RESUMO
Envenomations by colubrid snakes in Colombia are poorly known, consequently, the clinical relevance of these species in snakebite accidents has been historically underestimated. Herein, we report the first case of envenomation by opisthoglyphous snakes in Colombia occurred under fieldwork conditions at the municipality of Distracción, in the department of La Guajira. A female biologist was bitten on the index finger knuckle of her right hand when she tried to handle a false fer-de-lance snake (Leptodeira annulata). Ten minutes after the snakebite, the patient started to have symptoms of mild local envenomation such as edema, itching, and pain in the wound. After 40 minutes, the edema reached its maximum extension covering the dorsal surface of the right hand and causing complete loss of mobility. The clinical treatment focused on pain and swelling control. No laboratory tests were performed. The patient showed good progress with the total regression of the edema 120 hours after the snake-bite accident and complete recovery of the movement of the limb in one week. Venomous bites of "non-venomous snakes" (opisthoglyphous colubrid snakes) must be considered as a significant public health problem because patients lose their work capability during hours or even days and they are forced to seek medical assistance to treat the envenomation manifestations.
Los envenenamientos por colúbridos en Colombia son poco conocidos, por lo que la relevancia clínica de estas especies de serpientes en los accidentes ofídicos ha sido históricamente subestimada. Se presenta el primer caso de envenenamiento por una serpiente opistoglifa en Colombia, ocurrido bajo condiciones de trabajo de campo en el municipio de Distracción, departamento de La Guajira. Una bióloga fue mordida en el nudillo del dedo índice de la mano derecha cuando trató de manipular una falsa cabeza de lanza o falsa mapanare (Leptodeira annulata). Diez minutos después de la mordedura de la serpiente, la paciente presentó síntomas de envenenamiento local leve, como edema, picazón y dolor en la herida. Después de 40 minutos, el edema alcanzó su extensión máxima, cubriendo la superficie dorsal de la mano derecha y causando la pérdida completa de la movilidad. El tratamiento clínico se centró en el control del dolor y la inflamación. No se hicieron pruebas de laboratorio. La paciente tuvo una buena evolución, con la regresión total del edema 120 horas después del accidente ofídico y la normalización de los movimientos de la extremidad a la semana. Las mordeduras venenosas de serpientes "no venenosas" (serpientes colúbridas opistoglifas) deben considerarse un problema de salud pública importante, ya que los pacientes pierden la capacidad de trabajo durante horas o días y se ven obligados a buscar asistencia médica para contrarrestar las manifestaciones locales de envenenamiento.
Assuntos
Biologia , Bothrops , Traumatismos dos Dedos/etiologia , Doenças Profissionais/etiologia , Mordeduras de Serpentes , Adulto , Animais , Bothrops/fisiologia , Colômbia/epidemiologia , Venenos de Crotalídeos/intoxicação , Edema/etiologia , Feminino , Humanos , Hipestesia/etiologia , Hipotensão/induzido quimicamente , Dor/etiologia , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/etiologiaRESUMO
Objective: To report two patients who developed systemic neurotoxicity after consecutive bites by the same coral snake.Case report: Two previously healthy men (32-year-old and 34-year-old) found a coral snake in a woodpile while collecting wood for a barbecue. During the barbecue, both men became drunk and "played" with the snake, believing that they were handling a false coral snake, and were bitten within a few minutes of each other. Both patients were admitted to a referral tertiary care hospital (175 km from where the bites occurred) 16 hours and 19 hours postbite; both showed similar features of envenomation: palpebral ptosis, muscle weakness, dysphagia, and generalized myalgia. No fang marks or local pain were detected in either case. The patients were successfully treated with Brazilian coral snake antivenom (Fab´2) and discharged one-day postadmission, with improvement of myasthenia, but still showing palpebral ptosis. The offending snake was identified as a 42-cm-long Micrurus corallinus. During follow-up, both patients reported a transitory loss of taste that lasted approximately 3-4 weeks postbite.Conclusion: Consecutive bites by the same coral snake may cause systemic neurotoxicity (acute myasthenia) in more than one person, as well as transitory loss of taste, an underreported complication of snakebites.
