Venomous snakebites in children and adolescents: a 12-year retrospective review

Abstract

Snakebite envenomation is a worldwide problem and in Costa Rica. The following is a retrospective review of 79 patients admitted to the Hospital Nacional de Niños (HNN) from January 1985 to September 1996. Child's age ranged from 9 months to 14 years. The M: F ratio was 1.5:1. Sixty percent of the patients lived in remote rural areas. The most common clinical signs at the time of hospitalization were pain and edema. Fifty patients (63,29%) showed moderate to severe envenomation grades. Fifty-one (64,55%) was caused by Bothrops asper. Complications during hospitalization were compartment syndrome and secondary infection. Three children died, one from disseminated intravascular coagulation, another from renal insufficiency, and the third from a perforated duodenal ulcer. Patients who underwent early fasciotomy had significantly less hospitalization and fewer infectious complications, (p < 0.001). There was no relationship between the envenomation grade and length of hospitalization (p = 0.4). The most common pathogen isolated was S. aureus. Early fasciotomy seemed to reduce the complications seen in these patients. Further studies are necessary to identify the factors that may help clinicians to decide those who should undergo fasciotomy, as well as the best moment to perform it

Comparison of wildlife and captivity rattlesnakes (Crotalus durissus terrificus) microbiota

“…Moreover, this identification process can be useful for choosing an appropriate antibacterial therapy in patients who are the victims of such accidents, in agreement with other authors (Andrade et al 1989, Jorge et al 1994, Tagwireyi et al 2001, Hejnar et al 2007. A twelve year study by Avila-Agüero et al 2001, on snakebite accidents in children and adolescents concluded that bacterial infection was very common after the bites due to elevated bacterial colonization in the mouth of these snakes, favoring proliferation in damaged tissues.…”

Bothropssnakebite on the head: case report and review of the literature

“…Envenomation caused by Bothrops species is frequently accompanied by secondary local complications, including soft-tissue infections, mostly caused by Gram-negative and anaerobic bacteria (Ribeiro and Jorge, 1997;Ribeiro et al, 1998;Quiroga et al, 2000;Avila-Agü ero et al, 2001;Bucaretchi et al, 2001;Otero et al, 2002;França and Málaque, 2003). Interestingly, no such complications were observed in the present case, or in most of the other cases of head bite listed in the Table.…”

Overlooked Issues of Snakebite Management: Time for Strategic Approach

“…Although the precise mechanism is not known, involvement of ECM degrading hydrolytic enzymes and myonecrotic factors of venom might be warranted. However, venom induced tissue factors, agents from the pathogenic microbes of the snake buccal micro flora or opportunistic pathogens which could cause persistent tissue necrosis also cannot be ignored [156,157,158]. In addition, there could be complications associated in regenerating cells, ECM molecules and tendons that could lead to adhesion formation between tendons and surrounding fixed tissues and this could finally affect the voluntary motion of the affected limb.…”