Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.(AU)

Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.(AU)

Venomous animals of state of Piauí: epidemiology of accidents and list of medical importance species / Animais peçonhentos do estado do Piauí: epidemiologia dos acidentes e lista de espécies de importância médica

Os casos de envenenamentos aumentaram consideravelmente no Brasil, no entanto, para o estado do Piauí apenas dois estudos foram realizados até o momento. Aqui, investigamos, através dos formulários de notificação, as características epidemiológicas dos casos de envenenamentos ocorridos durante 11 anos na macrorregião de Picos, estado do Piauí, Nordeste do Brasil. Além disso, também verificamos se as espécies registradas nos formulários de notificação correspondem às espécies que ocorrem na região. Registramos 1.249 casos de envenenamentos, sendo 41% causados por escorpiões, 35% causados por serpentes e 24% causados por aranhas. Na maioria dos casos (aracnídeos = 99%, escorpiões = 93%, serpentes = 52%) não houve a identificação da espécie causadora do acidente. A maioria das vítimas dos acidentes (66%) eram indivíduos do sexo masculino entre 18 e 24 anos de áreas rurais, picadas durante atividades de campo na estação chuvosa (janeiro a março). Os locais de lesão mais comuns foram os membros inferiores (37%) e a maioria (53%) dos acidentes foi do tipo leve. Este é o primeiro estudo que reporta o perfil epidemiológico de uma série de envenenamentos (incluindo aracnídeos e serpentes) durante 11 anos de ocorrência no estado do Piauí. Além disso, também apresentamos a primeira lista de espécies de aracnídeos e serpentes de importância médica para o estado. Nossos resultados demonstram que houve uma alta incidência de acidentes por animais peçonhentos na região centro-sul do estado, a maioria dos registros não foi notificada no SINAN, a maioria dos registros não apresentou a identificação das espécies responsáveis pelo acidente, e há registros cujas espécies foram identificadas incorretamente.

Cases of poisoning have increased considerably in Brazil, however for state of Piauí only two studies were carried out so far. Here, we investigated, through the notification forms, the epidemiological characteristics of cases of poisoning that occurred during 11 years in a macro-region of Picos, state of Piauí, Northeastern Brazil. Furthermore, we also check whether the species recorded in the notification forms correspond to the species that occur in the region. We recorded 1.249 cases of envenomations, being 41% caused by scorpions, 35% caused by snakes and 24% caused by spiders. Most cases (arachnids = 99%, scorpions = 93%, snakes = 52%) there was no identification of species causing the accident. Most of the victims of the accidents (66%) were male individuals between 18 and 24 years from rural areas, stung during field activities in the rainy season (January-March). The most common injury sites were the lower limbs (37%) and the majority (53%) of the accidents was the mild type. This is the first study that reports the epidemiological profile of a series of envenomations (including arachnids and snakes) during 11 years of records in the state of Piauí. Furthermore, we also present the first list of species of arachnids and snakes of medical importance to the state. Our results demonstrate that there was a high incidence of accidents by venomous animals in the Center-South region of the state, most of the records was not notified in SINAN, most records does not present the identification of the species responsible for the accident, and there are records whose species was incorrectly identified.

Acidentes botrópicos em cães / Bothrops snakebites in dogs

Background: Snakebites occur frequently among humans and animals. In Brazil, about 23,000 cases of snakebite involving humans were recorded in 2016, 11% of them caused by venomous snakes. In the region of Cuiabá, capital of MatoGrosso, the highest occurrence is of snakes of the genus Bothrops (81%), followed by Crotalus (4%). Bothrops venom hasproteolytic, coagulant, and hemorrhagic effects, whereas Crotalus venom is neurotoxic, myotoxic and nephrotoxic. Thispaper reports on three cases of Bothrops snakebites in dogs treated at the Veterinary Hospital of the Federal Universityof Mato Grosso in 2017.Cases: Three dogs were treated showing clinical signs of snakebite, possibly by Bothrops, since their owners reportedthat these are the snakes most frequently found where they live. This information is consistent with the known geographicdistribution of snakes of the genus Bothrops in the state of Mato Grosso, Brazil. In the first report (Case 11), the patientwas bitten on two different occasions in a five-month interval, and died presumably due to anaphylactic shock causedby the venom injected by a second snakebite (Case 12). In both episodes, the animal presented a swollen face and neck,dyspnea and eye bleeding, and these signs were more severe in the second episode. Case 2 was a dog with severe neckand chest swelling and pain. The owner of this dog reported that he had taken his dog for a walk in the countryside, alongwith the dog of Case 1, and had returned home with both dogs about three hours before the consultation. Case 3 was aRottweiler living at a small family farm located 67 km from Cuiabá. The animal presented slight swelling and pain in theleft forelimb, and puncture wounds on the lower limb. Neutrophilic leukocytosis was observed in cases 1 and 3. In addition, Case 12 (the second episode of Case 1) presented thrombocytopenia and increased prothrombin time and activatedpartial...

