Accidents caused by Bothrops and Bothropoides in the State of Paraiba: epidemiological and clinical aspects / Acidentes causados por serpentes dos gêneros Bothrops e Bothropoides no Estado da Paraíba: aspectos clínicos e epidemiológicos

INTRODUCTION: Bothrops and Bothropoides snakes cause 70 percent of the ophidic accidents in Brazil. The species that cause ophidic accidents in State of Paraíba are Bothropoides erythromelas, Bothrops leucurus and Bothropoides neuwiedi. METHODS: This is a prospective and transverse study, following a quantitative approach of accidents involving Bothrops and Bothropoides admitted to the Toxicological Assistance and Information Centers of Campina Grande and João Pessoa (Ceatox-CG and Ceatox-JP), aimed at identifying the epidemiological and clinical profile of such accidents. All of the patients admitted had medical diagnoses and were monitored at Ceatox-CG or Ceatox-JP. RESULTS: The genera Bothrops and Bothropoides caused 91.7 percent of the ophidic accidents reported. Snake bites were frequent in men (75.1 percent), rural workers (65.1 percent), literate individuals (69 percent) between 11 and 20 years-old (21.7 percent), and toes the most common area attacked (52.7 percent). Most (86.6 percent) patients were admitted within 6 hours after the accident/bite, with a predominance of mild cases (64.6 percent). The annual occurrence in Paraíba was 5.5 accidents/100,000 inhabitants and lethality was 0.2 percent. CONCLUSIONS: Positive changes in the profiles of these accidents were verified, such as the non-application of inadequate solutions, including the use of tourniquet, coffee grounds, garlic, suction and/or cutting the bitten area. Moreover, the Itinerant Laboratory project, linked to Paraíba State University in partnership with Ceatox-CG, has contributed positively, providing several cities of the state with information regarding the prevention of accidents involving venomous animals. The local press has also contributed, reporting the educational work developed by the centers.

INTRODUÇÃO: As serpentes Bothrops e Bothropoides são responsáveis por 70 por cento dos acidentes ofídicos ocorridos no Brasil. As espécies causadoras de acidentes na Paraíba são Bothropoides erythromelas, Bothrops leucurus e Bothropoides neuwiedi. MÉTODOS: Tratou-se de um estudo prospectivo e transversal, com abordagem quantitativa dos acidentes botrópicos e botropóidicos atendidos e registrados pelos Centros de Assistência e Informação Toxicológica de Campina Grande e João Pessoa (Ceatox-CG e Ceatox-JP), com o objetivo de conhecer o perfil epidemiológico e clínico deste agravo. Todos os pacientes atendidos tiveram diagnóstico médico e acompanhamento pelos Ceatox CG e JP. RESULTADOS: Os gêneros Bothrops e Bothropoides foram responsáveis por 91,7 por cento dos acidentes ofídicos notificados. Atingindo frequentemente o sexo masculino (75,1 por cento), trabalhadores rurais (65,1 por cento), alfabetizados (69 por cento) e na faixa etária entre 11 a 20 anos (21,7 por cento), os dedos dos pés foram as regiões anatômicas mais acometidas (52,7 por cento). A maioria (86,6 por cento) dos pacientes foi atendida em até 6 horas após o acidente/picada com predominância de casos leves (64,6 por cento). A incidência anual no estado foi 5,5 acidentes/100.000 habitantes e a letalidade 0,2 por cento. CONCLUSÕES: Verificaram-se mudanças positivas no perfil desses acidentes, como a não utilização de medidas consideradas inadequadas (uso de torniquetes, borra de café, alho, incisão com sucção e outras). Além disso, o projeto Laboratório Itinerante, ligado a Universidade Estadual da Paraíba em parceria com o Ceatox-CG, tem contribuído positivamente, levando a várias cidades do estado informações sobre prevenção e tratamento dos acidentes causados por animais peçonhentos. A imprensa local também tem contribuído, divulgando esse trabalho educativo.

Hemoperitoneum Caused by Hepatic Necrosis and Rupture Following a Snakebite: a Case Report with Rare CT Findings and Successful Embolization

We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

Systemic interleukin-6 response in patients bitten by viperidae snakes

Envenomation by viperidae snakes causes local tissue damage similar to acute trauma in addition to various systemic effects of which coagulopathy is a major and lethal complication. Interleukin-6 [IL-6] is an important proinflammatory cytokine produced usually due to trauma. The present study was designed to investigate the possible role of IL-6 in the development of coagulopathy and its association with the severity of envenomation in patients. Thirty one adults patients of both sexes were included in this study divided according to the scoring system used to classify the severity of envenomation caused by vipers to four groups [group II mild grade, group III moderate grade, group IV severe grade and group V critical grade] in addition to six healthy adults of both sexes served as control group [group I]. Blood samples were taken on admission to hospital, then 24 and 48 hours after snake bite. Coagulation profile [Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], Fibrinogen level and Fibrin Degradation Products [FDPs] was determined. Also hematological tests were done [red blood cell count [RBCs], hemoglobin concentration [Hb%], white blood cell count [WBC] and platelet count]. Moreover IL-6 level was determined. The results revealed that envenomated patients presented with coagulopathy, showed significant increase of PT and APTT time, FDPs level and significant decrease of fibrinogen level, in addition to the abnormalities of hematological tests which manifested by significant decrease of RBCs, I-IB% and platelet count. These changes were significant in group V followed by IV and III while insignificant in group II. Such alterations were more on admission, decreased but still significant after 24 hours then returned to near normal values after 48 hours. As regard serum IL-6 level it showed significant increase in groups V followed by IV and III while there was insignificant increase in group II. Such increase was more on admission, decreased but still significant after 24 hours then returned to normal values after 48 hours. In conclusion, this study showed that IL-6 could be involved in the pathogenesis of systemic coagulopathy in envenomated patients also there was a significant association between severity of envenomation and IL-6 concentration, being higher in the critical and severe grades than the moderate and mild grades

Acute paraplegia following viper bite.

