Ageane Mota da Silva1, Mônica Colombini2, Ana Maria Moura-da-Silva2, Rodrigo Medeiros de Souza3, Wuelton Marcelo Monteiro4, Paulo Sérgio Bernarde5. 1. Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário, BR 364, Rio Branco, Acre, Brazil. 2. Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brazil. 3. Laboratório de Microbiologia, Imunologia e Parasitologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil. 4. Universidade do Estado do Amazonas, Manaus, AM, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil. 5. Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil. Electronic address: snakebernarde@hotmail.com.
Abstract
BACKGROUND: The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES: To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS: The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS: There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS: Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.
BACKGROUND: The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES: To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS: The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS: There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS: Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.
Authors: Wuelton Marcelo Monteiro; Jorge Carlos Contreras-Bernal; Pedro Ferreira Bisneto; Jacqueline Sachett; Iran Mendonça da Silva; Marcus Lacerda; Allyson Guimarães da Costa; Fernando Val; Lisele Brasileiro; Marco Aurélio Sartim; Sâmella Silva-de-Oliveira; Paulo Sérgio Bernarde; Igor L Kaefer; Felipe Gobbi Grazziotin; Fan Hui Wen; Ana Maria Moura-da-Silva Journal: Toxicon X Date: 2020-04-23
Authors: Paulo Sérgio Bernarde; Manuela Berto Pucca; Ageane Mota-da-Silva; Wirven Lima da Fonseca; Marllus Rafael Negreiros de Almeida; Isadora Sousa de Oliveira; Felipe Augusto Cerni; Felipe Gobbi Grazziotin; Marco A Sartim; Jacqueline Sachett; Fan Hui Wen; Ana Maria Moura-da-Silva; Wuelton M Monteiro Journal: Front Immunol Date: 2021-12-15 Impact factor: 7.561