Acidentes botrópicos em cães / Bothrops snakebites in dogs

Background: Snakebites occur frequently among humans and animals. In Brazil, about 23,000 cases of snakebite involving humans were recorded in 2016, 11% of them caused by venomous snakes. In the region of Cuiabá, capital of MatoGrosso, the highest occurrence is of snakes of the genus Bothrops (81%), followed by Crotalus (4%). Bothrops venom hasproteolytic, coagulant, and hemorrhagic effects, whereas Crotalus venom is neurotoxic, myotoxic and nephrotoxic. Thispaper reports on three cases of Bothrops snakebites in dogs treated at the Veterinary Hospital of the Federal Universityof Mato Grosso in 2017.Cases: Three dogs were treated showing clinical signs of snakebite, possibly by Bothrops, since their owners reportedthat these are the snakes most frequently found where they live. This information is consistent with the known geographicdistribution of snakes of the genus Bothrops in the state of Mato Grosso, Brazil. In the first report (Case 11), the patientwas bitten on two different occasions in a five-month interval, and died presumably due to anaphylactic shock causedby the venom injected by a second snakebite (Case 12). In both episodes, the animal presented a swollen face and neck,dyspnea and eye bleeding, and these signs were more severe in the second episode. Case 2 was a dog with severe neckand chest swelling and pain. The owner of this dog reported that he had taken his dog for a walk in the countryside, alongwith the dog of Case 1, and had returned home with both dogs about three hours before the consultation. Case 3 was aRottweiler living at a small family farm located 67 km from Cuiabá. The animal presented slight swelling and pain in theleft forelimb, and puncture wounds on the lower limb. Neutrophilic leukocytosis was observed in cases 1 and 3. In addition, Case 12 (the second episode of Case 1) presented thrombocytopenia and increased prothrombin time and activatedpartial...(AU)

Venomous animals of state of Piauí: epidemiology of accidents and list of medical importance species / Animais peçonhentos do estado do Piauí: epidemiologia dos acidentes e lista de espécies de importância médica

Os casos de envenenamentos aumentaram consideravelmente no Brasil, no entanto, para o estado do Piauí apenas dois estudos foram realizados até o momento. Aqui, investigamos, através dos formulários de notificação, as características epidemiológicas dos casos de envenenamentos ocorridos durante 11 anos na macrorregião de Picos, estado do Piauí, Nordeste do Brasil. Além disso, também verificamos se as espécies registradas nos formulários de notificação correspondem às espécies que ocorrem na região. Registramos 1.249 casos de envenenamentos, sendo 41% causados por escorpiões, 35% causados por serpentes e 24% causados por aranhas. Na maioria dos casos (aracnídeos = 99%, escorpiões = 93%, serpentes = 52%) não houve a identificação da espécie causadora do acidente. A maioria das vítimas dos acidentes (66%) eram indivíduos do sexo masculino entre 18 e 24 anos de áreas rurais, picadas durante atividades de campo na estação chuvosa (janeiro a março). Os locais de lesão mais comuns foram os membros inferiores (37%) e a maioria (53%) dos acidentes foi do tipo leve. Este é o primeiro estudo que reporta o perfil epidemiológico de uma série de envenenamentos (incluindo aracnídeos e serpentes) durante 11 anos de ocorrência no estado do Piauí. Além disso, também apresentamos a primeira lista de espécies de aracnídeos e serpentes de importância médica para o estado. Nossos resultados demonstram que houve uma alta incidência de acidentes por animais peçonhentos na região centro-sul do estado, a maioria dos registros não foi notificada no SINAN, a maioria dos registros não apresentou a identificação das espécies responsáveis pelo acidente, e há registros cujas espécies foram identificadas incorretamente.(AU)