Assuntos
Ageusia/prevenção & controle , Antivenenos/uso terapêutico , Cobras Corais , Síndromes Neurotóxicas/prevenção & controle , Mordeduras de Serpentes/terapia , Adulto , Ageusia/diagnóstico , Ageusia/etiologia , Animais , Antivenenos/administração & dosagem , Brasil , Humanos , Masculino , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/etiologia , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/etiologiaRESUMO
OBJECTIVES: Brazil is home to large variety of snake species, of which about 17% are venomous. A large proportion of reported snakebite accidents in the country take place in northeast Brazil. We aimed to analyse the epidemiology of snakebites as a public health concern in Rio Grande do Norte state. METHODS: A retrospective epidemiologic analysis was performed using data from the Brazilian Case Registry Database pertaining to the period 2007-2016, and considering environmental climate characteristics as an influential factor. RESULTS: A number of 3909 cases were reported in total. Among those cases, 58% involved venomous species and more than 80% of these were caused by Bothrops species. An association between environmental characteristics and the incidence of reported cases was found. The Borborema Potiguar region was the most affected area. Apart from that, deficiencies in managing the victims were described. CONCLUSION: This study highlights snakebite accidents as a public health concern in Rio Grande do Norte state. Snake bites are most likely being influenced by climate change and human activities. Continuous training of involved medical personnel could help optimise patient care and avoid under reporting in the accident reporting system.
OBJECTIFS: Le Brésil abrite de très nombreuses espèces de serpents, dont environ 17% sont venimeuses. Une grande partie des accidents rapportés de morsures de serpent dans le pays ont lieu dans le nord-est du pays. Notre objectif était d'analyser l'épidémiologie des morsures de serpents en tant que problème de santé publique dans l'Etat du Rio Grande do Norte. MÉTHODES: Une analyse épidémiologique rétrospective a été réalisée à l'aide des données de la Base de Données du Registre Brésilien des cas couvrant la période 2007-2016 et prenant en compte les caractéristiques climatiques de l'environnement comme facteur d'influence. RÉSULTATS: 3.909 cas au total ont été rapportés. 58% concernaient des espèces venimeuses et plus de 80% d'entre elles étaient causées par l'espèce Bothrops. Une association entre les caractéristiques environnementales et l'incidence des cas rapportés a été mise en évidence. La région de Borborema Potiguar était la plus touchée. Outre cela, les déficiences dans la prise en charges des victimes ont été décrites. CONCLUSION: Cette étude souligne que les accidents causés par des morsures de serpent constituent un problème de santé publique dans l'Etat de Rio Grande do Norte. Les morsures de serpents sont très probablement influencées par les changements climatiques et les activités humaines. La formation continue du personnel médical impliqué pourrait aider à optimiser les soins prodigués aux patients et à éviter une sous-notification dans le système de notification des accidents.
Assuntos
Mudança Climática , Meio Ambiente , Saúde Pública , Mordeduras de Serpentes , Serpentes , Acidentes , Adolescente , Adulto , Animais , Bothrops , Brasil/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/etiologia , Mordeduras de Serpentes/terapia , Venenos de Serpentes , Adulto JovemRESUMO
BACKGROUND: Envenoming induced by Bothrops snakebites is characterized by drastic local tissue damage that involves an intense inflammatory reaction and local hyperalgesia which are not neutralized by conventional antivenom treatment. Herein, the effectiveness of photobiomodulation to reduce inflammatory hyperalgesia induced by Bothrops moojeni venom (Bmv), as well as the mechanisms involved was investigated. METHODOLOGY/PRINCIPAL FINDINGS: Bmv (1 µg) was injected through the intraplantar route in the right hind paw of mice. Mechanical hyperalgesia and allodynia were evaluated by von Frey filaments at different time points after venom injection. Low level laser therapy (LLLT) was applied at the site of Bmv injection at wavelength of red 685 nm with energy density of 2.2 J/cm2 at 30 min and 3 h after venom inoculation. Neuronal activation in the dorsal horn spinal cord was determined by immunohistochemistry of Fos protein and the mRNA expression of IL-6, TNF-α, IL-10, B1 and B2 kinin receptors were evaluated by Real time-PCR 6 h after venom injection. Photobiomodulation reversed Bmv-induced mechanical hyperalgesia and allodynia and decreased Fos expression, induced by Bmv as well as the mRNA levels of IL-6, TNF-α and B1 and B2 kinin receptors. Finally, an increase on IL-10, was observed following LLLT. CONCLUSION/SIGNIFICANCE: These data demonstrate that LLLT interferes with mechanisms involved in nociception and hyperalgesia and modulates Bmv-induced nociceptive signal. The use of photobiomodulation in reducing local pain induced by Bothropic venoms should be considered as a novel therapeutic tool for the treatment of local symptoms induced after bothropic snakebites.
