RESUMO
Continuous monitoring of the snakebite envenoming allows elucidating factors that affect its incidence at spatial and temporal scales, and is a great tool to evaluate the proper management of snakebite in health centers. To determine if there have been changes over time in snakebite epidemiology in Costa Rica, we conducted a retrospective study using medical records from six hospitals for the years 2012-2013. A total of 475 snakebite patients were treated at the selected hospital during this period. Most bites occurred during the rainy season and primarily affected young men, mainly farm workers and schoolchildren. About 55% of bites occur in peri-domiciliary environments, although its prevalence varies geographically. Bothrops asper generates the vast majority of envenoming in the country, which is why the main local symptoms registered are edema, pain, and bleeding disorders. The time elapsed until treatment did not explain the degree of severity at admission. However, complications were observed more frequently in patients who took longer to receive treatment. The primary complications were bacterial infections, whereas kidney failure and compartment syndrome documented at very low frequencies. Only one death was recorded, reflecting the low fatality rate exhibited in the country. Hospital treatment included the rapid administration of antivenom and complementary treatment of antibiotics, analgesics, and antihistamines. The application of the latter as prophylactic does not seem to prevent the appearance of mild early adverse reactions, registered in 22.5% of the cases. Morbidity and mortality rates from snakebite have continued to decrease in the country, as a result of the efforts that Costa Rica has made to improve its public health system. Among those efforts, the creation of primary care centers (EBAIS) has reduced the time to treatment in many regions of the country. The Costa Rican experience of using antivenom in primary health care centers and maintaining good medical records could be considered for application in other countries where snakebite is a major health problem.
RESUMO
La Listeria monocytogenes es un bacilo o cocobacilo grampositivo, móvil, anaerobio, facultativo e intracelular que se adapta a los cambios ambientales extremos. Se transmite por alimentos contaminados. Infecta a recién nacidos, pacientes inmunosuprimidos, adultos mayores y mujeres embarazadas. Se la ha asociado con una elevada mortalidad fetal o neonatal. Puede cursar con un cuadro sintomático leve y autolimitado, pseudogripal inespecífico o tener graves repercusiones maternas y fetales. Se presenta el caso clínico de una paciente primigesta con embarazo de 19 semanas y corioamnionitis por Listeria monocytogenes. El tratamiento antibiótico iniciado oportunamente es fundamental para lograr la mejoría de la evolución materno-fetal y revertir el cuadro.
Listeria monocytogenes is a Grampositive bacillus or coco-bacillus, mobile, anaerobic facultative and intracellular that adapts to extreme environmental changes. It is transmitted by contaminated food. It infects newborns, immunosuppressed patients, older adults and pregnant women. It has been associated with high fetal or neonatal mortality. May present with a mild and self-limiting condition, non-specific pseudo-flu condition or have serious maternal or fetal repercussions. We present the clinical case of a primiparous patient with a 19-week pregnancy and chorioamnionitis due to Listeria monocytogenes. The antibiotic treatment of opportune initiation is fundamental to achieve the improvement of the maternal-fetal evolution and to revert the clinical profile.
