacente ao local da inoculação do veneno e encontramos evidências histoquímicas de miopatia mitocondrial. Os defeitos da transmissão neuromuscular foram mínimos. A maioria dos autores admite que veneno crotálico determina síndrome miastênica. Nossos achados indicam que ptose palpebral, facies miastênico e fraqueza muscular observados após acidente crotálico, correspondem provavelmente a miopatia mitocondrial, muitas vezes transitória e reversível.

Palavras-chave:veneno crotálico, mononeuropatia sensitiva, miopatia mitocondrial.

ABSTRACT

We studied 6 patients and 2 dogs that have been bitten by South American rattlesnake Crotalus durissus terrificus and one rabbit inoculated with crotalid venom. We analized sensory and motor peripheral nerve conduction, repetitive stimulation for studying neuromuscular transmission and electromyographies. Muscle biopsies were processed by histochemistry. All patients had peripheral mononeuropathy of the closest sensitive nerve to the area of snakebite. The neuromuscular transmission alterations were minimal. Muscle histochemistry of 4 patients, 2 dogs and 1 rabbit showed findings of mitochondrial myopathy. The majority of authors admit that crotalid venom causes myastenic syndrome. Our findings suggest that palpebral ptosis, myastenic facies and muscular weakness observed after crotalid poisoning are, probably, due to transient and reversible mitochondrial myopathy. As far as we know, this is the first report on the ability of the venom of this rattlesnake to cause local sensitive mononeuropathy and the first muscle histochemistry showing mitochondrial myopathy in humans poisoned by crotalid venom.

Key words:crotalid venom, sensory mononeuropathy, mitochondrial myopathy.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 19-setembro-1995.

Estudo realizado nos Departamentos de Neurologia, Moléstias Infecciosas e Patologia da Faculdade de Medicina de Botucatu, UNESP

Dr. Luís Antônio de Lima Resende - Departamento de Neurologia, Faculdade de Medicina de Botucatu -18618-000 Botucatu SP - Brasil.

