34www.scielo.br/rsbmt I www.rsbmt.org.br Revista da Sociedade Brasileira de Medicina Tropical 48(Suppl I):34-41, 2015http://dx.doi. org/10.1590/0037-8682-0105-2013 Review Article ABSTRACT Envenoming snakebites are thought to be a particularly important threat to public health worldwide, especially in rural areas of tropical and subtropical countries. The true magnitude of the public health threat posed by snakebites is unknown, making it diffi cult for public health offi cials to optimize prevention and treatment. The objective of this work was to conduct a systematic review of the literature to gather data on snakebite epidemiology in the Amazon region and describe a case series of snakebites from epidemiological surveillance in the State of Amazonas (1974Amazonas ( -2012. Only 11 articles regarding snakebites were found. In the State of Amazonas, information regarding incidents involving snakes is scarce. Historical trends show an increasing number of cases after the second half of the 1980s. Snakebites predominated among adults (20-39 years old; 38%), in the male gender (78.9%) and in those living in rural areas (85.6%). The predominant snake envenomation type was bothropic. The incidence reported by the epidemiological surveillance in the State of Amazonas, reaching up to 200 cases/100,000 inhabitants in some areas, is among the highest annual snakebite incidence rates of any region in the world. The majority of the cases were reported in the rainy season with a case-fatality rate of 0.6%. Snakebite envenomation is a great disease burden in the State of Amazonas, representing a challenge for future investigations, including approaches to estimating incidence under-notifi cation and casefatality rates as well as the factors related to severity and disabilities.

Most proteins in the venom had masses < 14kDa, low phospholipase A2 activity, and no proteolytic activity. The toxins inhibited the coagulation cascade. The venom had neurotoxic effects in mice, with a median lethal dose upon intravenous administration of 700 µg/kg. Immunogenic studies revealed abundant cross-reactivity of antielapidic serum with 14kDa toxins and limited cross-reactivity with toxins < 10kDa. These results indicate that antielapidic serum against M. surinamensis venom has weak potency (0.35mg/ml) in mice.

In recent years, many antimicrobial peptides have been found in the venoms of animals from different sources and have been intensively studied to elucidate their ability to inhibit the growth of potential pathogenic microorganisms. The aim of this study was to characterize and evaluate the in vitro antifungal activity of crude venom from two amazonian snakes: Bothrops atrox and Crotalus durissus ruruima. The molecular profile of representative proteins from the venom samples was obtained by reversed-phase high-performance liquid chromatography (RP-HPLC) and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Fungal inhibition was investigated by microdilution assays against two Candida albicans strains. Based on the chromatography and electrophoresis analyses, the venom from B. atrox and C. durissus ruruima were characterized. In addition, the venoms (400 µg/mL) were not able to cause significant inhibition (> 50%) of the growth of C. albicans KL-07, at only 9.09% (200 µg/mL) and 7.88% (400 µg/mL), respectively, and neither presented any influence on the growth of strain C. albicans ATCC 36232.