Accidente ofi ́dico en niños en Costa Rica: epidemiologi ́a y deteccio ́n de factores de riesgo en el desarrollo de absceso y necrosis

Saborío, Pablo; González, M Sánchez; Cambronero, María de los Ángeles Cano

doi:10.1016/s0041-0101(97)00076-7

Cited by 28 publications

(18 citation statements)

References 6 publications

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“…Snakebites are recorded mostly from remote rural or riverine areas, from where patients’ rescue to the health units is made exclusively by boat transportation, lasting several hours or even days [8–10]. Thus, late medical assistance is common and probably contributes to the high complication rates related to local necrosis [10–12] and secondary bacterial infections [10–15], that can lead to permanent function loss and disabilities [3,10,16–19]. It was suggested that secondary bacterial infections from snakebites are related to the oral and fangs microbiota of the perpetrating snake [20–26].…”

Section: Introductionmentioning

confidence: 99%

“…Besides, traditional treatment also contributes for the emergence of secondary infections, such as tourniquet use, local alternative medicines, incision and suction of the bite site [8,18,27]. These factors increase the development of expressive forms of secondary infection, which has been primarily diagnosed with identification of cellulitis or abscesses [12,13,22]. …”

Section: Introductionmentioning

confidence: 99%

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Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial

et al. 2017

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BackgroundSecondary bacterial infections from snakebites contribute to the high complication rates that can lead to permanent function loss and disabilities. Although common in endemic areas, routine empirical prophylactic use of antibiotics aiming to prevent secondary infection lacks a clearly defined policy. The aim of this work was to estimate the efficacy of amoxicillin clavulanate for reducing the secondary infection incidence in patients bitten by Bothrops snakes, and, secondarily, identify risk factors for secondary infections from snakebites in the Western Brazilian Amazon.Methods and findingsThis was an open-label, two-arm individually randomized superiority trial to prevent secondary infection from Bothrops snakebites. The antibiotic chosen for this clinical trial was oral amoxicillin clavulanate per seven days compared to no intervention. A total of 345 patients were assessed for eligibility in the study period. From this total, 187 accomplished the inclusion criteria and were randomized, 93 in the interventional group and 94 in the untreated control group. All randomized participants completed the 7 days follow-up period. Enzyme immunoassay confirmed Bothrops envenoming diagnosis in all participants. Primary outcome was defined as secondary infection (abscess and/or cellulitis) until day 7 after admission. Secondary infection incidence until 7 days after admission was 35.5% in the intervention group and 44.1% in the control group [RR = 0.80 (95%CI = 0.56 to 1.15; p = 0.235)]. Survival analysis demonstrated that the time from patient admission to the onset of secondary infection was not different between amoxicillin clavulanate treated and control group (Log-rank = 2.23; p = 0.789).Secondary infections incidence in 7 days of follow-up was independently associated to fibrinogen >400 mg/dL [AOR = 4.78 (95%CI = 2.17 to 10.55; p<0.001)], alanine transaminase >44 IU/L [AOR = 2.52 (95%CI = 1.06 to 5.98; p = 0.037)], C-reactive protein >6.5 mg/L [AOR = 2.98 (95%CI = 1.40 to 6.35; p = 0.005)], moderate pain [AOR = 24.30 (95%CI = 4.69 to 125.84; p<0.001)] and moderate snakebites [AOR = 2.43 (95%CI = 1.07 to 5.50; p = 0.034)].Conclusions/SignificancePreemptive amoxicillin clavulanate was not effective for preventing secondary infections from Bothrops snakebites. Laboratorial markers, such as high fibrinogen, alanine transaminase and C-reactive protein levels, and severity clinical grading of snakebites, may help to accurately diagnose secondary infections.Trial registrationBrazilian Clinical Trials Registry (ReBec): RBR-3h33wy; UTN Number: U1111-1169-1005.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial

et al. 2017

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“…In Costa Rica, the average of snakebites was 504 reports per year during 1990 to 2000 [ 7 ]. The study of these animals has focused greatly on poisonous species for their medical interest, since they are responsible for a significant number of snakebite incidents in the country [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Diversity of Aerobic Bacteria Isolated from Oral and Cloacal Cavities from Free-Living Snakes Species in Costa Rica Rainforest

