ABSTRACT
ABSTRACT Background: Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019. Methods: Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão. Results: A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases). Conclusions: The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.
ABSTRACT
Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.(AU)
Subject(s)
Animals , Thrombocytopenia , Bites and Stings , Antivenins , Risk Factors , Trimeresurus , Crotalid Venoms , Necrosis , Wounds and InjuriesABSTRACT
Phalotris lemniscatus es la única especie representante del género Phalotris en Uruguay. Esta especie tiene una amplia distribución que incluye Uruguay, Rio Grande do Sul en Brasil y el norte de Argentina que se extiende a las áreas fronterizas con Bolivia y Paraguay. Aunque este ofidio no es agresivo, se registraron dos accidentes en Uruguay en los que se observó acción local y sistémica del veneno. Los mismos ocurrieron en las manos después de manipulación excesiva y prolongada de los ejemplares. Localmente presentaron edema leve, pero en términos sistémicos el veneno de Phalotris causó alteraciones en la coagulación. Los pacientes se recuperaron totalmente después de 3 días. Serán necesarios más estudios para establecer una terapia adecuada para los envenenamientos graves provocados por esta especie.
Phalotris lemniscatus is the only species representative of Phalotris genus in Uruguay. This species has a wide distribution that includes Uruguay, Rio Grande do Sul in Brazil and northern Argentina extending to the areas bordering Bolivia and Paraguay. Although this snake is not aggressive, there were two snakebite accidents in Uruguay. They occurred on the hands after excessive and prolonged handling of the specimens. Locally they showed mild edema, but in systemically Phalotris venom caused alterations in blood coagulation. The patients recovered completely after 3 days. More studies will be required to establish an adequate therapy for Phalotris severe envenomations.
Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Snake Bites/drug therapy , Snake Bites/blood , Snake Venoms/toxicity , Uruguay/epidemiologyABSTRACT
Antivenoms have been widely used for more than a century for treating snakebites and other accidents with poisonous animais. Despite their efficacy, the use of heterologous antivenoms involves the possibility of adverse reactions due to activation of the immune system. In this paper, alternatives for antivenom production already in use were evaluated in light of their ability to minimize the occurrence of adverse reactions. These effects were classified according to their molecular mechanism as: anaphylactic reactions mediated by IgE, anaphylactoid reactions: aused by complement system activation, and pyrogenic reactions produced mainly by the presence of endotoxins in the final product. ln the future, antivenoms may be replaced by humanized antibodies, specific neutralizing compounds or vaccination. Meanwhile, improvements in antivenom quality will be focused on the obtainment of more purified and specific product in compliance with good manufacturing practices and at an affordable cost