Cases of poisoning have increased considerably in Brazil, however for state of Piauí only two studies were carried out so far. Here, we investigated, through the notification forms, the epidemiological characteristics of cases of poisoning that occurred during 11 years in a macro-region of Picos, state of Piauí, Northeastern Brazil. Furthermore, we also check whether the species recorded in the notification forms correspond to the species that occur in the region. We recorded 1.249 cases of envenomations, being 41% caused by scorpions, 35% caused by snakes and 24% caused by spiders. Most cases (arachnids = 99%, scorpions = 93%, snakes = 52%) there was no identification of species causing the accident. Most of the victims of the accidents (66%) were male individuals between 18 and 24 years from rural areas, stung during field activities in the rainy season (January-March). The most common injury sites were the lower limbs (37%) and the majority (53%) of the accidents was the mild type. This is the first study that reports the epidemiological profile of a series of envenomations (including arachnids and snakes) during 11 years of records in the state of Piauí. Furthermore, we also present the first list of species of arachnids and snakes of medical importance to the state. Our results demonstrate that there was a high incidence of accidents by venomous animals in the Center-South region of the state, most of the records was not notified in SINAN, most records does not present the identification of the species responsible for the accident, and there are records whose species was incorrectly identified.(AU)

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.(AU)

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.

Associação de plasma sanguíneo ao tratamento de envenenamento botrópico em equino: relato de caso / Plasma blood associated with the treatment of bothropic poisoning in equine: case report

O presente trabalho tem por objetivo relatar um caso de envenenamento botrópico em um equino, fêmea, seis anos de idade, da raça Quarto de Milha, pesando 460kg, que foi atendido no hospital veterinário da FCAV/Unesp, Campus de Jaboticabal, SP. No exame clínico, observou-se aumento bilateral de narina, com extrema sensibilidade ao toque, presença das marcas da presa da serpente na região rostral de focinho, mucosas róseas com petéquias. No exame de sangue, pôde-se detectar alteração no tempo de coagulação sanguínea (>30 minutos). O animal permaneceu internado, sendo instituída a seguinte terapia: soro antiofídico polivalente, transfusão de plasma sanguíneo equino, fluidoterapia intensa, flunixin meglumine e sulfa associado ao trimetoprim. A associação da transfusão de plasma sanguíneo equino ao tratamento convencional foi de extrema importância para correção da coagulopatia causada pelo acidente ofídico. A égua apresentou melhora clínica e resolução do quadro de envenenamento após cinco dias da internação.(AU)

This study aims to report a case of blood plasma association with the treatment of bothrops poisoning in an equine, female, six years of age, Quarter Horses, weighing 460 kg, which was served in the veterinary hospital of the FCAV/UNESP, Jaboticabal/SP. Clinical examination showed bilateral increase in nostrils, with great sensitivity to touch, presence of snake prey marks the rostral region of the snout, mucous rosy and with petechiae. Blood samples showed changes in blood clotting time (> 30 minutes). The animal remained in hospitalization with the following treatment: polyvalent antivenom, blood plasma transfusion, intensive fluid therapy, flunexim meglumine and sulfa associated with trimethoprim. The association of transfusion equine blood plasma to conventional treatment was extremely important for correction of coagulopathy caused by snakebite. The mare showed clinical improvement and resolution of poisoning symptoms after five days of hospitalization.(AU)

Associação de plasma sanguíneo ao tratamento de envenenamento botrópico em equino: relato de caso / Plasma blood associated with the treatment of bothropic poisoning in equine: case report

O presente trabalho tem por objetivo relatar um caso de envenenamento botrópico em um equino, fêmea, seis anos de idade, da raça Quarto de Milha, pesando 460kg, que foi atendido no hospital veterinário da FCAV/Unesp, Campus de Jaboticabal, SP. No exame clínico, observou-se aumento bilateral de narina, com extrema sensibilidade ao toque, presença das marcas da presa da serpente na região rostral de focinho, mucosas róseas com petéquias. No exame de sangue, pôde-se detectar alteração no tempo de coagulação sanguínea (>30 minutos). O animal permaneceu internado, sendo instituída a seguinte terapia: soro antiofídico polivalente, transfusão de plasma sanguíneo equino, fluidoterapia intensa, flunixin meglumine e sulfa associado ao trimetoprim. A associação da transfusão de plasma sanguíneo equino ao tratamento convencional foi de extrema importância para correção da coagulopatia causada pelo acidente ofídico. A égua apresentou melhora clínica e resolução do quadro de envenenamento após cinco dias da internação.(AU)

