Aims: To characterize the frequency and clinical characteristics of venomous animals’ accidents in Mâncio Lima, Acre. Study Design: A cross-sectional study. Place and Duration of Study: The study took place in Mâncio Lima, Acre, Brazil, between 2013 and 2015. Methodology: We included a cohort of 350 households (estimated to be 1,500 people of all ages) in the urban area of Mâncio Lima. The following questionnaires were applied: I. Occurrence of accidents by venomous animals and clinical characterization of accidents; II. The detailed description of households. Results: There were 111 (8%) accidents with snakes, 138 (9.9%) accidents with scorpions, 108 (7.8%) accidents with spiders and 99 (7.1%) accidents with stingrays. Bothrops jararaca was the most cited snake, being edema (local and systemic) and muscular pain the main symptoms. In relation to scorpionism and arachnidism, the hands were the body site of the greatest number of injuries, with local pain/tingling and pain/blistering being the main symptoms, respectively. Accidents by stingrays occurred mostly in the shallow part of the river; feet and legs were the main body sites affected and local pain/bleeding were the main symptoms. Conclusion: In Mâncio Lima, there was a severe frequency of envenomation in the population, specifically in low-income brown/black male rural workers with low educational level. A counter action is required with public health measures that protects the inhabitants of the region, offering greater hospital care and wide application of serum for everyone who needs it. It is also important to educate rural workers on venomous animals and preventive measures to avoid accidents.

Context: Septic Cavernous Sinus Thrombosis (CST) is a rare and potentially lethal illness that clinicians still occasionally see. We describe the evolution of a 6 months old infant patient who had a history of delayed vaccination and acquired a Pneumococcal Meningitis, leading to septic CTS. Case report: The patient was admitted with the complaint of constant crying and vomiting. The physical exam noticed: bulging of the bregmatic fontanelle, Glasgow Coma Score = 11, and bad general state. The clinical picture had begun one week before the hospitalization, but the fever had started just three days before. The vaccine neglection plus some pathological signs of meningeal infection guided the clinical thinking to meningitis, later confirmed by the lumbar puncture. Some days later, the patient presented paralysis of the third pair of cranial nerves, conducing to the inability to open the eyes, mydriatic non-photo reagent pupils, and bilateral swelling. A magnetic resonance confirmed thrombosis of traverse sinus along with the transition to the sigmoid one. Bilateral ptosis and exotropia were noticed. Antibiotic therapy resulted in progressive eye-opening and recurrence of photo reagent reflexes. The prognosis was great, pointed by the normotension and normal amplitude of the bregmatic fontanelle. Conclusion: The elimination of the meningeal infection focus was extremely important, since the pathophysiology of CST came from phlebitis of the cavernous sinuses, with consequent thrombus formation from the endothelial lesion. In addition, it is worth mentioning the omission of vaccination, which was concessive to the case.

Background: Coronavirus disease (COVID-19), once identified, soon spread globally, becoming a pandemic. Although patients present mainly with respiratory complaints, several neurological symptoms have been reported. Symptoms range from headache and nonspecific dizziness to seizures and cerebrovascular disease (CVD). It has also been shown that the severity of the infection is directly proportional to the development of neurological symptoms, especially CVD and changes in mental status. Objective: The present study aims to briefly review the neurological manifestations of COVID-19 and discuss the pathogenic mechanisms of Central Nervous System (CNS) involvement. Methods: This is an exploratory narrative review with a descriptive approach, consisting of an active search for scientific articles in the PubMed database. The descriptors “coronavirus infections”, “COVID-19” and “Nervous system” were used, with the Boolean operators “OR” and “AND”. Eighteen articles of systematic review and meta-analysis were included. Results: CNS manifestations included, among others: encephalitis, encephalopathy, consciousness decrease, headache, dizziness, acute myelitis, and stroke. As for the peripheral nervous system, skeletal muscle damage, chemosensory dysfunction, and Guillain-Barré syndrome were observed, with hyposmia being the most common symptom. CNS involvement may be related to a worse prognosis. Conclusion: The clinical involvement of the nervous system in COVID-19 is not uncommon, and can result in several neurological complications, especially in the most critical patients. The pathophysiological mechanisms of these events still need further investigation. In the meantime, physicians should value extra-respiratory symptoms ranging from hyposmia, to potentially fatal manifestations, such as stroke and encephalopathy.

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