Snakebite envenomation and death in the developing world.

The purpose of this review is to address the global incidence and management of snakebite envenomation and to describe the clinical characteristics and pathogenesis of envenomation by species of the family Viperidae, genera Bothrops and Crotalus, the most common venomous snakes in Brazil. We focus on the pathogenesis of the acute renal failure induced by these snakes. Envenomation after snakebite is an underestimated and neglected public health issue responsible for substantial illness and death as well as socioeconomic hardship to impoverished populations living in rural and tropical Africa, Asia, Oceania, and Latin America. In developed nations, snake bite typically occurs during recreational activities, whereas in developing countries it is an occupational disease more likely to affect young agricultural workers, predominantly men. Scarcity and delay of administration of antivenom, poor health services, and difficulties with transportation from rural areas to health centers are major factors that contribute to the high case-fatality ratio of snakebite envenomation.