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INTRODUCTION: Antivenom is a lifesaving medicine for treating snakebite envenoming, yet there has been a crisis in antivenom supply for many decades. Despite this, substantial quantities of antivenom stocks expire before use. This study has investigated whether expired antivenoms retain preclinical quality and efficacy, with the rationale that they could be used in emergency situations when in-date antivenom is unavailable. METHODS: Using WHO guidelines and industry test requirements, we examined the in vitro stability and murine in vivo efficacy of eight batches of the sub-Saharan African antivenom, South African Institute for Medical Research polyvalent, that had expired at various times over a period of 30 years. RESULTS: We demonstrate modest declines in immunochemical stability, with antivenoms older than 25 years having high levels of turbidity. In vitro preclinical analysis demonstrated all expired antivenoms retained immunological recognition of venom antigens and the ability to inhibit key toxin families. All expired antivenoms retained comparable in vivo preclinical efficacy in preventing the lethal effects of envenoming in mice versus three regionally and medically important venoms. CONCLUSIONS: This study provides strong rationale for stakeholders, including manufacturers, regulators and health authorities, to explore the use of expired antivenom more broadly, to aid in alleviating critical shortages in antivenom supply in the short term and the extension of antivenom shelf life in the longer term.
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Antivenenos , Mordeduras de Serpentes , Camundongos , Humanos , Animais , Antivenenos/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Peçonhas/uso terapêuticoRESUMO
The protein profile of Bothrops rhombeatus venom was compared to Bothrops asper and Bothrops atrox, and the effectiveness of antivenoms from the National Institute of Health of Colombia (INS) and Antivipmyn-Tri (AVP-T) of Mexico were analyzed. Protein profiles were studied with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and reverse-phase high-performance liquid chromatography (RP-HPLC). The neutralizing potency and the level of immunochemical recognition of the antivenoms to the venoms were determined using Western blot, affinity chromatography, and enzyme-linked immunosorbent assay (ELISA). Bands of phospholipase A2 (PLA2), metalloproteinases (svMPs) I, II, and III as well as serine proteinases (SPs) in the venom of B. rhombeatus were recognized by SDS-PAGE. With Western blot, both antivenoms showed immunochemical recognition towards PLA2 and svMP. INS showed 94% binding to B. rhombeatus venom and 92% to B. asper while AVP-T showed 90.4% binding to B. rhombeatus venom and 96.6% to B. asper. Both antivenoms showed binding to PLA2 and svMP, with greater specificity of AVP-T towards B. rhombeatus. Antivenom neutralizing capacity was calculated by species and mL of antivenom, finding the following for INS: B. asper 6.6 mgV/mL, B. atrox 5.5 mgV/mL, and B. rhombeatus 1.3 mgV/mL. Meanwhile, for AVP-T, the following neutralizing capacities were found: B. asper 2.7 mgV/mL, B. atrox 2.1 mgV/mL, and B. rhombeatus 1.4 mgV/mL. These results show that both antivenoms presented similarity between calculated neutralizing capacities in our trial, reported in a product summary for the public for the B. asper species; however, this does not apply to the other species tested in this trial.
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Antivenenos , Venenos de Crotalídeos , Animais , Academias e Institutos , Western Blotting , Bothrops asper , Bothrops atroxRESUMO
ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.
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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.
