South American rattlesnake (Crotalus durissus spp) envenomation in dogs in the semiarid region of Brazil

Background: South American rattlesnake (Crotalus durissus spp.) envenomation is rarely reported in small animals andlivestock in Brazil. Minor swelling at the snakebite site, skeletal muscle, and renal damage, and severe neurological signscharacterize the crotalic envenomation. This case report aims to present epidemiological, clinical, and pathological dataof two cases of Crotalus durissus spp envenomation in dogs in the Northeast of Brazil.Cases: Envenomation by Crotalus durissus spp. was recorded in two dogs in Patos, State of Paraíba, Brazil. In Case 1,the dog presented flaccid paralysis, hyporeflexia, a deficit of cranial nerves, epistaxis, and gingival hemorrhages. Laboratory assay showed proteinuria, myoglobinuria, regenerative thrombocytopenia, and increased serum activities of creatinekinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). The dogwas medicated with crotalic antivenom and wholly recovered from local and systemic clinical signs. In Case 2, the dogdied and was detected fang marks at the ventral region of the left mandible (two small parallel perforations spaced 2.0 cmapart) at the snakebite site. Cyanosis of the oral cavity, congestion, and hemorrhages in several organs were observed atnecropsy. Tubular nephrosis, muscular necrosis, hepatocytes swelling were observed. The owners witnessed snakebites,and the rattlesnakes (Crotalus durissus spp.) identified by the rattle at the end portion of the tail in both cases.Discussion: Natural South American rattlesnake envenomation presents complex clinical signs that makes diagnosis achallenge for veterinary practitioners. The criteria for the correct diagnosis and observed in the two dogs include witness ofthe snakebite, identification of the snake, detection of fang marks, clinical-pathological findings, and therapeutic responseto treatment with specific anti-venom....

South American rattlesnake (Crotalus durissus spp) envenomation in dogs in the semiarid region of Brazil

Background: South American rattlesnake (Crotalus durissus spp.) envenomation is rarely reported in small animals andlivestock in Brazil. Minor swelling at the snakebite site, skeletal muscle, and renal damage, and severe neurological signscharacterize the crotalic envenomation. This case report aims to present epidemiological, clinical, and pathological dataof two cases of Crotalus durissus spp envenomation in dogs in the Northeast of Brazil.Cases: Envenomation by Crotalus durissus spp. was recorded in two dogs in Patos, State of Paraíba, Brazil. In Case 1,the dog presented flaccid paralysis, hyporeflexia, a deficit of cranial nerves, epistaxis, and gingival hemorrhages. Laboratory assay showed proteinuria, myoglobinuria, regenerative thrombocytopenia, and increased serum activities of creatinekinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). The dogwas medicated with crotalic antivenom and wholly recovered from local and systemic clinical signs. In Case 2, the dogdied and was detected fang marks at the ventral region of the left mandible (two small parallel perforations spaced 2.0 cmapart) at the snakebite site. Cyanosis of the oral cavity, congestion, and hemorrhages in several organs were observed atnecropsy. Tubular nephrosis, muscular necrosis, hepatocytes swelling were observed. The owners witnessed snakebites,and the rattlesnakes (Crotalus durissus spp.) identified by the rattle at the end portion of the tail in both cases.Discussion: Natural South American rattlesnake envenomation presents complex clinical signs that makes diagnosis achallenge for veterinary practitioners. The criteria for the correct diagnosis and observed in the two dogs include witness ofthe snakebite, identification of the snake, detection of fang marks, clinical-pathological findings, and therapeutic responseto treatment with specific anti-venom....(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.

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)

Divergences between the Brazilian national information systems for recording deaths from venomous animals

Background: This paper aims to highlight and analyze discrepancies in reporting of deaths due to venomous animals in Brazil, from 2001 to 2015, between two national information systems: The Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação - SINAN) and the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM). Methods: Descriptive and comparative study of the SINAN and SIM information systems, was conducted via the following steps: collecting the death notices from SINAN and SIM; constructing tables and comparative graphics; and, only in scorpion sting fatalities, analyzing the distribution of deaths by age group as described in the specialized literature. Results: While SINAN identifies strong growth in the number of deaths from scorpion stings, SIM shows greater increase in the number of reported deaths from bee stings, especially in the South and Southeast regions. Notably, bees are the sole etiological agent that received more reports in SIM than in SINAN for every year in the period studied. The age-group distribution of the data on deaths from scorpion stings reinforced the indication of problems occurring in their registration in SINAN, especially since 2007, which may have an effect on analyses based on these data. Conclusion: Comparative analysis of these databases permits identification of important differences between profiles presented by these systems, which have equal relevance for Brazil as a whole and for its regions. These differences may influence the construction of various scenarios.(AU)

