title: Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital.
abstract: The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming (P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations < or = 1.5 g/L (P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet (P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs > or = 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.
authors.affiliation: Hospital Vital Brazil, Instituto Butantan, Av. Vital Brazil, 1500, Zip code 05503-900, São Paulo, SP, Brazil. fosfranca@butantan.gov.br
authors.forename: F O S
authors.initials: FO
authors.lastname: França
authors.forename: K C
authors.initials: KC
authors.lastname: Barbaro
authors.forename: H W
authors.initials: HW
authors.lastname: Fan
authors.forename: J L C
authors.initials: JL
authors.lastname: Cardoso
authors.forename: I S
authors.initials: IS
authors.lastname: Sano-Martins
authors.forename: S C
authors.initials: SC
authors.lastname: Tomy
authors.forename: M H
authors.initials: MH
authors.lastname: Lopes
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
authors.forename: R D G
authors.initials: RD
authors.lastname: Theakston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000941:Antigens / Q000097:blood; D000997:Antivenins / Q000008:administration & dosage; D001777:Blood Coagulation; D017837:Bothrops / Q000276:immunology*; D002648:Child; D003435:Crotalid Venoms / Q000276:immunology*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012909:Snake Bites / Q000097:blood / Q000276:immunology* / Q000628:therapy
chemical_list: D000941:Antigens; D000997:Antivenins; D003435:Crotalid Venoms; D005340:Fibrinogen