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|Title:||Coral snake bites in Brazil: a review|
De Capitani, Eduardo M.
Rodrigues, Cinthia K.
Silva, Nelson J. da
Risk, Jose Yamin
Silva, Luciana L. Casais E.
|Abstract:||Coral snakes ( Micrurus spp.) are the main representatives of the family Elapidae in the Americas. We reviewed the reports of coral snake bites in Brazil from 1933 to 2014 to determine the species involved, the clinical manifestations of envenomation, the treatment used and the outcome.Methods: Twenty four reports in English or Portuguese describing case series and case reports of coral snake bites were identifi ed by searching Internet databases (EMBASE, PubMed, Scielo and LILACS), books, abstracts published in congress proceedings, academic dissertations and personal communications. Sincethree reports dealt with the same cases, subsequent analysis was restricted to 21 reports (6 articles, 9 abstracts, 3 books, 2 academic dissertations, 1 personal communication) describing 150 cases. Results: Of the 150 cases, 60% were from Santa Catarina state (southern Brazil). The snakes were brought for identification in 82 cases ( Micrurus spp. n 22, M. corallinus n 37, M. frontalis n 12, M. lemniscatus n 5, M. filiformis n 1, M. hemprichi n 2, M. surinamensis n 1, M. spixii n 1 , M. ibiboboca n 1). Of the 134 cases in which the bite site was recorded, most involved the hands (46.3%) and feet (26.1%). The main clinical features described were local numbness/paresthesia (52%), local pain (47.3%), palpebral ptosis (45.3%), blurred vision (20%), weakness (16.7%), dysphagia (14.7%), myalgia (9.3%), inability to walk (9.3%), dyspnea (8%), and salivation (8%). Fang marks were present in 45.3%, and 14.7% were classified as asymptomatic. A slight increase in total blood creatine kinase was reported in two cases (1,766 IU and 1,354 IU). Therapeutic procedures included the use of anti- Micrurus antivenom raised against M. corallinus and M. frontalis venoms (76%; F(ab ´ )2, Instituto Butantan, Brazil), anticholinesterase drugs (7.3%) and mechanical ventilation (4.7%). Two patients (reported in 1933), developed respiratory failure/paralysis and died 6 hours and 17 hours post-bite, respectively. Conclusion: Neuromuscular blockade (pre- and/or post-synaptic) is the hallmark of systemic envenomation by Micrurus spp. Systemic neurotoxic envenomation was detected in 47.3% of patients (respiratory depression in 6%), similar to data reported by Wood et al. 1 Local features, such as paresthesia and pain, were also frequently reported. The two reported deaths were described in a situation where mechanical ventilation support was unavailable. Envenomation by Micrurus spp. in Brazil is uncommon. Although many patients developed systemic neurotoxicity, few required respiratory support|
|Editor:||Taylor & Francis|
|Citation:||Coral Snake Bites In Brazil: A Review. Informa Healthcare, v. 53, p. 281-282 MAY-2015.|
|Appears in Collections:||FCM - Artigos e Outros Documentos|
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