Morbidity survey of the history of snakebites in different communities in the alto Juruá, western Brazilian Amazon.

The Alto Juruá region has a rich diversity of venomous snakes, and snakebites represent an important cause of morbidity. The present study was carried out in five communities in the Alto Juruá region, and aimed to evaluate the history of snakebites in terms of which snakes were involved and what was the victims' conduct in relation to first aid and prevention. Between 2017 and 2019, semi-structured interviews were applied to 260 residents, 56 (21.53%) of whom had a history of snakebites. The profile of the victims is 73.2% male, a resident of rural areas who develops activities mainly in agriculture and extractivism and who has a low level of education. Just over half of the snakebites occurred during the rainy season (52.8%) and the majority during the day (77%). Bothrops bites were the most frequently reported (90.3%) and B. atrox was the most mentioned snake (jararaca and surucucu) for being responsible for snakebites (80.8%). Approximately 87.5% of the bites occurred to the lower limbs, and 48.2% of the victims were barefoot at the time of the bite. Inadequate first-aid procedures were reported, such as using tourniquets and consuming the drink known as "Específico Pessoa", not drinking water, and treatment with traditional therapy (phytotherapics, zootherapeutics and faith healers), as well as not seeking hospital care. Thus, the need to facilitate access to hospital units in these communities and health education (prevention and first aid) are essential in order to minimize this situation.

VENOMOUS SNAKEBITES IN CROATIA, CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT.

Venomous snake bites are recognized as a major public health problem, affecting mostly poor, underdeveloped areas in the tropical and subtropical areas. Every year, more than three million bite cases and about 100,000 deaths are registered worldwide. Over the past years, 632 people have been hospitalized in Croatia with only 3 deaths due to venomous snake bites. Favorable geographic position, warm climate and great biodiversity of Croatia have resulted in the development of a total of 15 species of snakes, of which only 3 are venomous: horned viper (Vipera ammodytes), the common European viper (Vipera berus) and meadow viper (Vipera ursinii macrops). Snake venom envenomation is called ophidism (greek ofis=snake). Snake venoms are complex mixtures of proteins and toxins that have a wide range of toxic effects. The clinical presentation of ophidism is due to hematotoxic, neurotoxic, myotoxic (cardiotoxic) and cytotoxic effects of venom. There is currently no test to identify patients with a systemic spread of the venom, the diagnosis is made by a combination of diagnostic tests, clinical symptoms and sings of systemic envenomation. Ophidism is a medical condition that requires urgent treatment. Following first aid given at the scene, the patient should be transported to the closest medical facility to assess the severity of the clinical presentation in a timely manner and take the necessary treatment measures.

Use of geospatial analyses to address snakebite hotspots in mid-northern Brazil - A direction to health planning in shortfall biodiversity knowledge areas.

Knowing the distribution of venomous snakes of medical importance is essential to identify areas at risk for snakebites. Thus, we used an integrative approach based on the application of geographic distribution data of venomous snakes, species distribution modeling (SDM), spatial organization of snakebites, and information on human population density for mapping the potential distribution of snakes and identifying areas at risk of snakebites in the state of Maranhão (mid-northern Brazil). From a compiled database of venomous snake records deposited in biological collections and the literature, we predict the potential distribution of venomous snakes in Maranhão, a state whose diversity and geographic distribution of venomous snake species are poorly known. With this, we constructed potential distribution maps for each venomous snake species with at least one occurrence record within state boundaries, as well as generalized maps by family (Viperidae and Elapidae) and the total number of venomous snakes in Maranhão State. We also obtained data on the number of snakebites recorded in each municipality of Maranhão over a decade (2009-2019) and we ran a Generalized Linear Model to test for relationships between the number of venomous snakebites, the area of occurrence of snakes, and human population density. We obtained 1046 records of venomous snake species for Maranhão, represented by 17 viperid and elapid species. Most of the records were from Viperidae (mostly Bothrops atrox and B. marajoensis) and were concentrated mainly in the Amazon of the northern portion of the state. The models showed accurate predictive performance for all modeled species. The entire area of Maranhão exhibits environmental conditions for the occurrence of venomous snakes, with higher suitability indices in the northern region, in the Amazon rainforest. The number of snakebites was positively correlated with the interaction between high-risk areas (i.e., greater distribution of venomous snakes) and human population density. Our study is a pioneer in using species distribution modeling in mid-northern Brazil to address the scarcity of data on snakebite-causing species, directly contributing to the theme of neglected tropical diseases of the World Health Organization.

