Aspectos clínicos e epidemiológicos de acidentes ofídicos na região do Alto Juruá, oeste da Amazônia brasileira

SILVA, Ageane Mota da; COLOMBINI, Mônica; MOURA-DA-SILVA, Ana Maria; SOUZA, Rodrigo Medeiros de; MONTEIRO, Wuelton Marcelo; BERNARDE, Paulo Sérgio

doi:10.1590/1809-4392201901561

Ageane Mota da SILVA

Instituto Federal do Acre (IFAC), Campus de Cruzeiro do Sul, Estrada da APADEQ nº 1.192, Bairro Nova Olinda, 69.980-000, Cruzeiro do Sul. Acre, Brazil

Universidade Federal do Acre (UFAC), Programa de Pós-Graduação Bionorte, Campus Universitário, BR 364 Km 04, Distrito Industrial, 69.915-900, Rio Branco, Acre, Brazil

Mônica COLOMBINI

Instituto Butantan, Laboratório de Imunopatologia, Av. Vital Brazil 1500, Butantã, 05503-900, São Paulo, SP, Brazil

Ana Maria MOURA-DA-SILVA

Instituto Butantan, Laboratório de Imunopatologia, Av. Vital Brazil 1500, Butantã, 05503-900, São Paulo, SP, Brazil

Rodrigo Medeiros de SOUZA

Universidade Federal do Acre (UFAC), Campus Floresta, Laboratório de Microbiologia, Imunologia e Parasitologia, Estrada do Canela Fina S/N, Gleba Formoso, 69.980-000, Cruzeiro do Sul, Acre, Brazil

Wuelton Marcelo MONTEIRO

Universidade do Estado do Amazonas (UEA), Av. Djalma Batista 3578, Flores, 69050-010, Manaus, AM, Brazil

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira s/n, Dom Pedro, 69040-000, Manaus, AM, Brazil

Paulo Sérgio BERNARDE ^** Corresponding author: SnakeBernarde@hotmail.com

Universidade Federal do Acre (UFAC), Campus Floresta, Laboratório de Herpetologia, Estrada do Canela Fina S/N, Gleba Formoso, 69.980-000, Cruzeiro do Sul, Acre, Brazil

https://orcid.org/0000-0002-2191-7817

* Corresponding author: SnakeBernarde@hotmail.com

ASSOCIATE EDITOR:

Claudia Keller

Instituto Federal do Acre (IFAC), Campus de Cruzeiro do Sul, Estrada da APADEQ nº 1.192, Bairro Nova Olinda, 69.980-000, Cruzeiro do Sul. Acre, Brazil

Universidade Federal do Acre (UFAC), Programa de Pós-Graduação Bionorte, Campus Universitário, BR 364 Km 04, Distrito Industrial, 69.915-900, Rio Branco, Acre, Brazil

Instituto Butantan, Laboratório de Imunopatologia, Av. Vital Brazil 1500, Butantã, 05503-900, São Paulo, SP, Brazil

Universidade Federal do Acre (UFAC), Campus Floresta, Laboratório de Microbiologia, Imunologia e Parasitologia, Estrada do Canela Fina S/N, Gleba Formoso, 69.980-000, Cruzeiro do Sul, Acre, Brazil

Universidade do Estado do Amazonas (UEA), Av. Djalma Batista 3578, Flores, 69050-010, Manaus, AM, Brazil

Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira s/n, Dom Pedro, 69040-000, Manaus, AM, Brazil

Universidade Federal do Acre (UFAC), Campus Floresta, Laboratório de Herpetologia, Estrada do Canela Fina S/N, Gleba Formoso, 69.980-000, Cruzeiro do Sul, Acre, Brazil

Figuras (4)
Tabelas (2)

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Figure 1
Location of the upper Juruá River region in Brazil. The municipalities belonging to the upper Juruá river are shown in gray.

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Figure 2
Jararaca or surucucu (Bothrops atrox), the snake responsible for envenomings in the present study in the upper Juruá River region. (A) Juvenile; (B) Adult. Credit: Paulo Sérgio Bernarde. This figure is in color in the electronic version.

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Figure 3
Monthly distribution of snakebites (red line), rainfall (black bars, values in mm), and water level of the Juruá River (grey bars, values in cm) from July 2017 to June 2018. This figure is in color in the electronic version.

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Figure 4
Evolution of Bothrops snakebite wounds in this study: (A) Foot with edema, ecchymosis and bleeding; (B) Leg with edema in three segments; (C) Foot with edema and blister; (D) Leg with necrosis. Credit: Ageane Mota da Silva. This figure is in color in the electronic version.

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Table 1
Clinical and epidemiological characteristics of snakebite cases (n = 133) treated in the Juruá Regional Hospital in the Municipality of Cruzeiro do Sul, in the upper Juruá River region (western Brazilian Amazonia), from July 2017 to June 2018. Sample size available for each parameter is indicated in parentheses in each case. N cases = number of cases.

