Tetanus after envenomations caused by freshwater stingrays

Area of Science:

• Toxicology
• Infectious Diseases
• Dermatology

Background:

• Freshwater stingray injuries are common but underreported in South America.
• Riverside populations and fishermen are primary victims, with increasing incidence among tourists.
• Envenomations cause intense pain, inflammation, necrosis, and are potentially tetanogenic.

Observation:

• Secondary infections, commonly by Aeromonas species like Aeromonas hydrophila, are frequent complications of stingray injuries.
• The injuries are considered potentially tetanogenic, a risk often overlooked in clinical settings.
• This report details two cases of tetanus following freshwater stingray injuries.

Findings:

• The first case involved a 51-year-old male who recovered from tetanus without sequelae.
• The second case, a 67-year-old male, developed severe tetanus, necrotizing soft-tissue infection, sepsis, and septic shock, ultimately leading to death.
• These cases represent the first documented instances of tetanus resulting from freshwater stingray injuries.

Implications:

• Freshwater stingray injuries pose a significant public health risk due to potential for severe infections, including tetanus.
• Increased awareness and preventative measures are crucial for riverside communities, fishermen, and tourists in endemic areas.
• Prompt medical evaluation and management, including tetanus prophylaxis, are essential for all freshwater stingray envenomations.