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Fernandes DA, Gomes BA, Mendonça SC, Pinheiro CDC, Sanchez EOF, Leitão SG, Fuly AL, Leitão GG. Alkaloids from Siparuna (Siparunaceae) are predicted as the inhibitors of proteolysis and plasma coagulation caused by snake venom and potentially counteract phospholipase A 2 activity of Bothrops jararaca. JOURNAL OF ETHNOPHARMACOLOGY 2024; 332:118349. [PMID: 38762214 DOI: 10.1016/j.jep.2024.118349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Snakebite envenomation (SBE) is the world's most lethal neglected tropical disease. Bothrops jararaca is the species that causes the greatest number of SBEs in the South and Southeastern of Brazil. The main symptoms are local (inflammation, edema, hemorrhage, and myonecrosis) and systemic (hemorrhage, hemostatic alterations with consumptive coagulopathy, and death) effects. Species of the genus Siparuna, Siparunaceae, are used in folk and traditional medicine to treat SBE. However, limited information is available concerning Brazilian Siparuna species against SBE. AIM OF THE STUDY To investigate the correlation between the compounds present in the extracts of five Siparuna species as potential agents against proteolytic activity, plasma coagulation, and phospholipase A2 (PLA2) activity caused by B. jararaca venom, using data obtained by UHPLC-MS/MS, biological activity, and multivariate statistics. MATERIALS AND METHODS The ethanol extracts from leaves of S. ficoides, S. decipiens, S. glycycarpa, S. reginae, and S. cymosa were fractionated by liquid-liquid extraction using different solvents of increasing polarity (hexane, dichloromethane, ethyl acetate, and n-butanol), affording their respective extracts, totaling 25 samples that were assayed through in vitro plasma coagulation and proteolytic activity assays. Moreover, the extracts were analyzed by UHPLC-MS/MS, using electrospray ionization (ESI) and atmospheric-pressure chemical ionization (APCI) in negative and positive ionization modes. The data was processed in MZmine v. 2.53 and evaluated by multivariate statistical tests (PLS) using the software UnscramblerX v. 10.4. These data were also used to build molecular networks (GNPS), and some ions of interest could be annotated using the library of molecules on the GNPS platform. RESULTS A total of 19 extracts inhibited B. jararaca-induced plasma coagulation, with emphasis on S. cymosa and S. reginae (800 s). The inhibition of the proteolytic activity was also promising, ranging from 16% (S. glycycarpa) to 99% (S. cymosa, S. decipiens, and S. reginae). In addition, most extracts from S. cymosa and S. reginae inhibited 70-90% of PLA2 activity. Based on data from positive mode APCI analyses, it was possible to obtain a statistic model with reliable predictive capacity which exhibited an average R2 of 0.95 and a Q2 of 0.88, indicating a robust fit. This process revealed five ions, identified as the alkaloids: coclaurine (1), stepholidine (2) O-methylisopiline (3), nornantenine (4) and laurolitsine (5). This is the first study to evidence the potential antivenom of alkaloids from Siparuna species. CONCLUSIONS Altogether, our results give support to the popular use of Siparuna extracts in SBE accidents, suggesting their potential as an alternative or complementary strategy against envenoming by B. jararaca venom. The predicted ions in the chemometric analysis for the assayed activities can also be correlated with the blocking activity and encourage the continuation of this study for possible isolation and testing of individual compounds on the used models.
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Affiliation(s)
- Diégina Araújo Fernandes
- Instituto de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Bloco H, Rio de Janeiro/RJ, 21941-902, Brazil.
| | - Brendo Araujo Gomes
- Programa de Pós-Graduação em Biotecnologia Vegetal e Bioprocessos, Universidade Federal do Rio de Janeiro, Rio de Janeiro/RJ, 21941-902, Brazil.
| | - Simony Carvalho Mendonça
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Bloco A2, Rio de Janeiro/RJ, 21941-902, Brazil.
| | - Camila de Castro Pinheiro
- Programa de Pós-Graduação em Ciências Biomédicas - Fisiologia e Farmacologia, Universidade Federal Fluminense, Niteroi/RJ, 24210-130, Brazil.
| | - Eladio Oswaldo Flores Sanchez
- Laboratório de Bioquímica de Proteínas de Animais Venenosos, Centro de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte/MG, 30510-010, Brazil.
| | - Suzana Guimarães Leitão
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Bloco A2, Rio de Janeiro/RJ, 21941-902, Brazil.
| | - André Lopes Fuly
- Departamento de Biologia Celular e Molecular, Instituto de Biologia, Universidade Federal Fluminense, Niteroi/RJ, 24210-201, Brazil.
| | - Gilda Guimarães Leitão
- Instituto de Pesquisas de Produtos Naturais, Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Bloco H, Rio de Janeiro/RJ, 21941-902, Brazil.
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Sachett A, Strand E, Serrão-Pinto T, da Silva Neto A, Pinto Nascimento T, Rodrigues Jati S, Dos Santos Rocha G, Ambrósio Andrade S, Wen FH, Berto Pucca M, Vissoci J, Gerardo CJ, Sachett J, Seabra de Farias A, Monteiro W. Capacity of community health centers to treat snakebite envenoming in indigenous territories of the Brazilian Amazon. Toxicon 2024; 241:107681. [PMID: 38461896 DOI: 10.1016/j.toxicon.2024.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The deaths from and morbidities associated with snakebites - amputations, loss of function in the limb, visible scarring or tissue damage - have a vast economic, social, and psychological impact on indigenous communities in the Brazilian Amazon, especially children, and represent a real and pressing health crisis in this population. Snakebite clinical and research experts have therefore proposed expanding antivenom access from only hospitals to include the community health centers (CHC) located near and within indigenous communities. However, there are no studies examining the capacity of CHCs to store, administer, and manage antivenom treatment. In response to this gap, the research team calling for antivenom decentralization developed and validated an expert-based checklist outlining the minimum requirements for a CHC to provide antivenom. METHODS The objective of this study was thus to survey a sample of CHCs in indigenous territories and evaluate their capacity to provide antivenom treatment according to this accredited checklist. The checklist was administered to nurses and doctors from 16 CHCs, two per indigenous district in Amazonas/Roraima states. RESULTS Our results can be conceptualized into three central findings: 1) most CHCs have the capacity to provide antivenom treatment, 2) challenges to capacity are human resources and specialized items, and 3) antivenom decentralization is feasible and appropriate in indigenous communities. CONCLUSION Decentralization would provide culturally and contextually appropriate care accessibility to a historically marginalized and underserved population of the Brazilian Amazon. Future studies should examine optimal resource allocation in indigenous territories and develop an implementation strategy in partnership with indigenous leaders. Beyond the indigenous population, the checklist utilized could be applied to community health centers treating the general population and/or adapted to other low-resource settings.
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Affiliation(s)
- André Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Thiago Serrão-Pinto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Faculdade de Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Alexandre da Silva Neto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thais Pinto Nascimento
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sewbert Rodrigues Jati
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Secretaria de Estado de Educação e Cultura de Roraima, Boa Vista, Brazil
| | - Gisele Dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | | | - Manuela Berto Pucca
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas de Araraquara, Universidade Estadual Paulista, Araraquara, Brazil
| | - João Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Charles J Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Altair Seabra de Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
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Knudsen C, Belfakir SB, Degnegaard P, Jürgensen JA, Haack AM, Friis RUW, Dam SH, Laustsen AH, Ross GMS. Multiplex lateral flow assay development for snake venom detection in biological matrices. Sci Rep 2024; 14:2567. [PMID: 38296989 PMCID: PMC10831076 DOI: 10.1038/s41598-024-51971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Bothrops and Lachesis are two of Brazil's medically most relevant snake genera, causing tens of thousands of bites annually. Fortunately, Brazil has good accessibility to high-quality antivenoms at the genus and inter-genus level, enabling the treatment of many of these envenomings. However, the optimal use of these treatments requires that the snake species responsible for the bite is determined. Currently, physicians use a syndromic approach to diagnose snakebite, which can be difficult for medical personnel with limited training in clinical snakebite management. In this work, we have developed a novel monoclonal antibody-based multiplex lateral flow assay for differentiating Bothrops and Lachesis venoms within 15 min. The test can be read by the naked eye or (semi)-quantitatively by a smartphone supported by a 3D-printed attachment for controlling lighting conditions. The LFA can detect Bothrops and Lachesis venoms in spiked plasma and urine matrices at concentrations spanning six orders of magnitude. The LFA has detection limits of 10-50 ng/mL in spiked plasma and urine, and 50-500 ng/mL in spiked sera, for B. atrox and L. muta venoms. This test could potentially support medical personnel in correctly diagnosing snakebite envenomings at the point-of-care in Brazil, which may help improve patient outcomes and save lives.
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Affiliation(s)
- Cecilie Knudsen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark.
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
| | - Selma B Belfakir
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark.
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
| | | | - Jonas A Jürgensen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Aleksander M Haack
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Rasmus U W Friis
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Søren H Dam
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Andreas H Laustsen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
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Serrão-Pinto T, Strand E, Rocha G, Sachett A, Saturnino J, Seabra de Farias A, Alencar A, Brito-Sousa JD, Tupetz A, Ramos F, Teixeira E, Staton C, Vissoci J, Gerardo CJ, Wen FH, Sachett J, Monteiro WM. Development and validation of a minimum requirements checklist for snakebite envenoming treatment in the Brazilian Amazonia. PLoS Negl Trop Dis 2024; 18:e0011921. [PMID: 38241387 PMCID: PMC10829989 DOI: 10.1371/journal.pntd.0011921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/31/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Currently, antivenoms are the only specific treatment available for snakebite envenoming. In Brazil, over 30% of patients cannot access antivenom within its critical care window. Researchers have therefore proposed decentralizing to community health centers to decrease time-to-care and improve morbidity and mortality. Currently, there is no evidence-based method to evaluate the capacity of health units for antivenom treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective antivenom administration and clinical management. METHODS This study utilized a modified-Delphi approach to develop and validate a checklist to evaluate the minimum requirements for health units to adequately treat snakebite envenoming in the Amazon region of Brazil. The modified-Delphi approach consisted of four rounds: 1) iterative development of preliminary checklist by expert steering committee; 2) controlled feedback on preliminary checklist via expert judge survey; 3) two-phase nominal group technique with new expert judges to resolve pending items; and 4) checklist finalization and closing criteria by expert steering committee. The measure of agreement selected for this study was percent agreement defined a priori as ≥75%. RESULTS A valid, reliable, and feasible checklist was developed. The development process highlighted three key findings: (1) the definition of community health centers and its list of essential items by expert judges is consistent with the Brazilian Ministry of Health, WHO snakebite strategic plan, and a general snakebite capacity guideline in India (internal validity), (2) the list of essential items for antivenom administration and clinical management is feasible and aligns with the literature regarding clinical care (reliability), and (3) engagement of local experts is critical to developing and implementing an antivenom decentralization strategy (feasibility). CONCLUSION This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items; identification of training needs across the care continuum; and demonstration of the validity, reliability, and feasibility provided by engaging local experts. Specific to Brazil, further added value comes in the potential use of the checklist for health unit accreditation as well as its applications to logistics and resource distribution. Future research priorities should apply this checklist to health units in the Amazon region of Brazil to determine which community health centers are or could be capable of receiving antivenom and translate this expert-driven checklist and approach to snakebite care in other settings or other diseases in low-resource settings.