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Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Mordeduras de Serpentes/complicações , Venenos de Serpentes/efeitos adversos , Mordeduras de Serpentes/terapia , Venenos de Serpentes/intoxicação , Traumatismos da Mão/etiologiaRESUMO
OBJECTIVE: This study assessed the risk factors for sustaining a snake bite, the prehospital measures employed, and the clinical needs of patients admitted with confirmed envenomation. METHODOLOGY: Data was collected at a single center, a rural secondary care hospital in Trinidad and Tobago. A cross-sectional method was used that enrolled all consenting patients requiring admission following clinical confirmation of snake envenomation during the period 2017-2019. Data collection involved a review of the patient record from the emergency room and hospital admission to establish the clinical need during the time of admission which was defined as the administration of medication, need for surgery, and critical care intervention. Data collection also involved a patient interview to establish demographics, prehospital measures employed, and assessment of the risk factors associated with sustaining the snake bite. RESULTS: 29 patients were admitted for snakebite envenomation during 2017-2019 and all patients consented to enrolment. Of these patients, 22 were male and most commonly were within the age range of 18-40 years old. 34.5% of patients were farmers and 68.9% of patients identified being bitten by the Mapepire Balsain snake. 65.5% of patients reported being unaware of the risk of snake bites and 82.8% were not wearing boots, with the lower limb being the most common bite site among 55.2%. 41.4% of bites were sustained during work-related activity while 34.5% of bites were sustained during recreational activity. Prehospital measures were employed by 18 of the 29 patients with the most common types being irrigation (10.3%), cutting (6.9%), tourniquets (44.8%), pressure immobilization (6.9%), topical applications (3.4%), and ingestion of a substance (6.9%). 34.5% received hospital care within 1 hour of the bite while 55.2% arrived at the hospital between 1 and 4 hours of being bitten. The clinical challenges of these patients included local reactions (82.8%), coagulopathy (72.4%), compartment syndrome (17.2%), cellulitis (3.4%), and dislocated shoulder (3.4%). The clinical needs of these patients included vitamin K (13.8%), antibiotics (93.1%), tetanus shots (17.2%), analgesia (6.8%), and anti-venom (82.7%). 10.3% of patients required debridement and 3.4% required a fasciotomy. The average stay in the hospital was 3.8 days. There were no documents of deaths or need for critical care. CONCLUSION: Persons are most likely to be envenomated by the M. Balsain in Trinidad. These patients are commonly males ranging anywhere from 18 to 40 years presenting local reactions and coagulopathy needing admittance to the hospital. While the majority of patients requiring admission performed some type of prehospital measure, very few did so with pressure immobilization. Furthermore, the majority of patients had a prolonged time before presenting to the hospital; this is a potential area for improvement in the health system through education and sensitization. There was a significant utilization of resources on these patients when taking into consideration their clinical needs, medication, and hospital stay; primary prevention should be a focus through the education of groups who are at higher risk for a venomous snake encounter.
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Abstract Snakebite is one of the major health issues posing considerable morbidity and mortality. According to an estimate of World Health Organization (WHO) (World health organization, 2021) approximately 5 million people are bitten by several species of snakes resulting in up to 2.5 million envenomation cases annually. The mainstay of treatment for envenomation is intravenous administration of anti-snake venom. Although antivenom neutralizes the systemic effects but it does not relieve the symptoms such as venom-induced hemorrhage, necrosis and nephrotoxicity. Moreover, the use of antivenoms is associated with hypersensitivity reactions including urticaria, anaphylaxis, or serum sickness due to their heterologous property. Furthermore, stringent storage conditions and narrow specificity of antivenoms limit their use in both developed as well as developing countries. In this context, researchers have been searching for natural products and plant extracts to explore their antivenom activity along with anti-myotoxic, anti-hemorrhagic and anti-inflammatory properties. Plant remedies may prove to be an effective alternate for antivenom sera with less adverse events and better tolerability. To the best of our knowledge, this is the first comprehensive review of medicinal plants possessing anti-snake venom activities against certain species of snakes. The current review highlights the investigated plants with their phytochemical analysis to integrate the available information for future research and development of antivenom sera.
