Epidemiología y características clínicas de las mordeduras de serpientes venenosas en el norte de la Amazonía del Ecuador (2017-2021) / Epidemiology and clinical features of venomous snake bites in the Northern Amazon of Ecuador (2017-2021)

Introducción. En Ecuador, las mordeduras de serpientes venenosas son un problema de salud pública. Sin embargo, no existe información hospitalaria reciente desde la Amazonía. Objetivo. Analizar retrospectivamente las características clínico-epidemiológicas de las mordeduras de serpientes en pacientes ingresados en un hospital de la Amazonía del Ecuador. Materiales y métodos. Se llevó a cabo un estudio transversal en el hospital provincial de Nueva Loja (Sucumbíos), que colinda con Colombia, 2017-2021. La información sobre las variables demográficas, epidemiológicas y clínicas, y la condición al egreso hospitalario, se obtuvieron de la ficha epidemiológica del Ministerio de Salud Pública. Resultados. En cinco años se hospitalizaron 147 pacientes (29,4 por año), sin que se presentaran muertes. Corresponden a 26, 34, 32, 29 y 26 casos, en el 2017, 2018, 2019, 2020 y 2021, respectivamente. Según el sexo, los más afectados fueron los hombres (n=99; 67,3 %), según el grupo etario, los de 21 a 30 años (n=28; 19,0 %) y, según la raza, los de etnia mestiza (n=94; 63,9 %), estudiantes y agricultores. La mediana de edad fue de 28 años (rango: 4 a 81). Hubo mayor prevalencia en abril, junio y septiembre. Todos los accidentes fueron causados por serpientes Viperidae. Veinte (13,6 %) casos fueron leves, 90 (61,2 %), moderados, y 37 (25,2 %), graves. La mordedura fue más frecuente en los pies (45 casos). El 53,1 % recibió suero antiofídico antes de la hospitalización y en el 19,8 % de los pacientes se colocó un torniquete. La mediana de tiempo de llegada al hospital fue de 5 horas (rango: 1-192), y lo más frecuente fue entre 2 y 3 horas (41 casos). No se encontraron diferencias estadísticamente significativas según la gravedad del caso. Conclusiones. Se evidenció una gran prevalencia de mordeduras de serpientes en el norte de la región amazónica-Ecuador, con mayor incidencia en la estación lluviosa y todas causadas por Viperidae. Es importante resaltar la mortalidad nula. Las campañas informativas sobre prevención y primeros auxilios, como la desmotivación del uso de torniquetes, serían fundamentales para reducir los casos, especialmente, en los grupos vulnerables.

Introduction: In Ecuador, poisonous snakebites are a public health problem. However, there is no recent hospital information from the Amazon. Objective: To retrospectively analyse the clinical-epidemiological characteristics of snakebites in patients admitted to a hospital in the Ecuadorian Amazon. Materials and methods: This is a cross-sectional study conducted at the Nueva Loja-Sucumbíos Provincial Hospital, bordering Colombia (2017-2021). Demographic, epidemiological and clinical variables, and condition at hospital discharge, were obtained from the epidemiological file of the Ministerio de Salud Pública. Results: In 5 years, 147 patients (29.4 per year) were hospitalized with no mortality. They corresponded to 26, 34, 32, 29 and 26 cases, in 2017, 2018, 2019, 2020 and 2021, respectively. Men with 99 (67.3%), aged 21-30 years with 28, mixed race with 94 cases, students, and farmers, were the most affected. The most affected (99; 67.3%) were men, people 21 to 30 years-old (28; 19.0%), mestizos (94; 63.9%), students, and farmers. The median age was 28 (range: 4-81) years. Prevalence was higher in April, June, and September. All accidents were caused by Viperidae snakes. Twenty (13.6%) cases were mild, (61.2%) were moderate and 37 (25.2%) were severe. The feet with 45 were the most bitten. Pre-hospitalization anti-venom serum was received by 53.1% and tourniquet by 19.8% patients. Median hospital arrival time was 5 (range 1-192) hours, mostly between 2-3 hours with 41 cases. No statistically significant differences were found considering the severity. Conclusions: A high prevalence of snakebites was evidenced in the north of the Amazon in Ecuador, with a higher incidence in the rainy season and all by Viperidae species. It is important to highlight the null mortality. Information campaigns on prevention and first aid, such as discouraging the use of tourniquets, especially among vulnerable groups.