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Affiliation(s)
- Thiago Serrão-Pinto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Faculdade de Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Gisele Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - André Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Joseir Saturnino
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Altair Seabra de Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - José Diego Brito-Sousa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Flávia Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Elizabeth Teixeira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Catherine Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - João Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
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Zimmerman A, Monteiro W, Nickenig Vissoci JR, Smith ER, Rocha T, Sachett J, Wen FH, Staton C, Gerardo CJ, Ogbuoji O. Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100651. [PMID: 38124996 PMCID: PMC10733094 DOI: 10.1016/j.lana.2023.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Background Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil's state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state. Methods We built a decision tree model to simulate three different antivenom scale-up scenarios: (1) scale up to 95% of hospitals, (2) scale up to 95% of CHCs, and (3) scale up to 95% of hospitals and 95% of CHCs. We consider each scenario with and without a 10% increase in demand for antivenom among SBE victims. For each scenario, we model the treatment costs averted, deaths averted, and disability-adjusted life years (DALYs) averted from a societal, health system, and patient perspective relative to the status quo and over a time horizon of one year. For each scenario and perspective, we also calculate the incremental cost per DALY averted and per death averted. We use a willingness to pay threshold equal to the 2022 gross domestic product (GDP) per capita of Brazil. Findings Scaling up antivenom to 95% of hospitals averts up to 2022 DALYs, costs up to USD $460 per DALY averted from a health system perspective, but results in net economic benefits up to USD $4.42 million from a societal perspective. Scaling up antivenom to 95% of CHCs averts up to 3179 DALYs, costs up to USD $308 per DALY averted from a health system perspective, but results in net economic benefits up to USD $7.35 million from a societal perspective. Scaling up antivenom to 95% of hospitals and CHCs averts up to 3922 DALYs, costs up to USD $328 per DALY averted from a health system perspective, but results in net economic benefits up to USD $8.98 million from a societal perspective. Interpretation All three antivenom scale up scenarios - scale up to 95% of hospitals, scale up to 95% of CHCs, and scale up to 95% of hospitals and 95% of CHCs - avert a substantial proportion of the SBE burden in Amazonas and are cost-saving from a societal perspective and cost-effective from a health system perspective. Funding W.M. and J.S. were funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq productivity scholarships). W.M. was funded by Fundação de Amparo à Pesquisa do Estado do Amazonas (PRÓ-ESTADO, call n. 011/2021-PCGP/FAPEAM, call n. 010/2021-CT&I ÁREAS PRIORITÁRIAS, call n. 003/2022-PRODOC/FAPEAM, POSGRAD/FAPEAM) and by the Ministry of Health, Brazil (Proposal No. 733781/19-035). Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW011944. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Charles J. Gerardo
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, United States
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Galan LEB, Silva VS, Silva VS, Monte RC, Jati SR, Oliveira IS, Cerni FA, Monteiro WM, Sachett J, Dantas DSM, Carbonell RCC, Pucca MB. Acute mesenteric ischemia following lancehead snakebite: an unusual case report in the Northernmost Brazilian Amazon. Front Med (Lausanne) 2023; 10:1197446. [PMID: 37425310 PMCID: PMC10323676 DOI: 10.3389/fmed.2023.1197446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Snakebites have a great impact in the Brazilian Amazon, being the lancehead Bothrops atrox the species responsible for most accidents, disabilities, and deaths. This study shows a case report of an indigenous patient from the Yanomami ethnicity, male, 33 years-old, envenomed by a B. atrox snake. Envenoming caused by B. atrox are characterized by local manifestations (e.g., pain and edema) and systemic manifestations, mainly coagulation disorders. The indigenous victim was admitted in the main hospital of Roraima and evolved with an unusual complication, an ischemia and necrosis of the proximal ileum, requiring segmental enterectomy with posterior side-to-side anastomosis. The victim was discharge after 27 days of hospitalization with no complaints. Snakebite envenomations may evolve with life-threatening complications, which can be treated by the antivenom following access to a healthcare unit, often late in indigenous population. This clinical case shows the need of strategies that aim improvement in the access to the healthcare by indigenous people, as well as demonstrates an unusual complication that may result from lancehead snakebites. The article also discusses the decentralization of snakebites clinical management to indigenous community healthcare centers to mitigate complications.
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Affiliation(s)
- Luis E. B. Galan
- Medical School, Federal University of Roraima, Boa Vista, Roraima, Brazil
| | | | | | - Rommel C. Monte
- Medical School, Federal University of Roraima, Boa Vista, Roraima, Brazil
| | - Sewbert R. Jati
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Isadora S. Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Felipe A. Cerni
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Wuelton M. Monteiro
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Jacqueline Sachett
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Domingos S. M. Dantas
- Programa Doutoral de Bioética da Faculdade de Medicina do Porto, Cidade do Porto, Portugal
| | | | - Manuela B. Pucca
- Post Graduate Program in Tropical Medicine (PPGMT) of the State University of Amazonas, Manaus, Amazonas, Brazil
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara, São Paulo, Brazil
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7
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Isaacson JE, Ye JJ, Silva LL, Hernandes Rocha TA, de Andrade L, Scheidt JFHC, Wen FH, Sachett J, Monteiro WM, Staton CA, Vissoci JRN, Gerardo CJ. Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis. PLoS Negl Trop Dis 2023; 17:e0011305. [PMID: 37343007 PMCID: PMC10284398 DOI: 10.1371/journal.pntd.0011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.
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Affiliation(s)
| | - Jinny Jing Ye
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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8
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Sachett JDAG, Vieira SSC, Soares FGS, Alcântara JA, Carvalho HBDS, da Silva EMG, da Silva IM, Monteiro WM. Treatment of a Snakebite Injury With Secondary Bacterial Infection: A Case Study. J Wound Ostomy Continence Nurs 2023; 50:245-249. [PMID: 37146116 DOI: 10.1097/won.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Pit viper snakebites are challenging as they often cause tissue injury and secondary bacterial infection that may impair full recovery of the affected limb. We describe the evolution of a snakebite injury with secondary infection and the use of specialized dressings to achieve tissue repair and complete closure of the wound. CASE Ms E., a 45-year-old woman, was bitten by a pit viper that began as a small lesion and progressed to necrosis, cellulitis, edema, and hyperemia of the perilesional skin, local inflammation, and infection. We implemented a combination of topical hydrogel therapy with calcium alginate and hydrofiber with 1.2% silver to promote autolytic debridement, combat local infection, and provide a moist wound environment. The wound required daily local treatment for 2 months due to extensive tissue damage, combined with the proteolytic action of the bothropic venom. CONCLUSION The care of wounds caused by snakebites is a challenge for the health care team due to tissue loss resulting from the action of the venom and secondary bacterial infection. Close follow-up with the use of systemic antibiotics and topical therapies proved effective in minimizing tissue loss in this case.
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Affiliation(s)
- Jacqueline de Almeida Gonçalves Sachett
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Samara Sousa Carvalho Vieira
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Frandison Gean Souza Soares
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - João Arthur Alcântara
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Hanna Beatriz de Souza Carvalho
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Eliana Marques Gomes da Silva
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Iran Mendonça da Silva
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Jacqueline de Almeida Gonçalves Sachett, PhD, College of Nursing, University of Amazonas State, Amazonas, Brazil; Research Department, Alfredo da Matta Foundation, Amazonas, Brazil
- Samara Sousa Carvalho Vieira, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Frandison Gean Souza Soares, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- João Arthur Alcântara, MSc, Postgraduate Program in Tropical Medicine, University of Amazonas State, Amazonas, Brazil
- Hanna Beatriz de Souza Carvalho, BSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Eliana Marques Gomes da Silva, MSc, College of Nursing, University of Amazonas State, Amazonas, Brazil
- Iran Mendonça da Silva, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil
- Wuelton Marcelo Monteiro, PhD, College of Medicine, University of Amazonas State, Amazonas, Brazil; Department of Research Medicina Tropical Dr. Heitor Vieira Dourado Foundation, Amazonas, Brazil
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9
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Coelho KF, Neves JCF, Ibiapina HNS, Magalhães-Gama F, Barbosa FBA, Silva FS, Wellmann IAM, Sachett JAG, Tarragô AM, Ferreira LCL, Malheiro A, Monteiro WM, Costa AG. Exploring the Profile of Cell Populations and Soluble Immunological Mediators in Bothrops atrox Envenomations. Toxins (Basel) 2023; 15:196. [PMID: 36977086 PMCID: PMC10051854 DOI: 10.3390/toxins15030196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Bothrops atrox envenomations are common in the Brazilian Amazon. The venom of B. atrox is highly inflammatory, which results in severe local complications, including the formation of blisters. Moreover, there is little information on the immune mechanisms associated with this condition. Thus, a longitudinal study was carried out to characterize the profile of the cell populations and soluble immunological mediators in the peripheral blood and blisters in B. atrox patients s according to their clinical manifestations (mild and severe). A similar response in both B. atrox patient groups (MILD and SEV) was observed, with an increase in inflammatory monocytes, NKT, and T and B cells, as well as CCL2, CCL5, CXCL9, CXCL10, IL-1β and IL-10, when compared with the group of healthy blood donors. After the administration of antivenom, the participation of patrolling monocytes and IL-10 in the MILD group was observed. In the SEV group, the participation of B cells was observed, with high levels of CCL2 and IL-6. In the blister exudate, a hyperinflammatory profile was observed. In conclusion, we revealed the involvement of cell populations and soluble mediators in the immune response to B. atrox envenomation at the local and peripheral level, which is related to the onset and extent of the inflammation/clinical manifestation.
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Affiliation(s)
- Kerolaine Fonseca Coelho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Juliana Costa Ferreira Neves
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Fábio Magalhães-Gama
- Programa de Pós-Graduação em Ciências da Saúde, Instituto René Rachou-Fundação Oswaldo Cruz (FIOCRUZ Minas), Belo Horizonte 30190-002, MG, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
| | - Fabiane Bianca Albuquerque Barbosa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Flavio Souza Silva
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
| | - Irmgardt Alicia María Wellmann
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
- Departamento de Ensino e Pesquisa, Fundação Alfredo da Matta (FUAM), Manaus 69065-130, AM, Brazil
| | - Andréa Monteiro Tarragô
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
| | - Luiz Carlos Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus 69040-000, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus 69067-005, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Universidade do Estado do Amazonas (UEA), Manaus 69050-001, AM, Brazil
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM), Manaus 69057-070, AM, Brazil
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10
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Mikołajczak KM, Barlow J, Lees AC, Ives CD, Strack M, de Almeida OT, Souza AC, Sinclair F, Parry L. Evaluating the influence of nature connection and values on conservation attitudes at a tropical deforestation frontier. CONSERVATION BIOLOGY : THE JOURNAL OF THE SOCIETY FOR CONSERVATION BIOLOGY 2023:e14067. [PMID: 36751965 DOI: 10.1111/cobi.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Inner phenomena, such as personal motivations for pursuing sustainability, may be critical levers for improving conservation outcomes. Most conservation research and policies, however, focus on external phenomena (e.g., ecological change or economic processes). We explored the factors shaping 9 conservation attitudes toward forest and wildlife protection among colonist farmers around an Amazonian deforestation frontier. Our data comprised 241 face-to-face quantitative surveys, complemented with qualitative insights from open-ended questionnaire responses and opportunistic semistructured interviews. To account for the full spectrum of possible inner motivations, we employed measures of nature connection (indicating biospheric motivation) and personal values organized around the traditionalism (traditionalist through to high openness to change) and universalism dimensions (egoistic through to altruistic motivations). We used averaged beta-binomial generalized linear models to assess the role of external factors (socioeconomic, sociodemographic, and environmental) and personal (inner) motivations on the variation in attitudes. Each attitude was modeled separately. The relative importance of each predictor was judged by the proportion of models where it appeared as significant. Proconservation views were expressed by the majority (at least 65%) of the respondents in 7 out of the 9 attitude models. The most consistent predictors were emotional nature connection and personal values (significant in 4-6 out of 9 models), rather than external phenomena (significant in 0-5 models). However, the poorest farmers had lower scores on the agreement with prioritizing nature over development (𝛽 = -0.52, 95% CI: -0.96 to -0.07). Qualitative data also indicated that economic barriers hinder forest conservation on farms. These results suggest that biospheric, traditionalistic, and altruistic motivations promote people's proconservation attitudes, but nurturing these latent motivations is unlikely to improve conservation outcomes if material poverty remains unaddressed. Integrating the inner-outer perspective into conservation thinking and practical interventions could foster environmental stewardship and increase human well-being.
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Affiliation(s)
- Katarzyna M Mikołajczak
- Grantham Research Institute, London School of Economics and Political Science, London, UK
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Jos Barlow
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Alexander C Lees
- Ecology and Environment Research Centre, Manchester Metropolitan University, Manchester, UK
| | | | - Micha Strack
- Georg-Elias-Müller-Institute for Psychology, Georg-August-Universität Göttingen, Göttingen, Germany
| | | | | | - Frazer Sinclair
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK
| | - Luke Parry
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
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11
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Nascimento TP, Vilhena Silva-Neto A, Baia-da-Silva DC, da Silva Balieiro PC, Baleiro AADS, Sachett J, Brasileiro L, Sartim MA, Martinez-Espinosa FE, Wen FH, Pucca MB, Gerardo CJ, Sampaio VS, Ferreira de Aquino P, Monteiro WM. Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia. PLoS Negl Trop Dis 2022; 16:e0010963. [PMID: 36469516 PMCID: PMC9754599 DOI: 10.1371/journal.pntd.0010963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/15/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.
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Affiliation(s)
- Thaís P. Nascimento
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
| | - Alexandre Vilhena Silva-Neto
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Djane Clarys Baia-da-Silva
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
- Amazonas Federal University, Manaus, Amazonas, Brazil
| | | | | | - Jacqueline Sachett
- Amazonas State University, Manaus, Amazonas, Brazil
- Butantan Institute, São Paulo, Brazil
| | - Lisele Brasileiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Marco A. Sartim
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | | | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Vanderson S. Sampaio
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | - Wuelton M. Monteiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
- * E-mail:
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Brasileiro-Martins LM, Nascimento TP, Silva-Neto AV, Martins F, Cavalcante SA, Martins RB, Marques H, Colombini M, Martins M, Sartim MA, Wen FH, Carlos de Lima Ferreira L, de Almeida Gonçalves Sachett J, Moura-da-Silva AM, Ferreira de Aquino P, Monteiro WM. The severity of acute kidney injury correlates with plasma venom levels in Bothrops atrox envenomings. Toxicon 2022; 219:106924. [PMID: 36126694 DOI: 10.1016/j.toxicon.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/17/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022]
Abstract
The Brazilian Amazon has high rates of snakebite envenomings (SBEs), with ∼90% caused by Bothrops atrox. Envenomings by this species can trigger local and systemic effects, such as acute kidney injury (AKI). Our aim was to identify predictors of AKI in Bothrops SBEs in patients from Manaus, Western Brazilian Amazon. A total of 127 patients were enrolled, with a predominance of men between 16 and 45 years old from rural areas. Of the 127 patients, 38.6% developed AKI, with 61.2% presenting stage I, 34.7% presenting stage II and 4.1% presenting stage III severity. The age groups 0-10 years and ≥60 years presented a significantly higher frequency of AKI compared to the 11-40 years group. Moderate/severe edema in the affeccted limb was significantly associated with lower risk of AKI [p = 0.01; OR = 0.11 (95%CI 0.02-0.53)]. Nausea [p = 0.01; OR = 54.44 (95%CI = 3.26-909.27)] and high blood urea levels [p = 0.01; OR = 5.38 (95%CI = 2.12-13.66)] were risk factors for AKI. There was a significant positive correlation between circulating venom levels and the highest creatinine serum values during the hospital stay (p = 0.03) and with the difference between the maximum creatinine levels and the creatinine levels on admission (p = 0.02). A positive correlation between serum venom concentrations and creatinine levels suggests a direct or indirect dose-dependent participation of the venom toxins in the pathogenesis of AKI.
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Affiliation(s)
- Lisele Maria Brasileiro-Martins
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Alexandre Vilhena Silva-Neto
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | - Felipe Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Hedylamar Marques
- Hemostasis Laboratory, Amazonas State Hematology and Hemotherapy Hospital Foundation, Manaus, 69050-001, Brazil
| | - Monica Colombini
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | - Marilaine Martins
- Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | - Fan Hui Wen
- Immunopathology Laboratory, Butantan Institute, São Paulo, 05503-900, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil
| | | | | | - Wuelton Marcelo Monteiro
- School of Health Sciences, Amazonas State University, Manaus, 69065-001, Brazil; Department of Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, 69040-000, Brazil.
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13
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Ramos MGDSN, Campos SDE, Strauch MA, Ott LC, Macieira DDB, de Alencar NX, Lessa DAB. Serum proteins and electrophoretic profile in horses undergoing crotalid venom hyperimmunization. J Equine Sci 2022; 33:31-35. [PMID: 36196141 PMCID: PMC9522620 DOI: 10.1294/jes.33.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/20/2022] [Indexed: 11/03/2022] Open
Abstract
Indisputably, the use of antivenoms for the treatment of snakebite envenoming is beneficial for the victims. However, there are few studies addressing the effect of long-term hyperimmunization in inoculated horses. It is known that the injection of snake venoms and adjuvants leads to local and systemic reactions in horses, but little is known about the response of inflammatory proteins. The aim of this study was to evaluate serum proteins and the electrophoretic profile of horses undergoing crotalid venom hyperimmunization. Twenty horses were divided into two groups: an inoculated group, comprising ten horses that were already being used for production of a Crotalus sp. antivenom, and a control group, comprising ten animals that had never been used for hyperimmunization. All animals were clinically healthy and without laboratory abnormalities. Total protein and albumin concentrations were measured in serum. Serum globulins were obtained by calculation. Plasma fibrinogen estimates were determined by the heat precipitation method. Serum proteinograms were obtained using agarose gel electrophoresis. The results revealed a significant increase in the concentrations of total serum proteins, globulins, and β-globulins in the inoculated group, exceeding the reference values. There were slight increases in the α-1- and α-2-globulin subfractions in serum-producing horses, with no statistical significance. We also observed that horses used to produce hyperimmune plasma developed hypoalbuminemia, although the decrease in albumin production was not statistically significant. Our findings suggest that the continuous use of horses to produce crotalid antivenom may lead to a chronic inflammatory stimulus, with changes in plasma levels of inflammatory proteins.