Neurological complications following viper bite are uncommon and are generally as a result of intracerebral or subarachnoid bleed and rarely due to cerebral infarction. We report a young male who following viperine bite developed local tissue swelling, haemorrhagic manifestations due to disseminated intravascular coagulation and later developed acute flaccid paraplegia as a result of dorsal spinal cord involvement.

Efecto proteolítico de venenos de serpientes del género bothrops (yarará) de la Argentina y su neutralización por un antiveneno bivalente / Proteolityc effect of bothrops snake venom (yarará) from Argentina and neutralization by bivalent antivenom

Se estudió la actividad proteolítica de los venenos del género Bothrops de diferentes especies que habitan el litoral argentino y su neutralización por un suero hiperinmune bivalente producido en la Argentina. Se midió la actividad proteolíticas sobre caseína y se determinó la dosis proteolítica mínima (DPM), y la dosis efectiva 50 (DE) del suero bivalente frente a cada veneno. Las actividades proteolíticas de los venenos B, alternatus, B. neuwiedii, B. jararaca, B. jararacussu y B. moojeni fueron inferiores a las que presentan otras especies de Bothrops que habitan la región de America Central. Los resultados de la DE mostraron que el suero fue efectivo para neutralizar tal actividad en todos ellos, a pesar de que el suero utilizado en estas experiencias era específico para B. alternatus y B. neuwiedii.

Lesines locales y sistemicas inducidas por veneno de Bothrops alternatus (víbora de la cruz) de Argentina / Local and sistemic lesions induced by Bothrops alternatus venom (víbora de la cruz) of Argentine

Se inocularon ratas de 220+= 20 g de peso, en grupos de 5 animales, con 800 ug de veneno de Bothrops alternatus de Argentina desecado y homogeneizado, diluído en 0,1 ml de solución salina, pore via intramuscular. Para la obtención de sangre y su posterior sacrificio, se anestesiaron a las 3, 9 y 24 horas, tomándose muestras del músculo inoculado, hígado y riñón. Se realizaron determinaciones enzimáticas y los tejidos se procesaron para histopatología. A las 3 horas, se observaron necrosis de fibras musculares confirmadas por métodos histoquímicos, hemorragia e infiltrado inflamatorio, los que se intensificaron a las 9 y 24 horas. Paralelamente se observó un incremento plasmático de lñas actividades enzimáticas de creatin fosfoquinasa (CPK), aspartato aminotransferasa (AST) y la alanina aminotransferasa (ALT); siendo máximo el aumento de CPK entre las 3 y 9 horas. La respuesta inflamatoria estudiada en ratón, mostró una reacción rápida cuya recuperación fue lenta. La necrosis de fibras musculares fue acompañada por peroxidación de lípidos y precipitación de calcio en las células. Las lesiones de te4jido hepático no fueron relevantes y en riñón se detectaron alteraciones en zona yuxtamedular y en el intersticio cortical

Russell's viper venom fractions and nephrotoxicity.

Apparently healthy Wistar rats of body weight 250-300 g were chosen for the experiments. A group of 6 rats were assigned for each fraction. The dose of Russell's viper venom (RVV) fraction used for in vivo experiments was 0.75 microgram/g body weight. Of each batch of 6 rats 3 were sacrificed on the third day and the remaining 3 on the fifth day after the administration of test venom fractions. Daily urine output with proteinuria and serum creatinine were determined on the day they were sacrificed. Kidneys from the rats were also examined under light microscopy after hematoxylin and eosin staining. In the in vitro experiment, kidney slices (1 mm thickness) from normal rat was incubated with RVV fractions of 5 mg/ml concentration. The predominant renal lesions observed in both sets of animal experiments were tubular degeneration and necrosis. The changes were mostly confined to proximal tubules. Glomerular changes were mild. Similar tubulotoxic effects were produced by whole RVV as well as single fractions. Therefore, it is possible that RVV contains a common nephrotoxic (protein) component which is present in all fractions of the venom. The renal damage caused by RVV seemed to be due to both systemic effects (mainly DIC and renal ischemia) and direct tubulotoxic effects of the venom.

Heparin therapy in Russell's viper bite victims with disseminated intravascular coagulation: a controlled trial.

A controlled clinical trial of low dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty patients with systemic envenoming were included in the study. They were randomized to receive low dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 unit 3 kg/hour in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical values. No significant difference was observed in the outcome among two groups, the recovery rate from the clotting defect being similar in both. The mean serum creatinine values of the two groups were also not statistically different. The results indicated that there is no beneficial effect of adding heparin to the standard treatment by antivenom.

Hypopituitarism following snake bite.

A patient who developed hypopituitarism after viperine envenomation is described. Thrombosis as a part of disseminated intravascular coagulation may have been the cause. Hypopituitarism should be suspected in such cases especially when there is associated acute renal failure.