Clinical manifestations and treatment of envenoming by Bothrops atrox and Bothropsbrazili snakes in Manaus region, Amazonas State, Brazil

Souza, A.R.B., Muniz, E.G., López-Lozano, J.L., Ferreira, L.C.L., Noronha, M.D.N.

Gerência de Animais Peçonhentos, Fundação de Medicina Tropical, Instituto de Medicina Tropical do Amazonas Manaus, Amazonas, Brasil

Bothrops species are the main cause of snake bites in humans in the amazonian rain forest. In Manaus region, 212 human victims of B. atrox and three of B. brazili were attended at Instituto de Medicina Tropical do Amazonas (FMT/IMT-AM) from 1986 to 1999. Snakes were identified at Gerência de Animais Peçonhentos – FMT/IMT-AM. Clinical symptoms and treatment of these patients are report in this study. Pain, abscess and local edema were the most frequent local manifestations of B. atrox and B. brazili snakebites. Systemic hemorrhage with coagulation disorders were observed with B. atrox (16%) and B. brazili (two cases) snake bites. Intracranial hemorrhage was also observed with both species, but only one B. atrox snake bite patient died. In B. atrox snake bites, 48.3% were classified as light cases. In B. brazili snakebite, one case was classified as moderate and two cases as severe. Some local complications in 39,0% of the patients were observed with B. atrox bites: cellulitis and abscesses were the  most frequent. One accident by B. brazili  showed cellulitis at the local bite. Renal failure was the single systemic complication observed by B. atrox  snakebites (10%), none severe. Bothropic antivenoms were used in the treatment of both Bothrops snake, two to six hours after the snakebite. B. atrox snake bites showed early reactions after administration of antivenom at 16% of cases. Twenty four hours after intravenous administration of antivenom, in eleven B. atrox snake bites patients was detected fibrinogen level. The symptomatology observed suggest similar clinical features of envenoming by B. atrox and B. brazili snakes in Manaus region. More studies of therapeutic efficacy of bothropic antivenoms on coagulation disorders produced by B. atrox venom are necessary.

CORRESPONDENCE TO:

Jorge Luis López Lozano, Conjunto Colina de Aleixo. Rua 17 Quadra F Casa 68, Manaus, AM, CEP: 69083-600, Brasil, Email: luisiam@hotmail.com