Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

A new case of envenomation by neotropical opisthoglyphous snake Philodryas olfersii (Lichtenstein, 1823) in Recife, State of Pernambuco, Brazil

Abstract Human envenomation by the snakes Colubridae and Dipsadidae are reported in Brazil, and envenomation by the Opisthoglyphous snake Philodryas olfersii could be dangerous. Here, we present the second record of an envenomation by Philodryas olfersii in Pernambuco, northeast Brazil. The male victim presented with mild erythema pain, paraesthesia, local numbness, and swollen lymph nodes. The symptoms were similar to those of a pit viper bite, and disappeared completely after 15 days.

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon

Abstract A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Envenomation by an opisthoglyphous snake, Erythrolamprus aesculapii (Dipsadidae), in southeastern Brazil

Abstract Snakebites by aglyphous or opisthoglyphous snakes are common in Brazil. We report a case of snakebite by the opisthoglyphous Erythrolamprus aesculapii. The victim presented with pain, edema, and bleeding at the bite site, along with erythema, similar to a Bothrops envenomation. In this type of snakebite, if the snake is not brought to the hospital, the victim may receive unnecessary serum therapy, with the risk of adverse reactions to the antivenom. The possibility of reducing after-effects with anti-inflammatory drugs and early antibiotic therapy for secondary infection need to be further investigated, preferably in multicenter studies, while observing good clinical practice.

Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

Abstract: Because the majority of colubrid species are considered harmless to human beings, colubrid snakebites are rarely reported. However, the venom of Rhabdophis, which is part of the Colubridae family, is procoagulant and leads to severe coagulopathy. Here, we present a case of disseminated intravascular coagulation with enhanced fibrinolysis following a Rhabdophis bite. Although coagulopathy can be treated effectively with the specific Rhabdophis antivenom, this antivenom is not widely available in Indonesia. We also found transient hypertension secondary to the colubrid venom, an unusual finding.

Internações hospitalares por causas externas envolvendo contato com animais em um hospital geral do interior da Bahia, 2009-2011 / Hospitalizations due to external causes involving contact with animals in a general hospital in the interior of Bahia State, Brazil, 2009-2011 / Internaciones hospitalarias por causas externas vinculado a contacto con animales en un hospital general del interior de Bahia, Brasil, 2009-2011

OBJETIVO: descrever as características das internações por causas externas envolvendo contato com animais em um hospital geral no interior da Bahia, no período de 2009 a 2011. MÉTODOS: estudo descritivo, com dados sobre internações no município de Jequié-BA. RESULTADOS: foram identificadas 246 internações por acidentes envolvendo contato com animais, sendo principalmente peçonhentos (83,3% por veneno de serpente e 6,5% por veneno de escorpião); predominaram vítimas do sexo masculino (66,7%), do grupo etário de 20 a 59 anos (50,4%) e residentes na zona rural (91,2%); a maioria das internações ocorreu no turno da noite (39,0%) e em dias úteis da semana (69,1%); a maior parte dos casos teve um tempo de internação de 1 a 3 dias (50,8%) e 97,6% deles evoluíram com alta hospitalar. CONCLUSÃO: ofidismo e escorpionismo foram os acidentes mais frequentes, acometendo predominantemente homens jovens residentes na zona rural.

OBJECTIVE: to describe the characteristics of hospitalizations due to external causes involving contact with animals in a general hospital in the interior of Bahia State (BA), Brazil, from 2009 to 2011. METHODS: this was a descriptive study using data on hospital admissions in Jequié-BA. RESULTS: there were 246 admissions owing to accidents involving contact with animals, especially venomous ones (83.3% snake venom, and 6.5% scorpion venom); most involved male victims (66.7%), the 20-59 year age group (50.4%), and people resident in rural areas (91.2%); most hospitalizations occurred during the night shift (39.0%) and on weekdays (69.1%); most cases had 1 to 3 day inpatient stays (50.8%), and 97.6% were subsequently discharged. CONCLUSION: snakebites and scorpion stings were the most frequent accidents and predominantly affected young men living in the rural area.

