4.1 Article

Snakebites caused by the genera Bothrops and Lachesis in the Brazilian Amazon: a study of factors associated with severe cases and death

Journal

Publisher

SOC BRASILEIRA MEDICINA TROPICAL
DOI: 10.1590/0037-8682-0558-2021

Keywords

Epidemiology; Snakebites; Risk factors; Death

Funding

  1. National Council for Scientific and Technological Development (CNPq)
  2. Institute of Health Technology Assessment of CNPq

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This study evaluated variables associated with death, systemic complications, and amputations in victims of snakebite caused by Bothrops or Lachesis snakes. The results showed that factors such as age, sepsis, renal failure, and hemorrhagic manifestations were related to death, while factors like age, time to healthcare, renal and hemorrhagic manifestations, and occurrence in rural areas were associated with systemic complications. Children were found to be associated with amputations.
Background: Snakebites are a major problem in developing countries owing to their high morbidity rates, severity, and sequelae. In Brazil, most cases of envenomation are caused by Bothrops and Lachesis snakes. The present study aimed to evaluate variables associated with death, systemic complications, and amputations in victims of envenomation due to Bothrops or Lachesis snake. Methods: An analytical epidemiological study was performed with data from the Notifiable Diseases Information System (Sistema de Informacao de Agravos de Notificacao [SINAN]) relating to the Brazilian Amazon for the period 2010-2015. A hierarchical Poisson regression analysis was performed with three aspects, namely, individual characteristics, sociodemographic characteristics, and clinical conditions. Results: The following associations were observed: i) advanced age (>65 years), sepsis, renal failure, and hemorrhagic manifestations were related to two outcomes - death due to snakebite and death from all causes; ii) more advanced age (>= 46 years), time to health care longer than 6 hours, renal and hemorrhagic manifestations, and region of occurrence being rural areas were associated with systemic complications; and iii) children (up to 12 years old) were associated with amputations. Conclusions: Knowledge of the characteristics associated with severe outcomes in snakebites may help identify patients who will require more intensive care or longer follow-up and may provide the physician with counseling rationale for their possible prognosis.

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