Boletim informativo de toxicologia: acidentes ofídicos / Toxicology Fact Sheet: Snakebites

Os acidentes por animais peçonhentos, especialmente os acidentes ofídicos, foram incluídos pela Organização Mundial da Saúde (OMS) na lista das doenças tropicais negligenciadas que acometem, na maioria das vezes, populações pobres que vivem em áreas rurais, devido à gravidade constituem um problema de saúde pública. O sucesso no tratamento do paciente para que os mesmos não gerem sequelas graves, podendo chegar ao óbito, requer atendimento de forma rápida, com o uso adequado do soro específico quando necessário para cada espécie de serpentes e na quantidade recomendada. Em Goiás as principais serpentes que causam acidente são dos gêneros: Bothrops (jararacas), Crotalus (cascavéis) e Micrurus (coral), são considerados acidentes graves que demandam o uso de soros antivenenos específicos

Accidents by venomous animals, especially snakebites, were included by the World Health Organization (WHO) in the list of neglected tropical diseases that affect, most of the time, poor people living in rural areas, due to the seriousness of a public health problem. . Successful treatment of the patient so that they do not generate serious sequelae, which can lead to death, requires quick care, with the appropriate use of specific serum when necessary for each species of snakes and in the recommended amount. In Goiás, the main snakes that cause accidents are of the genera: Bothrops (jararacas), Crotalus (rattlesnakes) and Micrurus (coral), are considered serious accidents that require the use of specific antivenom serums

Acidentes com animais peçonhentos no Brasil: uma revisão integrativa / Accidents with venomous animals in Brazil: an integrative review

Considerados como doenças negligenciadas pela Organização Mundial de Saúde, os acidentes com animais peçonhentos são de grande relevância média por apresentarem altos índices de mortalidade e morbidade. Objetivo - O objetivo desta revisão é apresentar os aspectos epidemiológicos e clínicos dos acidentes com animais peçonhentos no Brasil nos últimos dez anos. Métodos - Foram utilizadas publicações que compreendessem os aspectos clínicos e epidemiológicos de estados, regiões ou municípios brasileiros. Para a revisão foram os artigos foram selecionados em maio de 2020, compreendendo os anos de 2010 a 2020. Resultados e Discussão - Os principais acidentes foram relacionados às serpentes peçonhentas e escorpiões. Nas regiões Sudeste, Norte, Centro-Oeste os acidentes ofídicos foram os mais recorrentes, enquanto que, na região Nordeste, os acidentes com escorpiões e um estudo da região Sul um estudo destacou o araneísmo como principal acidente. Os sinais e sintomas do ofidismo variaram de acordo com o gênero das serpentes, sendo os acidentes com o gênero Bothrops predominante. Os sintomas recorrentes foram: dor, edema, equimose, hemorragia local e sistêmica e alterações na coagulação. O escorpionismo foi causado principalmente pelo gênero Tityus, sendo os casos graves relacionados ao comprometimento pulmonar. Conclusão - Os tipos de acidentes, bem como os sinais e sintomas do envenenamento apresentam muitas variáveis, como região geográfica, gênero e espécie dos animais. A melhoria da qualidade dos dados epidemiológicos e ampliação da assistência em saúde são fatores essenciais para a redução no número de casos de mortalidade e morbidades decorrentes do envenenamento por animais peçonhentos.

Considered as neglected by the World Health Organization, accidents with venomous animals are of great relevance because they have high mortality and morbidity rates. Purpose - This review has the purpose to present the epidemiological and clinical aspects of accidents with venomous animals in Brazil in the past ten years. Methods - Publications were used that understood the clinical and epidemiological aspects of Brazilian states, regions or municipalities. For the review, articles were selected in May 2020, covering the years 2010 to 2020. Results and Discussion - The main accidents were related to venomous snakes and scorpions. In the Southeast, North, and Center-West regions, snakebite accidents were the most recurrent, while in the Northeast region, accidents involving scorpions and a study in the Southern region highlighted accidents with arachnids as the most frequent type of incident. Signs and symptoms of snakebite varied according to the gender of the snakes, with predominance for accidents with the Bothrops genus. Recurring symptoms included pain, edema, ecchymosis, local and systemic hemorrhage, and changes in coagulation. Scorpionism was mainly caused by the Tityus genus, with severe cases presenting pulmonary involvement. Conclusion - The types of accidents, as well as the signs and symptoms of envenomation, present many variables which included geographic region, gender and species of animals. Improving the quality of epidemiological data and expanding health care are essential factors for reducing the number of mortality and morbidity cases resulting from envenomation by venomous animals.

