A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon

Abstract

Background Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. Methods This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. Results Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. Conclusions The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.

The Effectiveness of Antibiotics in Managing Bacterial Infections on Bite Sites following Snakebite Envenomation

“…The use of antibiotics as a preventative measure following envenomation by snakes is controversial or unnecessary, and therefore, they should only be used when there is confirmation of a wound infection [ 18 , 19 ]. Overuse or unnecessary administration of antibiotics in SBE victims can contribute to antimicrobial resistance, undesirable side effects, and increased treatment costs [ 20 , 21 ]. Moreover, wound infections that are not treated quickly can lead to serious complications such as abscess, gangrene, and necrosis, which may require surgical intervention, adding a strain on already fragile healthcare systems with limited resources and poor infrastructure [ 22 ].…”

First Insights into the Venom Composition of Two Ecuadorian Coral Snakes

“…In Ecuador, the Micrurus genus includes 17 species, but their venoms have not been investigated. The country does not produce antivenom and depends on importing these life-saving immunological agents [ 19 , 31 ]. Bothropic and Lachesis bites are covered by the polyvalent antivenom imported from Instituto Clodomiro Picado (Costa Rica) with demonstrated effectiveness, despite the high number of vials needed in some cases [ 31 , 38 ].…”

“…The country does not produce antivenom and depends on importing these life-saving immunological agents [ 19 , 31 ]. Bothropic and Lachesis bites are covered by the polyvalent antivenom imported from Instituto Clodomiro Picado (Costa Rica) with demonstrated effectiveness, despite the high number of vials needed in some cases [ 31 , 38 ]. However, envenomation by elapids remains a latent problem, despite the reduced number of cases.…”

“…These distinct patterns may have relevant translational implications for the snakebite therapy [ 20 , 23 , 29 ]. The manufacturing of horse-derived antivenom has been discontinued in Ecuador since 2012, and therefore, the country imports polyvalent antivenom produced using Bothrops asper , Crotalus durissus , and Lachesis muta to treat Viperidae accidents [ 31 , 32 ]. On the other hand, Elapidae envenomations are a rare but represent a significant health problem due to the lack of or scarce availability of anti-elapid antivenoms in the public healthcare system [ 33 ].…”

Antivenom availability, delays and use in Australia

“…Delays between arrival to hospital and antivenom administration are a significant concern in hospitals that stock antivenom. Various studies of snakebite, including in countries with limited resources, show that a large proportion of snakebite victims arrive to hospital within hours of the bite ( Silva et al, 2020 ; Johnston et al, 2017b ; Patino et al, 2022 ). However, there is limited information on the time delay between admission and antivenom administration, most studies report either time to hospital or time to antivenom, but not both.…”