Assuntos
Analgésicos/efeitos adversos , Citocinas/metabolismo , Hiperalgesia/terapia , Cininas/metabolismo , Terapia com Luz de Baixa Intensidade , Neurônios/efeitos dos fármacos , Mordeduras de Serpentes/terapia , Venenos de Serpentes/efeitos adversos , Analgésicos/administração & dosagem , Animais , Bothrops , Citocinas/genética , Feminino , Humanos , Hiperalgesia/etiologia , Hiperalgesia/genética , Hiperalgesia/metabolismo , Interleucina-10/genética , Interleucina-10/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Cininas/genética , Masculino , Camundongos , Mordeduras de Serpentes/etiologia , Mordeduras de Serpentes/genética , Mordeduras de Serpentes/metabolismo , Venenos de Serpentes/administração & dosagem , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismoRESUMO
This study investigated the correlation between the incidence of snakebite and indicators of agricultural development in municipal districts of the State of Bahia, Brazil. An ecological study was conducted with the 27,347 cases of snakebite poisoning reported to the Reportable Diseases National Information System in municipalities from the State of Bahia, Brazil, 2000-2009. The unit of analysis was each one of the 417 State municipalities, and the outcome variable was the average annual incidence of snakebite. Data were analyzed by multiple linear regression technique. The average annual incidence of snakebite ranged from zero to 221.96 per 100,000 inhabitants, according to the municipalities. The incidence of snakebite was positively and strongly associated with municipality characteristics: planted areas of cocoa and coffee, and the size of domestic bred chicken and bovine livestocks. It was concluded that several characteristics related to municipal agricultural profile were strongly associated with the incidence of snakebite.
Assuntos
Agricultura , Mordeduras de Serpentes/epidemiologia , Agricultura/estatística & dados numéricos , Brasil/epidemiologia , Humanos , Incidência , Mordeduras de Serpentes/etiologiaRESUMO
OBJECTIVE: There have been few studies evaluating snakebite mortality in Venezuela and South America. In this study we evaluate trends in fatal snakebites occurring in Venezuela between 1995 and 2002. METHODS: Epidemiological data for this study were retrieved from the records of the Ministry of Health of Venezuela. Using these data, we analyzed the impact of snakebites in Venezuela during the study period. RESULTS: During the study period, there were 266 reports of death due to snakebite; 79.7% were males, and 20.3% were females (P < .01). Annual mean deaths numbered 33 per year. Of total deaths, 24.1% occurred in victims 55-70 years old. Deaths in young children (<5 years old) accounted for 7.1% of the total. Mortality rate by age showed an age-dependent rate, with higher rates in older ages (P = .038). CONCLUSION: Snake envenomations are an important cause of injury and deaths in Venezuela as in many American countries. Surveillance of envenomations is essential for establishing guidelines, planning therapeutic supplies, and training medical staff on snakebite treatment, as well as assessing risk zones for travelers.
Assuntos
Mordeduras de Serpentes/epidemiologia , Serpentes , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Mordeduras de Serpentes/etiologia , Mordeduras de Serpentes/mortalidade , Mordeduras de Serpentes/prevenção & controle , Venezuela/epidemiologiaRESUMO
We reviewed snakebite records from the Costa Rican health system from the year 1990-2000. During this decade, a total of 5550 snakebite cases occurred in the country. While the average number of snakebites per year was relatively constant at 504 cases, the annual incidence per 100,000 people decreased. This reduction is mainly due to high population growth in Costa Rica, which increased 35% during the study period. The most affected population lives in rural areas characterized by high precipitation, and mainly includes young agricultural workers. The lancehead Bothrops asper is considered the most important species affecting humans.
Assuntos
Bothrops , Mordeduras de Serpentes/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Saúde da População Rural , Estações do Ano , Mordeduras de Serpentes/etiologiaRESUMO
The biochemical characteristics of hemorrhagic metalloproteinases isolated from snake venoms are reviewed, together with their role in the pathogenesis of the local tissue damage characteristic of crotaline and viperine snake envenomations. Venom metalloproteinases differ in their domain structure. Some enzymes comprise only the metalloproteinase domain, others have disintegrin-like and high cysteine domains and others present, besides these domains, an additional lectin-like subunit. All of them are zinc-dependent enzymes with highly similar zinc binding environments. Some metalloproteinases induce hemorrhage by directly affecting mostly capillary blood vessels. It is suggested that hemorrhagic enzymes cleave, in a highly selective fashion, key peptide bonds of basement membrane components, thereby affecting the interaction between basement membrane and endothelial cells. As a consequence, these cells undergo a series of morphological and functional alterations in vivo, probably associated with biophysical hemodynamic factors such as tangential fluid shear stress. Eventually, gaps are formed in endothelial cells through which extravasation occurs. In addition to hemorrhage, venom metalloproteinases induce skeletal muscle damage, myonecrosis, which seems to be secondary to the ischemia that ensues in muscle tissue as a consequence of bleeding and reduced perfusion. Microvessel disruption by metalloproteinases also impairs skeletal muscle regeneration, being therefore responsible of fibrosis and permanent tissue loss after snakebites. Moreover, venom metalloproteinases participate in the degradation of extracellular matrix components and play a relevant role in the prominent local inflammatory response that characterizes snakebite envenomations, since they induce edema, activate endogenous matrix metalloproteinases (MMPs) and are capable of releasing TNF-alpha from its membrane-bound precursor. Owing to their protagonic role in the pathogenesis of local tissue damage, snake venom metalloproteinases constitute relevant targets for natural and synthetic inhibitors which may complement antivenoms in the neutralization of these effects.