Venomous animals in Pernambuco: children at risk / Animais peçonhentos em Pernambuco: crianças em risco

Abstract Objectives: to analyze the epidemiological and clinical aspects of accidents caused by venomous animals in children under 15 years old. Methods: a cross-sectional study with an analytical component using secondary data from Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), (Poison Center in Pernambuco)), in 2017 to 2019. Notifications of accidents caused were included in the studied age group and evaluated the characteristics of poisoning (animal classification, exposure zone, place and time of the occurrence and specific use of serum therapy), and of the patient (sociodemographic variables, clinical condition and evolution). The analysis performed in STATA® 13.1 presents frequency distribution tables and Pearson's chi-square for comparison. Results: of the 2678 notifications, 82,8% were scorpionism and 10, 8% snakebite. The age group of1 to 9 years old (70.5%) and being male (54.1%) were predominant. Most of the cases occurred in urban area (80.9%), in Recife (67.3%), inside the victim's residence (83.9%) and at night (47.3%). The majority (87.1%) were classified as 'mild severity', 10% received antivenom therapy and one died (by scorpionism). Two cases of snakebite in the workplace were registered. Conclusion: there was a high frequency of accidents caused in the urban area, which may be related to the lack of urban planning and sanitary education. The accidents caused among children in the household environment and the suspicion of child labor in the age group of 10 to 14 years old were also highlighted which favors the development and habits of the venomous animal.

Resumo Objetivos: analisar aspectos epidemiológicos e clínicos dos acidentes por animais peçonhentos em menores de 15 anos. Métodos: estudo transversal com componente analítico utilizando dados secundários do Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), no período de 2017 a 2019. Foram incluídas as notificações dos acidentes na faixa etária estudada e avaliadas características do envenenamento (classe do animal, zona de exposição, local/turno da ocorrência e uso soroterapia específica) e do paciente (variáveis sociodemográficas, gravidade clínica e evolução). A análise realizada no STATA® 13.1 apresenta tabelas de distribuição de frequência e qui-quadrado de Pearson para comparação. Resultados: das 2678 notificações, 82,8% foram de escorpionismo e 10,8% de ofidismo. Predominaram na faixa etária de 1a 9 anos (70,5%) e sexo masculino (54,1%);ocorreram principalmente na zona urbana (80,9%),no Recife(67,3%), na residência da vítima (83,9%), durante horário noturno (47,3%). A maioria (87,1%) foi classificada como de gravidade leve, 10% receberam soroterapia e ocorreu um óbito (escorpionismo). Registraram-se dois casos de ofidismo em ambiente de trabalho. Conclusão: ressaltam-se os acidentes intradomiciliares entre crianças e a suspeita de trabalho infantil na faixa etária de 10 a 14anos.Os acidentes ocorreram sobretudo na zona urbana provavelmente associado à falta de planejamento e educação sanitária que favorece o desenvolvimento e hábitos do animal peçonhento.

Tendência temporal e perfil epidemiológico dos acidentes por animais peçonhentos no Brasil, 2007-2019 / Tendencia temporal y perfil epidemiológico de los accidentes por animales venenosos en Brasil, 2007-2019 / Temporal trend and epidemiological profile of accidents involving venomous animals in Brazil, 2007-2019

Objetivo: Analisar a tendência temporal dos acidentes causados por animais peçonhentos no Brasil, de 2007 a 2019. Métodos: Estudo transversal, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan). Para a análise temporal, utilizou-se a regressão linear de Prais-Winsten. Foram calculadas as incidências por sexo e faixa etária, risco relativo e letalidade. Resultados: No período de estudo, houve 2.102.657 casos de acidentes por animais peçonhentos. Com exceção do ofidismo, os demais acidentes apresentaram tendência temporal crescente na maioria das macrorregiões nacionais. Escorpionismo, ofidismo e araneísmo foram responsáveis por 86% dos acidentes, principalmente entre pessoas do sexo masculino em idade economicamente ativa. A de letalidade foi mais elevada para acidentes ofídicos (0,4%) e apílicos (0,3%). As crianças foram as principais vítimas de acidentes com abelhas, lagartas e "outros". Conclusão: Os acidentes com animais peçonhentos apresentaram tendência temporal crescente para a maioria dos agravos e diferentes perfis epidemiológicos.

Objetivo: Analizar la tendencia temporal de los accidentes con animales ponzoñosos en Brasil de 2007 a 2019. Métodos: Estudio transversal realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan). Para el análisis temporal se utilizó la Regresión Lineal de Prais-Wisten. Se calcularon las incidencias por sexo y grupo de edad, riesgo relativo y letalidad. Resultados: Durante el período del estudio hubo 2.102.657 casos de accidentes con animales ponzoñosos. Con excepción de la mordedura de serpiente, los demás accidentes mostraron una tendencia temporal creciente en la mayoría de las regiones del país. El escorpionismo, la mordedura de serpiente y la picadura de araña fueron responsables del 86% de los accidentes, afectando principalmente a personas del sexo masculino en edad laboral. Las tasas de letalidad más altas fueron por accidentes de mordedura de serpiente (0,4%) y picadura de araña (0,3%). Los niños fueron las principales vitimas de los acidentes con abejas, lagartas y "otros". Conclusión: Los accidentes com animales ponzoñosos mostraron una tendencia temporal creciente para la mayoría de las enfermedades y diferentes perfiles epidemiológicos.