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Affiliation(s)
| | - Sabrina Destri Emmerick Campos
- Department of Pathology and Veterinary Clinics, Universidade Federal Fluminense, Niterói, 24.230-340, Rio de Janeiro, Brazil
| | | | - Leila Cardozo Ott
- Universidade de Vassouras, Vassouras, 27.700-000, Rio de Janeiro, Brazil
| | - Daniel de Barros Macieira
- Department of Pathology and Veterinary Clinics, Universidade Federal Fluminense, Niterói, 24.230-340, Rio de Janeiro, Brazil
| | - Nayro Xavier de Alencar
- Department of Pathology and Veterinary Clinics, Universidade Federal Fluminense, Niterói, 24.230-340, Rio de Janeiro, Brazil
| | - Daniel Augusto Barroso Lessa
- Department of Pathology and Veterinary Clinics, Universidade Federal Fluminense, Niterói, 24.230-340, Rio de Janeiro, Brazil
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Bibliometric Analysis of Literature in Snake Venom-Related Research Worldwide (1933–2022). Animals (Basel) 2022; 12:ani12162058. [PMID: 36009648 PMCID: PMC9405337 DOI: 10.3390/ani12162058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Around the world, snake envenomation poses a serious health risk. Proteins with pharmacological effects are present in snake venom. Recent studies elaborate snake venom and its potential application, including as a cancer drug and antibacterial substances. Our study aimed to analyze the global profile of the literature in snake venom research from documents indexed in the Scopus database between 1933 and 2022. In total, 2999 documents were published with Brazil showing the highest productivity. Antivenom, proteomics, and transcriptomics are emerging as hot topics on a global scale. The present study offers a distinctive overview of snake venom research conducted worldwide. Abstract Snake envenomation is a severe economic and health concern affecting countries worldwide. Snake venom carries a wide variety of small peptides and proteins with various immunological and pharmacological properties. A few key research areas related to snake venom, including its applications in treating cancer and eradicating antibiotic-resistant bacteria, have been gaining significant attention in recent years. The goal of the current study was to analyze the global profile of literature in snake venom research. This study presents a bibliometric review of snake venom-related research documents indexed in the Scopus database between 1933 and 2022. The overall number of documents published on a global scale was 2999, with an average annual production of 34 documents. Brazil produced the highest number of documents (n = 729), followed by the United States (n = 548), Australia (n = 240), and Costa Rica (n = 235). Since 1963, the number of publications has been steadily increasing globally. At a worldwide level, antivenom, proteomics, and transcriptomics are growing hot issues for research in this field. The current research provides a unique overview of snake venom research at global level from 1933 through 2022, and it may be beneficial in guiding future research.
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de Souza TC, Farias BES, Bernarde PS, Chiaravalotti F, Frade DDR, Brilhante AF, Melchior LAK. Temporal trend and epidemiological profile of accidents involving venomous animals in Brazil, 2007-2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022025. [PMID: 36351057 PMCID: PMC9887982 DOI: 10.1590/s2237-96222022000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend of accidents involving venomous animals in Brazil from 2007 to 2019. METHODS this was a cross-sectional study carried out with data from the Notifiable Health Conditions Information System (SINAN). Prais-Winsten linear regression was used for the temporal analysis. We calculated incidence rates according to sex and age group, relative risk and case fatality ratio. RESULTS during the study period there were 2,102,657 cases of accidents involving venomous animals. With the exception of snakebite, the remaining accidents showed a rising temporal trend in most regions of the country. Scorpion stings, snake bites and spider bites were responsible for 86% of accidents, mainly affecting male people of working age. Accidents involving snakes (0.4%) and bees (0.3%) had the highest case fatality ratios. Children were the main victims of accidents involving bees, caterpillars and "others". CONCLUSION accidents involving venomous animals showed a rising temporal trend for most conditions, as well as different epidemiological profiles.
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Affiliation(s)
- Tiago Cruz de Souza
- Universidade Federal do Acre, Programa de Pós-Graduação em Ciências
da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil
| | | | - Paulo Sérgio Bernarde
- Universidade Federal do Acre, Laboratório de Herpetologia, Cruzeiro
do Sul, AC, Brazil
| | | | | | - Andreia Fernandes Brilhante
- Universidade Federal do Acre, Programa de Pós-Graduação em Ciências
da Saúde na Amazônia Ocidental, Rio Branco, AC, Brazil
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Gimenes SNC, Sachett JAG, Colombini M, Freitas-de-Sousa LA, Ibiapina HNS, Costa AG, Santana MF, Park JJ, Sherman NE, Ferreira LCL, Wen FH, Monteiro WM, Moura-da-Silva AM, Fox JW. Observation of Bothrops atrox Snake Envenoming Blister Formation from Five Patients: Pathophysiological Insights. Toxins (Basel) 2021; 13:toxins13110800. [PMID: 34822585 PMCID: PMC8618272 DOI: 10.3390/toxins13110800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
In the Brazilian Amazon, Bothrops atrox snakebites are frequent, and patients develop tissue damage with blisters sometimes observed in the proximity of the wound. Antivenoms do not seem to impact blister formation, raising questions regarding the mechanisms underlying blister formation. Here, we launched a clinical and laboratory-based study including five patients who followed and were treated by the standard clinical protocols. Blister fluids were collected for proteomic analyses and molecular assessment of the presence of venom and antivenom. Although this was a small patient sample, there appeared to be a correlation between the time of blister appearance (shorter) and the amount of venom present in the serum (higher). Of particular interest was the biochemical identification of both venom and antivenom in all blister fluids. From the proteomic analysis of the blister fluids, all were observed to be a rich source of damage-associated molecular patterns (DAMPs), immunomodulators, and matrix metalloproteinase-9 (MMP-9), suggesting that the mechanisms by which blisters are formed includes the toxins very early in envenomation and continue even after antivenom treatment, due to the pro-inflammatory molecules generated by the toxins in the first moments after envenomings, indicating the need for local treatments with anti-inflammatory drugs plus toxin inhibitors to prevent the severity of the wounds.
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Affiliation(s)
- Sarah N. C. Gimenes
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Jacqueline A. G. Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Dermatologia Alfredo da Matta, Manaus 69065-130, AM, Brazil
| | - Mônica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Luciana A. Freitas-de-Sousa
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
| | - Hiochelson N. S. Ibiapina
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Allyson G. Costa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus 69040-010, AM, Brazil
| | - Monique F. Santana
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
- Departamento de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus 69040-010, AM, Brazil
| | - Jeong-Jin Park
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
| | - Nicholas E. Sherman
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
| | - Luiz C. L. Ferreira
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Fan H. Wen
- Núcleo de Produção de Soros, Instituto Butantan, São Paulo 05503-900, SP, Brazil;
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69050-030, AM, Brazil; (J.A.G.S.); (H.N.S.I.); (A.G.C.); (M.F.S.); (W.M.M.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
| | - Ana M. Moura-da-Silva
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo 05503-900, SP, Brazil; (S.N.C.G.); (M.C.); (L.A.F.-d.-S.)
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, AM, Brazil;
- Correspondence: (A.M.M.-d.-S.); (J.W.F.)
| | - Jay W. Fox
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA; (J.-J.P.); (N.E.S.)
- Correspondence: (A.M.M.-d.-S.); (J.W.F.)
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Potet J, Beran D, Ray N, Alcoba G, Habib AG, Iliyasu G, Waldmann B, Ralph R, Faiz MA, Monteiro WM, de Almeida Gonçalves Sachett J, di Fabio JL, Cortés MDLÁ, Brown NI, Williams DJ. Access to antivenoms in the developing world: A multidisciplinary analysis. Toxicon X 2021; 12:100086. [PMID: 34786555 PMCID: PMC8578041 DOI: 10.1016/j.toxcx.2021.100086] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.
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Affiliation(s)
- Julien Potet
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Médecins Sans Frontières, Medical Department, Operational Center Geneva, Geneva, Switzerland
| | - Abdulrazaq Garba Habib
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Science, Bayero University Kano, Nigeria
| | - Garba Iliyasu
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Science, Bayero University Kano, Nigeria
| | | | - Ravikar Ralph
- Department of Internal Medicine & Poisons Information Center, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | | | - Wuelton Marcelo Monteiro
- Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | | | | | | | - Nicholas I. Brown
- Global Snakebite Initiative, 19 Haig Street, Ashgrove, Qld, 4060, Australia
- University of Queensland, Australia
| | - David J. Williams
- Global Snakebite Initiative, 19 Haig Street, Ashgrove, Qld, 4060, Australia
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Surgical Management of Patients with Snakebite-Related Musculoskeletal Complication-A Single Institution Experience in Cambodia. World J Surg 2021; 46:54-60. [PMID: 34523046 DOI: 10.1007/s00268-021-06307-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Snakebite-related injury is a serious public health issue. In Cambodia, it is estimated that up to 21,500 cases of envenoming occurs from snakebites annually. Musculoskeletal disability is a major long-term complication associated with the injury. In this study, we aim to describe surgical management and rehabilitation in snakebite-related musculoskeletal injuries at Children's Surgical Centre, Phnom Penh, Cambodia. METHODS We conducted a retrospective case series analysis of patients with snakebite-related injury who were treated between January 1, 2002 and December 31, 2018. Surgical patients were divided into the early and late presenting groups (= < one year vs. > one year, respectively) based on their time interval from snake bite to time of presentation. RESULTS There were 88 patients who presented with snakebite-related musculoskeletal injury during the cohort study period. Majority of them were male (n = 62, 71%) and had a median age of 24 years old (IQR 17-44). The injuries were all in the upper and lower limbs though lower limb injury was more common in female patients (81% vs. 48%, Fisher's test p = 0.005). The median time interval from snakebite to time of treatment was 3 years (IQR 3 months-11 years). In this study, 65 patients received surgical interventions. An ulcerated wound was the most common symptom among the early presenting group (78% vs. 24%), while scar contracture was most common among the late group (76% vs. 22%) (Fisher's test p < 0.0001). For management, surgical debridement was the most common primary intervention for the early group (52% vs. 19%), and contracture release was the most common for patients in the late group (62% vs. 15%) (Fisher's test p = 0.0004). Overall, the postoperative complication rate was highest in the late presenting group (34% vs. 3%, Fisher's test p = 0.005). CONCLUSION More than half of the patients presented with musculoskeletal injury require surgical correction. Our study demonstrated that scar contracture is the most common complaint among the late presenting group and is associated with high postoperative complication rate.
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Maciel Salazar GK, Saturnino Cristino J, Vilhena Silva-Neto A, Seabra Farias A, Alcântara JA, Azevedo Machado V, Murta F, Souza Sampaio V, Val F, Sachett A, Bernarde PS, Lacerda M, Hui Wen F, Monteiro W, Sachett J. Snakebites in "Invisible Populations": A cross-sectional survey in riverine populations in the remote western Brazilian Amazon. PLoS Negl Trop Dis 2021; 15:e0009758. [PMID: 34499643 PMCID: PMC8454940 DOI: 10.1371/journal.pntd.0009758] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/21/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022] Open
Abstract
In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants' demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2-49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4-39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.
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Affiliation(s)
- Guilherme Kemeron Maciel Salazar
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Joseir Saturnino Cristino
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alexandre Vilhena Silva-Neto
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Altair Seabra Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - João Arthur Alcântara
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Felipe Murta
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Souza Sampaio
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Sala de Análise de Situação em Saúde, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Fernando Val
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - André Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
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20
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Duda R, Monteiro WM, Giles-Vernick T. Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation. Toxicon X 2021; 11:100077. [PMID: 34381993 PMCID: PMC8334740 DOI: 10.1016/j.toxcx.2021.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE. Central African forests are a hotspot for snakebite envenomation. SBE research in central Africa has not mobilized anthropological literatures or methodologies. Policies to reduce SBE burden in central Africa should build on participatory research. Policies to reduce SBE burden should be co-developed with local and national stakeholders.
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Affiliation(s)
- Romain Duda
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Wuelton M Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Tamara Giles-Vernick
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
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21
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Cristino JS, Salazar GM, Machado VA, Honorato E, Farias AS, Vissoci JRN, Silva Neto AV, Lacerda M, Wen FH, Monteiro WM, Sachett JAG. A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study). PLoS Negl Trop Dis 2021; 15:e0009245. [PMID: 33661895 PMCID: PMC7963098 DOI: 10.1371/journal.pntd.0009245] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.
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Affiliation(s)
- Joseir Saturnino Cristino
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Guilherme Maciel Salazar
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Vinícius Azevedo Machado
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Eduardo Honorato
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Altair Seabra Farias
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Alexandre Vilhena Silva Neto
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marcus Lacerda
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Fan Hui Wen
- Bioindustrial Centre, Butantan Institute, São Paulo, Brazil
| | - Wuelton Marcelo Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus, Brazil
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22
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Silva FS, Ibiapina HNS, Neves JCF, Coelho KF, Barbosa FBA, Lacerda MVG, Sachett JAG, Malheiro A, Monteiro WM, Costa AG. Severe tissue complications in patients of Bothrops snakebite at a tertiary health unit in the Brazilian Amazon: clinical characteristics and associated factors. Rev Soc Bras Med Trop 2021; 54:e03742020. [PMID: 33656146 PMCID: PMC8008847 DOI: 10.1590/0037-8682-0374-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION: Snakebites in the Brazilian Amazon are caused mostly by snakes from the Bothrops genus and envenomated patients may suffer from tissue complications. METHODS: This study aimed to identify risk factors for severe tissue complications (STC) in patients with Bothrops snakebite in the Amazonas state, Brazil. RESULTS: Snakebites that were classified as severe and affected female patients with comorbidities presented greater risks of developing STCs. In addition, hospitalizations of patients with STC exceeded 5 days. CONCLUSIONS: Clinical and epidemiological characteristics can prove essential for assessing the evolution of STC and clinical prognosis of patients with Bothrops snakebites.
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Affiliation(s)
- Flavio Souza Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil
| | - Hiochelson Najibe Santos Ibiapina
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Juliana Costa Ferreira Neves
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Kerolaine Fonseca Coelho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Fabiane Bianca Albuquerque Barbosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Marcus Vinicius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação Oswaldo Cruz, Instituto de Pesquisas Leônidas e Maria Deane, Manaus, AM, Brasil
| | - Jacqueline Almeida Gonçalves Sachett
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação Alfredo da Matta, Diretoria de Ensino e Pesquisa, Manaus, AM, Brasil
| | - Adriana Malheiro
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Diretoria de Ensino e Pesquisa, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Manaus, AM, Brasil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Allyson Guimarães Costa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Instituto de Pesquisa Clínica Carlos Borborema, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil.,Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Diretoria de Ensino e Pesquisa, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Manaus, AM, Brasil.,Universidade do Estado do Amazonas, Programa de Pós-Graduação em Ciências Aplicadas à Hematologia, Manaus, AM, Brasil
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23
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Sanchez-Castro EE, Pajuelo-Reyes C, Tejedo R, Soria-Juan B, Tapia-Limonchi R, Andreu E, Hitos AB, Martin F, Cahuana GM, Guerra-Duarte C, de Assis TCS, Bedoya FJ, Soria B, Chávez-Olórtegui C, Tejedo JR. Mesenchymal Stromal Cell-Based Therapies as Promising Treatments for Muscle Regeneration After Snakebite Envenoming. Front Immunol 2021; 11:609961. [PMID: 33633730 PMCID: PMC7902043 DOI: 10.3389/fimmu.2020.609961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Snakebite envenoming is a global neglected disease with an incidence of up to 2.7 million new cases every year. Although antivenoms are so-far the most effective treatment to reverse the acute systemic effects induced by snakebite envenoming, they have a limited therapeutic potential, being unable to completely neutralize the local venom effects. Local damage, such as dermonecrosis and myonecrosis, can lead to permanent sequelae with physical, social, and psychological implications. The strong inflammatory process induced by snake venoms is associated with poor tissue regeneration, in particular the lack of or reduced skeletal muscle regeneration. Mesenchymal stromal cells (MSCs)-based therapies have shown both anti-inflammatory and pro-regenerative properties. We postulate that using allogeneic MSCs or their cell-free products can induce skeletal muscle regeneration in snakebite victims, improving all the three steps of the skeletal muscle regeneration process, mainly by anti-inflammatory activity, paracrine effects, neovascularization induction, and inhibition of tissue damage, instrumental for microenvironment remodeling and regeneration. Since snakebite envenoming occurs mainly in areas with poor healthcare, we enlist the principles and potential of MSCs-based therapies and discuss regulatory issues, good manufacturing practices, transportation, storage, and related-procedures that could allow the administration of these therapies, looking forward to a safe and cost-effective treatment for a so far unsolved and neglected health problem.
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Affiliation(s)
| | - Cecilia Pajuelo-Reyes
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
| | - Rebeca Tejedo
- Faculty of Medicine, Universidad Privada San Juan Bautista, Lima, Peru
| | - Bárbara Soria-Juan
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Surgery, Fundación Jiménez Díaz, Unidad de Terapias Avanzadas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Tapia-Limonchi
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
| | - Etelvina Andreu
- ISABIAL-Hospital General y Universitario de Alicante, Alicante, Spain.,Departmento de Fisica Aplicadas, University Miguel Hernández, Alicante, Spain
| | - Ana B Hitos
- Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Franz Martin
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Gladys M Cahuana
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain
| | - Clara Guerra-Duarte
- Center of Research and Development, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Thamyres C Silva de Assis
- Departament of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Francisco J Bedoya
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Soria
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,ISABIAL-Hospital General y Universitario de Alicante, Alicante, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain.,Institute of Bioengineering, University Miguel Hernandez de Elche, Alicante, Spain
| | - Carlos Chávez-Olórtegui
- Departament of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juan R Tejedo
- Institute of Tropical Diseases, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru.,Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain.,Department of Cell Regeneration and Advanced Therapies, Andalusian Center of Molecular Biology and Regenerative Medicine-CABIMER, University of Pablo de Olavide-University of Sevilla-CSIC, Seville, Spain.,Biomedical Research Network for Diabetes and Related Metabolic Diseases-CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain
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24
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Das S, Banerjee S, Naskar S, Das DK. Care-seeking behaviour of suspected snakebite cases admitted in a medical college of West Bengal: A pathway analysis. Med J Armed Forces India 2021; 77:58-62. [PMID: 33487867 PMCID: PMC7809565 DOI: 10.1016/j.mjafi.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/22/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Snakebite is a time decisive medical emergency requiring contact with health facility at the earliest. Many snakebite victims yet seek care from traditional healers (THs) or village quacks (VQs) before reaching an appropriate facility, which leads to adverse consequences. This study was conducted to assess care-seeking behaviour and pathways followed in reaching appropriate facilities among suspected snakebite cases and to identify associated factors. METHODS A hospital-based cross-sectional study was conducted at a medical college in West Bengal. All suspected snakebite cases admitted during a reference period of two months were studied. Study subjects and/or accompanying persons were interviewed for care-seeking behaviours and pathways followed. RESULTS Among the 393 study participants, most were ≤30 years of age, men, agricultural workers, of lower middle and lower socioeconomic class and only 69.5% had formal schooling. The commonest place of occurrence was the agricultural field (40.7%), and the commonest biting site was the lower extremity (77.6%). Only half of participants (55.2%) used immediate correct measures at the biting site. Incorrect practices included tourniquet application (29.5%), use of herbal preparation (7.1%), blade shaving at site (2.8%) etc. As first care-seeking points, 15% and 24.9% of cases visited THs and VQs, respectively. Pathway analysis revealed that unfavourable pathway was followed by 39.9% participants. Two unfavourable points were consulted by 3.8% of participants. The care-seeking pathway was significantly associated with religion, caste, education and socioeconomic class. CONCLUSIONS Findings of this study highlight the urgent need for behaviour change interventions addressing the myths and misconceptions of people regarding snakebite.
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Affiliation(s)
- Suman Das
- Resident (Community Medicine), Burdwan Medical College, West Bengal, India
| | - Sitikantha Banerjee
- Resident (Community Medicine), All India Institute of Medical Sciences, Nagpur, India
| | - Somnath Naskar
- Assistant Professor (Community Medicine), Burdwan Medical College, West Bengal, India
| | - Dilip K. Das
- Professor & Head (Community Medicine), Burdwan Medical College, West Bengal, India
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25
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Monteiro WM, de Farias AS, Val F, Neto AVS, Sachett A, Lacerda M, Sampaio V, Cardoso D, Garnelo L, Vissoci JRN, Sachett J, Wen FH. Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: 'Every Life Has Equal Value'. Toxins (Basel) 2020; 12:toxins12120772. [PMID: 33291444 PMCID: PMC7762137 DOI: 10.3390/toxins12120772] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
Snakebites are more frequent in the Brazilian Amazon than in other parts of Brazil, representing a high cost for the health system since antivenoms are only available through medical prescription from central municipal hospitals in most cases. The need for a cold chain and physicians usually restricts access to the only effective treatment of a snakebite, the antivenom. The complex topography of the rivers contributes to delays in treatment, and consequently increases the risk of severe complications, chronic sequelae and death. Thus, decentralization of antivenom treatment to primary healthcare facilities in the interior would increase access by indigenous population groups to proper healthcare. To standardize and evaluate the decentralization to low complexity indigenous healthcare units, we suggest the (i) development and validation of standardized operational procedures, (ii) training of professionals in the validated protocol in a referral health unit, (iii) implementation of the protocol in an indigenous healthcare unit, (iv) assessment of perceptions towards and acceptability of the protocol, and (v) estimation of the impact of the protocol's implementation. We expect that antivenom decentralization would shorten the time between diagnosis and treatment and, as such, improve the prognosis of snakebites. As health cosmology among indigenous populations has an important role in maintaining their way of life, the introduction of a new therapeutic strategy to their customs must take into account the beliefs of these peoples. Thus, antivenom administration would be inserted as a crucial therapeutic tool in a world of diverse social, natural and supernatural representations. The information presented here also serves as a basis to advocate for support and promotion of health policy initiatives focused on evidence-based care in snakebite management.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Altair Seabra de Farias
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Fernando Val
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Alexandre Vilhena Silva Neto
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - André Sachett
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Marcus Lacerda
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus 69057-070, Amazonas, Brazil;
| | - Vanderson Sampaio
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
- Technical Department, Amazonas Health Surveillance Foundation, Manaus 69093-018, Amazonas, Brazil;
| | - Deugles Cardoso
- Technical Department, Amazonas Health Surveillance Foundation, Manaus 69093-018, Amazonas, Brazil;
| | - Luiza Garnelo
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus 69057-070, Amazonas, Brazil;
| | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery and Duke Global Health Institute, Duke University, Durham, NC 27710, USA;
| | - Jacqueline Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065-130, Amazonas, Brazil
| | - Fan Hui Wen
- Bioindustrial Centre, Butantan Institute, Butantã 05503-900, São Paulo, Brazil
- Correspondence:
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26
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Ganança PHS, Fraga RD, Vasconcelos Neto LBD, Santos Júnior APD. A case report of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei Bailey, Thomas & Silva-Jr, 2005. Rev Soc Bras Med Trop 2020; 54:e20200194. [PMID: 33206870 PMCID: PMC7723376 DOI: 10.1590/0037-8682-0194-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022] Open
Abstract
We present a case of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei. A 26-year-old man was bitten on the right hand and was not medicated. Bleeding lasted a few seconds, while paresthesia, chills, and headache persisted for up to 10 hours. The pain disappeared after a week, and the edema, itching, and prickling persisted for another 3 days. Although this patient’s symptoms were typical of bites by South American opisthoglyphous snakes, they persisted longer than those of bites by some congeneric species. Our report adds a species to the list of medically relevant snakes.
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Affiliation(s)
- Pedro Henrique Salomão Ganança
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
| | - Rafael de Fraga
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Programa de Pós-graduação em Recursos Naturais da Amazônia, Santarém, PA, Brasil
| | - Lourival Baía de Vasconcelos Neto
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
| | - Alfredo Pedroso Dos Santos Júnior
- Universidade Federal do Oeste do Pará, Instituto de Ciências da Educação, Laboratório de Ecologia e Comportamento Animal, Santarém, PA, Brasil.,Universidade Federal do Oeste do Pará, Instituto de Ciências e Tecnologia das Águas, Programa de Pós-Graduação em Biodiversidade, Santarém, PA, Brasil
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Bisneto PF, Araújo BDS, Pereira HDS, Mendonça da Silva I, Sachett JDAG, Bernarde PS, Monteiro WM, Kaefer IL. Envenomations by coral snakes in an Amazonian metropolis: Ecological, epidemiological and clinical aspects. Toxicon 2020; 185:193-202. [PMID: 32710896 DOI: 10.1016/j.toxicon.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Envenomation by coral snakes represents a little known burden in Brazilian Amazonia. So far, details on clinical and epidemiological aspects remain obscure in the region. We gathered data from medical charts and from the scientific collection of snakes from Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, finding 26 cases of envenomation by five species of Micrurus in Manaus region, between 1987 and 2018. They represent 0.7% of the snakebites treated in the hospital since the records began, in 1979. Micrurus lemniscatus was responsible for most of the bites (10), followed by M. hemprichii (five), M. spixii (three), M. surinamensis (three) and M. averyi (one). There was no difference between the sexes of the snakes that caused bites. Patients were mostly males, and most of the cases were reported in urban areas. Bites predominated in dry season, and there was a clear geographical segregation among species. We describe seven cases of envenomation, three mild and four severe, all of which evolved to cure. Paresthesia (six), pain (five) and edema (four) were the most common local symptoms. Systemic features such as dyspnea/shallow breath (four), palpebral ptosis (four), blurred vision (three), dysarthria (three) and difficulty to walk (three) were also detected. Two patients bitten by Micrurus sp. and M. hemprichii, showed slight increased serum levels of creatine kinase (reference level <190 U/L), 1184 U/L and 1229 U/L, respectively, indicative of mild systemic myotoxicity. This is the first report of myotoxic manifestation in the envenomation by M. hemprichii. No patient developed respiratory failure, though one bitten by an adult M. spixii required intubation and mechanical ventilation due to decreased level of consciousness during evolution, probably related to induced sedation caused by concurrent alcohol intoxication. All patients were treated with Brazilian Micrurus antivenom (soro antielapídico, median = 10 vials). Six patients were pretreated intravenously with H1 and H2 antagonists and steroids, with two patients developing early adverse reactions. The median length of hospital stay was four days. Envenomations by coral snakes in Manaus region are clinically severe, but rare and sparsely distributed over time, making the detection of epidemiological and clinical patterns a challenge for public health.
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Affiliation(s)
- Pedro Ferreira Bisneto
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil.
| | - Bruno Dos Santos Araújo
- Faculdade Estácio do Amazonas, Av. Constantino Nery, 3693, Chapada, 69050-001, Manaus, Amazonas, Brazil
| | | | - Iran Mendonça da Silva
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação Alfredo da Matta - FUAM, Diretoria de Ensino e Pesquisa, Av. Codajás, 24, Cachoeirinha, 69065-130, Manaus, Amazonas, Brazil
| | - Paulo Sérgio Bernarde
- Universidade Federal do Acre - UFAC, Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Estrada do Canela Fina, Km 12, 69980-000, Cruzeiro do Sul, Acre, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas - UEA, Escola Superior de Ciências da Saúde, Programa de Pós-Graduação em Medicina Tropical, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado - FMT-HVD, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, 25, Dom Pedro, 69040-000, Manaus, Amazonas, Brazil
| | - Igor Luis Kaefer
- Universidade Federal do Amazonas - UFAM, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Zoologia, Av. General Rodrigo Octavio, 1200, Coroado I, 69067-005, Manaus, Amazonas, Brazil
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Oliveira LPD, Moreira JGDV, Sachett JDAG, Monteiro WM, Meneguetti DUDO, Bernarde PS. Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon. Rev Soc Bras Med Trop 2020; 53:e20200214. [PMID: 32997051 PMCID: PMC7523524 DOI: 10.1590/0037-8682-0214-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/17/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.
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Affiliation(s)
- Laiane Parente de Oliveira
- Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brasil
| | | | | | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Dionatas Ulises de Oliveira Meneguetti
- Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brasil.,Universidade Federal do Acre, Colégio de Aplicação, Rio Branco, AC, Brasil
| | - Paulo Sérgio Bernarde
- Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brasil.,Universidade Federal do Acre, Campus Floresta, Centro Multidisciplinar, Laboratório de Herpetologia, Cruzeiro do Sul, AC, Brasil
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29
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Silva JLD, Fonseca WLD, Mota da Silva A, Amaral GLGD, Ortega GP, Oliveira ADS, Correa RR, Oliveira I, Monteiro WM, Bernarde PS. Venomous snakes and people in a floodplain forest in the Western Brazilian Amazon: Potential risks for snakebites. Toxicon 2020; 187:232-244. [PMID: 32979388 DOI: 10.1016/j.toxicon.2020.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/17/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
People who live in rural or forested areas are more likely to be affected by snakebites, due to their presence in the natural habitat of snakes and due to activities such as extractivism and agriculture. To conduct an ethnobiological study regarding the knowledge related to venomous snakes, snakebites and the attitudes of people who frequent areas of floodplain forests in the Alto Juruá (Brazilian Amazon), and correlate this information with data on snakebites in the region and the ecology of the ophiofauna, 100 residents, who are actively involved in extractivism, fishing, or hunting in the forests of the region were interviewed. Boards with photographs of venomous snakes from the region were used to ask questions about their experiences. The sampling of snakes was carried on trails in a forest used by residents of the region in their extractivism activities. Four venomous species (Bothrops atrox, B. bilineatus smaragdinus, Micrurus lemniscatus and M. surinamensis) were recorded. Among the interviewees, 31% claimed that they had already suffered at least one snakebite. The B. atrox snake is the species that the inhabitants encounter most and the one that is most associated with snakebites. Bothrops b. smaragdinus was the most common snake found during the search. Regarding accident prevention, 60% of them reported wearing boots when walking in the forest. In relation to practices adopted after a bite, the majority stated that they would seek medical attention; however, many reported using first aid measures that would not be medically effective for the victim's recovery. Despite B. b. smaragdinus being the most common snake found by researchers, it is responsible for very few snakebites. This is probably due to its arboreal habits, since it is found at a higher than average height (6.3 m) which is much higher than the height of a human being. The surveyed population demonstrated knowledge of the main preventive measures against snakebites, although some inadequate and/or ineffective first aid measures are still adopted.
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Affiliation(s)
- Jéssica Lima da Silva
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil; Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, Acre, Brazil
| | - Wirven Lima da Fonseca
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário - BR 364, Rio Branco, Acre, Brazil
| | - Ageane Mota da Silva
- Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário - BR 364, Rio Branco, Acre, Brazil; Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, Acre, Brazil
| | - Gardênia Lima Gurgel do Amaral
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil
| | - Givanildo Pereira Ortega
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário - BR 364, Rio Branco, Acre, Brazil
| | - Andesson de Souza Oliveira
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil
| | - Radraque Rodrigues Correa
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil
| | - Igor Oliveira
- Laboratório de Pesquisa em Etnociências, Ecologia e Conservação (EtnoLab), Centro de Educação e Letras, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil; Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário - BR 364, Rio Branco, Acre, Brazil.