Assuntos
Metaloendopeptidases/fisiologia , Mordeduras de Serpentes/etiologia , Venenos de Serpentes/enzimologia , Animais , Vesícula/etiologia , Humanos , Músculo Esquelético/patologia , Necrose , Mordeduras de Serpentes/enzimologiaRESUMO
Over a 5 month period (October 1996 to February 1997), a rotating company of 146 servicemen belonging to the Navy Airborne 6th Regiment were assigned along the Maroni River in French Guyana. During this mission, the medical personnel treated 387 local residents. Etiologies comprised 51 malaria attacks including 46 involving Plasmodium falciparum and 4 rattlesnake envenomations. The most common cause of consultation by military personnel was mycotic and staphylococcal skin infections, but 5 cases involving poor acclimatization were treated during the hot and dry season. Seven malaria attacks involving Plasmodium falciparum including 2 that were severe occurred despite prophylaxis using chloroquine-proguanil. Treatment with halofantrine was successful in all but one case which required combined chemotherapy using quinine and doxycycline. Five cases of cutaneous leishmaniasis were observed in subjects involved in jungle training. No case of HIV infection was detected upon returning home since most personnel either followed the recommendation to abstain from sex (51 p. 100) or used a condom (90 p. 100 of personnel who had sexual relations). These data illustrate the health risks for mainland French nationals in the region of the Maroni River and underline the need for preventive measures and education.
Assuntos
Militares , Medicina Tropical , Aclimatação , Animais , Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Cloroquina/uso terapêutico , Preservativos , Venenos de Crotalídeos/efeitos adversos , Crotalus , Dermatomicoses/etiologia , Doxiciclina/uso terapêutico , França , Guiana Francesa , Infecções por HIV/prevenção & controle , Educação em Saúde , Humanos , Leishmaniose Cutânea/etiologia , Malária Falciparum/tratamento farmacológico , Malária Falciparum/etiologia , Fenantrenos/uso terapêutico , Quinina/uso terapêutico , Fatores de Risco , Abstinência Sexual , Mordeduras de Serpentes/etiologia , Infecções Cutâneas Estafilocócicas/etiologiaRESUMO
Se revisaron 16 casos de accidente ofídico, el cual ocurrió más frecuentemente en cercanías al domicilio (74 porciento) en horas de la tarde (56 porciento), y menores dee 15 años (50 porciento). Se presentó en igual porcentaje en hombres y en mujeres. Las zonas del cuerpo principalmente mordidas fueron el pie (44 porciento) y la pierna (25 porciento). El 45 porciento de los accidentes se presentó en estudiantes. La actividad más relacionada con el accidente fue el ir camiando (46 porciento). Los sintomas más importantes fueron el edema (94 porciento) y el dolor (88 porciento)
Assuntos
Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/etiologia , Mordeduras de Serpentes/epidemiologiaRESUMO
This study presents data on snakes recorded in the urban area of Cuiabá, Mato Grosso, Brazil. Sources of information included specimens captured by local residents (1986-1993) and turned over to the Mato Grosso Regional Ophiological Center (Normat), and data from the Anti-Venom Information Center (Ciave), regarding urban snake bites (1988-1993). Thirty-seven species of snakes from 25 genera and three families were recorded. Diurnal and terrestrial habits predominated, as well as a diet based on amphibians and/or lizards. From a total of 307 snake bites recorded, some 56% were of no clinical importance, caused by non-venomous snakes, whereas 44% were clinically relevant. Approximately 99% of the latter were attributed to vipers of the genus Bothrops, and especially the Bothrops moojeni and Bothrops neuwiedi species The colubrids Philodryas olfersii and Waglerophis merremii were probably responsible for most of the non-venomous snake bites.