Objective: to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. Methods: this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. Results: during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". Conclusion: accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.

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.

Epidemiology of accidents involving venomous animals in the State of Ceará, Brazil (2007-2019)

Abstract INTRODUCTION: Envenomation remains a neglected public health problem in most tropical countries. Epidemiological studies on accidents caused by venomous animals are scarce in the Northeast region of Brazil, mainly in the state of Ceará. The present study aimed to describe the epidemiological features of envenomation cases involving venomous animals in the State of Ceará, Northeastern Brazil, from 2007 to 2019. METHODS: The online Notifiable Diseases Information System was consulted for data on all envenomation cases involving venomous terrestrial animals. Data collected were evaluated for the number of accidents/year, number of accidents/zoological group, antivenom therapy, zone of occurrence, sex, age-group distribution, and deaths. RESULTS: A total of 54,980 cases were recorded, with the highest incidence being that of scorpion stings (67.2%), predominantly in women (52.4%; odds ratio=3.6; 95% confidence interval=3.5-3.8), equally affecting people aged 10-19 years and 40-59 years (21.4%), in the urban areas (odds ratio=10.3; 95% confidence interval=9.9-10.8), especially in the rainy months. Snakebites (16.7%) had an incidence of 8.1/100,000 inhabitants, but the highest case-fatality rates were observed in bee stings (1.3%) and spider bites (0.5%). Regarding therapeutic variables, a small percentage of people had access to serotherapy (5.3%). CONCLUSIONS This study highlights the accidents caused by terrestrial venomous animals as a public health problem that must be monitored in Ceará. Thus, our findings suggest that preventive actions against scorpion and bee stings should be intensified during the months of higher incidence to improve public policies for patient care.

Perfil epidemiológico dos acidentes causados por animais peçonhentos no município de Patrocínio, Minas Gerais: retrato de uma década / Epidemiological profile of accidents caused by venomous animals in the municipality of Patrocínio, Minas Gerais: portrait of a decade / Perfil epidemiológico de accidentes causados por animales venenosos en el municipio de Patrocínio, Minas Gerais: retrato de una década

Justificativa e objetivos: apesar dos avanços na área assistencial, os acidentes por animais peçonhentos ainda são um importante problema de saúde pública no Brasil. Entre os anos de 2015 e 2016, a região Sudeste apresentou o maior número de notificações, e Minas Gerais foi o estado com mais ocorrências. O objetivo deste estudo foi descrever as características epidemiológicas dos acidentes por animais peçonhentos notificados entre 2008 e 2017 no município de Patrocínio, Minas Gerais. Métodos: estudo descritivo retrospectivo realizado por meio da análise das informações das fichas de notificação do Sistema de Informação de Agravos de Notificação (SINAN) de vítimas de acidentes por animais peçonhentos ocorridos durante os anos de 2008 a 2017 em Patrocínio. Resultados: foram registrados 1.084 casos, a maioria ocasionada por escorpiões (47,23%), seguida por serpentes (17,07%), aranhas (15,31%) e abelhas (11,07%). Sobre as vítimas, constatou-se o predomínio de homens (63,10%) na faixa etária entre 20 a 39 anos (32,56%). A maior parte dos acidentes foi classificada como leve (89,11%) e a cura ocorreu em 98,80% dos casos; um evoluiu para óbito. Conclusão: embora os acidentes por animais peçonhentos não apresentem altas taxas de letalidade no município estudado, a incidência desse agravo de saúde tem aumentado nos últimos anos. Além disso, informações epidemiológicas atualizadas podem contribuir com ações de políticas públicas e informar a população local sobre os riscos iminentes.(AU)

Background and objectives: despite advances in health care, accidents involving venomous animals are still a major public health problem in Brazil. Between 2015 and 2016, the Southeast region had the highest number of notifications, and Minas Gerais was the state with more occurrences. The objective of this study was to describe the epidemiological characteristics of accidents by venomous animal notified between 2008 and 2017 in the municipality of Patrocínio, Minas Gerais. Methods: this is a retrospective descriptive study conducted by analyzing the information from reporting forms of the Notifiable Diseases Information System for victims of accidents with venomous animals occurred during the years 2008 to 2017 in Patrocínio. Results: in total, 1084 cases were recorded, mostly caused by scorpions (47.23%), followed by snakes (17.07%), spiders (15.31%) and bees (11.07%). There was a predominance of male victims (63.10%), aged between 20-39 years (32.56%). Most accidents were classified as mild (89.11%) and the cure occurred in 98.80% of cases; one evolved to death. Conclusion: although accidents with venomous animals do not have high mortality rates in the municipality studied, the incidence of this health problem has increased in recent years. In addition, this updated epidemiological information may contribute to public policy actions and inform the local population about imminent risks.(AU)

