Asato Mauro Shosuka, Cruz Carbonell Roberto Carlos, Martins Alessandra Galvão, Mendonça de Moraes Cléria, Chávez-Olórtegui Carlos, Apolonia da Costa Gadelha Maria, Pereira de Oliveira Pardal Pedro
Hospital Geral de Roraima, Boa Vista-Roraima, Brasil. Av. Brigadeiro Eduardo Gomes, 3308, Aeroporto, CEP: 69305-455, Boa Vista, Roraima, Brazil.
Universidade Federal de Roraima, Boa Vista - Roraima, Brasil. Av. Cap. Ene Garcês, n° 2413, Aeroporto, CEP: 69310-000, Boa Vista, Roraima, Brazil.
Toxicon X. 2020 Oct 22;8:100061. doi: 10.1016/j.toxcx.2020.100061. eCollection 2020 Dec.
The aim of this study was to evaluate the clinical-epidemiological factors associated with victims of rattlesnake envenoming in the state of Roraima, Brazil. In this location, rattlesnake accidents are caused by the subspecies . This is a prospective observational study carried out at the General Hospital of Roraima from april 2017 until july 2018. A total of 37 alleged rattlesnake victims had their medical records evaluated. However only one of them proved to be by . All individuals were residents from the savannas (lavrados) of Roraima. The town of Bonfim on the border between Brazil and Guyana had the highest occurrence of rattlesnake bites. The most affected group were males aged 13-20 years and farmers. The highest number of incidents occurred during daytime and lower limbs (feet) were the most major affected part of the body. Tourniquets were used as first aid after snake envenoming in 32.4% of victims. Out of 37 patients, 16.2% were classified as severe cases of snakebite envenoming and in 5.4% dry bites seem to have occurred. Among the symptomatic patients, 100% presented local manifestations and 70.3% presented systemic manifestations. The clinical setting showed local effects such as pain and edema while the systemic effects were blurred vision, myalgias, myasthenic facies, palpebral ptosis, muscle weakness and headache. Laboratory results of aspartate aminotransferase (62.2%), creatine phosphokinase (51.3%), lactic dehydrogenase (37.8%), urea level (32.4%) and serum creatinine (29.7%) were increased significantly in relation to the reference standards. In 16.2% of the cases, the victims presented acute kidney injury. Patients were treated with anticrotalic serum in 70.3% of the cases and antibotropic + anticrotalic serum in 24.3%. The victims of in Roraima showed a local symptomatology similar to envenoming, while systemic symptoms and laboratory analysis proved kidney and muscular injuries, similar to envenoming by in Brazil.
本研究的目的是评估巴西罗赖马州与响尾蛇咬伤受害者相关的临床流行病学因素。在该地区，响尾蛇伤人事件由特定亚种引起。这是一项于2017年4月至2018年7月在罗赖马州综合医院开展的前瞻性观察研究。共有37名疑似响尾蛇咬伤受害者的病历接受了评估。然而，其中只有一人被证实确实是被响尾蛇咬伤。所有个体均为罗赖马州稀树草原地区的居民。巴西与圭亚那边境的邦菲姆镇响尾蛇咬伤事件发生率最高。受影响最严重的群体是13至20岁的男性和农民。事件发生最多的时间段是白天，身体受影响最主要的部位是下肢（脚部）。32.4%的受害者在被蛇咬伤后使用了止血带进行急救。在37名患者中，16.2%被归类为严重的蛇咬伤中毒病例，5.4%似乎发生了干性咬伤。在有症状的患者中，100%出现局部症状，70.3%出现全身症状。临床症状表现为局部效应，如疼痛和水肿，而全身效应则有视力模糊、肌痛、肌无力面容、眼睑下垂、肌肉无力和头痛。与参考标准相比，天冬氨酸转氨酶（62.2%）、肌酸磷酸激酶（51.3%）、乳酸脱氢酶（37.8%）、尿素水平（32.4%）和血清肌酐（29.7%）的实验室检测结果显著升高。在16.2%的病例中，受害者出现急性肾损伤。70.3%的病例使用抗蛇毒血清进行治疗，24.3%的病例使用抗蛇毒血清加抗细菌血清进行治疗。罗赖马州的响尾蛇咬伤受害者表现出与其他蛇咬伤中毒相似的局部症状，而全身症状和实验室分析表明存在肾脏和肌肉损伤，这与巴西其他蛇咬伤中毒情况相似。
