The unwary hiker who puts his fingers in the crack between two stones and is bitten by a viper, the child who in the woods eats what he thinks is a blueberry, but is actually the berry of poisonous plants such as jimsonweed or nightshade. But also the contact with strange animals for those who live in these latitudes – bearded fire worms, swollen and colored jellyfish similar to balloons or floating toys, such as Portuguese caravels – which arrived here perhaps by taking advantage of a ‘passage’ in the holds of ships, thanks to the global warming. It is the dangers of summer, old and new, that risk ‘poisoning’ the holidays. Reviewing the main toxicological threats is Carlo Locatelli, director of the Maugeri Poison Control and Toxicology Center (Pavia), a structure that carries out 105 thousand consultations a year, of which over 80% for NHS hospitals. Risk can also hide inside the home.
Right in the days before the holidays, the expert stresses, “with schools closed and children at home, but parents still busy with their work activities, we see a bit of an increase in accidental exposure to domestic agents, that is, cases of children who find household products and handle or ingest them. Then, as families go on vacation, the problem eases.” And others begin to appear. Looking at the data from the poison control center, “plants cause more than 650 cases in a year and half are children under 14, the classic viper bite causes about 180 cases a year and in this case the under 14s are a minority, about twenty. For spiders we have about 500 cases a year and a tenth are under 14s. Fish are responsible for about a hundred cases a year and children are 10%, but these are underestimated data because we are called for complications or for fear of more serious effects from unknown animals. We use telemedicine a lot and if we have amateur photographs of the animals or a piece of the plant that caused the accident we send them to expert botanists, arachnologists and herpetologists to identify them. We do it with berries, spiders and vipers”.
In summer, explains Locatelli, “there is an increase in plant poisoning: for example, children are attracted by the colored berries they come across when going to the mountains or in the countryside. They think it is a fruit, a blackberry or a blueberry, and instead – as has happened to us in recent days – it is jimsonweed, a very widespread plant in our latitude”. Thus they develop “central anticholinergic syndrome. There is an antidote and it is easily identified by the doctor at the poison control center. But in summer there is still a danger represented by the easier and more likely intake of poisonous vegetables and berries. There is a a bit of everything, because children also eat flowers, they are attracted by the colorful and beautiful petals which fortunately have few toxic components compared to the parts of the plant, roots, bulbs and leaves”. Then each region has its specific plant risks, “in Sicily we have mandrake poisoning which people mistake for borage, elsewhere the threat will be of another type, because there are different plants in Northern Italy, in the Alps and so on”.
And then there is a classic: viper bites. “We have them continuously in the summer period – says Locatelli – but the vipers also start to bite in February because now, with the slightly warmer climate, they are out of hibernation earlier than in previous years, when they appeared at the end of March or April The viper is widespread everywhere in our territory, except in Sardinia. We have only had one case of a viper bite in Sardinia, an adult who was unloading wood from Tuscany among which the little snake was hiding.
“The viper is practically the only native poisonous reptile and it bites humans only if they disturb it. The toxins in its venom are used to immobilize small animals and feed. So the warnings to avoid being bitten are first of all to make noise, use a stick. It is very fast, and the bite can be recognized by the two dots that correspond to the fangs with which it injects the venom. It doesn’t always do this. According to the statistics we have, 50% of bites are not ‘poisoned’, the mark remains and that’s it, we give the anti-tetanus and that’s it. Of the other 50% of cases in which the viper injects venom, in 20-25% we have to make the antidote for significant and serious poisoning. Mortality is very low, but it can happen, especially in people with underlying pathologies. Even recently we have had serious cases with ‘level 4’ intoxication, treated correctly with the antidote they have recovered”.
Among animals, the viper can be considered the number one toxicological danger. “Because we have very few poisonous spiders”, explains Locatelli. “There was panic over the violin spider, frequently present in homes, but it is not lethal, it is not its Central American cousin which is instead powerfully poisonous. The local violin spider can cause significant lesions, necrosis in the area where it bites, which then needs to be cleaned and perhaps treated with antibiotics”. There is only one more dangerous spider: it has 13 red drops on its back and its name is Latrodectus tredecimguttatus. “It strikes people who perhaps work in the fields on their knees for horticulture, or in other situations. Its venom causes convulsions, we have to use an antidote. However, it is very rare, one or two cases a year. A couple of years ago we had five or six, because the ‘malmignatta’, as we call it in Italy, is present in some years, in others it is less frequent. In any case it is clearly distinguishable and is not found in the house. It is the only spider that is a bit problematic, but its bite can be treated”.
Another topic that is very much felt by holidaymakers concerns jellyfish, along with the ‘foreign’ fish and animals that are populating the Mediterranean. “There is the dogworm (Hermodice carunculata) – lists Locatelli – also called bearded fireworm, a problem for fishermen because it ends up in their nets and has stinging spines. The modification of marine fauna is evident, partly due to the passages that occur through the Suez Canal: with the warmer water these animals” typical of other waters “come to the Mediterranean. In part they travel in the holds of ships and these when they unload the water after long intercontinental navigations free them”. The dogworm “is not new in the Mediterranean”, however “in recent years the requests for help for this cause have become more frequent”. “It happened that we followed 10 cases of burns with our center, of toxicity due to contact with the dogworm and who knows how many other people have come across this animal. When it happens, you have to remove the needles from the affected part and then we usually use hot water as the first treatment because it manages to inactivate some of the proteins a little and make the swelling and pain go away.”
Likewise, there are “jellyfish that we didn’t have before: above all the Portuguese man-of-war, Physalia physalis, characteristic of subtropical tropical seas. I was impressed because over a month ago in a Ligurian port I saw so many of them. If you come into contact with its tentacles a lot, there can also be cardiotoxicity”. Locatelli’s message is to baby swimmers: “Be careful children, don’t touch them: they seem cute to look at but if you end up in the middle of one it’s a big problem”. There is no shortage of the usual weever fish: their venom is inactivated by water at a temperature of 40-45 degrees, you have to be quick, but be careful not to burn yourself with hot water. And the ‘imported’ scorpions, very rare cases, those from North Africa and Central America are more toxic than ours”.
Fortunately, carbon monoxide poisoning is very rare in summer, “but we do have some cases, especially in August, when people go to holiday homes or long-abandoned shelters, maybe it’s cold because it’s raining and they light the fireplace, but there’s a draft problem.”
Last chapter the alarms “for rabies, a pathology that has no chemical cause, but we deal with it because we have stocks of anti-rabies immunoglobulins. Italy is a ‘rabies free’ country, but in the Northeast there is a flow of foxes and other animals that move between the neighboring countries of the East and Trentino, Friuli, Alto Veneto, and there is a greater risk. In recent years we have also had a few cases of Italians who have been bitten or touched abroad by animals such as monkeys, birds, bats, dogs, cats, in endemic areas. If it is a risk lesion, a bite or a serious wound, we treat these patients with immunoglobulins, in addition to vaccinating them, because rabies has a very high mortality rate. Then we have found animals positive for the rabies virus also in Central Italy, because the bats that come from Russia take little time to arrive in
Italy and we do not have a bat ‘customs’, so if we have any doubts we treat. A child picked up an injured bat from the ground and was bitten; in cases like this, given the time it takes to examine the animal to know if it is affected by the virus, we act preventively”, concludes Locatelli.
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