Compartment Syndrome following <i>Bothrops</i> Snakebite Leads to Decompressive Fasciotomies

Valente-Aguiar, Murilo Sérgio; Silva, Bruno Gonçalves da Costa e; Magalhães, Teresa; Dinis-Oliveira, Ricardo Jorge

doi:10.1155/2019/6324569

Cited by 7 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanism of coagulopathy has been widely described in the literature [ 14 ]. Indeed, hypo-fibrinogenemia is a major systemic complication from snakebites, affecting more than 80% of patients [ 15 ]. This condition results from the action of serine proteinases having thrombin-like activity, which converts fibrinogen to fibrin, and also to the procoagulant activity of metalloproteinases, which activate factors II and X of the coagulation cascade, resulting in the formation of endogenous thrombin [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The involved enzymes are PI and P-III snake venom metalloproteinases (examples in the venom of B. atrox are Batroxase [ 22 ], Atroxlysin-Ia [ 23 ] and Batroxrhagin [ 24 ]). Systemic bleeding observed in snakebites was reported in 3.6–15.3% of patients [ 15 , 25 ]. It includes gingival bleeding, sub-conjunctival hemorrhage, hematuria, and, in severe cases, cerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Features and Management of Snakebite Envenoming in French Guiana

Résière

Houcke

Pujo

et al. 2020

Toxins

View full text Add to dashboard Cite

The management of snakebite (SB) envenoming in French Guiana (FG) is based on symptomatic measures and antivenom (AV) administration (Antivipmyn Tri®; Instituto Bioclon—Mexico). Our study aimed to assess clinical manifestations, the efficacy, and safety of Antivipmyn Tri® in the management of SB. Our study is a prospective observational work. It was conducted in the Intensive Care Unit (ICU) of Cayenne General Hospital between January 1st, 2016 and December 31, 2019. We included all patients hospitalized for SB envenoming. Our study contained three groups (without AV, three vials, and six vials Antivipmyn Tri®). During the study period, 133 patients were included. The main clinical symptoms were edema (98.5%), pain (97.7%), systemic hemorrhage (18%), blister (14.3%), and local hemorrhage (14.3%). AV was prescribed for 83 patients (62.3%), and 17 of them (20%) developed early adverse reactions. Biological parameters at admission showed defibrinogenation in 124 cases (93.2%), International Normalized Ratio (INR) > 2 in 104 cases (78.2%), and partial thromboplastin time (PTT) > 1.5 in 74 cases (55.6%). The time from SB to AV was 9:00 (5:22–20:40). The median time from SB to achieve a normal dosage of fibrinogen was 47:00 vs. 25:30, that of Factor II was 24:55 vs. 15:10, that of Factor V was 31:42 vs. 19:42, and that of Factor VIII was 21:30 vs. 10:20 in patients without and with AV, respectively, (p < 0.001 for all factors). Patients receiving Antivipmyn Tri® showed a reduction in the time to return to normal clotting tests, as compared to those who did not. We suggest assessing other antivenoms available in the region to compare their efficacy and safety with Antivipmyn Tri® in FG.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Features and Management of Snakebite Envenoming in French Guiana

Résière

Houcke

Pujo

et al. 2020

Toxins

View full text Add to dashboard Cite

show abstract

“…In common for the three cases of this study, the Bothrops snakebite evolved to compartment syndrome, secondary bacterial infection and extensive necrosis, leading to atrophy and amputation of the bitten limb. Local tissue damage is an important effect in human victims of Bothrops snakebites and, in the most severe cases, compartment syndrome appears as a dangerous complication due to the possibility of ischemia, tissue necrosis and neuropathy [ 34 , 35 , 36 , 37 ]. Pediatric cases of compartment syndrome from snakebites are reported worldwide [ 37 , 38 , 39 , 40 ], in clinical pictures very similar to those seen in this study.…”

