Time to treatment and severity of snake envenoming in Brazil

Abstract

Objective To analyze the relationship between time to treatment and severity of snakebite envenomation in Brazil. Methods This case-series retrospective study analyzed 144 251 snakebite cases in Brazil between 2007 and 2015, as reported to the Brazilian Notifiable Diseases Information System. The main dependent variable was snakebite envenomation severity (mild/moderate/severe). The main predictor was time to treatment (early (< 6 hours) vs. delayed (≥ 6 hours)). Covariables were snake type ( Bothrops/Crotalus/Micrurus/Lachesis ), patient's age and sex, bite site, and treatment at a specialized care center (center/noncenter). Polytomous logistic regression techniques were used to control the covariates and assess confounding and effect modification. Results The time to treatment variable was strongly associated with the severity of snakebite envenomation. Snake type and treatment at specialized care center modified the main association effect. The association between delayed time to treatment and envenomation severity was consistently stronger among patients treated at specialized care centers than among those who were not treated at such centers. Odds ratios tended to increase significantly from moderate to severe envenomation for cases within the subgroups “Center + Bothrops ” (1.37 to 2.05), “No center + Bothrops ” (1.25 to 1.47), “Center + Crotalus ” (1.35 to 3.03), “No center + Crotalus ” (0.97 to 2.72), and “Center + Lachesis ” (1.22 to 1.89). Discussion This study confirmed the classical hypothesis that the time between snakebite and initiation of medical care is associated with severity of snakebite envenomation. It is therefore necessary to provide snakebite victims early access to specialized medical care, particularly to antivenom therapy.

Epidemiological and clinical aspects of snakebites in the upper Juruá River region, western Brazilian Amazonia

“…This decrease in time to treatment may be due to the increase in the number of ambulances in Acre after 2015(O'Dwyer et al 2017, as well as to improvements in road infrastructure and telephone services, increasing the accessibility of patients to healthcare providers. The majority of mild cases in our study (43 of 59 cases, 73%) were among those treated in less than six hours, while 13 of 16 severe cases (81%) were among those treated after more than six hours had passed, which points to that longer delays in getting antivenom therapy are associated with an enhanced severity of sintomatology, including serious complications and death (Feitosa et al 2015b;Mise et al 2018;Roriz et al 2018).…”

Preclinical validation of a repurposed metal chelator as an early-intervention therapeutic for hemotoxic snakebite

“…7A). The antivenom control that was administered intraperitoneally at 15 mins, again in the absence of DMPS, also resulted in one early death (at 142 min) (39). Thus, delayed delivery of high doses of effective antivenom were unable to provide complete protection against envenoming by E. ocellatus.…”

Oral cavity bleeding following snakebite: A case report

“…The use of tourniquet aggravates the situation. Therefore, antibiotic therapy is recommended when there is evidence of infection (Mise et al, 2018). In the case described here, prophylactic antibiotic therapy was used because the hematoma was a possible contamination site, as it was exposed to the intraoral environment.…”

“…Because of its proteolytic action, it can alter the coagulation cascade due to blood incoagulability due to fibrinogen consumption. It can also promote the release of hypotensive substances and trigger capillary basement membrane lesions by the action of hemorrhagins, which together with platelet and coagulation disorders can lead to hemorrhagic manifestations (Bucaretchi et al, 2001;Mise et al, 2018;(Pinho & Pereira, 2001). ).…”