1. Azevedo-Marques MM, Cupo P, Coimbra TM, Hering SE, Rossi MA, Laura CJ. Myonecrosis, myoglobinuria and acute renal failure induced by south american rattlesnake (Crotalus durissus terrificus) envenomation in Brazil. Toxicon 1985; 23:631-636.
2. Azevedo-Marques MM, Hering SE, Cupo P. Evidence that Crotalus durissus terrificus (south american rattlesnake) envenomation in humans causes myolysis rather than hemolysis. Toxicon 1987; 25:1163-1168.
3. Azevedo-Marques MM, Cupo P, Amaral CFS, Hering SE. Rattlesnake bites: clinical features and complementary tests. Mem Inst Butantan 1990; 52(Supl):27-30.
4. Barraviera B. Estudo clínico dos acidentes ofídicos: revisão 1993. JBM 1993; 65:209-250.
5. Barraviera B, Coelho KYR, Curi PR, Meira DA. Liver dydfunction in patients bitten by Crotalus durrisus terrificus (Laurenti, 1768) snakes in Botucatu (State of São Paulo, Brazil). Rev Inst Med Trop São Paulo 1995; 37:63-69.
6. Chang CC, Lee JD. The presynaptic neuromuscular blocking action of taipoxin: a comparasion whit beta-burgarotoxin and crotoxin. Toxicon 1977; 15:571-576.
7. Cupo P, Azevedo-Marques MM, Hering SE. Clinical and laboratory features of South American rattlesnake (Crotalus durissus terrificus) envenomation in children. Trans R Soc Trop Med Hyg 1988; 82:924-929.
8. Cupo P, Azevedo-Marques MM, Hering SE. Acute myocardial infarction-like enzyme profile in human victims of Crotalus durissus terrificus envenoming. Trans R Soc Trop Med Hyg 1990; 84:447-451.
9. Cupo P, Azevedo-Marques MM, Hering SE. Acidente crotálico na infância: aspectos clínicos, laboratoriais, epidemiológicos e abordagem terapêutica. Rev Soc Bras Med Trop 1991; 24:87-96.
10. Dempster DW, Gopalarishnakone P, Hawgood BJ. Intramitochondrial calcium deposits associated witli muscle necrosis induced by crotoxin. J Physiol 1980; 300:19.
11. Dubowitz V. Muscle biopsy: a praticai approach. Ed 2. London: Bailliére Tindall, 1985; 19-40.
12. Ekenbäck K, Hulting J, Persson H, Wernell I. Unusual neurological symptoms in a case of severe crotalid envenomation. J Toxicol Clin Toxicol 1985; 23:357-364.
13. Giorgi R, Bemardi MM, Cury Y. Analgesic effect evoked by low molecular weight substances extracted from Crotalus durissus terrificus venom. Toxicon 1993; 31:1257-1265.
14. Gopalakrishnakone P, Hawgood BJ. Morphological changes in murine nerve, neuromuscular junction and skeletal muscle induced by the crotoxin complex. J Physiol 1979;291:5-6.
15. Gopalakrishnakone P, Dempster DW, Hawgood BJ, Elder HY. Cellular and mitochondrial changes induced in the structure of munire skeletal muscle by crotoxin, a neurotoxic phospholipase A₂ complex. Toxicon 1984; 22:85-98.
16. Hadler WA, Vital-Brazil O. Pharmacology of crystalline crotoxin. IV. Nephorotoxicity. Mem Inst Butantan 1966; 33:1001-1008.
17. Hawgood BJ, Smith JW. The mode of action at the moudse neuromuscular junction of the phospholipase A-crotapotin complex isolated from venom of the south american rattlesnake. Br J Pharmacol 1977; 61:597-606.
18. Jorge MT, Pereira Jr, Júnior WB, Ribeiro LA, Amato-Neto V, Rassi IE, Salem A. Comportamento de enzimas e alterações anátomo-patológicas do músculo esquelético em pacientes picados por serpente do gênero Crotalus. Rev Soe Bras Med Trop 1986;19(Supl):29.
19. Kamiguti AS, Cardoso JLC. Haemostatic changes caused by the venoms of south american snakes. Toxicon 1989;27:995-963.
20. Kimura J. Eletrodiagnosis in diseases of nerve and muscle: principles and practice. Philadelphia: FA Davis, 1983.
21. Kouyoumdjian JA, Harris JB, Johnson MA. Muscle necrosis caused by the sub-units of crotoxin. Toxicon 1986;24:575-583.
22. Magalhães RA, Ribeiro MMF, Resende NA, Amaral CFS. Rabdomiólise secundaria a acidente ofídico crotálico (crotalus durissus terrificus). Rev Inst Med Trap São Paulo 1986; 28:228-233.
23. Radvanyi F, Saliou B, Lembezat MP, Bon C. Binding of crotoxin, a presynaptic phospholipase A, neurotoxin, to negatively charged phospholipid vesicles. J Neurochem 1989;53:1252-1260.
24. Rossi MA. Peres LC, Paola F, Cupo P, Hering SE, Azevedo-Marques MM. Eletron-microscopic study of systemic myonecrosis due to poisoning by tropical rattlesnake (Crotalus durissus terrificus) in humans. Arch Pathol Lab Med 1989;113:169-173.
25. Shah AJ, Sahgal V, Muschler G, Subramani V, Singh H. Morphogenesis of the mitochondrial alterations in muscle diseases. J Neurol Sci 1982;55:25-37.
26. Siqueira JE, Higuchi ML, Nabut N, Lose A, Souza JK, Nakashima M. Lesão miocárdica em acidente ofídico pela espécie Crotalus durissus terrificus (cascavel): relato de caso. Arq Bras Card 1990;54;323-325.
27. Su MJ, Chang CC. Presynaptic effects of snake venom toxins which have phospholipase A₂ activity (beta-bungarotoxin, Taipoxin, crotoxin). Toxicon 1984; 22:631-640.
28. Vital Brazil O. Pharmacology of crystalline crotoxin: II. Neuromuscular blocking action. Mem Inst Butantan 1966; 33:981-992.
29. Vital Brasil O, Eugênio AGB, Laszlo GM. Origem da paralisia respiratória causada pela crotoxina. Ciência e Cultura 1973; 25:1165-1169.

Datas de Publicação

Publicação nesta coleção
07 Dez 2010
Data do Fascículo
Mar 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Azevedo-Marques MM, Cupo P, Coimbra TM, Hering SE, Rossi MA, Laura CJ. Myonecrosis, myoglobinuria and acute renal failure induced by south american rattlesnake (Crotalus durissus terrificus) envenomation in Brazil. Toxicon 1985; 23:631-636.

[2] 2. Azevedo-Marques MM, Hering SE, Cupo P. Evidence that Crotalus durissus terrificus (south american rattlesnake) envenomation in humans causes myolysis rather than hemolysis. Toxicon 1987; 25:1163-1168.

[3] 3. Azevedo-Marques MM, Cupo P, Amaral CFS, Hering SE. Rattlesnake bites: clinical features and complementary tests. Mem Inst Butantan 1990; 52(Supl):27-30.

[4] 4. Barraviera B. Estudo clínico dos acidentes ofídicos: revisão 1993. JBM 1993; 65:209-250.

[5] 5. Barraviera B, Coelho KYR, Curi PR, Meira DA. Liver dydfunction in patients bitten by Crotalus durrisus terrificus (Laurenti, 1768) snakes in Botucatu (State of São Paulo, Brazil). Rev Inst Med Trop São Paulo 1995; 37:63-69.

[6] 6. Chang CC, Lee JD. The presynaptic neuromuscular blocking action of taipoxin: a comparasion whit beta-burgarotoxin and crotoxin. Toxicon 1977; 15:571-576.

[7] 7. Cupo P, Azevedo-Marques MM, Hering SE. Clinical and laboratory features of South American rattlesnake (Crotalus durissus terrificus) envenomation in children. Trans R Soc Trop Med Hyg 1988; 82:924-929.

[8] 8. Cupo P, Azevedo-Marques MM, Hering SE. Acute myocardial infarction-like enzyme profile in human victims of Crotalus durissus terrificus envenoming. Trans R Soc Trop Med Hyg 1990; 84:447-451.

[9] 9. Cupo P, Azevedo-Marques MM, Hering SE. Acidente crotálico na infância: aspectos clínicos, laboratoriais, epidemiológicos e abordagem terapêutica. Rev Soc Bras Med Trop 1991; 24:87-96.

[10] 10. Dempster DW, Gopalarishnakone P, Hawgood BJ. Intramitochondrial calcium deposits associated witli muscle necrosis induced by crotoxin. J Physiol 1980; 300:19.

[11] 11. Dubowitz V. Muscle biopsy: a praticai approach. Ed 2. London: Bailliére Tindall, 1985; 19-40.

[12] 12. Ekenbäck K, Hulting J, Persson H, Wernell I. Unusual neurological symptoms in a case of severe crotalid envenomation. J Toxicol Clin Toxicol 1985; 23:357-364.

[13] 13. Giorgi R, Bemardi MM, Cury Y. Analgesic effect evoked by low molecular weight substances extracted from Crotalus durissus terrificus venom. Toxicon 1993; 31:1257-1265.

[14] 14. Gopalakrishnakone P, Hawgood BJ. Morphological changes in murine nerve, neuromuscular junction and skeletal muscle induced by the crotoxin complex. J Physiol 1979;291:5-6.

[15] 15. Gopalakrishnakone P, Dempster DW, Hawgood BJ, Elder HY. Cellular and mitochondrial changes induced in the structure of munire skeletal muscle by crotoxin, a neurotoxic phospholipase A₂ complex. Toxicon 1984; 22:85-98.

[16] 16. Hadler WA, Vital-Brazil O. Pharmacology of crystalline crotoxin. IV. Nephorotoxicity. Mem Inst Butantan 1966; 33:1001-1008.

[17] 17. Hawgood BJ, Smith JW. The mode of action at the moudse neuromuscular junction of the phospholipase A-crotapotin complex isolated from venom of the south american rattlesnake. Br J Pharmacol 1977; 61:597-606.

[18] 18. Jorge MT, Pereira Jr, Júnior WB, Ribeiro LA, Amato-Neto V, Rassi IE, Salem A. Comportamento de enzimas e alterações anátomo-patológicas do músculo esquelético em pacientes picados por serpente do gênero Crotalus. Rev Soe Bras Med Trop 1986;19(Supl):29.

[19] 19. Kamiguti AS, Cardoso JLC. Haemostatic changes caused by the venoms of south american snakes. Toxicon 1989;27:995-963.

[20] 20. Kimura J. Eletrodiagnosis in diseases of nerve and muscle: principles and practice. Philadelphia: FA Davis, 1983.

[21] 21. Kouyoumdjian JA, Harris JB, Johnson MA. Muscle necrosis caused by the sub-units of crotoxin. Toxicon 1986;24:575-583.

[22] 22. Magalhães RA, Ribeiro MMF, Resende NA, Amaral CFS. Rabdomiólise secundaria a acidente ofídico crotálico (crotalus durissus terrificus). Rev Inst Med Trap São Paulo 1986; 28:228-233.

[23] 23. Radvanyi F, Saliou B, Lembezat MP, Bon C. Binding of crotoxin, a presynaptic phospholipase A, neurotoxin, to negatively charged phospholipid vesicles. J Neurochem 1989;53:1252-1260.

[24] 24. Rossi MA. Peres LC, Paola F, Cupo P, Hering SE, Azevedo-Marques MM. Eletron-microscopic study of systemic myonecrosis due to poisoning by tropical rattlesnake (Crotalus durissus terrificus) in humans. Arch Pathol Lab Med 1989;113:169-173.

[25] 25. Shah AJ, Sahgal V, Muschler G, Subramani V, Singh H. Morphogenesis of the mitochondrial alterations in muscle diseases. J Neurol Sci 1982;55:25-37.

[26] 26. Siqueira JE, Higuchi ML, Nabut N, Lose A, Souza JK, Nakashima M. Lesão miocárdica em acidente ofídico pela espécie Crotalus durissus terrificus (cascavel): relato de caso. Arq Bras Card 1990;54;323-325.

[27] 27. Su MJ, Chang CC. Presynaptic effects of snake venom toxins which have phospholipase A₂ activity (beta-bungarotoxin, Taipoxin, crotoxin). Toxicon 1984; 22:631-640.

[28] 28. Vital Brazil O. Pharmacology of crystalline crotoxin: II. Neuromuscular blocking action. Mem Inst Butantan 1966; 33:981-992.

[29] 29. Vital Brasil O, Eugênio AGB, Laszlo GM. Origem da paralisia respiratória causada pela crotoxina. Ciência e Cultura 1973; 25:1165-1169.