title: Bites by coral snakes (Micrurus spp.) in Campinas, State of São Paulo, Southeastern Brazil.
abstract: Coral snakes (Micrurus spp.) are the main representatives of the Elapidae in South America. However, bites by these snakes are uncommon. We retrospectively reviewed the data from 11 individuals bitten by coral snakes over a 20-year period; four were confirmed (snake brought for identification) and seven were highly suspected (neuromuscular manifestations) cases of elapid envenoming. The cases were classified as dry-bite (n = 1, caused by M. lemniscatus; did not receive antivenom), mild (n = 2, local manifestations with no acute myasthenic syndrome; M. frontalis and Micrurus spp.), moderate (n = 5, mild myasthenia) or severe (n = 3, important myasthenia; one of them caused by M. frontalis). The main clinical features upon admission were paresthesia (local, n = 9; generalized, n = 2), local pain (n = 8), palpebral ptosis (n = 8), weakness (n = 4) and inability to stand up (n = 3). No patient developed respiratory failure. Antivenom was used in ten cases, with mild early reactions occurring in three. An anticholinesterase drug was administered in the three severe cases, with a good response in two. No deaths were observed. Despite the high toxicity of coral snake venoms, the prognosis following envenoming is good. In serious bites by M. frontalis or M. lemniscatus, the venom of which acts postsynaptically, anticholinesterases may be useful as an ancillary measure if antivenom is unavailable, if there is a delay in obtaining a sufficient amount, or in those patients given the highest recommended doses of antivenom without improvement of the paralysis or with delayed recovery.
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (UNICAMO), Hospital das Clínicas, 13083-970 Campinas, São Paulo, Brazil. bucaret@fcm.unicamp.br
authors.forename: Fábio
authors.initials: F
authors.lastname: Bucaretchi
authors.forename: Stephen
authors.initials: S
authors.lastname: Hyslop
authors.forename: Ronan José
authors.initials: RJ
authors.lastname: Vieira
authors.forename: Adriana Safioli
authors.initials: AS
authors.lastname: Toledo
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Madureira
authors.forename: Eduardo Mello
authors.initials: EM
authors.lastname: de Capitani
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001938:Brazil; D002648:Child; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D004546:Elapid Venoms / Q000506:poisoning*; D017815:Elapidae; D005260:Female; D006801:Humans; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012909:Snake Bites / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000997:Antivenins; D002800:Cholinesterase Inhibitors; D004546:Elapid Venoms; D009388:Neostigmine