Section: Discussionmentioning

confidence: 99%

Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives

Farias

Cristino

Arévalo³

et al. 2023

Toxins

View full text Add to dashboard Cite

Snakebites are a major public health problem in the Brazilian Amazon and may lead to local complications and physical deficiencies. Access to antivenom treatment is poorer in indigenous populations compared to other populations. In this study, we report three cases of long-term severe disabilities as a result of Bothrops atrox snakebites in indigenous children, according to the narratives of the parents. The three cases evolved to compartment syndrome, secondary bacterial infection and extensive necrosis. The cases are associated with delayed antivenom treatment due to very fragmented therapeutic itineraries, which are marked by several changes in means of transport along the route. The loss of autonomy at such an early stage of life due to a disability caused by a snakebite, as observed in this study, may deprive children of sensory and social experiences and of learning their future roles in the community. In common to all cases, there was precarious access to rehabilitation services, which are generally centralized in the state capital, and which leads to a prolonged hospitalization of patients with severe snakebite, and distances them from their territory and family and community ties. Prospective studies should be conducted in the Amazon that estimate the burden of disabilities from snakebites in order to formulate public policies for the treatment and rehabilitation of patients through culturally tailored interventions.

show abstract

“…However, compartment syndrome after snakebite is not a clinical diagnosis, because the pathophysiology is different from the consequences of trauma, which primarily results from an increased pressure within the affected area. Venom-induced compartment syndrome probably involves a direct cytotoxic effect of the venom and a reduced perfusion pressure [34,35]. Fasciotomy has been found to be only very rarely necessary after snakebite, and only if the intracompartmental pressure remains persistently elevated above 30 to 40 mm Hg over several hours, and if antivenom has been administered repeatedly [22,35,36].…”

Section: Original Articlementioning

confidence: 99%

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

et al. 2022

View full text Add to dashboard Cite

OBJECTIVE: The private keeping of exotic venomous snakes is legally permitted in Switzerland. The aim of the present study was to characterise the epidemiological and clinical features of bites by exotic venomous snakes over a period of 22 years in Switzerland. METHODS: We included all calls related to exotic snakebites recorded at the Swiss National Poisons Information Centre (Tox Info Suisse) from 1997 to 2018. Exclusion criteria comprised indigenous snakes, non-venomous exotic snakes such boas or pythons, clinical courses incompatible with a snakebite or calls from abroad. Follow-up information was graded according to the Poisoning Severity Score. RESULTS: Within the study period, 1,364 calls related to snakebites were recorded at Tox Info Suisse; 148 (11%) cases were attributed to exotic venomous snakes and fulfilled the study criteria. A total of 112 (98%) of 114 patients with medical follow-up information exhibited sufficient causality between exposure and clinical effects. Only adult patients were affected. The median age was 40 years (range 16–71) and the male gender was predominant (n = 136, 92%). Viperidae were involved in 87 (78%) and Elapidae in 25 (22%) patients. Overall, the main affected body part was the hand (89 patients, 79%). In the majority of the patients the clinical course was mild (46, 41%) or moderate (40, 36%), in a lower proportion asymptomatic (6, 5%) or with severe symptoms (20, 18%). No fatalities were reported in the study period. Severe symptoms were observed after elapid bites in six patients (24%) and after viper bites in 14 patients (16%). Besides local effects, neurological disorders after elapid bites and haematological disorders after viper bites were most frequently reported. Antivenom was administered in 24% (27 patients: 18 Viperidae, 21% and 9 Elapidae, 36%; 5 patients (4%) required multiple doses), overall, with good resolution of symptoms. CONCLUSION: Exotic snakebite is a rare occurrence in Switzerland but has led to medically relevant morbidity, sometimes requiring antivenom treatment. Over half of the envenomed patients required symptomatic or specific treatment. No fatalities or bites in children were reported.

show abstract

Compartment Syndrome following Bothrops Snakebite Leads to Decompressive Fasciotomies

Cited by 7 publications

References 23 publications

Clinical Features and Management of Snakebite Envenoming in French Guiana

Clinical Features and Management of Snakebite Envenoming in French Guiana

Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives

Exotic venomous snakebites in Switzerland reported to the National Poisons Information Centre over 22 years

Contact Info

Product

Resources

About