ACCIDENTS CAUSED BY ACCIDENTS CAUSED BY CROTALUS SNAKESCROTALUS SNAKES

ACCIDENTS CAUSED BY ACCIDENTS CAUSED BY CROTALUS SNAKESCROTALUS SNAKES

- Symposium -Clinical Toxinology and Envenoming

BENEDITO BARRAVIERAProfessor Titular de Infectologia da UNESP

Pesquisador do CEVAPbbviera@jvat.org.br

BENEDITO BARRAVIERAProfessor Titular de Infectologia da UNESP

Pesquisador do CEVAPbbviera@jvat.org.br

Crotalus genus (6 sub-species)

Crotalus durissus terrificus, collilineatus, cascavella, ruruima, marajoensis, trigonicus.

Crotalus durissus terrificus Caudisona durissa terrifica

Crotalus durissus terrificus,

collilineatus,

cascavella,

ruruima,

marajoensis,

trigonicus.

Distribution in Brazil

EPIDEMIOLOGYEPIDEMIOLOGY

GENUS OF SNAKEGENUS OF SNAKEBothropsBothrops – 86,16% – 86,16%CrotalusCrotalus – 8,94% – 8,94%LachesisLachesis – 2,39% – 2,39%MicrurusMicrurus – 0,63% – 0,63%Others – 1,88%Others – 1,88%

SITE OF THE BITESITE OF THE BITELegs – 62,75%Legs – 62,75%Arms – 12, 15%Arms – 12, 15%Others – 25,1%Others – 25,1%

MONTHS OF OCCURRENCEMONTHS OF OCCURRENCEDecember to May - summerDecember to May - summer

SEX, AGE AND PROFESSIONSEX, AGE AND PROFESSIONMale – 76,84%Male – 76,84%Female – 23,16Female – 23,16Age – 15 to 49 years (64,0%)Age – 15 to 49 years (64,0%)Rural workerRural worker

EPIDEMIOLOGYEPIDEMIOLOGY

Guia de Vigilância Epidemiológica, Caderno 14, 24p. 2008.

CENTER FOR THE STUDY OF VENOMS AND VENOMOUS ANIMALS CEVAP- UNESP

Objectives: Promote education, research and extension education in the context of Toxinology (science of toxins from microorganisms, plants and animals).

EPIDEMIOLOGYEPIDEMIOLOGY

Venomous snakes donated to CEVAP between 2002 and 2009

1-Neurotoxic activity neurotoxic symptoms

Crotalic envenoming Clinical aspects

MidriasisLocal bite

Ptosis, Diplopia and blurred vision

Crotalus durissus terrificus

NEUROTOXICITYNEUROTOXICITY

Crotalus durissus terrificusCrotalus durissus terrificus Crotalus durissus terrificusCrotalus durissus terrificus

Crotalic envenoming Clinical aspects

Rhabdomyolysis

Increase of CPK, DHL, AST and ALT

enzymes

Myoglobinuria

2-Systemic rhabdomyolyses skeletal muscle

Crotalus durissus terrificus

RhabdomyolysisCrotalus durissus terrificusCrotalus durissus terrificus

Crotalic envenoming Clinical aspects

Crotalus durissus terrificusEpistaxes

3-Bleeding and Clotting disturbance

Gingival bleeding

Crotalic envenoming Clinical aspects

Tubular necrosis causing renal failure

4-Renal failure

Crotalus durissus terrificus

Crotalic envenoming Clinical aspects

Liver cells with mitochondrial edemaIncrease of Alanine aminotransferase enzyme Liver necrosis

5-Liver toxicity

Liver with edema

Crotalus durissus terrificus

“Acute envenoming syndrome”

SPECIFIC ANTIVENOM CROTALUS TREATMENT

-Mild accident - 10 (100 mg) anticrotalic venom ampules by intravenous route without allergic test;

-Moderate accident - 20 (200 mg) anticrotalic venom ampules by intravenous route without allergic test;

-Severe accident - 30 (300 mg) anticrotalic venom ampules by intravenous route without allergic test.

1-Hospitalize the patient for at least 24 hours;

2-Make Clotting Test after 12 hours to evaluate clotting disturbance and indicate, if necessary, more antivenom;

3-Clean and wash the bite region;

4-Hidrate to prevent renal failure with Manitol 20%, four times a day for at least 5 days.

5-Increase pH with Sodium bicarbonate 5% , 50 ml by oral route, four times a day.

5-Give antibiotic prophylaxis – cefuroxime 125 to 250 mg twice a day, for 5 to 7 days;

6-Indicate tetanus immunoprophylaxis; immunoprophylaxis;

7-If renal failure occurs hemodyalisis.7-If renal failure occurs hemodyalisis.

SUPPORTIVE TREATMENT

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Site:www.jvat.org.br/barraviera/index.htm

Email:bbviera@jvat.org.br

Site:www.jvat.org.br/barraviera/index.htm

Email:bbviera@jvat.org.br

Pela atenção, Pela atenção, Muito obrigado !!!Muito obrigado !!!Pela atenção, Pela atenção, Muito obrigado !!!Muito obrigado !!!