This study aims to report a case of blood plasma association with the treatment of bothrops poisoning in an equine, female, six years of age, Quarter Horses, weighing 460 kg, which was served in the veterinary hospital of the FCAV/UNESP, Jaboticabal/SP. Clinical examination showed bilateral increase in nostrils, with great sensitivity to touch, presence of snake prey marks the rostral region of the snout, mucous rosy and with petechiae. Blood samples showed changes in blood clotting time (> 30 minutes). The animal remained in hospitalization with the following treatment: polyvalent antivenom, blood plasma transfusion, intensive fluid therapy, flunexim meglumine and sulfa associated with trimethoprim. The association of transfusion equine blood plasma to conventional treatment was extremely important for correction of coagulopathy caused by snakebite. The mare showed clinical improvement and resolution of poisoning symptoms after five days of hospitalization.(AU)

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions.Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection.Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (2 = 4.6; p= 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p= 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years.Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.(AU)

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions.Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection.Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (χ2 = 4.6; p= 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p= 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years.Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.(AU)

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions.Methods This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection.Results A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (2 = 4.6; p= 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p= 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years.Conclusion Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania.

The international view of envenoming in Brazil: myths and realities

Being distant from Brazil's great natural diversity, from its long tradition in the study of snakebites and from the fact that it is one of the few countries which has a national information system for monitoring incidents involving venomous animals, non-Brazilian researchers face risks when estimating the incidence of these accidents in the country. The present work offers a critical review of the main estimates undertaken since 1954. It is interesting to note contradictions between textual and graphic information within the same article, variations over time in the work of a same researcher and differences among distinct authors, and that all these issues remain unmentioned or undiscussed. Comparison among such estimates and the data available at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN) creates an opportunity to identify the degree of imprecision present in those articles, and draws attention to the need for the production of studies at both the regional and national levels, based on concrete data collected at national, state and municipal levels, which has been available on the internet since 2001.(AU)

The international view of envenoming in Brazil: myths and realities

Being distant from Brazil's great natural diversity, from its long tradition in the study of snakebites and from the fact that it is one of the few countries which has a national information system for monitoring incidents involving venomous animals, non-Brazilian researchers face risks when estimating the incidence of these accidents in the country. The present work offers a critical review of the main estimates undertaken since 1954. It is interesting to note contradictions between textual and graphic information within the same article, variations over time in the work of a same researcher and differences among distinct authors, and that all these issues remain unmentioned or undiscussed. Comparison among such estimates and the data available at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN) creates an opportunity to identify the degree of imprecision present in those articles, and draws attention to the need for the production of studies at both the regional and national levels, based on concrete data collected at national, state and municipal levels, which has been available on the internet since 2001.

The international view of envenoming in Brazil: myths and realities

Being distant from Brazil's great natural diversity, from its long tradition in the study of snakebites and from the fact that it is one of the few countries which has a national information system for monitoring incidents involving venomous animals, non-Brazilian researchers face risks when estimating the incidence of these accidents in the country. The present work offers a critical review of the main estimates undertaken since 1954. It is interesting to note contradictions between textual and graphic information within the same article, variations over time in the work of a same researcher and differences among distinct authors, and that all these issues remain unmentioned or undiscussed. Comparison among such estimates and the data available at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN) creates an opportunity to identify the degree of imprecision present in those articles, and draws attention to the need for the production of studies at both the regional and national levels, based on concrete data collected at national, state and municipal levels, which has been available on the internet since 2001.

Estudo epidemiológico dos acidentes por serpentes associados aos usos da terra em Manhuaçu - MG, de 2007 a 2015.

