Snakebites by Bothrops spp in children in Campinas, São Paulo, Brazil.
From January, 1984 to March, 1999, 73 children under 15 y old (ages 1-14 y, median 9 y) were admitted after being bitten by snakes of the genus Bothrops. Twenty-six percent of the children were classified as mild envenoming, 50.7% as moderate envenoming and 20.6% as severe envenoming. Two patients (2.7%) showed no signs of envenoming. Most of the patients presented local manifestations, mainly edema (94.5%), pain (94.5%) ecchymosis (73.9%) and blisters (11%). Local and/or systemic bleeding was observed in 28.8% of the patients. Before antivenom (AV) administration, blood coagulation disorders were observed in 60.7% (incoagulable blood in 39.3%) of the 56 children that received AV only in our hospital. AV early reactions, most of which were considered mild, were observed in 44.6% of these cases (in 15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). The main clinical complications observed were local infection (15.1%), compartment syndrome (4.1%), gangrene (1.4%) and acute renal failure (1.4%). No deaths were recorded. There were no significant differences with regard to severity of envenoming versus the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75) or in the frequency of patients with AV early reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infection was significantly greater in severe cases (p < 0.001). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenoming (p = 0.04).
Bucaretchi
F
F
Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil. bucaret@fcm.unicamp.br
Herrera
S R
SR
Hyslop
S
S
Baracat
E C
EC
Vieira
R J
RJ
D000293:Adolescent; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D017837:Bothrops; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003435:Crotalid Venoms / Q000506:poisoning; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012909:Snake Bites / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors
D000997:Antivenins; D003435:Crotalid Venoms