Epidemiological and clinical aspects of ophidian bothropic accidents in dogs / Aspectos epidemiológicos e clínicos dos acidentes ofídicos botrópicos em cães

Snakebites are included in the group of emergencies for domestic animals, and these consultations demand technical knowledge as well as careful clinical evaluation of patients. Because of the importance of this theme and the higher prevalence of snakebites caused by snakes of the genus Bothrops in Rio Grande do Sul state, Brazil, this study aimed to address the epidemiological and clinical aspects of these accidents in dogs in the state, in addition to establishing their incidence. Clinical records of dogs, with a diagnosis of ophidian bothropic accident, assisted at the Toxicological Information Center of Rio Grande do Sul (CIT-RS) were revised from 2014 to 2016. These data were collected at the Toxicological Information Center, Statistics and Evaluation Center, State Secretary of Health. Data on the incidence of accidents and epidemiological and clinical information were obtained for each case. A total of 53 records were revised. In the records that included animal sex (n=49), 53% were female and 46.9% were male. As for animal age (n=47), the dogs ranged from one to 14 years, and most of them (46.9%) were in the 1-4-year age group. Over half of the cases occurred in the rural area (60.7%), and the head and neck were the main venom inoculation sites (76.3%). Diseases were characterized by clinical courses varying from hyperacute (<30 min to 6h), acute (6-24h), to subacute (4-5 days). Severe accidents accounted for 40% of the cases, with edema as the most frequent clinical sign (88.7%) followed by hemorrhagic manifestations (41.5%). Associations of epidemiological and clinical aspects coupled with history of exposure are important characteristics to assist with suspicion and definitive diagnosis of bothropic accidents in dogs.(AU)

Os acidentes ofídicos se enquadram no grupo de emergências para animais domésticos e esses atendimentos demandam conhecimento técnico, aliado a uma criteriosa avaliação clínica do paciente. Devido à importância do tema e a maior frequência de acidentes ofídicos provocados por serpentes do gênero Bothrops no Rio Grande do Sul, esse estudo teve como objetivo abordar os aspectos epidemiológicos e clínicos desses acidentes em cães nesse estado, além de estabelecer a frequência em que ocorrem. Foram revisados os protocolos de atendimentos clínicos de cães realizados pelo Centro de Informações Toxicológicas do Rio Grande do Sul (CIT-RS) com diagnóstico de acidente ofídico botrópico, entre o período de 2014 e 2016. Esses dados fazem parte do Centro de informação Toxicológica, Secretaria da Saúde, RS, Núcleo de Estatística e Avaliação. Foram obtidos dados relacionados à frequência dos acidentes e informações referentes à epidemiologia e à clínica de cada caso. Totalizaram-se 53 registros de atendimentos. Dos protocolos que informaram o sexo (n=49), 53% corresponderam a fêmeas e 46,9%, a machos. Em relação à idade (n=47), houve uma variação entre um e 14 anos, com maior concentração dos casos entre 1-4 anos (46,9%). Mais da metade dos atendimentos ocorreu em zona rural (60,7%) e a cabeça e o pescoço foram os principais locais de inoculação do veneno botrópico (76,3%). Observou-se uma doença com um curso que variou de hiperagudo (<30 min à 6h), agudo (6-24h) a subagudo (4-5 dias). Acidentes graves representaram 40% dos casos, no qual edema foi o sinal clínico mais frequente (88,7%), seguido por manifestações hemorrágicas (41,5%). A associação dos aspectos epidemiológicos e clínicos, aliados ao histórico de exposição, constituem características importantes que auxiliam na suspeita e no diagnóstico definitivo do acidente botrópico em animais.(AU)

Epidemiological and clinical aspects of ophidian bothropic accidents in dogs / Aspectos epidemiológicos e clínicos dos acidentes ofídicos botrópicos em cães