OBJETIVO: describir las características de las internaciones por causas externas vinculadas al contacto con animales en un hospital general en el interior de Bahia, Brasil, en el período de 2009 a 2011. MÉTODOS: estudio descriptivo, con datos sobre admisiones en Jequié-BA. RESULTADOS: fueron identificadas 246 internaciones por accidentes vinculado al contacto con animales, especialmente venenosos (83,3% veneno de serpiente y 6,5% de escorpión); predominantemente victimas varones (66,7%), entre 20-59 años (50,4%) y residentes de zonas rurales (91,2%); la mayoría de las hospitalizaciones ocurrieron en el turno de noche (39,0%) y en días útiles de semana (69,1%); la mayoría de los casos tuvieron un tiempo de internación de 1 a 3 días (50,8%) y 97,6% fueron dados de alta. CONCLUSIÓN: ofidismo y escorpionismo fueron los accidentes más frecuentes, acometiendo predominantemente hombres jóvenes residentes en la zona rural.

A snakebite caused by a bushmaster (Lachesis muta): report of a confirmed case in State of Pernambuco, Brazil

ABSTRACTWe report a case of envenomation caused by a bushmaster ( Lachesis muta) in a male child in State of Pernambuco, Brazil. The victim showed discrete local manifestations, but presented altered blood coagulation 2 hours after the bite. Ten ampoules of bothropic-lachetic antivenom therapy were administered, and 48 hours later, the patient showed discrete edema, pain, and ecchymosis around the bite and normal blood coagulation. The patient was discharged 5 days after the envenomation. The prompt administration of specific treatment was important for the favorable outcomes observed.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

Exposición a agentes de riesgo biológico en trabajadores chilenos: Reporte del Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Exposure to occupational biological risks: Experience of a toxicology information center

Background: Exposure to Biological Agents during work is an emergent type of occupational risk. Aim: To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. Material and Methods: All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). Results: In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). Conclusions: Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

The Ocular Complications of an Envenomous Snakebite

An envenomous snakebite is an important public health problem that can lead to irreversible loss of vision. Snake venom neurotoxins mainly act on the peripheral nervous system at the neuromuscular junction; and result in the implication of the cranial nerves. Consequently; mild neurological symptoms that relate to cephalic muscle paralysis; including exotropia; ptosis; diplopia and ophthalmoplegia; can occur. This happens because the extraocular muscles are especially susceptible to neurological muscular blockage. Other neurological complications of snake venom include accommodation paralysis; optic neuritis; globe necrosis; keratomalacia; uveitis; and loss of vision due to cortical infarction. Haemostatic complications may include subconjuctival haemorrhage; hyphema; and vitreous and retinal haemorrhages. Another rare complication of a snakebite is ocular injury. Snakebite injuries are often accompanied by facial swelling; periorbital ecchymosis; massive subconjuctival haemorrhage; severe corneal oedema and exophthalmos in the affected eye. Unfortunately; such injuries result in permanent loss of vision; as early evisceration is deemed necessary to reduce the amount and effect of the venom in the affected eye. With such a variety of ocular complications as a result of a venomous snakebite; it is important for primary care physicians to have some basic knowledge of the management of these complications; as they may prove to be vital where patients present with a snakebite and possible venom injection in the eye

Perfil eco-epidemiológico de los accidentes por ofidios en Monagas, Venezuela (2002-2006) / Eco-epidemiological profile of snakebite accidents in Monagas state, Venezuela (2002-2006)

