Clinical characteristics and long-term disabilities in children following Bothrops atrox envenomation in Manaus, western Brazilian Amazon
Débora Nery Oliveira1,2, Jady Shayenne Mota Cordeiro1,2, Andrea Gabriela Mota Saraiva3, Hiran Sátiro Souza da Gama1,2, Daniel Barros Castro2,4,5, Alexandre Vilhena Silva-Neto1, André Sachett1, Marco Aurélio Satim1,6, Felipe Murta1,2, Wuelton Marcelo Monteiro1,2,7, Jacqueline de Almeida Gonçalves Sachett1,2,8* [ + show more ]
Received: 10 December 2025 | Accepted: 12 May 2026 | Published: 17 July 2026
https://doi.org/10.1590/1678-9199-JVATITD-2025-0092
Abstract
Background: In the Brazilian Amazon, most snakebites are caused by Bothrops atrox. Although pediatric cases are less frequent, children are more vulnerable to severe complications and long-term disabilities. This study aims to describe the clinical profile of B. atrox envenomation in children treated at a tertiary hospital in Manaus, in Western Brazilian Amazon, and to characterize the resulting long-term musculoskeletal impairments in a subgroup of these patients. Methods: We retrospectively analyzed sociodemographic and clinical data from patients up to 12 years and 11 months of age treated between January 2010 and December 2023. A total of 258 children who were victims of B. atrox envenoming were eligible; however, a subgroup of 27 children underwent in-person musculoskeletal evaluations starting three months after hospital discharge. Results: In the subgroup of children evaluated, the majority were male (63%), were aged over ten years (59.3%), and were from rural areas (96.3%). Over half (51.8%) received medical care within six hours after the bite. The lower limbs were most frequently affected (96.3%). Common local symptoms included pain (100%), edema (96.3%), bleeding (37%), and bruising (29.6%). Secondary infections occurred in 18.5% of cases. Most envenomations were classified as moderate in severity (44.4%). In this subgroup, long-term disabilities were identified in 21 children (77.7%), who presented primarily with intermittent chronic pain (55.5%). Physical examination revealed scars (59.3%), edema (22.2%), and deformities (3.7%). Sensory alterations were noted in tactile (11.1%), pain (25.9%), thermal (22.2%), and vibratory (29.6%) sensitivity. Range of motion was impaired in 37% of cases, and one child exhibited abnormal posture and reflexes. Conclusions: This study highlights a broad spectrum of persistent musculoskeletal sequelae following Bothrops envenomation in children. Our findings underscore the urgent need for comprehensive care, follow-up, and rehabilitation programs for pediatric snakebite victims in the Amazon region.
Keywords: Snakebite; Children; Long-term disabilities; Neglected tropical diseases; Bothrops atrox