Justificación y objetivos: a pesar de los avances en salud, los accidentes de animales venenosos siguen siendo un importante problema de salud pública en Brasil. Entre 2015 y 2016, la región sudeste tuvo el mayor número de notificaciones y Minas Gerais fue el estado con más casos. El objetivo de este estudio fue describir las características epidemiológicas de los accidentes por animales venenosos notificados entre 2008 y 2017 en el municipio de Patrocínio, Minas Gerais. Métodos: estudio descriptivo retrospectivo llevado a cabo mediante el análisis de la información de los formularios de notificación del Sistema de Información de Enfermedades Notificables de víctimas de accidentes con animales venenosos que ocurrieron durante los años 2008 a 2017 en Patrocínio. Resultados: se registraron 1084 casos, en su mayoría causados por escorpiones (47.23%), seguidos de serpientes (17.07%), arañas (15.31%) y abejas (11.07%). Predominaron las víctimas del sexo masculino (63,10%), con edades entre 20 y 39 años (32,56%). La mayoría de los accidentes se clasificaron como leves (89,11%) y la curación se produjo en el 98,80% de los casos; uno evolucionó hasta la muerte. Conclusiones: aunque los accidentes con animales venenosos no tienen altas tasas de mortalidad en el municipio estudiado, la incidencia de este problema de salud ha aumentado en los últimos años. Además, esta información epidemiológica actualizada puede contribuir a las acciones de política pública e informar a la población local sobre los riesgos inminentes.(AU)

Incidência de acidentes ofídicos por gêneros de serpentes nos biomas brasileiros / Incidence of venomous snakebite accidents by snake species in Brazilian biomes

Resumo O aporte de insumos para o tratamento de acidentes ofídicos, bem como o treinamento da equipe assistencial devem ser orientados de acordo com a frequência e riscos por áreas geográficas. O objetivo deste artigo é analisar a tendência da taxa de incidência de acidentes ofídicos segundo gênero de serpentes nos biomas brasileiros no período de 2003 a 2012. Estudo ecológico de tendência da taxa de incidência dos acidentes ofídicos por serpentes dos gêneros Bothrops, Crotalus, Lachesis e Micrurus para os biomas no período de 2003-2012, por meio de regressão de Prais-Winsten. O número de acidentes passou de 26.082 em 2003 para 27.870 em 2012, com aumento de demanda por insumos. A análise de tendência da taxa de incidência mostrou tendência estacionária, exceto para o gênero Crotalus com tendência ascendente no agregado do Brasil. Tendência ascendente foi verificada no Cerrado para o gênero Crotalus, Lachesis e Micrurus, no Pampa também para Crotalus, na Caatinga para o gênero Lachesis e na Mata Atlântica para o gênero Micrurus. A tendência estacionária verificada para os acidentes ofídicos no Brasil decorre da maioria destes (87%) serem causados por serpentes do gênero Bothrops. No entanto, destaca-se aumento do risco para acidentes com serpentes dos gêneros Crotalus, Lachesis e Micrurus.

Abstract The supply of antidotes for the treatment of venomous snakebite accidents, as well as the training of the care team, should be structured according to the frequency and risks by geographical areas. The scope of this article is to analyze the trend of the incidence of snakebite accidents in Brazilian biomes between 2003 and 2012. It involved the ecological study by means of Prais-Winsten regression of the incidence of snakebites by the Bothrops, Crotalus, Lachesis and Micrurus species for the Brazilian biomes in the period from 2003 to 2012. The research revealed that the number of accidents increased from 26,082 in 2003 to 27,870 in 2012 with an increased demand for antidotes. The trend analysis of the incidence showed a stationary trend, except for the Crotalus species with an upward trend in the Brazilian aggregate. An upward trend was found in the Cerrado for the Crotalus, Lachesis and Micrurus species: in the Pampa for Crotalus; in the Caatinga for Lachesis and in the Atlantic Forest for Micrurus. The conclusion drawn is that the stationary trend observed for snakebite accidents in Brazil is due to the fact that the majority of these (87%) are caused by snakes of the Bothrops species. However, it should be stressed that there is an increased risk of accidents with snakes of the Crotalus, Lachesis and Micrurus species.