El accidente causado por animales venenosos representa un problema global, especialmente en las áreas subtropicales y tropicales del mundo. En Venezuela, es endémico para varias regiones incluyendo la zona nororiental. Con el objetivo de ampliar y actualizar el perfil eco-epidemiológico del ofidismo en el estado Monagas, se evaluó su comportamiento, en cada municipio, durante 5 años de registro (2002 - 2006). Se contabilizaron 339 accidentes ofídicos (con promedio de 68 anuales). El incidente ocurrió con mayor frecuencia en agricultores, adultos jóvenes y de género masculino, durante sus labores en el campo y en el periodo diurno. La incidencia siguió un patrón estacional bimodal con predominio en épocas de alta y baja pluviosidad. Los envenenamientos botrópicos (28,6%) fueron más frecuentes que los crotálicos (14,5%), con proporción 2:1. El 87,9% recibió sueroterapia específica. La incidencia promedio anual en la entidad se ubicó en 11,30 casos por 100.000 habitantes, siendo Punceres (46,29), Acosta (20,91) y Bolívar (19,52) los municipios con mayor impacto. El estado Monagas presentó un mapa de endemicidad distribuido en municipios de (1) muy alta endemicidad, (2) alta endemicidad, (3) mediana endemicidad, (4) baja endemicidad y (5) muy baja endemicidad. Durante el período analizado no se registró muerte por esta causa en el estado. Los hallazgos sugieren la importancia del accidente por serpientes en Monagas, con especial importancia en la mitad norte de la entidad.

The accidents caused by venomous animals are a global problem, especially in subtropical and tropical regions of the world. In Venezuela, they are endemic in several regions including the northeast. In order to expand and update the ecoepidemiological profile of snake bites in Monagas state, their behavior was assessed in each municipality for 5 years (2002 -2006). There were 339 ophidian accidents (on average 68 per year). The bites occurred more frequently in young adult male farmers, while working in the field and during daytime. The incidence followed a bimodal seasonal pattern with predominance in high and low rainfall periods. Bothropic envenoming (28.6%) were the most frequent followed by Crotalic ones (14.5%), with a 2:1 ratio. 87.9% received specific serum therapy. The annual average incidence in the state was 11.30 cases per 100,000 inhabitants. Punceres (46.29), Acosta (20.91) and Bolivar (19.52) were the municipalities with the highest impact. Monagas state showed an endemicity map with municipalities having (1) very high endemicity, (2) high endemicity, (3) medium endemicity, (4) low endemicity and (5) very low endemicity. In the studied period there were no deaths from this cause in the state. The findings suggest the importance of snake accidents in Monagas, especially in the northern half of the state.

Maternal exposure to Bothrops jararaca snake venom: effects in mice offsprings / Exposição maternal ao veneno de Bothrops jararaca: efeitos na prole de camundongos

Objective - Bothrops jararaca snake is involved in almost 90% of all reports in the State of São Paulo, Brazil. Little is known about the effect of maternal exposure to B. jararaca snake venom [BjV] on fetal development. This study was designed to investigate the effect of a moderate dose of the venom (1.2 mg/kg sc on either gestation day GD5 or GD12), in pregnant mice and their offspring. Methods - In dams, during pregnancy, it was observed the body weight gain, food and water consumptions. In the last day of pregnancy, dams were submitted to a cesarean and the reproductive performance was measured. Thus, the fetuses body weight, the number of live and dead fetuses as wells as the external, visceral or skeletal alterations were assessed. Results - Results showed that the venom injection on GD5 did not change the dams weight and reproductive parameters, the fetuses weight, but it was observed high incidence of skeletal anomalies such as incomplete skull ossification and supernumerary ribs relative to controls. Dams treated in GD11 showed decreased food ingestion in the day after treatment. Their offspring presented a high incidence of skeletal anomalies such as vertebrae anomalies, sternebrae anomalies and incomplete skull ossification, which might be a sign of craniostenosis, than controls. Conclusions - In conclusion, subcutaneous administration of 1.2mg/kg BjV to pregnant mice either at GD4 or GD12 produced subtle maternal toxicity but a clear fetotoxicity. Whether these observations represent a reaction to treatment and, if so, the underlying mechanisms and their toxicological impact remain to be examined further in future studies.