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30
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Diniz-Sousa R, Moraes JDN, Rodrigues-da-Silva TM, Oliveira CS, Caldeira CADS. A brief review on the natural history, venomics and the medical importance of bushmaster ( Lachesis) pit viper snakes. Toxicon X 2020; 7:100053. [PMID: 32793880 PMCID: PMC7408722 DOI: 10.1016/j.toxcx.2020.100053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022] Open
Abstract
Snakes of the genus Lachesis, commonly known as bushmasters, are the largest venomous snakes in the Americas. Because these snakes have their habitats in areas of remote forests they are difficult to find, and consequently there are few studies of Lachesis taxa in their natural ecosystems. Bushmasters are distributed in tropical forest areas of South and Central America. In Brazil they can be found in the Amazon Rainforest and the Atlantic Forest. Despite the low incidence of cases, laquetic envenoming causes severe permanent sequelae due to the high amount of inoculated venom. These accidents are characterized by local pain, hemorrhage and myonecrosis that can be confused with bothropic envenomings. However, victims of Lachesis bites develop symptoms characteristic of Lachesis envenoming, known as vagal syndrome. An important message of this bibliographic synthesis exercise is that, despite having the proteomic profiles of all the taxa of the genus available, very few structure-function correlation studies have been carried out. Therefore the motivation for this review was to fill a gap in the literature on the genus Lachesis, about which there is no recent review. Here we discuss data scattered in a number of original articles published in specialized journals, spanning the evolutionary history and extant phylogeographic distribution of the bushmasters, their venom composition and diet, as well as the pathophysiology of their bites to humans and the biological activities and possible biotechnological applicability of their venom toxins.
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Affiliation(s)
- Rafaela Diniz-Sousa
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
- Sao Lucas University Center (UniSL), Porto Velho, RO, Brazil
| | - Jeane do N. Moraes
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | | | - Cláudia S. Oliveira
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
| | - Cleópatra A. da S. Caldeira
- Center for the Study of Biomolecules Applied to Health (CEBio), Oswaldo Cruz Foundation Rondônia, Porto Velho, RO, Brazil
- Graduate Program in Experimental Biology (PGBIOEXP), Federal University of Rondônia (UNIR), Porto Velho, RO, Brazil
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31
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Rudresha GV, Manjuprasanna VN, Urs AP, Choudhury M, Rajaiah R, Vishwanath BS. Serine protease from Tricosanthus tricuspidata accelerates healing of Echis carinatus venom-induced necrotic wound. Toxicon 2020; 183:1-10. [DOI: 10.1016/j.toxicon.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
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The relationship between clinics and the venom of the causative Amazon pit viper (Bothrops atrox). PLoS Negl Trop Dis 2020; 14:e0008299. [PMID: 32511239 PMCID: PMC7302866 DOI: 10.1371/journal.pntd.0008299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/18/2020] [Accepted: 04/16/2020] [Indexed: 11/26/2022] Open
Abstract
Snake venoms are complex mixtures of proteins with toxic activities, with many distinct isoforms, affecting different physiological targets, comprised in a few protein families. It is currently accepted that this diversity in venom composition is an adaptive advantage for venom efficacy on a wide range of prey. However, on the other side, variability on isoforms expression has implications in the clinics of human victims of snakebites and in the efficacy of antivenoms. B. atrox snakes are responsible for most of the human accidents in Brazilian Amazon and the type and abundance of protein families on their venoms present individual variability. Thus, in this study we attempted to correlate the individual venom proteome of the snake brought to the hospital by the patient seeking for medical assistance with the clinical signs observed in the same patient. Individual variability was confirmed in venoms of the 14 snakes selected for the study. The abundance of each protein family was quite similar among the venom samples, while the isoforms composition was highly variable. Considering the protein families, the SVMP group presented the best correlation with bleeding disorders and edema. Considering individual isoforms, some isoforms of venom metalloproteinase (SVMP), C-type lectin-like toxins (CTL) and snake venom serine proteinases (SVSP) presented expression levels that with statistically significant positive correlation to signs and symptoms presented by the patients as bleeding disorders, edema, ecchymosis and blister formation. However, some unexpected data were also observed as the correlation between a CTL, CRISP or LAAO isoforms with blister formation, still to be confirmed with a larger number of samples. Although this is still a small number of patient samples, we were able to indicate that venom composition modulates clinical manifestations of snakebites, to confirm at the bedside the prominent role of SVMPs and to include new possible toxin candidates for the development of toxin inhibitors or to improve antivenom selectiveness, important actions for the next generation treatments of snakebites. Bothrops atrox is a snake of major medical importance in the Amazon. Its venom is specialized to kill preys in the nature, especially because of coagulotoxic and proteolytic activities. B. atrox envenomings cause local inflammation and, in a significant proportion, systemic manifestations, namely bleeding disorders. These signs and symptoms are caused by the various toxins present in the venom of this snake, which act in the organism by different mechanisms. It is not known to what extent the composition of the venom that was inoculated by the snake that caused the envenoming can influence the patient’s clinical condition. To study this subject, this work correlated the constituents of the venom with the clinical manifestations of hospitalized patients, taking advantage of the fact that many patients bring the snake responsible for the bite. The abundance of each toxin family was similar among the venom samples, but the variants composition of each toxin was highly variable. Considering the protein families, a group named metalloproteases (SVMP) presented the best correlation with bleeding disorders and edema. Some variants of venom SVMPs, and other toxin families, such as C-type lectin-like toxins (CTL) and snake venom serine proteinases (SVSP) presented correlation to signs and symptoms presented by the patients as bleeding disorders, edema, ecchymosis and blister formation. Our results show that venom composition modulates clinical manifestations of snakebites.
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Monteiro WM, Contreras-Bernal JC, Bisneto PF, Sachett J, Mendonça da Silva I, Lacerda M, Guimarães da Costa A, Val F, Brasileiro L, Sartim MA, Silva-de-Oliveira S, Bernarde PS, Kaefer IL, Grazziotin FG, Wen FH, Moura-da-Silva AM. Bothrops atrox, the most important snake involved in human envenomings in the amazon: How venomics contributes to the knowledge of snake biology and clinical toxinology. Toxicon X 2020; 6:100037. [PMID: 32550592 PMCID: PMC7285970 DOI: 10.1016/j.toxcx.2020.100037] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 01/22/2023] Open
Abstract
Bothrops atrox snakes are mostly endemic of the Amazon rainforest and is certainly the South American pit viper responsible for most of the snakebites in the region. The composition of B. atrox venom is significantly known and has been used to trace the relevance of the venom phenotype for snake biology and for the impacts in the clinics of human patients involved in accidents by B. atrox. However, in spite of the wide distribution and the great medical relevance of B. atrox snakes, B. atrox taxonomy is not fully resolved and the impacts of the lack of taxonomic resolution on the studies focused on venom or envenoming are currently unknown. B. atrox venom presents different degrees of compositional variability and is generally coagulotoxic, inducing systemic hematological disturbances and local tissue damage in snakebite patients. Antivenoms are the effective therapy for attenuating the clinical signs. This review brings a comprehensive discussion of the literature concerning B. atrox snakes encompassing from snake taxonomy, diet and venom composition, towards clinical aspects of snakebite patients and efficacy of the antivenoms. This discussion is highly supported by the contributions that venomics and antivenomics added for the advancement of knowledge of B. atrox snakes, their venoms and the treatment of accidents they evoke.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jorge Carlos Contreras-Bernal
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Pedro Ferreira Bisneto
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Iran Mendonça da Silva
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Manaus, Brazil
| | - Allyson Guimarães da Costa
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | - Fernando Val
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Lisele Brasileiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | - Sâmella Silva-de-Oliveira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil
| | - Igor L. Kaefer
- Programa de Pós-Graduação em Zoologia, Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Manaus, Brazil
| | | | | | - Ana Maria Moura-da-Silva
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Butantan, São Paulo, Brazil
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34
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Sachett JDAG, Val FF, Alcântara JA, Cubas-Vega N, Montenegro CS, da Silva IM, de Souza TG, Santana MF, Ferreira LCL, Monteiro WM. Bothrops atrox Snakebite: How a Bad Decision May Lead to a Chronic Disability: A Case Report. Wilderness Environ Med 2020; 31:317-323. [PMID: 32456876 DOI: 10.1016/j.wem.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.
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Affiliation(s)
| | - Fernando F Val
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - João A Alcântara
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Nadia Cubas-Vega
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Iran M da Silva
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Monique F Santana
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Luiz C L Ferreira
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton M Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Assessing the Increase of Snakebite Incidence in Relationship to Flooding Events. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020. [DOI: 10.1155/2020/6135149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Snakebite envenoming causes up to 138,000 deaths and 400,000 permanently disabled victims worldwide every year. Flooding is one of the many factors that seems to influence the incidence of snakebite. The catastrophic floods from late 2018 in Kerala (India) were widely broadcast and are an example of how flooding events are related to the increased incidence of snakebite. This relationship has been mentioned regularly in scientific and grey literature, but usually quite scarcely in comparison to other topics linked to snakebite. Additionally, web media, mobile communications, and social media have started playing an important role not only in providing access to information on flooding-related snakebite events, but also in snakebite prevention at a larger scale. In order to better understand to what extent the relationship between snakebite incidence and flooding is reported and quantified and appraise the importance of mobile communications and social media in snakebite prevention and management, we performed multiple searches in generic (Google) and specialized (PubMed, Web of Science, Google Scholar) databases. We retrieved 68 scientific articles and 5 reports ranging from 1892 to 2018 mentioning or analyzing flooding and the increased incidence of snakebite. Additionally, we found 68 web media reports linking flooding and snakebite. This review indicates that the increase of snakebite incidence due to flooding has been repeatedly observed all over the world. This phenomenon could be exacerbated because of climate change, which is expected to increase the overall magnitude and frequency of flooding. However, it could also be mitigated by the role the Internet, mobile communications, and social media could play in snakebite prevention and human and animal rescue strategies during flooding.
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Magalhães SFV, Peixoto HM, Moura N, Monteiro WM, de Oliveira MRF. Snakebite envenomation in the Brazilian Amazon: a descriptive study. Trans R Soc Trop Med Hyg 2020; 113:143-151. [PMID: 30476298 DOI: 10.1093/trstmh/try121] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/05/2018] [Accepted: 10/30/2018] [Indexed: 02/01/2023] Open
Abstract
Snakebite envenomation in the Brazilian Amazon is a recognized public health problem that does not receive the appropriate attention from key stakeholders. The morbidity rate is relevant, but still underestimated. Thus, the present study updates the current state of knowledge on snakebite envenomation in the Brazilian Amazon. It follows a descriptive method and contributes new knowledge about the dynamics of snakebites and the associated morbidity and mortality reported in the Brazilian Amazon. The study is based on information from cases registered and retrieved from the Brazilian Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação-SINAN). The registers we studied covers a period of six years, 2010-2015. Most snakebites occurred in the states of Pará (30 693 cases, 43.34%) and Amazonas (9386 cases, 13.25%), with a higher prevalence in males of an economically active age. The main genus involved in bites was Bothrops sp. The mortality rate was 0.24 per hundred thousand and the case fatality rate was 0.51%. Although low case fatality and mortality rates were observed, much can still be done to prevent snakebites as they continue to be a serious public health problem considering the severity and potentially high economic impact for the individual and to society.