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Plantas Medicinais/efeitos adversos , Venenos de Serpentes/análise , Antivenenos/análise , Venenos Elapídicos/isolamento & purificação , Compostos Fitoquímicos/agonistas , Mordeduras de Serpentes/classificação , Organização Mundial da Saúde , Extratos Vegetais , Administração Intravenosa/instrumentaçãoRESUMO
Greater access to the Internet has boosted the online pet trade and especially enabled the trade in niche-targeted groups, such as venomous species. Despite their fearsome reputation, an array of venomous animals, such as snakes, spiders and scorpions arise interest among pet hobbyists, which exposes owners, sellers, and others involved in their transport and maintenance to potentially serious accidents by envenomation. To assess the potential risk to human health posed by the trade and ownership of venomous pet snakes, we examined social media posts trading or portraying native and exotic venomous species as pets (Facebook™ and YouTube™) and official seizures in Brazil between 2015 and 2020. In addition, we recorded all venomous snakebite events occurring in the country during the same period from the Brazilian Ministry of Health database. We compiled 114,931 venomous snakebite events resulting in over 600 human deaths. Bothrops spp. and Crotalus spp. were responsible for 86% and 10% of these events. We recorded 241 individual venomous snakes kept as pets of at least 16 species (seven native and nine non-native). The taxa with higher numbers of snakebites were also those most often kept as pets. Venomous pet snakes were sold at low prices, US$ 71.70 ± 18.44 on average. Our findings highlight a dangerous market, given the similarity of taxa raised as pets and those causing snakebites, combined with low availability of anti-venom for exotic species in Brazil. Additionally, several of the venomous pet snakes recorded are invasive species in many countries. Trade in venomous snakes is prohibited in Brazil, but the law is not well-enforced. To curb this illegal market and discourage consumer demand, we suggest that tougher penalties for sellers and owners should be considered, along with the development of awareness campaigns on the consequences of the snakebite injuries and the lack of antivenoms.
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Animais de Estimação , Mordeduras de Serpentes , Animais , Antivenenos , Bothrops , Brasil/epidemiologia , Crotalus , Humanos , Mordeduras de Serpentes/epidemiologia , SerpentesRESUMO
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.
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Humanos , Animais , Masculino , Adulto , Adulto Jovem , Mordeduras de Serpentes/epidemiologia , Bothrops , Brasil/epidemiologia , Incidência , Estudos Retrospectivos , Distribuição por SexoRESUMO
Snake bites are a serious health hazard occurs throughout the world especially in tropical countries like India. Anti-Snake Venom Serum is the only remedy available to treat snake bite victims successfully till date. Infusion of ASV may lead to adverse reactions ranging from severe itching of the skin, hives to potentially serious allergic reactions. Considering all above difficulties research workers all over the world is constantly in search of a cheap and readily available easy formulate remedy for treating snake bite victims. In present study aqueous extract of Rauvolfia serpentina root was checked for the antidote properties against Naja naja venom by in vitro and in vivo methods. Various in vitro neutralization tests like Acetyl cholinesterase, Protease and ATPase activity of Naja naja venom were carried out and the root extract was neutralized all the toxic effects induced by the venom. The in vivo assessment of venom lethality (LD50) of Naja naja venom was found to be 0.301 µg. The aqueous root extract was effectively neutralized the venom lethality and effective dose (ED50) was found to be 12.88 mg/ 3LD50 of Naja naja venom. LC-MS analysis from root extract of Rauvolfia serpentina was done for confirmation of the bioactive compounds.
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This article discusses the epidemiology, prevention, clinical features, and treatment of venomous bites by snakes, lizards, and spiders; stings by fish, jellyfish, echinoderms, insects, and scorpions; and poisoning by ingestion of fish, turtles, and shellfish. Invertebrate stings cause fatalities by anaphylaxis, secondary to acquired hypersensitivity (Hymenoptera, such as bees, wasps, and ants; and jellyfish), and by direct envenoming (scorpions, spiders, jellyfish, and echinoderms). Simple preventive techniques, such as wearing protective clothing, using a flashlight at night, and excluding venomous animals from sleeping quarters, are of paramount importance to reduce the risk of venomous bites and stings.