Análise bioquímica do veneno da serpente Philodryas patagoniensis: caracterização preliminar de uma calicreína-símile

The snakebite is considered a worldwide public health concern that is constantly neglected as it occurs, essentially, in regions of Africa, Asia and Latin America. As these accidents usually happen in countries that are emerging or underdeveloped, the incidence and mortality data end up not being accurate due to the lack of proper notification. In addition, the affected patient often may not receive adequate treatment due to the difficulty in identifying the snake and having access to serum therapy. Snakes can be found throughout Brazilian territory, and snakes are quite common in the country. Among the genera that can be found in the country, it is included in the genus Philodryas, which has some species of snakes, among them is Philodryas patagoniensis. The envenomation by this snake, generally, does not evolve into a serious clinical condition. However, its venom generates edematogenic and hemorrhagic activity, in addition to pain and tissue damage in the injured area, which causes cases of poisoning by this snake to be mistaken for the snake-like accident by Bothrops. In relation to the toxins present in this snake's venom, its composition, biological function and physiological activities are still unclarified. Therefore, the aim of this work is to investigate the composition of the species' venom with regard to the evaluation of a possible release of kinins from the KN-BK substrate by the venom of this snake. Kinins are released by kallikrein, which could indicate a similar kallikrein present in Philodryas patagoniensis venom that would be precisely involved in the process of releasing bradykinin, an inflammatory mediator. This kallikrein-simile contributes to the triggering of clinical manifestations such as pain and edema caused by the poisoning of this snake.

O acidente ofídico é considerado um problema de saúde pública mundial, constantemente negligenciado por ocorrer, essencialmente, em regiões da África, Ásia e América Latina. Pelo fato de os acidentes acontecerem geralmente em países que são emergentes ou subdesenvolvidos, os dados de incidência e mortalidade acabam não sendo precisos pela falta da notificação apropriada. Além disso, o paciente acometido, muitas vezes, pode não receber o tratamento adequado pela dificuldade na identificação da serpente e ao acesso a soroterapia. As serpentes podem ser amplamente encontradas em todo território brasileiro, sendo o ofidismo bastante comum no país. Em meio aos gêneros que podem ser encontrados no país, está incluído o gênero Philodryas, que possui algumas espécies de serpentes, dentre elas, a Philodryas patagoniensis. O envenenamento por esta serpente, geralmente não evolui para um quadro clínico grave. No entanto, seu veneno gera atividade edematogênica e hemorrágica além de dor e dano tecidual no local lesado, o que faz com que os casos de envenenamento por essa serpente sejam confundidos com o acidente ofídico causados por serpentes do gênero Bothrops. Em relação às toxinas presentes no veneno dessa serpente, sua composição, função biológica e atividades fisiológicas ainda não são esclarecidas. Diante disto, o intuito deste trabalho é investigar a composição do veneno da espécie no que diz respeito à avaliação de uma possível liberação de cininas do substrato KN-BK pelo veneno dessa serpente. As cininas são liberadas pelas calicreínas plasmática e teciduais humanas e são peptídeos bioativos com funções na regulação da pressão arterial e participação em processos inflamatórios. Assim, a observação de uma calicreína-símile presente no veneno de Philodryas patagoniensis poderia estar envolvida no desencadeamento das manifestações clínicas como a dor e o edema acarretadas pelo envenenamento desta serpente.

Snakebite Envenoming Diagnosis and Diagnostics.

Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. However, the availability of auxiliary diagnostic tests at the disposal of the clinicians vary from country to country, and the level of experience within snakebite diagnosis and intervention may be quite different for clinicians from different hospitals. As such, achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. This review aims to highlight regional differences in epidemiology and clinical snakebite management on a global scale, including an overview of the past and ongoing research efforts within snakebite diagnostics. Finally, the review is rounded off with a discussion on design considerations and potential benefits of novel snakebite diagnostics.

Perfil epidemiológico dos acidentes causados por animais peçonhentos no município de Patrocínio, Minas Gerais: retrato de uma década / Epidemiological profile of accidents caused by venomous animals in the municipality of Patrocínio, Minas Gerais: portrait of a decade / Perfil epidemiológico de accidentes causados por animales venenosos en el municipio de Patrocínio, Minas Gerais: retrato de una década

Justificativa e objetivos: apesar dos avanços na área assistencial, os acidentes por animais peçonhentos ainda são um importante problema de saúde pública no Brasil. Entre os anos de 2015 e 2016, a região Sudeste apresentou o maior número de notificações, e Minas Gerais foi o estado com mais ocorrências. O objetivo deste estudo foi descrever as características epidemiológicas dos acidentes por animais peçonhentos notificados entre 2008 e 2017 no município de Patrocínio, Minas Gerais. Métodos: estudo descritivo retrospectivo realizado por meio da análise das informações das fichas de notificação do Sistema de Informação de Agravos de Notificação (SINAN) de vítimas de acidentes por animais peçonhentos ocorridos durante os anos de 2008 a 2017 em Patrocínio. Resultados: foram registrados 1.084 casos, a maioria ocasionada por escorpiões (47,23%), seguida por serpentes (17,07%), aranhas (15,31%) e abelhas (11,07%). Sobre as vítimas, constatou-se o predomínio de homens (63,10%) na faixa etária entre 20 a 39 anos (32,56%). A maior parte dos acidentes foi classificada como leve (89,11%) e a cura ocorreu em 98,80% dos casos; um evoluiu para óbito. Conclusão: embora os acidentes por animais peçonhentos não apresentem altas taxas de letalidade no município estudado, a incidência desse agravo de saúde tem aumentado nos últimos anos. Além disso, informações epidemiológicas atualizadas podem contribuir com ações de políticas públicas e informar a população local sobre os riscos iminentes.(AU)

Background and objectives: despite advances in health care, accidents involving venomous animals are still a major public health problem in Brazil. Between 2015 and 2016, the Southeast region had the highest number of notifications, and Minas Gerais was the state with more occurrences. The objective of this study was to describe the epidemiological characteristics of accidents by venomous animal notified between 2008 and 2017 in the municipality of Patrocínio, Minas Gerais. Methods: this is a retrospective descriptive study conducted by analyzing the information from reporting forms of the Notifiable Diseases Information System for victims of accidents with venomous animals occurred during the years 2008 to 2017 in Patrocínio. Results: in total, 1084 cases were recorded, mostly caused by scorpions (47.23%), followed by snakes (17.07%), spiders (15.31%) and bees (11.07%). There was a predominance of male victims (63.10%), aged between 20-39 years (32.56%). Most accidents were classified as mild (89.11%) and the cure occurred in 98.80% of cases; one evolved to death. Conclusion: although accidents with venomous animals do not have high mortality rates in the municipality studied, the incidence of this health problem has increased in recent years. In addition, this updated epidemiological information may contribute to public policy actions and inform the local population about imminent risks.(AU)

