Ophidian envenomings in a region of Brazilian Western Amazon
DOI:
https://doi.org/10.7322/jhgd.v30.9958Keywords:
Venomous animals, Serpent Bites, Amazonian EcosystemAbstract
Introduction: Snakebite accidents are a public health problem and are considered clinical emergencies, what makes studies in high-incidence regions very important.
Objective: To describe the clinical and epidemiological aspects of patients suffering from snakebite accidents in a region of the Western Amazon, Brazil.
Methods: It is a cross-sectional, retrospective and documentary quantitative approach, from 2015 to 2016, held at the Regional Hospital of Juruá, located in the city of Cruzeiro do Sul, Acre, Brazil. Epidemiological data were obtained from the forms of the Notification Disease Information System (SINAN), in the Epidemiological Surveillance Sector of the hospital. The following variables were verified: month of occurrence, snake identification (type of accident), accident location (urban and rural), locality, municipality, victim data (age group, sex, anatomical region affected), symptoms and signs circumstances of the accident, time elapsed between accident and care, number of ampoules used, and type of serum.
Results: An average of 124 cases of snakebite accidents were treated per year (76.71 cases per 100,000 inhabitants/year), most of them were botropic accidents and the patients were male adult and rural workers, bitten in the lower limbs. More than 30% of cases were treated six hours after poisoning and 24-hour care is a risk factor for complications, as seven of the eight patients who had complications were treated within one day of the accident.
Conclusion: It was presented a constant increase in the cases, which generated a worrying point of reflection, which may be associated with two factors, where one turns to the improvement in the displacement of victims (improvements in branch roads and implementation of SAMU speedboat) facilitating plus transport and telephone coverage by improving communication, or the failure of public health policies to provide better conditions and guidance to the population.
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References
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2. Moreno E, Queiroz-Andrade M, Lira-da-Silva RM, Tavares-Neto J. Caracteristicas clinicoepidemiologicas dos acidentes ofidicos em Rio Branco, Acre. Rev Soc Bras Med Trop. 2005;38(1):15-21. DOI: http://dx.doi.org/10.1590/S0037-86822005000100004
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5. Pierini SV, Warrell DA, Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian Indians of the Jurua valley, acre state, Brazil. Toxicon. 1996;34(2):225-36. DOI: http://dx.doi.org/10.1016/0041-0101(95)00125-5
6. Lima JS, Martelli Júnior H, Martelli DRB, Silva MS, Carvalho SFG, Canela JR, et al. Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil. Rev Soc Bras Med Trop. 2009;42(5):561-4. DOI: http://dx.doi.org/10.1590/S0037-86822009000500015
7. Wen FH, Monteiro WM, Silva AMM, Tambourgi DV, Silva IM, Sampaio VS, et al. Snakebites and Scorpion Stings in the Brazilian Amazon: Identifying Research Priorities for a Largely Neglected Problem. PLoS Negl Trop Dis. 2015;9(5):e0003701. DOI: http://dx.doi.org/10.1371/journal.pntd.0003701
8. Bochner R, Fiszon JT, Machado C. A Profile of Snake Bites in Brazil, 2001 to 2012. J Clin Toxicol. 2014;4(3):100-94. DOI: http://dx.doi.org/10.4172/2161-0495.1000194
9. Ribeiro LA, Albuquerque MJ, Campos VAFP, Katz G, Takaoka NY, Lebrão ML, et al. Óbitos por serpentes peçonhentas no Estado de São Paulo: avaliação de 43 casos, 1988/93. Rev Assoc Médica Bras. 1998;44(4):312-8. DOI: http://dx.doi.org/10.1590/S0104-42301998000400010
10. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92. DOI: http://dx.doi.org/10.1590/S0044-59672009000300025
11. Bernarde PS, Gomes JO. Serpentes peçonhentas e ofidismo em Cruzeiro do Sul, Alto Juruá, Estado do Acre, Brasil. Acta Amaz. 2012;42(1):65-72. DOI: http://dx.doi.org/10.1590/S0044-59672012000100008
12. Bernade PS. Serpentes peçonhentas e acidentes ofídicos no Acre. Curitiba: Anolis Books, 2012.
13. Campbell JA, Lamar WW. The venomous reptiles of the Western Hemisphere. Ithaca: Cornell University Press, 2004.
14. Oliveira ME, Martins M. When ans where to find a pitviper: activity patterns and habitat use of the lancehead, bothrops atrox, in central amazonia, Brazil. Herpetol Nat Hist. 2001;8(2):101-10.
