title: Snake bites by the jararacuçu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in São Paulo State, Brazil.
abstract: The jararacuçu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in São Paulo State, Brazil. We examined 29 cases of proven jararacuçu bites recruited over a 20-year period in two São Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care-unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.
authors.affiliation: Divisäo Clinica Médica Hospital Universitário, Universidade de São Paulo (HU-USP), Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Milani Júnior
authors.forename: M T
authors.initials: MT
authors.lastname: Jorge
authors.forename: F P
authors.initials: FP
authors.lastname: de Campos
authors.forename: F P
authors.initials: FP
authors.lastname: Martins
authors.forename: A
authors.initials: A
authors.lastname: Bousso
authors.forename: J L
authors.initials: JL
authors.lastname: Cardoso
authors.forename: L A
authors.initials: LA
authors.lastname: Ribeiro
authors.forename: H W
authors.initials: HW
authors.lastname: Fan
authors.forename: F O
authors.initials: FO
authors.lastname: França
authors.forename: I S
authors.initials: IS
authors.lastname: Sano-Martins
authors.forename: D
authors.initials: D
authors.lastname: Cardoso
authors.forename: C
authors.initials: C
authors.lastname: Ide Fernandez
authors.forename: J C
authors.initials: JC
authors.lastname: Fernandes
authors.forename: V L
authors.initials: VL
authors.lastname: Aldred
authors.forename: M P
authors.initials: MP
authors.lastname: Sandoval
authors.forename: G
authors.initials: G
authors.lastname: Puorto
authors.forename: R D
authors.initials: RD
authors.lastname: Theakston
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage; D001778:Blood Coagulation Disorders / Q000209:etiology; D017837:Bothrops; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003435:Crotalid Venoms / Q000032:analysis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000209:etiology; D012909:Snake Bites / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms