Predictors of complications in venomous snakebites

Objectives: Factors responsible for causing complications in venomous snakebites are unknown. The present study was planned to identify such factors. Material and Methods: This was a prospective and observational study. All patients presenting to the emergency department between April 2016 and August 2017 with venomous snakebites and meeting inclusion/exclusion criteria were enrolled. Patients were divided into two groups based on the presence/absence of complications. Risk factors associated with complications were analyzed. Results: Out of 236 patients screened, 156 were eligible. Mean age was 39.5 ± 15.6; majority (n = 122, 78.2%) were in the age group of 20–59 years; 119 (76.3%) were males. Eighty-eight patients (56.4%) developed complications, of which, cellulitis/compartment syndrome (n = 54, 34.6%) was most common, followed by acute kidney injury (n = 18, 11.5%), coagulopathy/disseminated intravascular coagulation (n = 17, 10.9%), neuroparalysis needing ventilator (n = 12, 7.7%), shock (n = 8, 5.1%), acute respiratory distress syndrome (three patients, 1.9%), and sepsis (one patient, 0.6%). The mortality rate was 1.92%. On univariate analysis, low hemoglobin, elevated neutrophil count, lower lymphocyte count, serum creatinine, initial/total dose of anti-snake venom, and prolonged hospital stay had a statistically significant association with complications. On multivariate analysis, elevated neutrophil count (OR 1.084; 95% CI 0.997, 1.179) and prolonged hospital stay (OR 1.975; 95% CI 1.393, 2.800) were associated with complications. Bite-to-needle time was associated with mortality. Conclusion: The nature of complications depends on composition of venom, and thus varies with geographical region. The Association of neutrophil and lymphocyte counts points to an inflammatory hypothesis. The Association of bite-to-needle time with mortality highlights the early use of antivenom. Awareness of risk factors may guide in predicting complications.

Snakebites caused by the genera Bothrops and Lachesis in the Brazilian Amazon: a study of factors associated with severe cases and death

ABSTRACT Background: Snakebites are a major problem in developing countries owing to their high morbidity rates, severity, and sequelae. In Brazil, most cases of envenomation are caused by Bothrops and Lachesis snakes. The present study aimed to evaluate variables associated with death, systemic complications, and amputations in victims of envenomation due to Bothrops or Lachesis snake. Methods: An analytical epidemiological study was performed with data from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação [SINAN]) relating to the Brazilian Amazon for the period 2010-2015. A hierarchical Poisson regression analysis was performed with three aspects, namely, individual characteristics, sociodemographic characteristics, and clinical conditions. Results: The following associations were observed: i) advanced age (>65 years), sepsis, renal failure, and hemorrhagic manifestations were related to two outcomes - death due to snakebite and death from all causes; ii) more advanced age (≥46 years), time to health care longer than 6 hours, renal and hemorrhagic manifestations, and region of occurrence being rural areas were associated with systemic complications; and iii) children (up to 12 years old) were associated with amputations. Conclusions: Knowledge of the characteristics associated with severe outcomes in snakebites may help identify patients who will require more intensive care or longer follow-up and may provide the physician with counseling rationale for their possible prognosis.

Severe tissue complications in patients of Bothrops snakebite at a tertiary health unit in the Brazilian Amazon: clinical characteristics and associated factors

Abstract INTRODUCTION: Snakebites in the Brazilian Amazon are caused mostly by snakes from the Bothrops genus and envenomated patients may suffer from tissue complications. METHODS: This study aimed to identify risk factors for severe tissue complications (STC) in patients with Bothrops snakebite in the Amazonas state, Brazil. RESULTS: Snakebites that were classified as severe and affected female patients with comorbidities presented greater risks of developing STCs. In addition, hospitalizations of patients with STC exceeded 5 days. CONCLUSIONS: Clinical and epidemiological characteristics can prove essential for assessing the evolution of STC and clinical prognosis of patients with Bothrops snakebites.

Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

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)

The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia

Abstract INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

Ophidian envenomings in a region of Brazilian Western Amazon / Envenenamentos ofídicos em uma região da Amazônia Ocidental Brasileira

INTRODUCTION: Snakebites are a public health problem and are considered clinical emergencies, what makes studies in high-incidence regions very importantOBJECTIVE: To describe the clinical and epidemiological aspects of patients suffering from snakebite accidents in a region of the Western Amazon, BrazilMETHODS: It is a cross-sectional, retrospective and documentary quantitative approach, from 2015 to 2016, held at the Regional Hospital of Juruá, located in the city of Cruzeiro do Sul, Acre, Brazil. Epidemiological data were obtained from the forms of the Notification Disease Information System (SINAN), in the Epidemiological Surveillance Sector of the hospital. The following variables were verified: month of occurrence, snake identification (type of accident), accident location (urban and rural), locality, municipality, victim data (age group, sex, anatomical region affected), symptoms and signs circumstances of the accident, time elapsed between accident and care, number of ampoules used, and type of serumRESULTS: An average of 124 cases of snakebites were treated per year (76.71 cases per 100,000 inhabitants/year), most of them were botropic accidents and the patients were male adult and rural workers, bitten in the lower limbs. More than 30% of cases were treated six hours after poisoning and 24-hour care is a risk factor for complications, as seven of the eight patients who had complications were treated within one day of the accidentCONCLUSION: It was presented a constant increase in the cases, which generated a worrying point of reflection, which may be associated with two factors, where one turns to the improvement in the displacement of victims (improvements in branch roads and implementation of SAMU speedboat) facilitating plus transport and telephone coverage by improving communication, or the failure of public health policies to provide better conditions and guidance to the population

INTRODUÇÃO: Os acidentes ofídicos são um problema de saúde pública e são considerados emergências clínicas, motivo este que torna os estudos em regiões de grande incidência muito importantesOBJETIVO: Descrever os aspectos clínicos e epidemiológicos de pacientes vítimas de acidentes ofídicos em uma região da Amazônia Ocidental, BrasilMÉTODO: Trata-se de um transversal, retrospectivo e documental de abordagem quantitativa, no período de 2015 a 2016, realizado no Hospital Regional do Juruá, localizado na cidade de Cruzeiro do Sul, Acre, Brasil. Os dados epidemiológicos foram obtidos a partir das fichas do Sistema de Informação de Agravos de Notificação (SINAN), no Setor de Vigilância Epidemiológica do hospital. Foram verificadas as seguintes variáveis: mês de ocorrência, identificação da serpente (tipo de acidente), local do acidente (zona urbana e rural), localidade, município, dados da vítima (faixa etária, sexo, região anatômica atingida), sintomas e sinais apresentados, circunstâncias do acidente, tempo decorrido entre o acidente e o atendimento, a quantidade de ampolas utilizadas e o tipo de soro no tratamento das vítimasRESULTADOS: Foram atendidos em média 124 casos de acidentes ofídicos por ano (76,71 casos por 100.000 habitantes/ano), sendo a maioria acidentes botrópicos e os pacientes constituídos por indivíduos adultos do sexo masculino e trabalhadores rurais, picados nos membros inferiores. Mais de 30% dos casos foram atendidos seis horas após o envenenamento e o atendimento após 24 horas é um fator de risco para complicações, uma vez que sete dos oito pacientes que apresentaram complicações foram atendidos depois de um dia do acidenteCONCLUSÃO: Apresentou um crescente constante nos casos, o que gerou um ponto de reflexão preocupante, que pode estar associado a dois fatores, onde um volta-se para a melhora no deslocamento das vítimas (melhorias nas estradas dos ramais e implantação de lancha do SAMU) facilitando mais o transporte e na cobertura de telefonia melhorando a comunicação, ou a falha das políticas de saúde pública na oferta de melhores condições e orientações para a população

Construction and validation of an educational booklet to provide care for snakebite victims / Construcción y validación de una cartilla educativa para la atención de víctimas de ofidismo / Construção e validação de cartilha educativa para prestação de cuidados às vítimas de ofidismo

ABSTRACT Objective: To describe the process of construction and validation of an educational booklet for the care of snakebite victims. Methods: Methodological research on the process of building and validating an educational booklet. The construction was developed based on Echer's theoretical framework with validation performed by thirteen judges, from January to April 2019. The items evaluated were the following: structure and appearance; objectives and relevance using the Likert scale. For the validation analysis, the Content Validity Index (CVI) was used, with a cut-off point higher than 0.78. Results: The booklet contained the following items: Presentation, Snakebite Accidents: What they are, Incidence in Brazil, Santa Casa de Sobral, Types Genus, Signs and Symptoms, Prevention, Immediate Conduct, Severity and Treatment, In-Hospital Care and, finally, References. None of the items evaluated presented a value below the minimum agreement adopted. The global mean of the CVI was 0.94, confirming the validation of the booklet with the judges. The evaluators also made suggestions, which were accepted. Conclusions: The construction of the material clarified the best care and prevention strategies and its objectives, appearance, structure, and relevance were considered to be in agreement from the validation.

RESUMEN Objetivo: Describir el proceso de construcción y validación de una cartilla educativa para la atención de víctimas de ofidismo. Métodos: Investigación metodológica sobre el proceso de construcción y validación de una cartilla educativa. La construcción se desarrolló en base al marco teórico de Echer, con validación a cargo de trece jueces, entre enero y abril de 2019. Los ítems evaluados fueron los siguientes: estructura y aspecto; objetivos y relevancia, con utilización de la escala Likert. Para el análisis de validación, se utilizó el Índice de Validez del Contenido (IVC), con un punto de corte superior a 0,78. Resultados: La cartilla contenía los ítems de Presentación, Accidentes por enfermedad: Qué son, Incidencia en Brasil, Santa Casa de Sobral, Tipos de géneros, Signos y síntomas, Prevención, Conducta inmediata, Gravedad y tratamiento, Atención hospitalaria y, finalmente, Referencias. Ninguno de los ítems evaluados presentó un valor por debajo del acuerdo mínimo adoptado. La media global del IVC fue de 0,94, lo que confirma la validación de la cartilla por los jueces. Los evaluadores también hicieron sugerencias, que fueron aceptadas. Conclusiones: La construcción del material presentó las mejores estrategias de atención y prevención, y sus objetivos, aspecto, estructura y relevancia se consideraron acordes, a partir de la validación.

RESUMO Objetivo: Descrever o processo de construção e validação de uma cartilha educativa para a prestação de cuidados às vítimas de ofidismo. Métodos: Pesquisa metodológica do processo de construção e validação de uma cartilha educativa. A construção foi desenvolvida a partir do referencial teórico de Echer, sendo a validação realizada por treze juízes, de janeiro a abril de 2019. Os itens avaliados foram: estrutura e aparência; objetivos e relevância, utilizando-se da escala tipo Likert. Para a análise da validação, utilizou-se o Índice de Validade de Conteúdo (IVC), com recomendação de ponto de corte superior a 0,78. Resultados: A cartilha continha os itens Apresentação, Acidentes Ofídicos: O que são, Incidência no Brasil, Santa Casa de Sobral, Tipos de Gêneros, Sinais e Sintomas, Prevenção, Condutas Imediatas, Gravidade e Tratamento, Cuidados Intra-hospitalar, e por fim as Referências. Nenhum dos itens avaliados apresentou valor abaixo da concordância mínima adotada. A média global do IVC foi de 0,94, ratificando a validação da cartilha junto aos juízes. Os avaliadores também realizaram sugestões, as quais foram acatadas. Conclusões: A construção do material clarificou as melhores estratégias de cuidado e prevenção, sendo seus objetivos, sua aparência, estruturação e relevância considerados concordantes a partir da validação.

Increase in the risk of snakebites incidence due to changes in humidity levels: A time series study in four municipalities of the state of Rondônia

Abstract INTRODUCTION: Snakebites represent a serious global public health problem, especially in tropical countries. In Brazil, the incidence of snakebites ranges from 19 to 22 thousand cases per 100000 persons annually. The state of Rondônia, in particular, has had an increasing incidence of snakebites. METHODS: A retrospective cross-sectional study on snakebites was conducted from January 2007 to December 2018. Brazil's Information System for Notifiable Diseases was queried for all snakebites reported in Porto Velho, Ariquemes, Cacoal, and Vilhena. Data on land surface temperatures during the day and night, precipitation, and humidity were obtained using the Google Earth Engine. A Bayesian time series model was constructed to describe the pattern of snakebites and their relationship with climate data. RESULTS: In total, 6326 snakebites were reported in Rondônia. Accidents were commonly caused by Bothrops sp. (n=2171, 81.80%). Snakebites most frequently occurred in rural areas (n=2271, 85.5%). Men, with a median age of 34 years (n=2101, 79.1%), were the most frequent bitten. Moderate clinical manifestation was the most common outcome of an accident (n=1101, 41.50%). There were clear seasonal patterns with respect to rainfall, humidity, and temperature. Rainfall and land surface temperature during the day or night did not increase the risk of snakebites in any city; however, changes in humidity increased the risk of snakebites in all cities. CONCLUSION: This study identified the population exposed to snakes and the influence of anthropic and climatic factors on the incidence of snakebites. According to climate data, changes in humidity increased the risk of snakebites.

Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussions for clinical-epidemiological diagnosis and surveillance

Abstract INTRODUCTION: The popular names "surucucu" and "jararaca" have been used in literature for Lachesis muta and Bothrops atrox snakes, respectively. We present the popular names reported by patients who suffered snakebites in the Alto Juruá region. METHODS: Fifty-seven (76%) patients saw the snakes that caused the envenomations and were asked about their popular names and sizes. RESULTS: The snakes Bothrops atrox, referred to as "jararaca," were recognized as being mainly juveniles (80.7%) and "surucucu" as mainly adults (81.8%). CONCLUSIONS: The name "surucucu" is used in the Alto Juruá region for the snake B. atrox, mainly for adult specimens.

Envenomations by colubrids: case reports

Introduction: Envenomations by non-venomous snakes in Brazil are poorly accounted for and classified as mild, in which pain, erythema and local edema are reported. Objective: To describe accidents by Philodryas olfersii and Hydrodynastes gigas that occurred in the State of Pará, Brazil. Case report: The patient bitten by Philodryas presented bleeding, pain, local edema and axillary adenopathy. The patient bitten by Hydrodynastes had pain, local growing edema, as well as ecchymosis, fever and headache. No laboratory tests were performed. The treatment was based on pain control after identification of the snakes. Conclusion: The local symptomatology of colubrids is similar to accidents with Bothrops. It is important that health professionals perform a correct diagnosis for proper treatment.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Background Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions: We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.(AU)

Associação de plasma sanguíneo ao tratamento de envenenamento botrópico em equino: relato de caso / Plasma blood associated with the treatment of bothropic poisoning in equine: case report

O presente trabalho tem por objetivo relatar um caso de envenenamento botrópico em um equino, fêmea, seis anos de idade, da raça Quarto de Milha, pesando 460kg, que foi atendido no hospital veterinário da FCAV/Unesp, Campus de Jaboticabal, SP. No exame clínico, observou-se aumento bilateral de narina, com extrema sensibilidade ao toque, presença das marcas da presa da serpente na região rostral de focinho, mucosas róseas com petéquias. No exame de sangue, pôde-se detectar alteração no tempo de coagulação sanguínea (>30 minutos). O animal permaneceu internado, sendo instituída a seguinte terapia: soro antiofídico polivalente, transfusão de plasma sanguíneo equino, fluidoterapia intensa, flunixin meglumine e sulfa associado ao trimetoprim. A associação da transfusão de plasma sanguíneo equino ao tratamento convencional foi de extrema importância para correção da coagulopatia causada pelo acidente ofídico. A égua apresentou melhora clínica e resolução do quadro de envenenamento após cinco dias da internação.(AU)

This study aims to report a case of blood plasma association with the treatment of bothrops poisoning in an equine, female, six years of age, Quarter Horses, weighing 460 kg, which was served in the veterinary hospital of the FCAV/UNESP, Jaboticabal/SP. Clinical examination showed bilateral increase in nostrils, with great sensitivity to touch, presence of snake prey marks the rostral region of the snout, mucous rosy and with petechiae. Blood samples showed changes in blood clotting time (> 30 minutes). The animal remained in hospitalization with the following treatment: polyvalent antivenom, blood plasma transfusion, intensive fluid therapy, flunexim meglumine and sulfa associated with trimethoprim. The association of transfusion equine blood plasma to conventional treatment was extremely important for correction of coagulopathy caused by snakebite. The mare showed clinical improvement and resolution of poisoning symptoms after five days of hospitalization.(AU)