Objetivo - O veneno de Bothrops jararaca está envolvido em quase 90% dos casos de envenenamento do Estado de São Paulo, Brasil. Pouco se sabe sobre o efeito no desenvolvimento fetal quando no caso de envenenamento materno. Este estudo examinou, em camundongas prenhes e sua prole, os efeitos do envenenamento por uma dose moderada do veneno de B. jararaca (1,2 mg/kg sc no 5° (GD5) e 11°(GD11) da gestação. Métodos - Anotou-se durante a gestação o ganho de peso corporal e o consumo de água e comida materno; no último dia de gestação, as mães foram submetidas a uma cesariana e a performance reprodutiva foi avaliada. Para tanto, anotou-se o peso dos fetos, o número de fetos vivos e mortos, assim como examinou-se a presença de alterações externas, esqueléticas, e viscerais. Resultados - Os resultados mostraram que a injeção do veneno no GD5 não alterou o peso materno, o consumo de água e ração, o peso dos fetos e os parâmetros reprodutivos, tendo sido observada alta incidência de anomalias esqueléticas tais como ossificação do crânio incompleta e costelas supranumerárias em relação aos controles. O envenenamento no GD11 promoveu decréscimo na ingestão de alimentos no dia subsequente ao tratamento. Neste caso, a prole apresentou alta incidência de anomalias esqueléticas tais como anomalias vertebrais, do esterno e ossificação incompleta do crânio, ou seja, craniostenose. Conclusões - O envenenamento moderado pelo veneno da B. jararaca em camundongas prenhas tanto no GD5 como no GD11 produziram efeitos sutís ao nível materno, porém nos fetos, apareceram severas alterações. Estudos futuros deverão ser feitos para entender os mecanismos subjacentes a este envenenamento durante a gestação.

Poisoning due to Philodryas olfersii (Lichtenstein, 1823) attended at Restauração Hospital in Recife, State of Pernambuco, Brazil: case report / Envenenamento por Philodryas olfersii (Lichtenstein, 1823) atendido no Hospital da Restauração do Recife, Estado de Pernambuco, Brasil: relato de caso

Few papers have been published on snake bites caused by Philodryas olfersii. We report here the first case identified at the Centro de Assistência Toxicológica do Hospital da Restauração, Recife, State of Pernambuco. This case was described based on medical protocols, interviewing the patient and identifying the animal that caused the bite. The patient presented pain, heat, erythema, edema and ecchymosis, without other laboratory abnormalities or coagulation disorders. The treatment consisted of administration of eight ampoules of antibothropic serum, and post-administration allergenic reactions were observed. The importance of bites by opistoglyph snakes needs to be reconsidered in research and at specialized treatment centers.

Existem poucas publicações de acidentes ofídicos causados pela espécie Philodryas olfersii. Relatamos aqui o primeiro caso identificado no Centro de Assistência Toxicológica do Hospital da Restauração, Recife, Estado de Pernambuco. A descrição do caso foi realizada com base nos protocolos médicos, entrevista com o paciente e identificação do animal causador do acidente. O paciente apresentou dor, calor, eritema, edema e equimose, sem outras alterações laboratoriais ou distúrbios da coagulação. O tratamento executado mediante a administração de oito ampolas de soro antibotrópico apresentou reações alergênicas pós-administração. A relevância dos acidentes por serpentes opistóglifas deve ser reconsiderada na pesquisa e nos centros de tratamento especializados.

A importância dos acidentes ofídicos como causa de mortes em bovinos no Brasil / The importance of snake bites as cause of cattle death in Brazil

A revisão da literatura pertinente indica que as opiniões sobre a importância dos acidentes ofídicos, como causa de mortes em bovinos no Brasil, são divergentes no meio veterinário. Enquanto alguns acreditam que são pouco importantes, ou que têm menor significado do que lhes é atribuído, outros são da opinião que esses acidentes são freqüentes. Verificou-se que só foi relatado diagnóstico fundamentado de dois casos fatais de envenenamento por Bothrops spp em bovinos, e de nenhum por Crotalus spp. Um questionário por nós submetido a patologistas e clínicos veterinários que atuam em diversos Estados do país, revelou apenas raros casos suspeitos de envenenamento ofídico fatal em bovinos no Brasil. Em nossas viagens de estudo e nos trabalhos de diagnóstico nunca estabelecemos o diagnóstico de morte por acidente ofídico em bovinos. Os casos tidos como envenenamento ofídico, na sua grande maioria, são apenas suposições, sem embasamento. Esses "diagnósticos", em geral, são feitos à distância dos animais que morreram, à revelia de exame clínico, necropsia e estudo histopatológico. Importante foi a constatação de que, no Brasil, embora algumas serpentes do gênero Bothrops possam, teoricamente, produzir quantidades suficientes de veneno para matar um bovino adulto, em experimentos realizados, apenas Bothrops alternatus foi capaz de levar a morte um dos três bovinos experimentalmente por ela picados; esse animal tinha apenas 279 kg. Já as serpentes do gênero Crotalus poderiam inocular quantidades letais de veneno para bovinos adultos. Mesmo assim, tanto para Bothrops spp, como para Crotalus spp, há que se considerar que as serpentes, em geral, só inoculam parte do veneno disponível. Esse estudo indica que é necessário melhor investigar as mortes suspeitas de terem sido causadas por acidente ofídico em bovinos no Brasil. O estabelecimento do diagnóstico de morte por envenenamento ofídico, porém, só é possível pela determinação precisa do quadro clínico-patológico...