Epidemiology of snakebites in Colombia (2008-2016) / Epidemiología de las mordeduras por serpientes en Colombia (2008-2016)

ABSTRACT Objective To describe the main epidemiological features of snakebites in Colombia during the period 2008 to 2016. Methods A retrospective (quantitative) descriptive analytical empirical study was carried out, based on the official databases of the Public Health Surveillance in the Integral Information System of the Social Protection (SISPRO) and the Surveillance System in Public Health (Sivigila) of the reported cases of snakebites in Colombia for that period. Results In total, 37 066 cases were reported, with annual incidences ranging from 7.0 (2008) to 9.7 (2011 and 2012) cases per 100,000 population. Mortality rates ranged from 0.059 (2013) to 0.091 (2011) deaths per 100 000 population, with case fatality rates ranging from 0.6% (2013) to 1.0% (2010). Indigenous and Afro-Colombian populations were highly affected, and highest incidences occurred in males, and in people living in rural areas. The average age of affected people is 31.7 years (95% CI 28.3 34.5). The regions with higher incidence are Amazonia and Orinoquia. Species of the genus Bothrops are responsible for the highest number of bites (64.5%), owing to their wide distribution in Colombia. Regarding clinical manifestations, pain and edema were observed in 86.9% and 78.8% of patients, respectively. Cellulitis and abscesses were the most frequent local complications of these envenomings. Conclusions Results underscore the relevance of snakebite envenoming in Colombia, and provide information for improving the public health attention to these envenoming.(AU)

RESUMEN Objetivo Describir las principales características epidemiológicas de las mordeduras por serpientes en Colombia durante el período 2008-2016. Métodos Se realizó un estudio retrospectivo (cuantitativo) analítico empírico sobre los reportes de accidentes por mordedura de serpientes en Colombia para el período 2008 a 2016, a partir de las bases de datos oficiales del Sistema Integral de Información de la Protección Social (SISPRO) y del Sistema Nacional de Vigilancia en Salud Pública (Sivigila). Resultados Se reportaron 37 066 casos de mordeduras por serpientes en ese período. Las incidencias anuales oscilaron entre 7,0 (2008) y 9,7 (2011 y 2012) casos por 100,000 habitantes. Las tasas de mortalidad oscilaron entre 0,059 (2013) y 0,091 (2011) muertes por 100 000 habitantes, con tasas de letalidad entre 0,6% (2013) y 1,0% (2010). Los grupos más afectados fueron las poblaciones indígenas y afrocolombianas, y las personas residentes en zonas rurales. La edad promedio de las personas afectadas fue 31,7 años (IC 95% 28,3 34,5). Las regiones con mayor incidencia fueron la Amazonía y la Orino-quía. Especies del género Bothrops fueron responsables del mayor número de casos (64,5%), debido a su amplia distribución en el territorio colombiano. Con relación a las manifestaciones clínicas, se describió dolor y edema en 86,9% y 78,8% de los pacientes, respectivamente. Las complicaciones locales más frecuentes fueron las celulitis y los abscesos. Conclusiones Los resultados muestran la importancia de las mordeduras por serpientes en Colombia y suministran información para mejorar la atención de la salud pública ante estos envenenamientos.(AU)

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

Abstract INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.

Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015 / Ofidismo en Tocantins: análisis ecológico de determinantes y áreas de riesgo, 2007- 2015 / Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015

Objetivo: Investigar o perfil dos casos de acidentes ofídicos, seus determinantes e áreas de risco no estado do Tocantins. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação do período 2007-2015. Empregou-se regressão linear múltipla e os testes Mann-Whitney e Kruskal-Wallis. Resultados: Foram notificados 7.764 acidentes ofídicos (incidência de 62,1/100 mil habitantes; letalidade de 0,5%). As variáveis associadas ao ofidismo foram densidade demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabalho agropecuário (Coef.=0,02 - IC95% 0,01;0,03), índice de desenvolvimento humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de mandioca (Coef.=8,49 - IC95% 1,66;15,32), população indígena (Coef.=0,02 - IC95% 0,00;0,04), proporção de população analfabeta (Coef.=4,70 - IC95% 0,61;8,79) e população empregada (Coef.=3,00 - IC95% 0,93;5,06), que explicaram 64,48% da variação. As áreas de alto risco foram as regiões de saúde Amor Perfeito, Cantão, Cerrado Tocantins Araguaia e Médio Norte Araguaia. Conclusão: Aspectos socioeconômicos e demográficos municipais associaram-se ao ofidismo.

Objetivo: Investigar el perfil de accidentes ofídicos, sus determinantes y áreas de riesgo, en el estado de Tocantins. Métodos: Estudio ecológico con datos del Sistema de Información de Enfermedades de Agravamiento de Notificación, 2007-2015. Se utilizaron pruebas de regresión lineal y pruebas de Mann-Whitney y Kruskal-Wallis. Resultados: Se reportaron 7.764 accidentes ofídicos (incidencia: 62,1/100.000 hab.; letalidad: 0,5%). Las variables relacionadas al ofidismo fueron densidad demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabajo agrícola (Coef.=0,02 - IC95% 0,01;0,03), índice de desarrollo humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de yuca (Coef.=8,49 - IC95% 1,66;15,32), población indígena (Coef.=0,02 - IC95% 0,00;0,04), proporción de la población analfabeta (Coef.=4,70 - IC95% 0,61;8,79) y empleados (Coef.=3,00 - IC95% 0,93;5,06), explicando 64,48% de la variación. Las áreas de alto riesgo fueron las regiones de salud Amor Perfecto, Cantão, Cerrado Tocantins Araguaia y Medio Norte Araguaia. Conclusión: Aspectos socioeconómicos y demográficos municipales se asociaron con el ofidismo.