Caracterización de los casos de accidente ofídico atendidos por el Centro de Información y Estudio de Medicamentos y Tóxicos (CIEMTO) de Medellín, Colombia durante 2016 / Characterization of snakebite cases attended by the drug and poison research and information center ( CIEMTO) in Medellin, Colombia during 2016

RESUMEN Introducción: Las mordeduras de serpiente continúan siendo un problema de salud pública, especialmente en países tropicales como Colombia. Objetivo: Caracterizar los casos de accidente ofídico atendidos en un nuevo centro de asesoría toxicológica de Medellín, Colombia. Metodología: Se realizó un estudio descriptivo, retrospectivo, revisando la base de datos donde se registra la información relacionada con la asesoría brindada por dicho centro desde el 1 de enero hasta el 31 de diciembre de 2016. Resultados: Se registraron 117 casos de accidente ofídico, de los cuales 93 (79%) eran hombres y 24 (21%) mujeres, con una mediana de edad de 32 años (rango: 2 a 82 años). El seguimiento de los casos pudo lograse en 55 de los 117 accidentes (47%), y se describieron complicaciones en 18 de los 55 (33%) pacientes. La complicación descrita con mayor frecuencia fue brote maculopapular pruriginoso asociado con la administración del suero, sin que se identificaran diferencias entre las distintas marcas de suero antiofídico utilizado. Se documentó la muerte de un paciente (0,85%). El género Bothrops produjo la mayoría de los accidentes. Discusión: Los datos obtenidos coinciden con la bibliografía publicada.

ABSTRACT Introduction: Snakebites continue to be a public health problem, especially in tropical countries like Colombia. Objetive: To characterize the snakebite cases attended by a new poison center in Medellin, Colombia. Methodology: A descriptive, retrospective study was carried out, reviewing the information of the Center's database from January 1st to December 31st, 2016. Results: There were 117 cases of ophidian accidents, affecting 93 men (79%) and 24 women (21%), with a median age of 32 years (range: 2 to 82 years). The follow-up of the cases could be done in 55 of the 117 accidents (47%), and complications were described in 18 of those 55 (33%) patients. The most commonly reported complication was a pruritic maculopapular rash that was associated to serum administration, without differences between the several brands of anti-ophidian serum used. The death of one patient (0.85%) was documented. The genus Bothrops caused most of the accidents. Discussion: Our results agree with previously published data.

Comportamiento epidemiológico del accidente ofídico en el Departamento del Magdalena, Colombia (2009-2013) / Epidemiological Behavior of Ophidean Accidents in the Department of Magdalena, Colombia (2009-2013) / Comportamento epidemiológico dos acidentes ofídico no Departamento de Magdalena, Colômbia (2009-2013)

Objetivo: determinar el comportamiento epidemiológico del accidente ofídico en el Departamento del Magdalena, según los eventos notificados durante los años 2009-2013. Materiales y métodos: estudio de tipo descriptivo y retrospectivo. El tamaño muestral fueron 485 casos notificados al Sistema de Vigilancia en Salud Pública. La información fue organizada en Microsoft Excel® y procesada en Epi-info® versión 3.5.4 de 2012. Se realizó análisis bivariado mediante estadística descriptiva, prueba de asociación (OR) y significancia (p<0,05); guardando el rigor ético y metodológico correspondiente. Resultados: el grupo etario más afectado fue el de 10 a 29 años (44,5%), con predominio en el sexo masculino (73%), la mayoría residentes en área rural (59%). Los municipios con mayor incidencia y notificación de casos fueron zona bananera (15,9%), Ciénaga (11,8%), El Banco (10,7%), Pivijay (9,5%) y Ariguaní (8,2%). Se encontró asociación estadística entre el ser mordido por serpiente mapaná y estar realizando tanto labores de agricultura [OR= 0,53 (IC95%: 0,36-0,77; p=0,00116)] como oficios domésticos [OR= 2,29 (IC95%: 1,36 - 3,87; p=0,00148)]. De igual forma, entre el ser mordido por serpiente mapaná y presentar náuseas [OR= 1,60 (IC95%: 1,04-2,44; p=0,029)], como manifestación clínica sistémica. Conclusiones: el accidente ofídico sigue siendo un evento de interés para la salud pública global. Sin embargo, es necesario que exista mayor adherencia al protocolo nacional de vigilancia epidemiológica y se mejore la notificación por parte de las instituciones primarias para evitar subregistros. Además, que se sigan realizando investigaciones entre regiones, que permitan comparar hallazgos y establecer estrategias de control y prevención.