Justificación y objetivos: a pesar de los avances en salud, los accidentes de animales venenosos siguen siendo un importante problema de salud pública en Brasil. Entre 2015 y 2016, la región sudeste tuvo el mayor número de notificaciones y Minas Gerais fue el estado con más casos. El objetivo de este estudio fue describir las características epidemiológicas de los accidentes por animales venenosos notificados entre 2008 y 2017 en el municipio de Patrocínio, Minas Gerais. Métodos: estudio descriptivo retrospectivo llevado a cabo mediante el análisis de la información de los formularios de notificación del Sistema de Información de Enfermedades Notificables de víctimas de accidentes con animales venenosos que ocurrieron durante los años 2008 a 2017 en Patrocínio. Resultados: se registraron 1084 casos, en su mayoría causados por escorpiones (47.23%), seguidos de serpientes (17.07%), arañas (15.31%) y abejas (11.07%). Predominaron las víctimas del sexo masculino (63,10%), con edades entre 20 y 39 años (32,56%). La mayoría de los accidentes se clasificaron como leves (89,11%) y la curación se produjo en el 98,80% de los casos; uno evolucionó hasta la muerte. Conclusiones: aunque los accidentes con animales venenosos no tienen altas tasas de mortalidad en el municipio estudiado, la incidencia de este problema de salud ha aumentado en los últimos años. Además, esta información epidemiológica actualizada puede contribuir a las acciones de política pública e informar a la población local sobre los riesgos inminentes.(AU)

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

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.

The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia

Abstract INTRODUCTION: We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS: We interviewed 100 villagers who were active in the forests. RESULTS: Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS: The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia.

BACKGROUND: The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES: To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS: The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS: There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS: Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.

Snakebites in the Municipality of Tarauacá, Acre, Western Brazilian Amazon / Acidentes ofídicos no Município de Tarauacá, Acre, Oeste da Amazônia brasileira

INTRODUCTION: Snakebites are a public health problem and are considered a common clinical emergency in several tropical countries, especially in rural and forested regions where these animals are more frequent. It is estimated that approximately 28,800 cases of snakebites per year occur in Brazil, with an average of 119 deaths, in which the north region has the highest rate of incidence. However, the accuracy of these data ends up being brought into question, since there are undoubtedly many cases of under-reporting and even cases that are not reported at all, due to logistical and geographical reasons or due to a lack of preparation as to the precise identification of the problem. OBJECTIVE: This study aimed to describe the epidemiological characteristics of the reported cases of snakebites victims in the municipality of Tarauacá (Acre), comparing the morbidity coefficient with other Amazonian regions, and to observe possible factors associated with the appearance of complications in these cases. METHODS: This is a retrospective descriptive study through the analysis of the clinical-epidemiological information found on the notification sheets of the Information System of Notification Diseases of victims of snakebites that occurred during the period between 2012 and 2016 in Tarauacá. RESULTS: We recorded 96 snakebite cases during the study period, with the majority (95.8%) classified as botropic, followed by laquetics (3.2%) and one by a non-venomous snake (1%). No deaths were recorded. Snakebites were more frequent in rural areas (87.5%), most being an occupational accident, and affected mainly adult male individuals in their lower limbs. Most cases occurred during the rainy season and had a positive correlation with rainfall. CONCLUSIONS: The morbidity coefficient registered in Tarauacá in 2016 (72.5 cases per 100,000 inhabitants) was higher than that recorded in the cities of Cruzeiro do Sul and Rio Branco and in the states of Acre and Amazonas. Although most patients receive antivenom within the first six hours, many victims do not receive appropriate hospital care until more than 24 hours after the envenoming, which is a factor associated with the appearance of complications.