15. Acre. Governo do Estado. Programa Estadual de Zoneamento Ecológico-Econômico do Estado do Acre. Zoneamento ecológico-econômico do Acre fase II: documento síntese. Rio Branco: Secretaria de Estado de Planejamento e Desenvolvimento Econômico Sustentável, 2006.
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19. Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med. 2018;11:209-16. DOI: http://dx.doi.org/10.2147/IJGM.S136153
20. Ochola FO, Okumu MO, Muchemi GM, Mbaria JM, Gikunju JK. Epidemiology of snake bites in selected areas of Kenya. Pan Afr Med J. 2018;29:217. DOI: http://dx.doi.org/10.11604/pamj.2018.29.217.15366
21. Spyres MB, Ruha AM, Seifert S, Onisko N, Padilla-Jones A, Smith EA. Occupational Snake Bites: a Prospective Case Series of Patients Reported to the ToxIC North American Snakebite Registry. J Med Toxicol. 2016;12(4):365-9. DOI: http://dx.doi.org/10.1007/s13181-016-0555-7
22. Bhalla G, Mhaskar D, Agarwal A. Clinical profile of snake bite at a tertiary care centre. Toxicol Int. 2014;21(2):203-8. DOI: http://dx.doi.org/10.4103/0971-6580.139811
23. Borges CC, Sadahiro M, Santos MC. Aspectos epidemiológicos e clínicos dos acidentes ofídicos ocorridos nos municípios do Estado do Amazonas. Rev Soc Bras Med Trop. 2018;32(6):637-46. DOI: http://dx.doi.org/10.1590/S0037-86821999000600005
24. Yañez-Arenas C, Yañez-Arenas A, Martínez-Ortíz D. Panorama epidemiológico de las mordeduras por serpiente venenosa en el estado de Yucatán, México (2003-2012). Gac Med Mex. 2016;152(4):568-74.
25. Turci LCB, Albuquerque S, Bernarde PS, Miranda DB. Uso do hábitat, atividade e comportamento de Bothriopsis bilineatus e de Bothrops atrox (Serpentes: Viperidae) na floresta do Rio Moa, Acre, Brasil. Biota Neotrop. 2009;9(3):197-206. DOI: http://dx.doi.org/10.1590/S1676-06032009000300020
26. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RR, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian western Amazonia. Rev Soc Bras Med Trop. 2018;51(3):338-46. DOI: http://dx.doi.org/10.1590/0037-8682-0489-2017
27. Saboia CDO, Bernade PS. Snakebites in the Municipality of Tarauacá , Acre , West of the Brazilian Amazon. J Hum Growth Dev. 2019;29(1):290-7. DOI: http://dx.doi.org/10.7322/jhgd.157760
