Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera Bothrops and Crotalus being the most studied and main responsible for severe and lethal envenomations. In the country, Crotalus genus (i.e., rattlesnakes) is represented by Crotalus durissus species, showing seven different subspecies distributed along the country, including Crotalus durissus ruruima, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by C. d. ruruima venom in Roraima state.

Background: Snakebite envenoming can be a life-threatening condition, for which emergency care is essential. The Bothrops (lancehead) genus is responsible for most snakebite-related deaths and permanent loss of function in human victims in Latin America. Bothrops spp. venom is a complex mixture of different proteins that are known to cause local necrosis, coagulopathy, and acute kidney injury. However, the long-term effects of these viper envenomings have remained largely understudied. Case presentation: Here, we present a case report of a 46-years old female patient from Las Claritas, Venezuela, who was envenomed by a snake from the Bothrops genus. The patient was followed for a 10-year period, during which she presented oliguric renal failure, culminating in kidney failure 60 months after the envenoming. Conclusion:In Latin America, especially in Brazil, where there is a high prevalence of Bothrops envenoming, it may be relevant to establish long-term outpatient programs. This would reduce late adverse events, such as chronic kidney disease, and optimize public financial resources by avoiding hemodialysis and consequently kidney transplantation.

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Introdução: As Condições Sensíveis à Atenção Primária (CSAP) compreendem os agravos em saúde que são atendidos no primeiro nível de atenção à saúde, caso esse atendimento seja negligenciado pode haver evolução deste agravo sendo necessária internação hospitalar. Objetivo: Conhecer as características das internações por condições sensíveis à atenção primária que ocorreram nas Instituições Hospitalares do estado de Roraima no período de 2011 à 2015. Métodos: Trata-se de um estudo ecológico de base populacional que utiliza dados secundários do DATASUS. Resultados: No período estudado, evidenciou-se a ocorrência de 155.063 internações no HGR, sendo que 22,79% (35.344) destas foram internações por Condições Sensíveis a Atenção Primária e 82,19% referentes a e pacientes residentes em Boa Vista, visto que as pneumonias bacterianas foram as principais causas de internação, seguido por infecção da pele e tecido subcutâneo. Conclusões: Neste estudo foi possível quantificar as internações ocorridas no estado de Roraima de 2011 à 2015 e traçar um perfil das internações pelas CSAP, identificando as principais causas de internação que necessitam de intervenção por meio de programas dirigidos na atenção primária.

Introduction: The Amazonas is the largest state of Brazil, being located in the northwestern of the country. Nevertheless, the Amazonas is not so populous; its population corresponds only to 1.9% (4,063,614 habitants) from the population of Brazil. On the other hand, the state is famous for its rich flora and fauna including venomous animals such as snakes, spiders and scorpions. Therefore, epidemiological studies of venomous animal accidents in the region becomes essential for the development of better therapeutical strategies and preventing actions to reduce the occurrence of these accidents. Objective: The present study aimed to perform an epidemiological analysis of accidents caused by venomous animals in the Amazonas state from 2012 to 2015. Methods: The data were obtained by consulting the Sistema de Informação de Agravos de Notificação (SINAN, Information System for Notifiable Diseases) and Sistema Nacional de Informações Tóxico-Farmacológicas (SINITOX, National System of Toxic-Pharmacological Information) databases. Data of accidents caused by venomous animals between 2012 and 2015 were collected from the Amazonas 60 municipalities. The variables analyzed were: year of highest incidence, municipality with the highest incidence, age of the victims, sex of the victim, animal responsible for the accident, time interval between the accident and therapeutics and deaths. Results: During the years 2012 to 2015, a total of 9,349 cases of accidents involving venomous animals were reported in Amazonas state, with most victims registered in Manaus (1,331 cases). Most of the victims present 20 to 39 years-old and were male. The snakes were responsible for the most accidents, followed by scorpions. Most of the victims reach the hospital and start the therapy between 1 to 3 hours after the accident. The deaths in the state present less than 20 cases per year. Conclusion: This study expands the knowledge about the epidemiological profile of venomous animal accidents in Amazonas state, which is crucial for quantifying the disease burden, contributing to evidence-based healthcare planning, and evaluating effectiveness and relative contribution of primary, secondary and tertiary preventative measures for reducing these accidents and their complications in the region.

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