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Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/prevenção & controle , Mordeduras e Picadas/terapia , Animais , Antivenenos/uso terapêutico , Ásia/epidemiologia , Brasil/epidemiologia , Ciguatera , Hemorragia/etiologia , Humanos , Intoxicação por Frutos do MarRESUMO
RESUMEN Introducción: Las mordeduras de serpiente continúan siendo un problema de salud pública, especialmente en países tropicales y subtropicales. Objetivo: Describir las características clínicas y epidemiológicas de los accidentes ofídicos de un Hospital Regional de Paraguay durante los años 2010 al 2016. Material y Métodos: Se realizó un estudio observacional, descriptivo de corte transversal donde se analizaron datos recolectados de fichas epidemiológicas de pacientes con antecedentes de accidentes ofídicos que acudieron al Hospital Regional de Coronel Oviedo desde enero 2010 a diciembre 2016. Resultados: Se registraron 143 casos de ofidismo, con predominio en el sexo masculino (65,7%), en edades comprendidas entre 11 y 40 años (58%). El género de la serpiente agresora, responsable de la gran mayoría de los accidentes ofídicos, fue el Bothrops sp. (58%). La localización más frecuente de la mordedura fueron los miembros inferiores (82,5%). La principal manifestación local fue el dolor (85,3%) y de las manifestaciones generales resaltó la falta de coagulación (42%). La letalidad registrada en el estudio fue de 0,7%. Conclusión: El accidente ofídico sigue siendo un evento de interés para la salud pública, ya que aumenta la morbilidad y mortalidad de los pobladores de zonas rurales del departamento de Caaguazú.
ABSTRACT Introduction: Snake bites continue to be a public health problem, especially in tropical and subtropical countries. Objective: To describe the clinical and epidemiological characteristics of the ophidic accidents of a Regional Hospital of Paraguay during the years 2010 to 2016. Material and Methods: An observational, descriptive, cross-sectional study was carried out where data collected from epidemiological records of patients with a history of ophidian accidents who attended the Regional Hospital of Coronel Oviedo from January 2010 to December 2016 were analyzed. Results: 143 cases of ophidism were registered, with predominance in males (65.7%), in ages between 11 and 40 years (58%). The gender of the aggressor snake, responsible for the great majority of the ophidic accidents, was the Bothrops (58%). The most frequent location of the bite was the lower limbs (82.5%). The main local manifestation was pain (85.3%) and general manifestations highlighted incoagulability (42%). The lethality recorded in the study was 0.7%. Conclusion: The ophidic accident continues to be an event of interest for public health, since it increases the morbidity and mortality of the inhabitants of rural areas of the department of Caaguazú.
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Bothrops lanceolatus, a member of the Viperidae family and Crotalinae subfamily, is the only snake causing envenomation in Martinique, which is the only place it exists in the world. Any bite by this snake may result in severe thrombotic complications including cerebral, pulmonary, and myocardial infarction and affecting the patient's vital or functional prognosis. The exact composition of the venom as well as the mechanisms of toxicity involved are still debated today. The first specific antivenom immunotherapy (AVI), Bothrofav1, manufactured in 1991, reduced mortality and morbidity significantly. In 2004, however, an increase in the number of cases of Bothrops lanceolatus envenomation-induced ischemic strokes despite early AVI administration, raised questions about its effectiveness and encouraged the development of a second AVI, Bothrofav2, which became available in February 2011. Causes of the failures with the first AVI remain hypothetical, and the effectiveness of the second is under evaluation. This article reviews the published data available on this rare envenomation, present in one of our French overseas departments and discusses its fascinating scientific and medical issues.