INTRODUÇÃO: Os acidentes ofídicos constituem um problema de saúde pública, sendo considerada uma emergência clínica comum em vários países tropicais, principalmente em regiões de zona rural e florestadas, onde esses animais são mais frequentes. É estimado ocorrerem aproximadamente 28.800 casos anuais de acidentes ofídicos no Brasil, com uma média de 119 óbitos, no qual a região Norte apresenta a maior incidência. Todavia, a precisão desses dados acaba sendo questionada, pois devem ocorrer muitas subnotificações e mesmo não notificações por questões logísticas e geográficas ou decorrentes ao despreparo quanto à identificação precisa do agravo. OBJETIVO: Descrever características epidemiológicas dos casos notificados de vítimas de acidentes ofídicos no município de Tarauacá (Acre), comparando o coeficiente de morbidade com outras regiões amazônicas e observar possíveis fatores associados ao surgimento de complicações dos casos. MÉTODO: Trata-se de um estudo descritivo retrospectivo através da análise das informações clínico-epidemiológicas das fichas de notificação do Sistema de Informação de Agravos de Notificação de vítimas de acidentes ofídicos ocorridos durante o período de 2012 a 2016 em Tarauacá RESULTADOS: Foram registrados 96 casos durante o período de estudo, sendo a maioria (95,8%) classificada como botrópico, seguido de laquéticos (3,2%) e um por serpente não peçonhenta (1%). Nenhum óbito foi registrado. Os acidentes foram mais frequentes na área rural (87,5%), sendo um acidente ocupacional, acometendo principalmente indivíduos adultos do sexo masculino em seus membros inferiores. A maioria ocorreu durante a estação chuvosa e teve correlação positiva com a pluviosidade. CONCLUSÃO: O coeficiente de morbidade registrado em 2016 (72,5 casos por 100.000 habitantes) foi maior do que o registrado em Cruzeiro do Sul e Rio Branco e também para os estados do Acre e Amazonas. Apesar da maioria dos pacientes receber a soroterapia dentro das primeiras seis horas, muitos recebem o devido atendimento hospitalar após 24 horas decorrido o envenenamento, sendo um fator associado ao surgimento de complicações.

Secondary hemostasis studies of crude venom and isolated proteins from the snake Crotalus durissus terrificus.

Among the activities triggered by Crotalus durissus terrificus snake venom, coagulation is intriguing and contradictory since the venom contains both coagulant and anticoagulant precursor proteins. This work describes the in vitro effects of crude venom and purified proteins from snake Crotalus durissus terrificus as they affect coagulation factors of clotting pathways. Coagulant and/or anticoagulant activities of crude venom, and purified proteins were all analyzed directly in human plasma. Clots formed by crude venom and Gyroxin presented as flexible hyaline masses in punctiform distribution. Clot formation time evaluation of isolated proteins with PT and APTT assays made it possible to infer that these proteins interfere in all coagulation pathways. However, regarding ophidism by C. d. terrificus, Gyroxin acts directly, breaking down fibrinogen to fibrin and increasing the amount plasminogen activator, which results in the formation of thrombi. Crotoxin complex, Crotoxin A and Crotoxin B proteins can act in prothrombinase complex formation; Crotoxin B can inhibit prothrombinase complex formation by direct interaction with Factor Xa. Crotamine interacts with negatively charged regions of differing coagulation factors in all coagulation pathways, and possesses a whole set of activities causing dysfunction, activation and/or inhibition of natural anticoagulants and disturbing hemostasis.

Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussions for clinical-epidemiological diagnosis and surveillance

Abstract INTRODUCTION: The popular names "surucucu" and "jararaca" have been used in literature for Lachesis muta and Bothrops atrox snakes, respectively. We present the popular names reported by patients who suffered snakebites in the Alto Juruá region. METHODS: Fifty-seven (76%) patients saw the snakes that caused the envenomations and were asked about their popular names and sizes. RESULTS: The snakes Bothrops atrox, referred to as "jararaca," were recognized as being mainly juveniles (80.7%) and "surucucu" as mainly adults (81.8%). CONCLUSIONS: The name "surucucu" is used in the Alto Juruá region for the snake B. atrox, mainly for adult specimens.

Non-venomous snakebites in the Western Brazilian Amazon

Abstract INTRODUCTION: In this study, we examined the clinical manifestations, laboratory evidence, and the circumstances of snakebites caused by non-venomous snakes, which were treated at the Regional Hospital of Juruá in Cruzeiro do Sul. METHODS: Data were collected through patient interviews, identification of the species that were taken to the hospital, and the clinical manifestations. RESULTS: Eight confirmed and four probable cases of non-venomous snakebites were recorded. CONCLUSIONS: The symptoms produced by the snakes Helicops angulatus and Philodryas viridissima, combined with their coloration can be confused with venomous snakes (Bothrops atrox and Bothrops bilineatus), thus resulting in incorrect bothropic snakebite diagnosis.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report.