Objective: To determine the epidemiological behavior of snakebite accidents in the Department of Magdalena, in the years between 2009 and 2013. Materials and methods: Descriptive and retrospective study. The sample size was 485 cases reported to the national Public Health Surveillance System. The information was organized in Microsoft Excel® and processed in Epi-INFO program version 3.5.4 of 2012. Bivariate analysis was performed using descriptive statistics, association test (OR) and statistical significance (p <0.05); keeping the corresponding ethical and methodological rigor. Results: The age group between 10 and 29 years was the most affected (44.5%), predominantly males (73%) living in rural areas (59%). The municipalities with the highest incidence and reporting cases were zona bananera (15.9%), Ciénaga (11.8%), El Banco (10.7%), Pivijay (9.5%) and Ariguaní (8.2%). We found statistical association between being bitten by mapana snake and exerting both agricultural work: OR = 0.53 (CI95%: 0.36 - 0.77; p = 0.00116) and housework: OR = 2.29 (CI95%: 1.36 - 3.87; p = 0.00148). It appears similar between being bitten by a mapana snake and having nausea: OR = 1.60 (CI95%: 1.04 - 2.44; p = 0.029) as systemic clinical manifestations. Conclusions: The snakebites continue to be events of interest to global public health. However, it is necessary to encourage adherence to the national epidemiological surveillance protocol and to improve notification in the primary institutions to avoid underreporting. Moreover, it is important to continue the research in different regions in order to compare findings and to establish prevention and control strategies.

Objetivo: determinar o comportamento epidemiológico da ophidism Acidente no Departamento de Magdalena, de acordo com os eventos relatados durante 2009-2013. Materiais e métodos: Descritiva retrospectivo estudo. O tamanho da amostra foi de 485 casos notificados ao sistema de vigilância em saúde pública. A informação foi organizada em Microsoft Excel e processados no Epi-INFO® 2012. Versão 3.5.4 bivariada meio de estatística descritiva, teste de associação (OR) e significância (p <0,05) foi analisada; mantendo o rigor ético e metodológico correspondente. Resultados: A faixa etária mais acometida foi a 10-29 anos (44,5%), predominantemente no sexo masculino (73%), a maioria dos quais vivem em áreas rurais (59%). Os municípios com os maiores casos de incidência e de informação foram: zona bananera (15,9%), Ciénaga (11,8%), El Banco (10,7%), Pivijay (9,5%) e Ariguaní (8,2%). Associação estatística entre ser mordido por serpente encontrada mapaná e estar fazendo tanto trabalho agrícola: OR = 0,53 (IC 95%: 0,36-0,77; p = 0,00116) como o trabalho doméstico: OR = 2,29 (95% CI: 1,36-3,87; p = 0,00148). Da mesma forma, entre ser mordido por cobra e mapaná nauseado: OR = 1,60 (IC 95%: 1,04-2,44; p = 0,029) e as manifestações clínicas sistémicas. Conclusões: O acidente ofídico continua a ser um evento de interesse para a saúde pública global. No entanto, é preciso haver uma maior adesão ao protocolo nacional de vigilância epidemiológica e de notificação por parte das instituições primárias é melhor evitar a subnotificação. Além disso, a contínua pesquisa de implementação entre as regiões, para a comparação de resultados e desenvolvimento de estratégias de prevenção e controle.