Objective: To investigate the epidemiological profile of snakebite accident cases, their determinants and risk areas in the state of Tocantins. Methods: This was an ecological study using data from the Notifiable Health Conditions Information System, from 2007 to 2015. Multiple linear regression and the Mann-Whitney and Kruskal-Wallis tests were used. Results: A total of 7,764 snakebite accidents were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were population density (Coeff.=1.36, 95%CI 0.72;1.99), farming work (Coeff.=0.02, 95%CI 0.01;0.03), municipal human development index (Coeff.=2.99 - 95%CI 0.60;5.38), area planted with cassava (Coeff.=8.49 - 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 - 95%CI 0.00; 0.04), proportion of illiterate people (Coeff.=4.70 - 95%CI 0.61;8.79) and employed people (Coeff.=3.00 - 95%CI 0.93;5,06), which together accounted for 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Mid-North Araguaia health regions. Conclusion: Municipal socioeconomic and demographic aspects were associated with snakebites.

Epidemiology of the injury with venomous animals in the state of Rio Grande do Norte, Northeast of Brazil / Epidemiologia dos acidentes com animais peçonhentos no estado do Rio Grande do Norte, Nordeste do Brasil

Abstract This report is an investigation of the epidemiological features of injuries with venomous animals in the Rio Grande do Norte state, Northeastern Brazil, from 2007 to 2014. A total of 30,429 cases were analyzed. Cases were distributed over all months of the period studied and occurred mainly in urban areas. Scorpion stings showed the highest percentage of cases, but the chance of death among snakebites was higher. Envenomation predominated in females with age between 20 and 49 years old. Children and elderly showed a higher chance of death. Most victims were bitten on the extremities of the limbs and received medical care within 0-1 hour after being bitten. The main local and systemic symptoms reported were pain and headache, respectively. Cases were mostly classified as mild and progressed to cure. Few victims show local and systemic complications. The high number of accidents with venomous animals shows that Rio Grande do Norte may be an important risk area for such injuries. Furthermore, this study provides data for the development of health actions to promote control and prevention of these injuries in this region.

Resumo Este estudo é uma investigação das características epidemiológicas dos acidentes com animais peçonhentos no estado do Rio Grande do Norte, Nordeste do Brasil, de 2007 a 2014. Um total de 30.429 casos foram analisados. Os casos foram distribuídos em todos os meses do período estudado e ocorreram principalmente em áreas urbanas. Os acidentes escorpiônicos representaram maior percentual de casos, entretanto, a chance de morte entre acidentes ofídicos foi maior. Os envenenamentos predominaram em mulheres com idade entre 20 e 49 anos. Crianças e idosos exibiram maiores chances de morte. A maioria das vítimas foi picada nas extremidades dos membros e recebeu assistência médica entre 0-1 hora após o incidente. Os principais sintomas locais e sistêmicos reportados foram dor e cefaléia, respectivamente. Os casos foram principalmente classificados como leves e progrediram para cura. Poucas vítimas manifestaram complicações locais e sistêmicas. O elevado número de acidentes com animais peçonhentos indica que o estado do Rio Grande do Norte pode ser uma importante área de risco para tais acidentes. Além disso, este estudo fornece dados que poderão ser utilizados para a elaboração de ações em saúde, a fim de promover o controle e a prevenção desses acidentes nesta região.

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.

Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon

Abstract INTRODUCTION: We present here the risk from snakebites because of palm extractivism in western Amazonia. METHODS: The data were extracted from a cross-sectional sample study, from January 2016 to April 2018, at the Juruá Regional Hospital of Cruzeiro do Sul (Acre). RESULTS: There were 14 Bothrops incidents involving males, most of them occurring during the harvesting of "açaí" (Euterpe precatoria). CONCLUSIONS: During the harvesting of "açaí," there is the risk of the presence of B. atrox on the ground near the palm tree, and of B. bilineatus at the top of the palm tree.

Non-venomous snakebites in the Western Brazilian Amazon

Abstract INTRODUCTION: In this study, we examined the clinical manifestations, laboratory evidence, and the circumstances of snakebites caused by non-venomous snakes, which were treated at the Regional Hospital of Juruá in Cruzeiro do Sul. METHODS: Data were collected through patient interviews, identification of the species that were taken to the hospital, and the clinical manifestations. RESULTS: Eight confirmed and four probable cases of non-venomous snakebites were recorded. CONCLUSIONS: The symptoms produced by the snakes Helicops angulatus and Philodryas viridissima, combined with their coloration can be confused with venomous snakes (Bothrops atrox and Bothrops bilineatus), thus resulting in incorrect bothropic snakebite diagnosis.