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Bothrops , Mordeduras de Serpentes , Animais , Protocolos Clínicos , Humanos , Martinica , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/terapiaRESUMO
Snake bites represent a serious public health risk in many regions of the globe, especially in tropical areas. Clinical signs and postmortem changes are well described in human and other mammalian species. However, detailed case reports about venomous snake attacks in avian species are limited. This report describes presumptive fatal envenomations in three psittacines caused by pit vipers in a Brazilian zoo. In one case, a Brazilian lancehead (Bothrops moojeni) was captured in the aviary. In all three cases the dermis around the suspected snake bite area exhibited hemorrhages and edema. Histologically, degeneration and necrosis of subcutaneous musculature were observed. Lung, heart, and kidneys displayed focal hemorrhages. The local changes are similar to those described for mammalian patients including humans. However, except for the parenchymatous hemorrhages, additional external and internal gross and histopathological lesions were missing. After ruling out other causes, such as aggression and dicoumarinic intoxication, the presumptive diagnosis of snake envenomation was made. The smaller size and variabilities of pathophysiological effects of the venom in parrots might explain the different lesion patterns observed, compared with mammals. Possibly, the birds may have reacted differently to envenomation by pit vipers and died before the venom could cause macroscopic and histological changes often observed in mammals.
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Doenças das Aves/etiologia , Crotalinae , Psittaciformes , Mordeduras de Serpentes/veterinária , Animais , Animais de Zoológico , Evolução Fatal , Feminino , Masculino , Mordeduras de Serpentes/patologiaRESUMO
Introducción: el accidente ofídico es el cuadro clínico producido por la mordedura de una serpiente venenosa. En el Ecuador se describen 41 especies de serpientes venenosas. Objetivo: caracterizar clínica y epidemiológicamente el accidente ofídico en pacientes del Hospital Básico de Jipijapa (Manabí-Ecuador). Método: se realizó un estudio observacional retrospectivo durante enero 2008 - abril 2012, a partir de las historias clínicas de los pacientes hospitalizados con diagnóstico de accidente ofídico o mordedura de serpiente en el Servicio de Medicina Interna del Hospital Básico de Jipijapa (Manabí-Ecuador). Resultados: del total de 78 pacientes, 61 (78,2%) recibieron suero antiofídico (SAO) y 17 pacientes (21,8%) no recibieron. No se encontró relación entre los días de hospitalización y el hecho de haber o no recibido SAO (p= 0,8), ni tampoco entre la prueba de coagulación positiva o negativa con el tiempo de hospitalización (p= 0,7). Se encontró una correlación baja entre la variable prueba de coagulación y el grado de mordedura, siendo estadísticamente significativo (p= 0,04). Se observó incremento de mordeduras en ciertos meses, en relación con los hábitos migratorios y reproductivos de las serpientes. Conclusiones: existió dificultad en la aplicación de protocolos de atención para accidente ofídico y si bien esto no repercutió en la morbilidad y mortalidad, puede afectar en la optimización de los recursos disponibles.
Introduction: ophidian accident is the clinical picture caused by the bite of a venomous snake. Forty one species of poisonous snakes are described in Ecuador Objective: to describe clinically and epidemiologically the ophidian accident in patients of the Basic Hospital of Jipijapa (Manabí-Ecuador). Methods: a retrospective observational, descriptive study, based on medical records of hospitalized patients with a diagnosis of snake bite in Internal Medicine Basic Hospital, Jipijapa (Manabí-Ecuador) during January 2008 - April 2012 was done. Results: of the total 78 patients, 61 (78.2%) received antivenin and 17 patients (21.8%) did not receive. There was no relationship between days of hospitalization and the fact of having or not received antivenin, p=Ns (0.8) nor between test positive or negative coagulation time found hospitalization p=Ns (0.7). A low correlation was found between the coagulation test variable and the degree of bite, being statistically significant (p = 0.04). An increase of bites in certain months, in relation to the migratory and reproductive habits of the snakes was observed. Conclusions: there was difficulty in applying protocols of care for ophidian accidents and although this did not affect morbidity and mortality, it can affect the optimization of available resources.