Accidente ofídico en el departamento de Sucre, Colombia / Ophidic accident in the department of Sucre, Colombia

Objetivo: Describir el comportamiento del accidente ofídico en el departamento de Sucre. Métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se analizaron 803 reportes de accidentes ofídicos notificados al sistema de vigilancia epidemiologia del departamento de Sucre, durante los años 2007 a 2012, la información fue suministrada por la dirección de salud pública de la secretaria de salud del departamento de Sucre, en formato Excel©, descargada directamente del aplicativo SIVIGILA. Los datos obtenidos se analizaron estadísticamente empleando medidas de tendencia central. Resultados: En el 48.2% de los casos, el género Bothrops se identificó como el agente agresor y en el 83.9% de los casos la mordedura se localizó en las extremidades del paciente. En 356 casos equivalentes al 44% el paciente no fue hospitalizado o no se consignó esta información en la ficha. En el tratamiento de los casos hospitalizados se empleó un promedio de 4.3 ± 4.5 viales por paciente; estos datos son consistentes con el protocolo para casos leves registrados (n=450), pero al revisar los casos individuales se encontró que 228 pacientes solo recibieron entre 1 y 3 ampollas. En 84 casos solo se administró un vial.

Objective: Describe the behavior of ophidic accident in the department of Sucre. Methods: A descriptive, retrospective study was done from 2007 to 2012, in this study, 803 cases of snakebites were reported to the surveillance system of the epidemiology department of Sucre. In this department, the snakebite accidents occurs along the entire year, mainly affecting men 15 to 44 years. Those affected come from all municipalities in the department and around the rural area, and it is mainly engaged in agriculture and domestic work; however, the town of Sincelejo accounts for 28.8% of all notifications. Results: In 48.2% of cases, the genus Bothrops was identified as the offending agent and in 83.9% of cases, the bite was found in the patient's limbs. In 356 cases or 44% the patients were hospitalized or the information of this records were not found. The treatment of hospitalized cases averaged 4.3 ± 4.5 shots were used per patient; This data is consistent with the protocol for registered mild cases (n = 450), but reviewing individual cases; then, it was found that 228 patients received only 1 to 3 ampoules. In 84 cases only one shot was administered.

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions.Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection.Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (χ2 = 4.6; p= 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p= 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years.Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.(AU)

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions.Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection.Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (2 = 4.6; p= 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p= 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years.Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.

ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT / Lesão renal aguda causada pelo veneno das cobras Crotalus e Bothrops: revisão da epidemiologia, das manifestações clínicas e do tratamento

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents. .

RESUMO Os acidentes ofídicos são importante problema de saúde pública devido à incidência, morbidade e mortalidade. Aumento do número de casos tem sido registrado no Brasil nos últimos anos. Vários estudos apontam para a importância do conhecimento das complicações clínicas e do tratamento adequado desses acidentes. Entretanto o conhecimento dos fatores de risco não é suficiente, e existe número crescente de óbitos devido a esses acidentes no Brasil. Neste contexto, a injúria renal aguda (IRA) aparece como uma das principais causas de óbito e sequela nestas vítimas, que são principalmente homens trabalhadores de zonas rurais. Os gêneros Bothrops e Crotalus são os principais responsáveis pelo envolvimento renal nos acidentes ofídicos na América do Sul. O presente estudo faz uma revisão da literatura sobre a IRA causada pela picada das serpentes dos gêneros Bothrops e Crotalus em suas diversas características, enfatizando a abordagem terapêutica mais adequada para estes casos. Estudos recentes tem sido realizados para a busca de terapias complementares para o tratamento dos acidentes ofídicos, incluindo o uso de ácido lipóico, sinvastatina e alopurinol. Algumas plantas, como a Apocynaceae, Lamiaceae e Rubiaceae parecem ter papel benéfico no tratamento destes envenenamentos. Estudos futuros irão certamente encontrar novas estratégias terapêuticas para os acidentes ofídicos. .

The international view of envenoming in Brazil: myths and realities

Being distant from Brazil's great natural diversity, from its long tradition in the study of snakebites and from the fact that it is one of the few countries which has a national information system for monitoring incidents involving venomous animals, non-Brazilian researchers face risks when estimating the incidence of these accidents in the country. The present work offers a critical review of the main estimates undertaken since 1954. It is interesting to note contradictions between textual and graphic information within the same article, variations over time in the work of a same researcher and differences among distinct authors, and that all these issues remain unmentioned or undiscussed. Comparison among such estimates and the data available at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN) creates an opportunity to identify the degree of imprecision present in those articles, and draws attention to the need for the production of studies at both the regional and national levels, based on concrete data collected at national, state and municipal levels, which has been available on the internet since 2001.(AU)