TGF-ß1 polymorphism in American tegumentary leishmaniasis in a Southern Brazilian population

Abstract INTRODUCTION: Genetic polymorphisms define the cytokine production leading to susceptibility or resistance to diseases. We studied the cytokine polymorphism in the development of tegumentary leishmaniasis (TL). METHODS: Genotyping of TNF-α, TGF-β1, IFN-γ, IL-6, and IL-10 were performed by polymerase chain reaction assay. RESULTS: G and C alleles of TGF- β1 (codon 25) were the most common in controls and patients, respectively. G/G was the most frequent genotype in controls, and G/C and C/C in patients. CONCLUSIONS: G/G genotype of codon 25 in TGF-β1 appeared to confer resistance, and G/C and C/C genotypes, susceptibility to TL in this population.

Epidemiological and clinical aspects of ophidian bothropic accidents in dogs / Aspectos epidemiológicos e clínicos dos acidentes ofídicos botrópicos em cães

Snakebites are included in the group of emergencies for domestic animals, and these consultations demand technical knowledge as well as careful clinical evaluation of patients. Because of the importance of this theme and the higher prevalence of snakebites caused by snakes of the genus Bothrops in Rio Grande do Sul state, Brazil, this study aimed to address the epidemiological and clinical aspects of these accidents in dogs in the state, in addition to establishing their incidence. Clinical records of dogs, with a diagnosis of ophidian bothropic accident, assisted at the Toxicological Information Center of Rio Grande do Sul (CIT-RS) were revised from 2014 to 2016. These data were collected at the Toxicological Information Center, Statistics and Evaluation Center, State Secretary of Health. Data on the incidence of accidents and epidemiological and clinical information were obtained for each case. A total of 53 records were revised. In the records that included animal sex (n=49), 53% were female and 46.9% were male. As for animal age (n=47), the dogs ranged from one to 14 years, and most of them (46.9%) were in the 1-4-year age group. Over half of the cases occurred in the rural area (60.7%), and the head and neck were the main venom inoculation sites (76.3%). Diseases were characterized by clinical courses varying from hyperacute (<30 min to 6h), acute (6-24h), to subacute (4-5 days). Severe accidents accounted for 40% of the cases, with edema as the most frequent clinical sign (88.7%) followed by hemorrhagic manifestations (41.5%). Associations of epidemiological and clinical aspects coupled with history of exposure are important characteristics to assist with suspicion and definitive diagnosis of bothropic accidents in dogs.(AU)

Os acidentes ofídicos se enquadram no grupo de emergências para animais domésticos e esses atendimentos demandam conhecimento técnico, aliado a uma criteriosa avaliação clínica do paciente. Devido à importância do tema e a maior frequência de acidentes ofídicos provocados por serpentes do gênero Bothrops no Rio Grande do Sul, esse estudo teve como objetivo abordar os aspectos epidemiológicos e clínicos desses acidentes em cães nesse estado, além de estabelecer a frequência em que ocorrem. Foram revisados os protocolos de atendimentos clínicos de cães realizados pelo Centro de Informações Toxicológicas do Rio Grande do Sul (CIT-RS) com diagnóstico de acidente ofídico botrópico, entre o período de 2014 e 2016. Esses dados fazem parte do Centro de informação Toxicológica, Secretaria da Saúde, RS, Núcleo de Estatística e Avaliação. Foram obtidos dados relacionados à frequência dos acidentes e informações referentes à epidemiologia e à clínica de cada caso. Totalizaram-se 53 registros de atendimentos. Dos protocolos que informaram o sexo (n=49), 53% corresponderam a fêmeas e 46,9%, a machos. Em relação à idade (n=47), houve uma variação entre um e 14 anos, com maior concentração dos casos entre 1-4 anos (46,9%). Mais da metade dos atendimentos ocorreu em zona rural (60,7%) e a cabeça e o pescoço foram os principais locais de inoculação do veneno botrópico (76,3%). Observou-se uma doença com um curso que variou de hiperagudo (<30 min à 6h), agudo (6-24h) a subagudo (4-5 dias). Acidentes graves representaram 40% dos casos, no qual edema foi o sinal clínico mais frequente (88,7%), seguido por manifestações hemorrágicas (41,5%). A associação dos aspectos epidemiológicos e clínicos, aliados ao histórico de exposição, constituem características importantes que auxiliam na suspeita e no diagnóstico definitivo do acidente botrópico em animais.(AU)