Artavia‐León

Romero-Guerrero

Sancho-Blanco

et al. 2017

International Scholarly Research Notices

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Costa Rica has a significant number of snakebites per year and bacterial infections are often complications in these animal bites. Hereby, this study aims to identify, characterize, and report the diversity of the bacterial community in the oral and cloacal cavities of venomous and nonvenomous snakes found in wildlife in Costa Rica. The snakes where captured by casual encounter search between August and November of 2014 in the Quebrada González sector, in Braulio Carrillo National Park. A total of 120 swabs, oral and cloacal, were taken from 16 individuals of the Viperidae and Colubridae families. Samples were cultured on four different media at room temperature. Once isolated in pure culture, colonies were identified with the VITEK® 2C platform (bioMérieux). In order to test the identification provided on environmental isolates, molecular analyses were conducted on 27 isolates of different bacterial species. Specific 16S rDNA PCR-mediated amplification for bacterial taxonomy was performed, then sequenced, and compared with sequences of Ribosomal Database Project (RDP). From 90 bacterial isolates, 40 different bacterial species were identified from both oral and cloacal swabs. These results indicate the diversity of opportunistic pathogens present and their potential to generate infections and zoonosis in humans.

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“…As serpentes injetam em média cerca de 3 a 5 ml de veneno, o qual contém substâncias ativas e grande quantidade de bactérias Gram-negativas, anaeróbias e Gram-positivas (Avila-Aguero et al, 2001b). Esse veneno produz dano tecidual importante, resultando em edema, dor e sangramento no local da picada, que podem evoluir com complicações como celulite, abscessos, necrose tecidual e síndrome compartimental requerendo, freqüentemente debridamentos, drenagem ou outros procedimentos cirúrgicos para o seu tratamento (Sabório et al, 1998;Bucaretchi et al, 2001;Avila-Aguero et al, 2001b), contudo, amputações são complicações felizmente raras (Jorge at al., 1999).…”

Section: Quadro Localunclassified

“…Gengivorragia, sangramento em ferimentos pré-existentes, epistaxe, hematúria, sangramentos digestivos, hematomas à distância, sangramento genital, petéquias, sangramento no sistema nervoso central e outros sangramentos espontâneos podem ser observados (Barral-Netto et al, 1991;Bauab et al, 1994;Kamiguti, Sano-Martins, 1995;Sabório et al, 1998Mosquera, et al, 2003. -Martins et al, 1994;).…”

Section: Quadro Sistêmicounclassified

Idade com fator de risco para gravidade e complicações nos acidentes botrópicos atendidos no Hospital Vital Brazil do Instituto Butantan/SP

Franco¹

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Siqueira França, pela amizade, confiança paciência e horas de dedicação na orientação desse trabalho com eterno bom humor. Ao querido amigo Alexandre Rocha Padilha exemplo de médico e cidadão. Sem ele esse trabalho não existiria. A Dra. Fan Wen Hui pela colaboração no desenho do estudo e apoio irrestrito. A Dr. Bernd Genser do Instituto de Saúde Coletiva da Universidade Federal da Bahia, pela análise estatística. Ao Hospital Vital Brazil do Instituto Butantan/SP, local da realização deste trabalho. A Fernanda Silva Fuscaldi, bolsista PIBIC/CNPq-Instituto Butantan, pelo apoio na confecção do banco de dados. Aos Doutores Eliseu Waldman, Ana Marli Sartori e Kátia Bárbaro por todas as sugestões dadas no exame de qualificação. A Beatriz Franco pela ajuda na tradução da língua inglesa. A Graziela Miranda, minha mãe, por todas as sugestões dadas. Aos funcionários do Hospital Vital Brazil do Instituto Butantan/SP, em especial a Lourdes Elza, sempre dispostas na busca dos prontuários. A Professora Dra. Marta Heloísa Lopes pelo incentivo à atividade acadêmica ao desenvolvimento desse trabalho além da amizade e do carinho. A Dra. Eliana Bataglia Gutiérrez por ter ajudado a despertar o interesse pelo mundo acadêmico. A Rosemeire Ribeiro e Roseli Santo por todo o apoio nas diversas etapas desse trabalho e pela gentileza e carinho com que cuidam da pós-graduação da MI. Ao Professor Dr. Aluísio Segurado pelo incentivo. À Disciplina de Emergências Clínicas do FMUSP pelas horas concedidas a esse fim. Ao Departamento de Doenças Infecciosas e Parasitárias-FMUSP responsável pela minha formação profissional.

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Accidente ofi ́dico en niños en Costa Rica: epidemiologi ́a y deteccio ́n de factores de riesgo en el desarrollo de absceso y necrosis

Cited by 28 publications

References 6 publications

Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial

Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial

Diversity of Aerobic Bacteria Isolated from Oral and Cloacal Cavities from Free-Living Snakes Species in Costa Rica Rainforest

Idade com fator de risco para gravidade e complicações nos acidentes botrópicos atendidos no Hospital Vital Brazil do Instituto Butantan/SP

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