BACKGROUND: Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. CASE PRESENTATION: We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. CONCLUSIONS: We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Background Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions: We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.(AU)

Perfil epidemiológico del accidente ofídico en las tierras bajas de Guatemala / Epidemiological profile of the ophidian accident in the Guatemalan lowlands

Se describe el perfil epidemiológico del accidente ofídico en las tierras bajas de Guatemala a partir del análisis de 305 expedientes de casos atendidos en los hospitales regionales de Escuintla y San Benito, Petén, entre 2008 y 2013. De los 305 casos, 169 correspondieron al Hospital Regional de Escuintla y 136 al Hospital Regional de San Benito Petén. Los casos del Hospital Regional de Escuintla correspondieron a pacientes provenientes de los departamentos de Escuintla, Santa Rosa, Chimaltenango, Retalhuleu, Suchitepéquez, Sacatepéquez, Sololá y Guatemala. Los casos del Hospital Regional de San Benito Petén correspondieron a pacientes provenientes del área centro y norte de Petén, y algunos referidos del área sur. La edad media de la víctima fue 25.2 años. La enfermedad afectó más a hombres (61.3%) que a mujeres (38.7%). La mayoría de los afectados (28.3%) eran agricultores. Las especies de serpiente que se consignaron en los expedientes con mayor frecuencia fueron Bothrops asper (serpiente barba amarilla) en la región norte y Crotalus simus (serpiente cascabel) en la región sur. La mayoría de las mordeduras ocurrieron en los miembros inferiores. Los eventos de mordedura ocurrieron durante el día y durante la noche en proporciones similares. El tiempo medio que tarda la víctima en llegar al hospital fue de 5.6 horas. Se describen también otros aspectos epidemiológicos y se discuten las implicaciones ecológicas y sociales de los datos generado.

The epidemiological profile of snakebite envenomation in the lowlands of Guatemala is described. The data were generated from the analysis of 305 snakebite envenomation cases treated at Regional Hospitals in Escuintla and San Benito, Petén between years 2008 and 2013. The cases treated at the Regional Hospital of Escuintla occurred in the southern lowlands whereas the cases treated at the Regional Hospital of San Benito Petén occurred in the northern lowlands of Guatemala. The average age of the victim was 25.2 years. Envenomation frequencies were higher for men (61.3%) than for women (38.7%). Farmer was the most involved occupation (28.3%). Bothrops asper (the fer-de-lance snake) was recorded as the main causative of envenomation in the northern lowlands whereas Crotalus simus (the tropical rattlesnake) was the main causative species in the southern lowlands. Most snake bites occurred in the lower limbs of the victim. Envenomation occurred in similar proportions at day or at night. The elapsed time between the envenomation event and the arrival of the victim to the hospital was 5.6 hours. Other epidemiological aspects are also addressed and the ecological and social implications of the data are discussed.

Arachnidism, scorpionism and ophidism in Ouro Preto Municipality, Minas Gerais State, Brazil

Abstract: INTRODUCTION This retrospective study shows the profile of arachnidism, ophidism, and scorpionism in the Ouro Preto Municipality, Brazil, from January 2007 to December 2013. METHODS The data were gathered from forms of the Epidemiological Surveillance Sector of the town's Health's Municipal Secretary. RESULTS Of the 412 envenomations, 308 were caused by spiders, 78 by scorpions, and 26 by snakes. The highest number of incidents involved people aged 20-34 years. Females were more affected than males. There were no reports of death. CONCLUSIONS The results show that envenomations caused by spiders, scorpions and snakes have decreased in recent years.

