Prognostic factors for amputation in the case of envenoming by snakes of the Bothrops genus (Viperidae)

Jorge, Miguel Tanús; Ribeiro, Lucilene Arilho; O’Connell, João Lucas

doi:10.1080/00034989958393

Cited by 31 publications

(5 citation statements)

References 15 publications

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“…The severity of the envenomation, in particular mortality, is related to the species, but also the size, of the snake responsible for the bite, which determine the composition of the venom and the quantity injected respectively [14; 15; 71]. This explains why some snakebites are asymptomatic, when the snake is not venomous, or when it does not inject its venom [6; 7; 63; 64].…”

Section: Discussionmentioning

confidence: 99%

“…This explains why some snakebites are asymptomatic, when the snake is not venomous, or when it does not inject its venom [6; 7; 63; 64]. It is more difficult to explain some of the factors identified by Jorge et al [71] as the season or time of day. This may be due to a particular distribution of species within stands, depending on time and space according to their ecological tropisms.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and mortality due to snakebite in the Americas

2017

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BackgroundBetter knowledge of the epidemiological characteristics of snakebites could help to take measures to improve their management. The incidence and mortality of snakebites in the Americas are most often estimated from medical and scientific literature, which generally lack precision and representativeness.Methodology/Principal findingsAuthors used the notifications of snakebites treated in health centers collected by the Ministries of Health of the American countries to estimate their incidence and mortality. Data were obtained from official reports available on-line at government sites, including those of the Ministry of Health in each country and was sustained by recent literature obtained from PubMed. The average annual incidence is about 57,500 snake bites (6.2 per 100,000 population) and mortality is close to 370 deaths (0.04 per 100,000 population), that is, between one third and half of the previous estimates. The incidence of snakebites is influenced by the abundance of snakes, which is related to (i) climate and altitude, (ii) specific preferences of the snake for environments suitable for their development, and (iii) human population density. Recent literature allowed to notice that the severity of the bites depends mainly on (i) the snake responsible for the bite (species and size) and (ii) accessibility of health care, including availability of antivenoms.Conclusions/SignificancesThe main limitation of this study could be the reliability and accuracy of the notifications by national health services. However, the data seemed consistent considering the similarity of the incidences on each side of national boundaries while the sources are distinct. However, snakebite incidence could be underestimated due to the use of traditional medicine by the patients who escaped the reporting of cases. However, gathered data corresponded to the actual use of the health facilities, and therefore to the actual demand for antivenoms, which should make it possible to improve their management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and mortality due to snakebite in the Americas

2017

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“…There is scarce information in relation to local complications, especially necrosis [59,62] and amputation [63], associated to anatomical region bitten, systemic bleeding, renal failure, older age and use of tourniquet. Although secondary bacterial infections were observed in around 40% of the B .…”

Section: Discussionmentioning

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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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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“…Local inflammation could lead to amputation, especially in patients bitten in the fingers and among those who developed blisters and abscesses at the bite site. Systemic bleeding and renal failure are also possible outcomes [ 57 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Albuquerque

Paiva

Martins

et al. 2020

J. Venom. Anim. Toxins incl. Trop. Dis

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Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in

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Prognostic factors for amputation in the case of envenoming by snakes of the Bothrops genus (Viperidae)

Cited by 31 publications

References 15 publications

Incidence and mortality due to snakebite in the Americas

Incidence and mortality due to snakebite in the Americas

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

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

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