Os acidentes ofídicos ainda são um sério problema de saúde pública negligenciado. Para o tratamento é usado o soro antiofídico, que tem ampla disponibilidade no país. Entretanto, o desconhecimento na identificação de cobras peçonhentas e dos sintomas decorrentes de um acidente contribui para a ocorrência de falhas na terapia. A mortalidade ou sequelas da vítima resultam da toxicidade do veneno, quantidade inoculada e eficácia do tratamento. É necessária a procura imediata pelo serviço de saúde, uma vez que, o intervalo de tempo entre o acidente e o início do tratamento tem associação direta com a gravidade dos casos. A cidade de Manhuaçu, em Minas Gerais, é centro de referência do Sistema Único de Saúde (SUS) para o tratamento das vítimas da região e tem o maior número de notificações do estado. O presente estudo busca descrever a dinâmica da ocorrência dos acidentes com serpentes, caracterizar o perfil dos pacientes, avaliar o tratamento com soro antiofídico e associar aos usos da terra em Manhuaçu. Foi realizada análise descritiva retrospectiva e ecológica dos dados do Sistema de Informação de Agravos de Notificação (SINAN), utilizando para isso o Excel 10.0 e Stata 12.0. Dados secundários do Instituto Brasileiro de Geografia e Estatística (IBGE) foram usados para as características socioambientais do Município. No total, foram estudados 360 acidentes por serpentes, no período de 2007 a 2015. Observou-se quanto ao perfil dos pacientes que 278 (77,2%) eram homens, 204 (56,6%) adultos e 232 (64,4%) foram mordidos nos membros inferiores. Quanto à ocorrência do acidente, 289 (80,2%) aconteceram na zona rural. Ainda, 169 (46,9%) casos foram relacionados ao trabalho e 194 (53,8%) vítimas tinham a ocupação associada à agricultura, o que poderia ser um número ainda maior em vista das respectivas 76 (21,1%) e 152 (42,2%) fichas com essas variáveis ignoradas. Verificou-se que 313 (86,9%) foram acidentes botrópicos (gênero Bothrops), e 40 (11,1%) casos foram ignorados, não identificando a serpente. Em relação ao tratamento, 274 (76,1%) pacientes foram atendidos com menos de três horas após o envenenamento e 324 (90%) receberam soro antiofídico. A concordância do número de ampolas usadas em relação à gravidade do quadro clínico dos pacientes, calculada pelo coeficiente Kappa, foi de 59.81% (p<0,05), resultando em um tratamento de classificação moderada. No período de tempo analisado, não ocorreu nenhum óbito por ofidismo. Maio foi o mês com maior número de acidentes por serpentes (IC 95%=3,3±0,309), diferente do padrão observado na região Sudeste. O percentual de inércia do sistema de análise de componentes principais foi de 82% e 87%, associando, a incidência e gravidade dos acidentes respectivamente, com variáveis ambientais que aumentariam a oferta de alimento para as serpentes. A falta de dados no preenchimento da ficha de notificação impossibilitou a completa caracterização da ocorrência dos acidentes. A avaliação do tratamento mostrou-se eficaz, mesmo com a ocorrência de casos de não conformidade com a recomendação do Ministério da Saúde. A análise das características dos acidentes em Manhuaçu permitem inferir condições ambientais específicas que merecem melhor estudo. Os resultados visam orientar intervenções e contribuir para a melhor organização dos serviços de saúde quanto à prevenção, diagnóstico e tratamento dos casos na esfera municipal.

Snake accidents still are a serious neglected public health problem. The antiophidic serum is used for treatment and it is widely available in the country. However, the lack of knowledge about the identification of venomous snakes and the symptoms of an accident increase therapy failures. The mortality or sequel of a victim may result from poison toxicity, inoculated amount and treatment efficacy. Its necessary to search the health service imediately after an snake accident, since the time lapse between the accident and the beginning of the treatment has a direct association with the severity of the cases. The city of Manhuaçu, in Minas Gerais, is a reference center of the Unified Health System (SUS) for the treatment of the victims of the region and has the highest number of notifications of the state. The present study seeks to describe the dynamics of the occurrence of snake accidents in Manhuaçu, characterize the profile of the pacients, evaluate the treatment with antiophidic serum and associate the accidents to the use of land in Manhuaçu. A descriptive and retrospective analysis of the data of the Information System of Notification Diseases (SINAN) was carried out using Excel 10.0 and Stata 12.0. Secondary data from the Brazilian Institute of Geography and Statistics (IBGE) were used for socio-environmental characteristics of the city. In total, 360 snake accidents were studied in 2007-2015. It was observed that 278 (77.2%) were men, 204 (56.6%) adults, 232 (64.4%) were bitten in the lower limbs. Regarding the occurrence of the accident, 289 (80.2%) occurred in the rural area. Furthermore, 169 (46.9%) cases were work related and 194 (53.8%) victims had an occupation related to agriculture, which could be an even larger number considering the respective 76 (21.1%) and 152 (42.2%) cases that ignored the profession of the victim. It was verified that 313 (86.9%) are bothropics accidents (genus Bothrops) and 40 (11.1%) cases were ignored, not identifying the snake. Regarding the treatment, 274 (76.1%) patients were treated less than 3 hours after the poisoning and 324 (90%) received antiofidic serum. The agreement of the number of ampoules used in relation to the severity of the patients' clinical condition, calculated by the Kappa coefficient (p<0,05), was 59.81%, classified as moderate. In the period of time analyzed, there was no death due to snake bite. The month with more accidents with snakes was May (IC 95%=3,3±0,309), differing from the pattern observe in Southeast region. The inertia percentage of the main components analysis system was 82 and 87%, showing, respectively, the incidence and gravity of the accidents associated with environmental variables that would increase food availability for snakes. The lack of data in filling in the notification form makes it impossible to fully characterize the occurrence of accidents. The evaluation of the treatment was effective, despite the occurrence of cases that were not in accordance of Ministry of Health recommendation. The analysis of the characterics of the accidents in Manhuaçu allow to infer specific environmental conditions that deserver further studies. The results aim to orientate interventions and contribute to a better organization of health services in the prevention, diagnosis and treatment of cases in the municipal sphere.

Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006

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)

Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006

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)

Serpentes peçonhentas e ofidismo em Cruzeiro do Sul, Alto Juruá, Estado do Acre, Brasil / Venomous snakes and ophidism in Cruzeiro do Sul, Alto Juruá, State of Acre, Brazil

Apesar da importância dos acidentes ofídicos na Saúde Pública, são relativamente poucas as pesquisas realizadas sobre esse tema no Brasil. Devido aos poucos estudos sobre ofidismo na Amazônia e especialmente no estado do Acre, trabalhos epidemiológicos são de grande relevância. Esse estudo apresenta a lista de serpentes peçonhentas e aspectos epidemiológicos dos acidentes ofídicos em Cruzeiro do Sul, região do Alto Juruá (Acre), verificando quais gêneros de serpentes são responsáveis pelos envenenamentos e aspectos que envolvem o acidente e o atendimento hospitalar. Os dados epidemiológicos foram coligidos a partir do SINAN (Sistema de Informações de Agravos de Notificação), no setor de vigilância epidemiológica do Hospital Regional do Juruá, no município de Cruzeiro do Sul. Sete espécies de serpentes peçonhentas foram registradas nesse município: três viperídeos (Bothrops atrox, Bothriopsis bilineata e Lachesis muta) e quatro elapídeos (Micrurus hemprichii, M. lemniscatus, M. remotus and M. surinamensis). Durante o período de dois anos (agosto de 2007 a julho de 2009) foram registrados 195 casos de acidentes ofídicos. Cinquenta e um por cento dos acidentes foi classificado como laquético (Lachesis), seguido pelo botrópico (Bothrops e Bothriopsis) com 38 por cento e crotálico (Crotalus) com 2 por cento. Em 9 por cento dos casos o gênero da serpente envolvida não foi informado. A maioria dos acidentes envolveu indivíduos adultos do gênero masculino em área rural, afetados principalmente nos membros inferiores. Os casos ocorreram mais frequentemente nos meses de novembro a abril, coincidindo com os maiores níveis pluviométricos. A maioria dos acidentes foi atribuída equivocadamente à serpente L. muta, tendo sido provavelmente causados por B. atrox.

Despite the importance of accidents involving snakebites, research on this theme in Brazil is relatively rare, especially in the Amazon region. Due to the poor number of studies about ophidism in the state of Acre and to the importance of this type of research in public health, epidemiological works on snake bite accidents are of great relevance. This study presents the list of species of poisonous snakes and the epidemiological aspects of snakebites in Cruzeiro do Sul, region of Alto Juruá (State of Acre, Brazil), in order to verify the snake genera responsible for the bites, and the main aspects involving the accidents and hospital attending. The epidemiologic data were collected from SINAN (National Databank of Major Causes of Morbidity) in the sector of epidemiologic vigilance of Hospital Regional do Juruá, in Cruzeiro do Sul. Seven species of poisonous snakes were recorded in Cruzeiro do Sul: three viperids (Bothrops atrox, Bothriopsis bilineata and Lachesis muta) and four elapids (Micrurus hemprichii, M. lemniscatus, M. remotus and M. surinamensis). During a two-year period (August 2007 to July 2009) 195 cases of snakebites were recorded. Fifty-one percent of the accidents were classified as lachetic (Lachesis), followed by bothropic (Bothrops and Bothriopsis) with 38 percent and crotalic (Crotalus) with 2 percent. In 9 percent of cases the snake genus involved was not informed. The majority of the accidents involved adult males living in rural areas, mainly affected in the lower limbs. The cases occurred most frequently from November to April, coinciding with the highest pluviometric levels. Most snakebites were equivocally attributed to L. muta, and were probably caused by B. atrox.