28. Bernade PS, Mota-da-silva A, Abreu LC. Ofidismo no Estado do Acre - Brasil. J Amaz Heal Sci. 2015;1(2):44–63.
29. Otero R, Guti6rrez JM, Ntitiezl V, Robles A, Estrada R, Segura E, et al. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia and The Regional Group on Antivenom Therapy Research. Trans R Soc Trop Med Hyg. 1996;90(6):696-700. DOI: http://dx.doi.org/10.1016/s0035-9203(96)90442-3
30. Smalligan R, Cole J, Brito N, Laing GD, Mertz BL, Manock S, et al. Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms. BMJ. 2004;329(7475):1129. DOI: http://dx.doi.org/10.1136/bmj.329.7475.1129
31. Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, et al. Venomous snake bites: Clinical diagnosis and treatment. J Intensive Care. 2015;3(1):16. DOI: http://dx.doi.org/10.1186/s40560-015-0081-8
32. Pardal PPO, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42. DOI: http://dx.doi.org/10.1016/s0035-9203(03)00005-1
33. Lundquist AL, Chari RS, Wood JH, Miller GG, Schaefer HM, Raiford DS, et al. Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review. Liver Transplant. 2007;13(5):647-50. DOI: http://dx.doi.org/10.1002/lt.21098
34. Kanji S, Chant C. Allergic and hypersensitivity reactions in the intensive care unit. Crit Care Med. 2010;38(6 Suppl.):S162-8. DOI: http://dx.doi.org/10.1097/CCM.0b013e3181de0c99
35. Boothpur R, Hardinger KL, Skelton RM, Lluka B, Koch MJ, Miller BW, et al. Serum sickness after treatment with rabbit antithymocyte globulin in a heart transplant recipient with previous rabbit exposure. Am J Kidney Dis. 2010;55(3):141-3. DOI: http://dx.doi.org/10.1053/j.ajkd.2009.06.017
36. Feitosa ES, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(Suppl I):34-41. DOI: http://dx.doi.org/10.1590/0037-8682-0105-2013
37. Mitra S, Agarwal A, Shubhankar BU, Masih S, Krothapalli V, Lee BM, et al. Clinico-epidemiological profile of snake bites over 6-year period from a rural secondary care centre of Northern India: A descriptive study. Toxicol Int. 2015;22(1):77-82. DOI: http://dx.doi.org/10.4103/0971-6580.172263
38. Ribeiro LA, Jorge MT, Iversson LB. Epidemiologia do acidente por serpentes peçonhentas: estudo de casos atendidos em 1988. Rev Saude Publica. 1995;29(5):380-8. DOI: http://dx.doi.org/10.1590/S0034-89101995000500007
39. Machado C, Bochner R, Fiszon JT. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006. J Venom Anim Toxins Incl Trop Dis. 2012;18(2):217-24. DOI: http://dx.doi.org/10.1590/S1678-91992012000200012
2. Moreno E, Queiroz-Andrade M, Lira-da-Silva RM, Tavares-Neto J. Caracteristicas clinicoepidemiologicas dos acidentes ofidicos em Rio Branco, Acre. Rev Soc Bras Med Trop. 2005;38(1):15-21. DOI: http://dx.doi.org/10.1590/S0037-86822005000100004
3. Oliveira RJ, Kirchner RM, Scherer ME, Santos ER, Eidelwein LPS. Perfil epidemiológico de acidentes ofídicos no estado do Rio Grande do Sul no período de 2007 a 2013. Enciclop Biosf. 2015;11(22):3074-83. DOI: http://dx.doi.org/10.18677/Enciclopedia_Biosfera_2015_024
4. Feitosa EL, Sampaio VS, Salinas JL, Queiroz AM, Silva IM, Gomes AA, et al. Older age and time to medical assistance are associated with severity and mortality of snakebites in the Brazilian Amazon: A case-control study. PLoS One. 2015;10(7): e0132237. DOI: http://dx.doi.org/10.1371/journal.pone.0132237
5. Pierini SV, Warrell DA, Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian Indians of the Jurua valley, acre state, Brazil. Toxicon. 1996;34(2):225-36. DOI: http://dx.doi.org/10.1016/0041-0101(95)00125-5