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In Colombia the incidence of ophidic accidents and its treatment in animals is rarely documentes which negatively affects its prognosis. A case is described of a German Sheperd with antecedent of a snake bite by Bothrops asper in the right infra-orbitary region which ocurred approximately 12 hours before consultation. To physical examination bilateral inflammation of the facial soft tissues and bleeding through the bite site were evidenced. After evaluating the anamnesic and the results of clinical and paraclinical exams the final diagnosis was moderate bothropic accident. Medical management consisted in administration of antiophidic serum, after which the patient showed favorable clinical evolution aproximately eight hours after treatment was established, being released two days after coming into the clinic. In this report the medical management established and the clinical evolution of the pacient are described.
En Colombia la incidencia del accidente ofídico y su tratamiento en animales está escasamente documentado lo que afecta negativamente su pronóstico. Se describe el caso de un Pastor alemán con antecedente de mordedura por Bothrops asper en la región infraorbital derecha ocurrida aproximadamente 12 horas antes de la consulta. Al examen físico se evidenció una inflamación bilateral de tejidos blandos faciales, y un sangrado a través del sitio de la mordedura. Después de evaluar los anamnésicos y los resultados de los exámenes clínico y paraclínicos el diagnóstico final fue accidente Bothrópico moderado. El manejo médico consistió en la administración de suero antiofídico ante lo cual el paciente mostro evolución clínica favorable, aproximadamente ocho horas después de instaurado el tratamiento, siendo dado de alta dos días después de ingresado a la clínica. En este reporte se describe el manejo médico instaurado y la evolución clínica del paciente.
Na Colômbia, a incidência de picadas de cobra e o tratamento dos animais domésticos é pouco conhecida, o que afeta negativamente o prognóstico desse tipo de acidente. Descreve-se o caso de um pastor alemão com uma história de mordida de cobra venenosa (Bothrops asper) na região infraorbitária direita ocorrida cerca de 12 horas antes da consulta medica. Ao exame físico, evidenciou-se inflamação bilateral do tecido mole facial e sangramento evidenciado através do lugar da mordida. Depois de avaliar os anamnésicos e os resultados dos exames clínicos e paraclínicos, o diagnóstico final foi mordida botrópica moderada. O manejo médico consistiu na administração de soro antiofídico, depois disto, o paciente apresentou evolução clínica favorável após oito horas de começado o tratamento. O cachorro recebeu a alta medica dois dias depois. Neste relatório, descreve-se o manejo medico instaurado e a evolução clínica do paciente
RESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Ethnobotanical studies show that Tabebuia aurea has been used as anti-inflammatory and for snake bite. Evaluate the effect of treatment with the hydroethanolic extract of Tabebuia aurea (HETa) on inflammatory, hemorrhagic and myotoxic activities induced by Bothrops neuwiedi (BnV) in mice. MATERIALS AND METHODS: The anti-inflammatory, antihemorragic and antimyotoxic properties of the HETa 100, 200 and 400mg/kg or BnV neutralized with HETa (1:50) were evaluated using the following animal models: BnV-induced paw edema, BnV-induced recruitment of polymorphonuclear cells into the peritoneal cavity, hemorrhagic activity, myotoxic activity and hydrogen peroxide production by peritoneal macrophages in vitro. RESULTS: HETa inhibited the paw edema and polymorphonuclear cell recruitment into the peritoneal cavity. BnV neutralized with HETa reduced the hemorrhagic activity and histopathological analysis of skeletal muscle tissue showed that the hemorrhagic area was smaller and multifocal. The leukocyte infiltrate was less intense and muscle necrosis discrete. BnV induced hydrogen peroxide production and BnV neutralized reduced this production. In addition, the HETa was nontoxic to macrophages. CONCLUSIONS: The activities of the HETa presented herein justify the popular use of Tabebuia aurea in inflammatory situations from snake bite.