Oftalmoplejía asociada a neurotoxicidad por veneno de serpiente: presentación de un caso y revisión de la literatura / Ophthalmoplegia associated with snake venom neurotoxicity: case report and literature review

Resumen El accidente ofídico es la lesión resultante de la mordedura de una serpiente, en el caso de ofidios venenosos se puede producir inoculación del veneno, constituyéndose además en ofidiotoxicosis. Esta entidad ha sido declarada por la Organización Mundial de la Salud como una enfermedad tropical olvidada. En el caso de Colombia constituye un problema aún vigente con una incidencia nacional de 9.7 casos por 100.000 habitantes, según datos reportados en el 2012. Las manifestaciones clínicas y la evolución de los pacientes se encuentran en relación directa con la composición del veneno de la serpiente, el cual es una especie específica. El propósito del presente artículo es describir, por medio de un caso clínico las características semiológicas y fisiopatológicas de un caso de ofidiotoxicosis con complicaciones neurológicas, haciendo una revisión de la literatura actual. Presentamos el caso de un paciente masculino, de 54 años de edad, que sufrió accidente ofídico grave, se discute con detalle las situaciones que pudieron haber contribuido al desenlace del paciente.

Summary The ophidian accident is the injury resulting from the bite of a snake, in the case of venomous snakes venom inoculation may occur, constituting itself in ophidiotoxicosis. This entity has been declared by the world health organization as a forgotten tropical disease. In the case of Colombia, this is still a problem, with a national incidence of 9.7 cases per 100,000 inhabitants, according to data reported in 2012. The clinical manifestations and evolution of the patients are directly related to the composition of the venom of the Snake which is specific species. The purpose of the present article is to describe, through a clinical case, the semiological and pathophysiological characteristics of a case of opiotoxicosis with neurological complications, making a review of the current literature. We present the case of a 54-year-old male patient who presented a severe ophidian accident, discussing in detail the situations that might have contributed to the outcome of the patient.

Accidente ofídico en el departamento de Sucre, Colombia / Ophidic accident in the department of Sucre, Colombia

Objetivo: Describir el comportamiento del accidente ofídico en el departamento de Sucre. Métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se analizaron 803 reportes de accidentes ofídicos notificados al sistema de vigilancia epidemiologia del departamento de Sucre, durante los años 2007 a 2012, la información fue suministrada por la dirección de salud pública de la secretaria de salud del departamento de Sucre, en formato Excel©, descargada directamente del aplicativo SIVIGILA. Los datos obtenidos se analizaron estadísticamente empleando medidas de tendencia central. Resultados: En el 48.2% de los casos, el género Bothrops se identificó como el agente agresor y en el 83.9% de los casos la mordedura se localizó en las extremidades del paciente. En 356 casos equivalentes al 44% el paciente no fue hospitalizado o no se consignó esta información en la ficha. En el tratamiento de los casos hospitalizados se empleó un promedio de 4.3 ± 4.5 viales por paciente; estos datos son consistentes con el protocolo para casos leves registrados (n=450), pero al revisar los casos individuales se encontró que 228 pacientes solo recibieron entre 1 y 3 ampollas. En 84 casos solo se administró un vial.

Objective: Describe the behavior of ophidic accident in the department of Sucre. Methods: A descriptive, retrospective study was done from 2007 to 2012, in this study, 803 cases of snakebites were reported to the surveillance system of the epidemiology department of Sucre. In this department, the snakebite accidents occurs along the entire year, mainly affecting men 15 to 44 years. Those affected come from all municipalities in the department and around the rural area, and it is mainly engaged in agriculture and domestic work; however, the town of Sincelejo accounts for 28.8% of all notifications. Results: In 48.2% of cases, the genus Bothrops was identified as the offending agent and in 83.9% of cases, the bite was found in the patient's limbs. In 356 cases or 44% the patients were hospitalized or the information of this records were not found. The treatment of hospitalized cases averaged 4.3 ± 4.5 shots were used per patient; This data is consistent with the protocol for registered mild cases (n = 450), but reviewing individual cases; then, it was found that 228 patients received only 1 to 3 ampoules. In 84 cases only one shot was administered.