6. Lima JS, Martelli Júnior H, Martelli DRB, Silva MS, Carvalho SFG, Canela JR, et al. Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil. Rev Soc Bras Med Trop. 2009;42(5):561-4. DOI: http://dx.doi.org/10.1590/S0037-86822009000500015
7. Wen FH, Monteiro WM, Silva AMM, Tambourgi DV, Silva IM, Sampaio VS, et al. Snakebites and Scorpion Stings in the Brazilian Amazon: Identifying Research Priorities for a Largely Neglected Problem. PLoS Negl Trop Dis. 2015;9(5):e0003701. DOI: http://dx.doi.org/10.1371/journal.pntd.0003701
8. Bochner R, Fiszon JT, Machado C. A Profile of Snake Bites in Brazil, 2001 to 2012. J Clin Toxicol. 2014;4(3):100-94. DOI: http://dx.doi.org/10.4172/2161-0495.1000194
9. Ribeiro LA, Albuquerque MJ, Campos VAFP, Katz G, Takaoka NY, Lebrão ML, et al. Óbitos por serpentes peçonhentas no Estado de São Paulo: avaliação de 43 casos, 1988/93. Rev Assoc Médica Bras. 1998;44(4):312-8. DOI: http://dx.doi.org/10.1590/S0104-42301998000400010
10. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92. DOI: http://dx.doi.org/10.1590/S0044-59672009000300025
11. Bernarde PS, Gomes JO. Serpentes peçonhentas e ofidismo em Cruzeiro do Sul, Alto Juruá, Estado do Acre, Brasil. Acta Amaz. 2012;42(1):65-72. DOI: http://dx.doi.org/10.1590/S0044-59672012000100008
12. Bernade PS. Serpentes peçonhentas e acidentes ofídicos no Acre. Curitiba: Anolis Books, 2012.
13. Campbell JA, Lamar WW. The venomous reptiles of the Western Hemisphere. Ithaca: Cornell University Press, 2004.
14. Oliveira ME, Martins M. When ans where to find a pitviper: activity patterns and habitat use of the lancehead, bothrops atrox, in central amazonia, Brazil. Herpetol Nat Hist. 2001;8(2):101-10.
15. Acre. Governo do Estado. Programa Estadual de Zoneamento Ecológico-Econômico do Estado do Acre. Zoneamento ecológico-econômico do Acre fase II: documento síntese. Rio Branco: Secretaria de Estado de Planejamento e Desenvolvimento Econômico Sustentável, 2006.
16. Intitutudo Brasileiro de Geodrafia e Estatística (IBGE). Censo demográfico. 2017.
17. SAS Institute. JMP. Version 10. (1989 – 2013). Cary, NC: 2013.
18. El hattimy F, Chafiq F, Hami H, Mokhtari A, Soulaymani A, Rachida SB. Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013. Epidemiol Health. 2018;40: e2018024. DOI: http://dx.doi.org/10.4178/epih.e2018024
19. Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med. 2018;11:209-16. DOI: http://dx.doi.org/10.2147/IJGM.S136153
20. Ochola FO, Okumu MO, Muchemi GM, Mbaria JM, Gikunju JK. Epidemiology of snake bites in selected areas of Kenya. Pan Afr Med J. 2018;29:217. DOI: http://dx.doi.org/10.11604/pamj.2018.29.217.15366
21. Spyres MB, Ruha AM, Seifert S, Onisko N, Padilla-Jones A, Smith EA. Occupational Snake Bites: a Prospective Case Series of Patients Reported to the ToxIC North American Snakebite Registry. J Med Toxicol. 2016;12(4):365-9. DOI: http://dx.doi.org/10.1007/s13181-016-0555-7
22. Bhalla G, Mhaskar D, Agarwal A. Clinical profile of snake bite at a tertiary care centre. Toxicol Int. 2014;21(2):203-8. DOI: http://dx.doi.org/10.4103/0971-6580.139811
23. Borges CC, Sadahiro M, Santos MC. Aspectos epidemiológicos e clínicos dos acidentes ofídicos ocorridos nos municípios do Estado do Amazonas. Rev Soc Bras Med Trop. 2018;32(6):637-46. DOI: http://dx.doi.org/10.1590/S0037-86821999000600005
24. Yañez-Arenas C, Yañez-Arenas A, Martínez-Ortíz D. Panorama epidemiológico de las mordeduras por serpiente venenosa en el estado de Yucatán, México (2003-2012). Gac Med Mex. 2016;152(4):568-74.