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Table 2
Clinical and epidemiological characteristics of cases of bothropic envenoming in the Juruá Regional Hospital, in the Municipality of Cruzeiro do Sul in the upper Juruá River region (western Brazilian Amazon), from July 2017 to June 2018, according to severity grade (mild, moderate or severe). Sample size is indicated in each case, in parentheses after the parameter. Data for number of ampoules are minimum - maximum followed by the average in parentheses. For other parameters values are the absolute numbers followed by the frequency (%) in parentheses.

Parameter	N cases	Frequency (%)
Type of snakebite (133)
Bothropic	118	88.7
Non-venomous/dry bite	15	11.3
Season (120)
Rainy (Nov to Apr)	79	65.8
Dry (May to Oct)	41	34.2
Type of land use
Rural	114	85.7
Urban	19	14.3
Sex of snakebite victim
Masculine	102	76.7
Feminine	31	23.3
Age group
0 to 10	15	11.3
11 to 20	37	27.8
21 to30	21	15.8
31 to 40	28	21.0
41 to 50	19	14.4
51 to 60	8	6.0
> 60	5	3.7
Occupation (133)
Farmer	64	48
Student	33	25
Housewife	5	4.0
Other	31	23
Time to hospital (133)
0 to 1 hour	16	12.0
1 to 3 hours	34	25.6
3 to 6 hours	29	21.8
6 to 12 hours	24	18.0
12 to 24 hours	15	11.3
> 24 hours	15	11.3
Body part bitten (133)
Foot	89	67.0
Leg	23	17.0
Thigh	2	1.6
Hand	13	10.0
Arm	2	1.5
Forearm	1	0.7
Head	1	0.7
Thorax	2	1.5
Level of bothropic envenoming (118)
Mild	59	50.0
Moderate	43	36.5
Severe	16	13.5
Physical symptoms/complications (118)
Pain	110	93.2
Edema	110	93.2
Bruising	15	12.7
Bleeding at site of bite	13	11.0
Blisters	12	10.2
Secondary infection	11	9.0
Cellulitis	8	6.7
Local lymphadenopathy	6	5.1
Necrosis	3	2.5
Abscess	2	1.7
Erysipelas	1	0.8
Compartment syndrome	1	0.8
Systemic symptoms/complications (118)
Blood coagulation change (103)	85	82.5
Hemorrhages	26	22.0
Acute renal failure	6	5.1
Dyspnea	2	1.7
Hemorrhagic stroke	1	0.8
Septic shock	1	0.8
Death	1	0.8

Parameter	Mild	Moderate	Severe
Number of ampoules applied for antivenom therapy (103)	2 - 8 (4.5)	3 - 12 (6.7)	8 - 22 (12.5)
Time to hospital treatment (118)
≤ 6 hours	43 (65.2)	20 (30.3)	3 (4.5)
> 6 hours	16 (30.8)	23 (44.2)	13 (25)
Ethnicity (118)
Indigenous (7)	2 (28.5)	2 (28.5)	3 (43)
Non-Indigenous (111)	57 (51.3)	41 (37)	13 (11.7)
Municipality (118)
Cruzeiro do Sul	28 (51.9)	21 (38.8)	5 (9.3)
Mâncio Lima	12 (57.1)	7 (33.3)	2 (9.6)
Rodrigues Alves	10 (58.8)	5 (29.5)	2 (11.7)
Porto Walter	0	03 (75)	1 (25)
Marechal Thaumaturgo	0	0	1 (100)
Tarauacá	4 (100)	0	0
Feijó	0	1 (100)	0
Guajará	5 (38.5)	5 (38.5)	3 (23)
Atalaia do Norte	0	1 (50)	1 (50)
Jordão	0	0	1 (100)
Type of land use (118)
Rural	52 (48)	42 (38)	15 (14)
Urban	7 (78)	1 (11)	1(11)
Age group (118)
0 to 10	7 (54)	2 (15)	4 (31)
11 to 20	24 (68,6)	9 (25.7)	2 (5.7)
21 to 30	6 (33.3)	10 (55.5)	2 (11.2)
31 to 40	10 (42)	11(46)	3 (12)
41 to 50	8(47)	7 (41)	2 (12)
51 to 60	4 (57)	3 (43)	0
> 60	0	1 (25)	3 (75)
Sex (118)
Male	48 (50)	35 (37)	12 (13)
Female	11 (48)	8 (35)	4 (17)
Anatomical region bitten (116)
Lower members	50 (51.5)	33 (34.1)	14 (14.4)
Upper members	6 (37.5)	9 (56.2)	1 (6.3)
Trunk	1 (50)	1 (50)	0
Head	0	0	1 (100 )

[1] * Corresponding author: SnakeBernarde@hotmail.com

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Aspectos clínicos e epidemiológicos de acidentes ofídicos na região do Alto Juruá, oeste da Amazônia brasileira

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