Chafiq Fouad, El Hattimy Faiçal, Rhalem Naima, Chippaux Jean-Philippe, Soulaymani Abdelmajid, Mokhtari Abdelrhani, Soulaymani-Bencheikh Rachida
Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc ; Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
J Venom Anim Toxins Incl Trop Dis. 2016 Mar 16;22:8. doi: 10.1186/s40409-016-0065-8. eCollection 2016.
Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013.
This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone.
During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %).
Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.
蛇咬伤在全球范围内造成了相当大的伤亡，尤其是在热带地区，对公众健康构成了重大但被忽视的威胁。2008年，摩洛哥抗毒与药物警戒中心（CAPM）开始制定一项控制蛇咬伤的具体策略，并于2012年正式确定。本研究的目的是描述并更新2009年至2013年期间通报给CAPM的蛇咬伤的流行病学特征。
这项为期五年的回顾性研究纳入了所有通过邮件或电话通报给CAPM的蛇咬伤病例。
在研究期间，CAPM共收到873例蛇咬伤病例报告，平均发病率为每10万居民2.65例，每年有218例。发病率最高的是丹吉尔-得土安地区，有357例（40.9%），其次是苏斯-马萨-德拉地区，有128例（14.6%）。患者的平均年龄为26.8±17.2岁。男女比例为1.67:1，77%的病例发生在农村地区。咬伤主要发生在春季（44%），其次是夏季（42%）。在54例（6.2%）病例中确定了蛇的种类：游蛇科占31%（n = 18），蝰蛇占67%（n = 36），主要是摩洛哥锯鳞蝰、鼓腹咝蝰和角蝰。在311例（35.6%）病例中，患者出现了蝰蛇中毒症状。在23.5%的蝰蛇中毒病例中观察到血小板减少，而在7.6%的患者中观察到骨筋膜室综合征。41例患者（5%）使用了FAV-Afrique®。在接受抗蛇毒血清治疗的患者中，38例康复，3例死亡。报告了27例死亡（3.9%）。
尽管为更好地了解摩洛哥蛇咬伤的流行病学（发病率、严重程度、涉及的蛇种）做出了具体努力，但仍未得到充分重视。因此，仍有必要进一步开展工作，以确保能够获得针对有毒蛇种的适当抗蛇毒血清，并改善摩洛哥蛇咬伤中毒的治疗。