A review of the literature shows that opinions on the importance of snake bites as cause of cattle death in Brazil are divergent among veterinarians; some think they are of no importance or of only minor significance, others are of the opinion that snake bites are frequent. However, the literature only reports two confirmed fatal cases by Bothrops and none by Crotalus in cattle in the country. A questionnaire which was submitted for appraisal to veterinary pathologists and clinicians in various States of Brazil, revealed only suspected cases of fatal accidents by snakes in cattle. During our field and laboratory diagnostic work we never made a diagnosis of a snake bite accident. Many "diagnoses" have apparently been made at a distance from where the animals died, without clinical and post-mortem examination, nor histological studies. By this way, the great majority of cases seems to be only supposition. In Brazil there are only few snakes of the genus Bothrops theoretically able to produce sufficient amounts of venom to kill an adult bovine. Nevertheless, in experiments, only Bothrops alternatus was able to cause the death of just one out of three bovines bitten, and this animal only weighed 279 kg. Snakes of the genus Crotalus can produce sufficient amounts of venom to kill an adult bovine; however it is known, that snakes of the genus Crotalus as well as of Bothrops generally inoculate only a part of their venom. These considerations indicate that the deaths suspected to have been caused by snake bites in cattle in Brazil have to be studied more thoroughly. A diagnosis can only be confirmed by establishing the precise clinical and pathological picture. Our current opinion is that fatal snake bites are much less frequent in cattle than often believed, and that their importance is generally much exaggerated.

Routine antibiotic therapy in the management of the local inflammatory swelling in venomous snakebites: results of a placebo-controlled study.

OBJECTIVE: To evaluate the value of routine antibiotic therapy in the management of the local swelling of patients with venomous snakebites. METHODS: A prospective, placebo-controlled study at the General Hospital, Anuradhapura, Sri Lanka where 144 patients with envenoming and local swelling in the leg were allocated to receive either antibiotics (Group A = test group) or placebo (Group B = controls). Benzyl penicillin 2 mega units intravenously 6 hourly and metronidazole 500 mg by intravenous infusion 8 hourly for 5 days from the first day of the bite were given to Group A. Ethical committee approval was obtained from the Committee of General Hospital, Anuradhapura. MAIN OUTCOME MEASURES: Circumference difference between the affected limb and the normal limb, length of the swelling measured in centimetres, and the physical characteristics of the local swelling of both groups were compared. RESULTS: Group A had 69 patients and the Group B 75. The mean circumference difference (MCD) of the leg between the groups showed no significant difference for 4 days (P > 0.05), except at the site of the bite on the third day when the Group B showed a significant improvement (p = 0.02). There was no significant difference in the length of the local swelling or the score of physical characteristics between the two groups (P > 0.05). The proportions of recovery of the local swelling on the fourth and fifth day had no significant difference between the groups (P > 0.05). CONCLUSION: The routine use of antibiotics (penicillin and metronidazole) does not seem to be of value in reducing the local inflammatory swelling in venomous snakebite.

Guidelines for management of snake bite cases

Poisonous snakes occur in many parts of the world and are especially prevalent in Indian subcontinent. Keeping in view the nature of work, the Army personnel are at an increased risk of snake bite. The management of snake bite has been divided into Field and Hospital management. A review of current opinions on the first aid and hospital management has been discussed and guidelines for management of snake bite cases is formulated