Envenenamento por Crotalus durissus marajoensis em Muaná, Ilha de Marajó, estado do Pará, Brasil

Abstract

anos de idade, picado por cascavel no tornozelo direito quando caminhava em área de campo. Após o envenenamento, relatou parestesia sem dor local. Em seguida, apresentou sensação de peso na cabeça, dificuldade de abrir as pálpebras, disartria, visão turva e diplopia. Deu entrada no Hospital Municipal de Muaná, 9 h após a picada, com os sinais e sintomas referidos, acrescidos de náuseas, tontura, dificuldade de deambular e mialgia. Devido à ausência do antiveneno específico no hospital do município, o paciente foi encaminhado para o Pronto Socorro Municipal em Belém do Pará, onde chegou após 18 h do acidente, apresentando fácies neurotóxica, midríase, colúria e oligúria. O caso foi classificado como envenenamento grave e aplicado o antiveneno específico. Após quatro dias, o paciente foi transferido para o Hospital Universitário João de Barros Barreto, com evidência de neurotoxicidade, onde foram realizadas medidas de suporte clínico e exames laboratoriais. Foram observadas alterações no hemograma, no coagulograma, nos níveis de ureia, creatinina, transaminases e creatinofosfoquinase, evidenciando rabdomiólise. Apesar do tratamento soroterápico e de suporte clínico terem sido realizados tardiamente, houve evolução para a cura clínica. CONCLUSÃO: Ressalta-se a importância da soroterapia precoce e a raridade do envenenamento por essa subespécie, cujas características clínicas são as mesmas dos demais acidentes crotálicos relatados no Brasil.

Envenoming by the rattlesnake Crotalus durissus ruruima in the state of roraima, Brazil

“…The most frequent neurological manifestations in the systemic symptomatic victims are: myasthenic facies, palpebral ptosis, muscle weakness, headache, dark and double vision. The symptoms observed by Pardal et al (2007) and Faro et al (2020) were drowsiness, myasthenic facies, bipalpebral ptose, ophthalmology and dark vision impairment in victims of C. d. marajoensis envenoming on Marajó Island, Brazil. In the State of São Paulo, Bucaretchi et al (2002) and Cupo et al (2003) , describe the envenoming by C. d. terrificus .…”

“…However, after a new assessment of the cases, with information from the companion and the results of changes in muscle enzymes in laboratory tests, even without systemic neurotoxic manifestations, led to the assumption that it was rattlesnake envenomig and that the specific AC was administered. Bucaretchi et al (2002) and Faro et al (2020) , show that the increased of muscle enzymes are suggestive of rattlesnake envenomings in Brazil.…”

“…When evaluating the nine patients suspected of envenoming by Bothrops , it is observed that local pain and edema were the most frequent clinical manifestations. These symptoms are absent in the accident by C. d. marajoensis ( Faro et al, 2020 ) and less frequently in acidentes caused by C. d. terrificus ( Cupo et al, 1991 ; Bucaretchi et al, 2002 ), however, frequent in accidents by Bothrops ( Pardal et al, 2004 ), which led to the suspicion of botropic envenoming and induced doctors to use AB. However, after a new assessment of the cases, with information from the companion and the results of changes in muscle enzymes in laboratory tests, even without systemic neurotoxic manifestations, led to the assumption that it was rattlesnake envenomig and that the specific AC was administered.…”

“…Erythema and edema are rare, and when they occur they are discrete, usually close to the affected site, being ascending edema unusually observed. In addition to local manifestations, other systemic symptoms characterize the effect of envenoming like myasthenic facies, prostration, drowsiness, myalgia, urine alterations (reddish or dark), kidney failure, bleeding among others ( Bucaretchi et al, 2002 ; Pardal et al, 2007 ; Faro et al, 2020 ). These clinical manifestations are accompanied by increased serum levels of the enzymes aspartate aminotransferase (AST), creatine phosphosphokinase (CPK), lactate dehydrogenase (LDH), myoglobin, urea and creatinine in blood ( Azevedo-Marques et al, 1985 , 1987 bib_Azevedo_Marques_et_al_1985 bib_Azevedo_Marques_et_al_1987 ; Cupo et al, 1991 ; Bucaretchi et al, 2002 ).…”

Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology

“…In C. d. terrificus , serum CK activity increases early, reaching a peak in the first 24 hours after the bite, remaining above reference levels for more than four days in some patients ( 116 , 117 ). In envenomings caused by C. d. terrificus ( 117 , 118 , 124 ), C. d. collilineatus ( 124 , 125 ), C. d. marajoensis ( 126 ), and C. d. ruruima ( 26 ), CK activity was above normal levels in ~90% of the patients ( 118 , 124 , 125 ). Serum activities of lactate dehydrogenase and liver transaminases are also elevated in most cases.…”