Snakebites are included in the group of emergencies for domestic animals, and these consultations demand technical knowledge as well as careful clinical evaluation of patients. Because of the importance of this theme and the higher prevalence of snakebites caused by snakes of the genus Bothrops in Rio Grande do Sul state, Brazil, this study aimed to address the epidemiological and clinical aspects of these accidents in dogs in the state, in addition to establishing their incidence. Clinical records of dogs, with a diagnosis of ophidian bothropic accident, assisted at the Toxicological Information Center of Rio Grande do Sul (CIT-RS) were revised from 2014 to 2016. These data were collected at the Toxicological Information Center, Statistics and Evaluation Center, State Secretary of Health. Data on the incidence of accidents and epidemiological and clinical information were obtained for each case. A total of 53 records were revised. In the records that included animal sex (n=49), 53% were female and 46.9% were male. As for animal age (n=47), the dogs ranged from one to 14 years, and most of them (46.9%) were in the 1-4-year age group. Over half of the cases occurred in the rural area (60.7%), and the head and neck were the main venom inoculation sites (76.3%). Diseases were characterized by clinical courses varying from hyperacute (<30 min to 6h), acute (6-24h), to subacute (4-5 days). Severe accidents accounted for 40% of the cases, with edema as the most frequent clinical sign (88.7%) followed by hemorrhagic manifestations (41.5%). Associations of epidemiological and clinical aspects coupled with history of exposure are important characteristics to assist with suspicion and definitive diagnosis of bothropic accidents in dogs.(AU)

Os acidentes ofídicos se enquadram no grupo de emergências para animais domésticos e esses atendimentos demandam conhecimento técnico, aliado a uma criteriosa avaliação clínica do paciente. Devido à importância do tema e a maior frequência de acidentes ofídicos provocados por serpentes do gênero Bothrops no Rio Grande do Sul, esse estudo teve como objetivo abordar os aspectos epidemiológicos e clínicos desses acidentes em cães nesse estado, além de estabelecer a frequência em que ocorrem. Foram revisados os protocolos de atendimentos clínicos de cães realizados pelo Centro de Informações Toxicológicas do Rio Grande do Sul (CIT-RS) com diagnóstico de acidente ofídico botrópico, entre o período de 2014 e 2016. Esses dados fazem parte do Centro de informação Toxicológica, Secretaria da Saúde, RS, Núcleo de Estatística e Avaliação. Foram obtidos dados relacionados à frequência dos acidentes e informações referentes à epidemiologia e à clínica de cada caso. Totalizaram-se 53 registros de atendimentos. Dos protocolos que informaram o sexo (n=49), 53% corresponderam a fêmeas e 46,9%, a machos. Em relação à idade (n=47), houve uma variação entre um e 14 anos, com maior concentração dos casos entre 1-4 anos (46,9%). Mais da metade dos atendimentos ocorreu em zona rural (60,7%) e a cabeça e o pescoço foram os principais locais de inoculação do veneno botrópico (76,3%). Observou-se uma doença com um curso que variou de hiperagudo (<30 min à 6h), agudo (6-24h) a subagudo (4-5 dias). Acidentes graves representaram 40% dos casos, no qual edema foi o sinal clínico mais frequente (88,7%), seguido por manifestações hemorrágicas (41,5%). A associação dos aspectos epidemiológicos e clínicos, aliados ao histórico de exposição, constituem características importantes que auxiliam na suspeita e no diagnóstico definitivo do acidente botrópico em animais.(AU)

Snakebites notified to the poison control center of Morocco between 2009 and 2013

Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013. Methods This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone. Results During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %). Conclusion Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.(AU)

Snakebites notified to the poison control center of Morocco between 2009 and 2013

Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013. Methods This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone. Results During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %). Conclusion Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.(AU)

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.

The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa: a crucial step for the management of envenomation

During the 6th International Conference on Envenomation by Snakebites and Scorpion Stings in Africa held in Abidjan, from 1 to 5 June 2015, the measures for the management of envenomation were discussed and new recommendations were adopted by the participants. The high incidence and severity of this affliction were confirmed by several studies conducted in African countries. The poor availability of antivenom, particularly because of the cost, was also highlighted. Some experiences have been reported, mainly those regarding the financial support of antivenom in Burkina Faso (more than 90 %) and Togo (up to 60 %) or the mandatory reporting of cases in Cameroon. Key recommendations concerned: improvement of epidemiological information based on case collection; training of health workers in the management of envenomation; policy to promote the use of effective and safe antivenom; and antivenom funding by sharing its costs with stakeholders in order to improve antivenom accessibility for low-income patients.(AU)