Assuntos
Bothrops , Venenos de Crotalídeos/toxicidade , Hemorragia/tratamento farmacológico , Inflamação/tratamento farmacológico , Músculos/efeitos dos fármacos , Extratos Vegetais/uso terapêutico , Tabebuia/química , Animais , Hemorragia/induzido quimicamente , Peróxido de Hidrogênio/metabolismo , Inflamação/induzido quimicamente , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Masculino , Camundongos , Músculos/patologiaRESUMO
Bellucia dichotoma Cogn. (Melastomataceae) is one of various plant species used in folk medicine in the west of the state of Pará, Brazil, to treat snake bites. Many studies have been carried out to evaluate the effectiveness of anti-snake bite plants, but few of these use the same preparation methods and doses as those traditionally used by the local populations. This study therefore compared inhibition of the main local effects of B. atrox venom (BaV) by aqueous extract of B. dichotoma (AEBd) administered according to traditional methods and pre-incubated with BaV). The concentrations of phenolic compounds (tannins and flavonoids) in AEBd were determined by colorimetric assays. The effectiveness of AEBd in inhibiting the hemorrhagic and edematogenic activities of BaV was evaluated in mice in four different experimental in vivo protocols: (1) pre-incubation (venom:extract, w/w); (2) pre-treatment (p.o.); (3) post-treatment (p.o.); and (4) AEBd (p.o.) in combination with Bothrops antivenom (BA) (i.v.). To assess in vitro inhibition of BaV phospholipase A2 activity, the pre-incubation method or incorporation of AEBd or BA in agarose gels were used. The effect of AEBd on BaV was determined by SDS-PAGE, zymography and Western blot. Colorimetric assays revealed higher concentrations of (condensed and hydrolyzable) tannins than flavonoids in AEBd. Hemorrhagic activity was completely inhibited using the pre-incubation protocol. However, with pre-treatment there was no significant inhibition for the concentrations tested, and with the post-treatment only the 725 mg/kg dose of AEBd was able to inhibit 40.5% (p = 0.001) of the hemorrhagic activity of BaV. Phospholipase A2 activity was only inhibited when AEBd was pre-incubated with BaV. BaV-induced edema was completely inhibited with pre-incubation (p < 0.05) and significantly reduced (p < 0.05) with pre- and post-treatment (p.o.) for the concentrations tested. The reduction in local edema was even greater when AEBd was administered in combination with BA. The SDS-PAGE profiles showed that several of the BaV protein (SDS-PAGE) and enzyme (zymography) bands were not detected when the venom was pre-incubated, and Western blot revealed that this was not caused by the AEBd enzymes observed in the zymogram. The "pseudo inhibition" observed after pre-incubation in this study may be due to the presence of tannins in the extract, which could act as chelating agents, removing metalloproteins and Ca²âº ions and thus inhibiting hemorrhagin and PLA2 activity. However, when administered according to traditional methods, B. dichotoma extract was effective in blocking BaV-induced edematogenic activity and had an additional effect on inhibition of this activity by BA.
Assuntos
Antivenenos/uso terapêutico , Bothrops , Venenos de Crotalídeos/antagonistas & inibidores , Melastomataceae/química , Casca de Planta/química , Extratos Vegetais/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Animais , Antivenenos/química , Antivenenos/isolamento & purificação , Antivenenos/farmacologia , Brasil , Venenos de Crotalídeos/enzimologia , Venenos de Crotalídeos/toxicidade , Edema/etiologia , Edema/prevenção & controle , Inibidores Enzimáticos/química , Inibidores Enzimáticos/isolamento & purificação , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Etnofarmacologia , Fosfolipases A2 do Grupo II/antagonistas & inibidores , Fosfolipases A2 do Grupo II/metabolismo , Hemorragia/etiologia , Hemorragia/prevenção & controle , Hemostáticos/química , Hemostáticos/isolamento & purificação , Hemostáticos/farmacologia , Hemostáticos/uso terapêutico , Masculino , Medicina Tradicional , Camundongos , Neurotoxinas/antagonistas & inibidores , Neurotoxinas/toxicidade , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Extratos Vegetais/farmacologia , Proteínas de Répteis/antagonistas & inibidores , Proteínas de Répteis/metabolismo , Pele/efeitos dos fármacos , Mordeduras de Serpentes/fisiopatologia , Taninos/análise , Taninos/farmacologia , Taninos/uso terapêuticoRESUMO
Snake bite envenoming is a disease with potential serious neurological complications. We report a case of an adolescent who was bitten by a rattlesnake and developed bilateral posterior circulation stroke. The rattlesnake was later identified as being Crotalus durissus terrificus. Stroke was probably due to toxic vasculitis or toxin-induced vascular spasm and endothelial damage.