25. Turci LCB, Albuquerque S, Bernarde PS, Miranda DB. Uso do hábitat, atividade e comportamento de Bothriopsis bilineatus e de Bothrops atrox (Serpentes: Viperidae) na floresta do Rio Moa, Acre, Brasil. Biota Neotrop. 2009;9(3):197-206. DOI: http://dx.doi.org/10.1590/S1676-06032009000300020
26. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RR, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian western Amazonia. Rev Soc Bras Med Trop. 2018;51(3):338-46. DOI: http://dx.doi.org/10.1590/0037-8682-0489-2017
27. Saboia CDO, Bernade PS. Snakebites in the Municipality of Tarauacá , Acre , West of the Brazilian Amazon. J Hum Growth Dev. 2019;29(1):290-7. DOI: http://dx.doi.org/10.7322/jhgd.157760
28. Bernade PS, Mota-da-silva A, Abreu LC. Ofidismo no Estado do Acre - Brasil. J Amaz Heal Sci. 2015;1(2):44–63.
29. Otero R, Guti6rrez JM, Ntitiezl V, Robles A, Estrada R, Segura E, et al. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia and The Regional Group on Antivenom Therapy Research. Trans R Soc Trop Med Hyg. 1996;90(6):696-700. DOI: http://dx.doi.org/10.1016/s0035-9203(96)90442-3
30. Smalligan R, Cole J, Brito N, Laing GD, Mertz BL, Manock S, et al. Crotaline snake bite in the Ecuadorian Amazon: randomised double blind comparative trial of three South American polyspecific antivenoms. BMJ. 2004;329(7475):1129. DOI: http://dx.doi.org/10.1136/bmj.329.7475.1129
31. Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, et al. Venomous snake bites: Clinical diagnosis and treatment. J Intensive Care. 2015;3(1):16. DOI: http://dx.doi.org/10.1186/s40560-015-0081-8
32. Pardal PPO, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42. DOI: http://dx.doi.org/10.1016/s0035-9203(03)00005-1
33. Lundquist AL, Chari RS, Wood JH, Miller GG, Schaefer HM, Raiford DS, et al. Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review. Liver Transplant. 2007;13(5):647-50. DOI: http://dx.doi.org/10.1002/lt.21098
34. Kanji S, Chant C. Allergic and hypersensitivity reactions in the intensive care unit. Crit Care Med. 2010;38(6 Suppl.):S162-8. DOI: http://dx.doi.org/10.1097/CCM.0b013e3181de0c99
35. Boothpur R, Hardinger KL, Skelton RM, Lluka B, Koch MJ, Miller BW, et al. Serum sickness after treatment with rabbit antithymocyte globulin in a heart transplant recipient with previous rabbit exposure. Am J Kidney Dis. 2010;55(3):141-3. DOI: http://dx.doi.org/10.1053/j.ajkd.2009.06.017
36. Feitosa ES, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(Suppl I):34-41. DOI: http://dx.doi.org/10.1590/0037-8682-0105-2013
37. Mitra S, Agarwal A, Shubhankar BU, Masih S, Krothapalli V, Lee BM, et al. Clinico-epidemiological profile of snake bites over 6-year period from a rural secondary care centre of Northern India: A descriptive study. Toxicol Int. 2015;22(1):77-82. DOI: http://dx.doi.org/10.4103/0971-6580.172263
38. Ribeiro LA, Jorge MT, Iversson LB. Epidemiologia do acidente por serpentes peçonhentas: estudo de casos atendidos em 1988. Rev Saude Publica. 1995;29(5):380-8. DOI: http://dx.doi.org/10.1590/S0034-89101995000500007
39. Machado C, Bochner R, Fiszon JT. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006. J Venom Anim Toxins Incl Trop Dis. 2012;18(2):217-24. DOI: http://dx.doi.org/10.1590/S1678-91992012000200012
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2020-03-26
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