The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa: a crucial step for the management of envenomation

During the 6th International Conference on Envenomation by Snakebites and Scorpion Stings in Africa held in Abidjan, from 1 to 5 June 2015, the measures for the management of envenomation were discussed and new recommendations were adopted by the participants. The high incidence and severity of this affliction were confirmed by several studies conducted in African countries. The poor availability of antivenom, particularly because of the cost, was also highlighted. Some experiences have been reported, mainly those regarding the financial support of antivenom in Burkina Faso (more than 90 %) and Togo (up to 60 %) or the mandatory reporting of cases in Cameroon. Key recommendations concerned: improvement of epidemiological information based on case collection; training of health workers in the management of envenomation; policy to promote the use of effective and safe antivenom; and antivenom funding by sharing its costs with stakeholders in order to improve antivenom accessibility for low-income patients.

Snakebites notified to the poison control center of Morocco between 2009 and 2013

Background Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013. Methods This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone. Results During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %). Conclusion Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.(AU)

The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa: a crucial step for the management of envenomation

During the 6th International Conference on Envenomation by Snakebites and Scorpion Stings in Africa held in Abidjan, from 1 to 5 June 2015, the measures for the management of envenomation were discussed and new recommendations were adopted by the participants. The high incidence and severity of this affliction were confirmed by several studies conducted in African countries. The poor availability of antivenom, particularly because of the cost, was also highlighted. Some experiences have been reported, mainly those regarding the financial support of antivenom in Burkina Faso (more than 90 %) and Togo (up to 60 %) or the mandatory reporting of cases in Cameroon. Key recommendations concerned: improvement of epidemiological information based on case collection; training of health workers in the management of envenomation; policy to promote the use of effective and safe antivenom; and antivenom funding by sharing its costs with stakeholders in order to improve antivenom accessibility for low-income patients.(AU)

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Background Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.(AU)

Epidemiology of envenomations by terrestrial venomous animals in Brazil based on case reporting: from obvious facts to contingencies

Background:Envenomation remains a neglected public health issue in most tropical countries. A better understanding of the epidemiology of bites and stings by venomous animals should facilitate their prevention and management. This study aimed to explore the benefits that could be derived from the compulsory notification of cases as it is now routinely practiced in Brazil.Methods:The Brazilian Notifiable Diseases Information System (SINAN) was consulted online for the 2001-2012 period on all envenomations by venomous terrestrial animals. We studied the incidence, severity, number of deaths, gender, season of accident and time between the accident and hospital consultation.Results:In total, 1,192,667 accidents and 2,664 deaths from terrestrial venomous animals (snakes, scorpions, spiders, bees and caterpillars) were reported in Brazil during these 12 years, the circumstances of which are detailed in this study. Most envenomations and deaths were caused by snakebites and scorpion stings. However, incidence and mortality showed high regional variations. During this period, the steady and parallel increase of the cases from all the species resulted from several factors including the human population increase, gradual improvement of data collection system and, probably, environmental and socioeconomic factors affecting in a different way the incidence of envenomation by each zoological group and by region.Conclusion:Mandatory reporting of cases appears to be a useful tool to improve the management of envenomations. However, local studies should be continued to account for the variability of accident circumstances and refine measures necessary for their management.(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 (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.

Viper bites complicate chronic agrochemical nephropathy in rural Sri Lanka

Snakebite is a common occupational health hazard among Sri Lankan agricultural workers, particularly in the North Central Province. Viperine snakes, mainly Russells viper envenomation, frequently lead to acute renal failure. During the last two decades, an agrochemical nephropathy, a chronic tubulointerstitial disease has rapidly spread over this area leading to high morbidity and mortality. Most of the epidemiological characteristics of these two conditions overlap, increasing the chances of co-occurrence. Herein, we describe four representative cases of viperine snakebites leading to variable clinical presentations, in patients with chronic agrochemical nephropathy, including two patients presented with acute and delayed anuria. These cases suggest the possibility of unusual manifestations of snakebite in patients with Sri Lankan agrochemical nephropathy, of which the clinicians should be aware. It could be postulated that the existing scenario in the Central America could also lead to similar clinical presentations.(AU)