Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon

Jacqueline De Almeida Gonçalves Sachett,Iran Mendonça Silva,Fabiano Peixoto Costa,Vanderson Souza Sampaio,Wuelton Marcelo Monteiro,Marcus Vinícius Guimarães Lacerda,Fábio Francesconi Vale,Pedro Pereira De Oliveira Pardal,Akemi Shibuya

doi:10.1590/0037-8682-0356-2017

Abstract

This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care.

Highlights

Introduction: This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections
To identify factors associated with secondary infections from stingray injuries, a cross-sectional study was used where development of secondary bacterial infection was classified as the dependent variable
This study shows that stingray injuries prevailed across all of the study area, with a higher incidence in males living in rural areas

Summary

Introduction

This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. Conclusions: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care. Both traumatic and toxic components are involved in stingray injuries from marine or freshwater stingray punctures, and are common in coastal regions globally[1,2]. Injuries resulting from Amazonian freshwater stingrays have been reported in non-endemic countries, where these animals are kept as pets, and where physicians are less informed about the management of these types of injuries[26,27,28,29,30]

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