Assuntos
Adolescente , Animais , Humanos , Masculino , Crotalus , Venenos de Crotalídeos/toxicidade , Mordeduras de Serpentes/complicações , Acidente Vascular Cerebral/etiologia , Angiografia por Ressonância Magnética , Mordeduras de Serpentes/diagnóstico , Acidente Vascular Cerebral/diagnósticoRESUMO
All snakebites registered in Rio de Janeiro state, Brazil, between 2001 and 2006 were analyzed. Of these, the snake species involved was identified in 2,431 cases, most of which were caused by Bothrops (2,347). Most victims were male (78.4%) and the age group most frequently attacked was between 20 and 39 years (38.4%). As for severity, 1,118 (45.9%) were classified as minor, 748 (30.7%) as moderate, and 209 (8.6%) as severe. Progression towards complete cure occurred in 1,567 patients; 39 had sequelae; three died; and clinical outcomes were not monitored in 822 cases. The time between bite and first medical attention was less than three hours in 74.6% of cases. Most occurred in municipalities with vast areas of preserved Atlantic Forest: Angra dos Reis (208), Rio de Janeiro (197), Parati (186), Teresópolis (134), and Petrópolis (110). Accident frequency was highest between November and April, in which the daily average is practically twice that observed in other months. Although results show that Rio de Janeiro state has a good level of medical care, it could be improved by creating multidisciplinary teams that include doctors, biologists, and nurses. The Vital Network for Brazil helps to promote a stimulating environment for this type of training, with both traditional courses and distance learning. Training hours must be increased to improve the skills of professionals responsible for victim care.(AU)
Assuntos
Mordeduras de Serpentes/epidemiologia , Perfil de Saúde , Mordeduras e Picadas , Bothrops , Sistemas de Informação em SaúdeRESUMO
All snakebites registered in Rio de Janeiro state, Brazil, between 2001 and 2006 were analyzed. Of these, the snake species involved was identified in 2,431 cases, most of which were caused by Bothrops (2,347). Most victims were male (78.4%) and the age group most frequently attacked was between 20 and 39 years (38.4%). As for severity, 1,118 (45.9%) were classified as minor, 748 (30.7%) as moderate, and 209 (8.6%) as severe. Progression towards complete cure occurred in 1,567 patients; 39 had sequelae; three died; and clinical outcomes were not monitored in 822 cases. The time between bite and first medical attention was less than three hours in 74.6% of cases. Most occurred in municipalities with vast areas of preserved Atlantic Forest: Angra dos Reis (208), Rio de Janeiro (197), Parati (186), Teresópolis (134), and Petrópolis (110). Accident frequency was highest between November and April, in which the daily average is practically twice that observed in other months. Although results show that Rio de Janeiro state has a good level of medical care, it could be improved by creating multidisciplinary teams that include doctors, biologists, and nurses. The Vital Network for Brazil helps to promote a stimulating environment for this type of training, with both traditional courses and distance learning. Training hours must be increased to improve the skills of professionals responsible for victim care.(AU)