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

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

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

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

Snakebite envenomation in the Brazilian Amazon: a cost-of-illness study.

BACKGROUND: Snakebites account for significant morbidity and mortality. Their occurrence in the Brazilian Amazon warrants an analysis that will enable better understanding of their economic impact and thus contribute to their management and prevention. This study aimed to estimate the cost of snakebite envenomation in the Brazilian Amazon in 2015. METHODS: We conducted a cost-of-illness study of snakebite in the Brazilian Amazon in 2015 based on official surveillance data to estimate burden from a societal, patient and public health system perspective. Direct medical costs were estimated via a top-down approach. Loss of productivity was estimated by a human capital approach. RESULTS: The study included 11 503 cases and 56 deaths. The estimated cost to the health system was US$3.115.861,28. The estimated cost due to premature death caused by snakebite was US$3031 300.38. The cost attributed to the loss of productivity due to absence from work was US$1539 518.62. The estimated cost from the patient's perspective was US$268 914.18. Therefore the total cost of snakebite in the Brazilian Amazon was estimated to be almost than US$8 million in 2015. CONCLUSIONS: The economic burden of snakebite in Brazilian Amazon is notably high. Snakebites cause loss of productivity through inpatient treatment or deaths.

Snakebite envenomation in the Brazilian Amazon: a descriptive study.

Snakebite envenomation in the Brazilian Amazon is a recognized public health problem that does not receive the appropriate attention from key stakeholders. The morbidity rate is relevant, but still underestimated. Thus, the present study updates the current state of knowledge on snakebite envenomation in the Brazilian Amazon. It follows a descriptive method and contributes new knowledge about the dynamics of snakebites and the associated morbidity and mortality reported in the Brazilian Amazon. The study is based on information from cases registered and retrieved from the Brazilian Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação-SINAN). The registers we studied covers a period of six years, 2010-2015. Most snakebites occurred in the states of Pará (30 693 cases, 43.34%) and Amazonas (9386 cases, 13.25%), with a higher prevalence in males of an economically active age. The main genus involved in bites was Bothrops sp. The mortality rate was 0.24 per hundred thousand and the case fatality rate was 0.51%. Although low case fatality and mortality rates were observed, much can still be done to prevent snakebites as they continue to be a serious public health problem considering the severity and potentially high economic impact for the individual and to society.