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Affiliation(s)
- Samara Freire Valente Magalhães
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil
| | - Henry Maia Peixoto
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil.,Institute of Health Technology Assessment of the National Council for Scientific and Technological Development (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Noely Moura
- Ministry of Health. Radio and TV Department (SRTV) 701, via W5 Norte. Edf. PO700 -6th floor
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, número 25, Dom Pedro, Manaus-AM, Brazil.,Universidade do Estado do Amazonas (UEA), Av. Pedro Teixeira, 25, Dom Pedro, Manaus-AM, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical (Tropical Medicine Centre), Universidade de Brasília (UnB), University Campus Darcy Ribeiro, Asa Norte, Brasília-DF, Brazil.,Institute of Health Technology Assessment of the National Council for Scientific and Technological Development (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil
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Bisneto PF, Alcântara JA, Mendonça da Silva I, de Almeida Gonçalves Sachett J, Bernarde PS, Monteiro WM, Kaefer IL. Coral snake bites in Brazilian Amazonia: Perpetrating species, epidemiology and clinical aspects. Toxicon 2020; 175:7-18. [DOI: 10.1016/j.toxicon.2019.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
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Bhaumik S, Norton R, Jagnoor J. Burden and risk factors for snakebite in India: protocol for a systematic review. F1000Res 2020; 9:25. [PMID: 32399199 PMCID: PMC7194469 DOI: 10.12688/f1000research.21924.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 03/29/2024] Open
Abstract
Introduction: Snakebites are a neglected tropical disease with a high burden in South and South-East Asia and sub-Saharan Africa. In 2019, the World Health Organization (WHO) released a roadmap which aims for a 50% reduction in death and disability due to snakebite globally by 2030. It is estimated that India has the highest number of snakebite deaths in the world. Objective: To synthesize evidence on the burden (incidence/ prevalence, mortality, morbidity, health facility and economic), and risk factors for snakebite in India. Methods: We will search for peer-reviewed literature and grey literature in six electronic databases (MEDLINE, EMBASE, Global Health, PsychInfo, CENTRAL, SafetyLit) and hand-search IndMed, conference abstracts, relevant websites and citation tracking. Two reviewers will screen and extract data independently with a third reviewer acting as an arbiter for any inconsistencies. Quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. For burden, data from facility based and community-based studies will be synthesised and reported separately, except in the case of studies conducted concurrently. We will conduct narrative analyses with the aim of understanding patterns in data through tabulation for both burden and risk factors evidence synthesis. The PROGRESS Plus lens will be used to explore equity pertaining to burden of snakebites. Analyses for each individual risk factor-outcome pair will be conducted and reported separately. If appropriate, meta-analyses will be conducted as per JBI guidelines, assessing heterogeneity using Tau-squared, Cochran's Q test and Chi-squared (p > 0.05) tests. We plan to conduct sub-group analyses based on setting, study design, sex/gender, age-groups, tribal people and occupation. A funnel plot will be generated if there are more than nine studies included in a specific meta-analysis, to assess publication bias. Asymmetry of the funnel plot will be adjudged using the Egger, Begg and Harbord tests.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
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Bhaumik S, Norton R, Jagnoor J. Burden and risk factors for snakebite in India: protocol for a systematic review. F1000Res 2020; 9:25. [PMID: 32399199 PMCID: PMC7194469 DOI: 10.12688/f1000research.21924.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Snakebite is a neglected tropical disease with a high burden in South and South-East Asia and sub-Saharan Africa. In 2019, the World Health Organization (WHO) released a roadmap which aims for a 50% reduction in death and disability due to snakebite globally by 2030. It is estimated that India has the highest number of snakebite deaths in the world. Objective: To synthesize evidence on the burden (incidence/ prevalence, mortality, morbidity, health facility and economic), and risk factors for snakebite in India. Methods: We will search for peer-reviewed literature and grey literature in six electronic databases (MEDLINE, EMBASE, Global Health, PsychInfo, CENTRAL, SafetyLit) and hand-search IndMed, conference abstracts, relevant websites and citation tracking. Two reviewers will screen and extract data independently with a third reviewer acting as an arbiter for any inconsistencies. Quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. For burden, data from facility based and community-based studies will be synthesised and reported separately, except for studies conducted concurrently. We will conduct meta-analysis for community-based studies at state-level for incidence/prevalence, mortality and morbidity , if appropriate. The PROGRESS Plus lens will be used to explore equity . Analyses for each individual risk factor-outcome pair will be conducted and reported separately. If appropriate, meta-analyses will be conducted as per JBI guidelines, assessing heterogeneity using Tau-squared, Cochran's Q test and Chi-squared (p > 0.05) tests. We plan to conduct sub-group analyses based on pre-specific parameters. A funnel plot will be generated if there are more than nine studies included in a specific meta-analysis, to assess publication bias When meta-analysis is not appropriate, structured tabulation of results across studies and/or by vote counting based on the direction of effect as per guidelines in the Cochrane Handbook.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
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Silva JLD, Siva AMD, Amaral GLGD, Ortega G, Monteiro WM, Bernarde PS. The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia. Rev Soc Bras Med Trop 2019; 53:e20190305. [PMID: 31859953 PMCID: PMC7083381 DOI: 10.1590/0037-8682-0305-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation. METHODS We interviewed 100 villagers who were active in the forests. RESULTS Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species. CONCLUSIONS The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.
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Affiliation(s)
- Jessyca Lima da Silva
- Universidade Federal do Acre, Campus Floresta, Centro Multidisciplinar, Laboratório de Herpetologia, Cruzeiro do Sul, AC, Brasil.,Universidade Federal do Acre, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde na Amazônia Ocidental, Rio Branco, AC, Brasil
| | - Ageane Mota da Siva
- Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, AC, Brasil.,Universidade Federal do Acre, Programa de Pós-Graduação Bionorte, Rio Branco, AC, Brasil
| | - Gardênia Lima Gurgel do Amaral
- Universidade Federal do Acre, Campus Floresta, Centro Multidisciplinar, Laboratório de Herpetologia, Cruzeiro do Sul, AC, Brasil
| | - GivanildoPereira Ortega
- Universidade Federal do Acre, Campus Floresta, Centro Multidisciplinar, Laboratório de Herpetologia, Cruzeiro do Sul, AC, Brasil.,Universidade Federal do Acre, Programa de Pós-Graduação Bionorte, Rio Branco, AC, Brasil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Paulo Sérgio Bernarde
- Universidade Federal do Acre, Campus Floresta, Centro Multidisciplinar, Laboratório de Herpetologia, Cruzeiro do Sul, AC, Brasil
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da Silva AM, Colombini M, Moura-da-Silva AM, de Souza RM, Monteiro WM, Bernarde PS. Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia. Toxicon 2019; 171:66-77. [PMID: 31628968 DOI: 10.1016/j.toxicon.2019.10.238] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/31/2019] [Accepted: 10/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Alto Juruá region, located in the extreme western part of the Brazilian Amazonia, possesses an indigenous and riverine population which is involved in agricultural and forest extraction activities, and is a region that stands out for its high incidence of snakebites. OBJECTIVES To assess the attitudes of the victims, the characteristics of the snakes and the circumstances of the snakebites which occurred in a region where human populations are highly exposed to snakes. METHODS The study was conducted at the Regional Hospital of Juruá in the Municipality of Cruzeiro do Sul (Acre), which regularly attends victims of snakebites in the Alto Juruá region. The snakes that caused the envenomations were identified from clinical and epidemiological diagnosis of the symptoms and signs that patients presented during hospital, and by enzyme immunoassay for venom detection using serum samples of the patients, or by identification of the snake responsible for the envenomation when it was taken to the hospital or photographed. People who suffered or witnessed the snakebite were interviewed to assess the circumstances of the bite, the attitude adopted after the accident and whether they recognized the species of snake that caused the envenomation. RESULTS There were 133 cases of snakebite (76.24/100.000 inhabitants), mainly involving male individuals living in the rural area and who had a low level of education. The most affected groups were farmers (48%) and children and teenagers (39%). It was observed that 8.3% of them presented a history of recurrence for bites. The lower limbs were the most affected anatomical region (84%). The Bothrops atrox snake, mainly small specimens (mostly juveniles), was the main species involved in the envenomations (83.4%). Snakebites occurred mainly in forest areas, backyards of houses in rural areas and near to aquatic environments, during activities (walking, farming, extractivism, hunting). Most of the time, the snake was on the ground and the bite occurred because of the approximation of the individual, either by trampling or by approximation of a hand. Half of the victims performed some kind of inadequate first aid (not drinking water, use of tourniquet, incision at the site of the bite, use of black stone, drinking a compound "Específico Pessoa"). CONCLUSIONS Snakebite is an important cause of morbidity in the Alto Juruá region. Bothrops bites are mostly caused by small-sized specimens, probably due to the greater abundance of B. atrox juveniles, and also because small snakes are more difficult for people to see. People are more often bitten on the lower limbs probably due to the size of B. atrox (small and medium) and because the snakes are usually on the ground in most situations. Many victims resort to ineffective actions that can cause complications and also delay serotherapy. A low level of education is a factor that may contribute to worse outcomes in snakebites since it is associated with a lack of knowledge of preventive and first aid measures.
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Affiliation(s)
- Ageane Mota da Silva
- Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, Acre, Brazil; Programa de Pós-Graduação Bionorte, Universidade Federal do Acre, Campus Universitário, BR 364, Rio Branco, Acre, Brazil
| | - Mônica Colombini
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brazil
| | | | - Rodrigo Medeiros de Souza
- Laboratório de Microbiologia, Imunologia e Parasitologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, AM, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil.
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Loren Rebouças Santos H, Diego de Brito Sousa J, Arthur Alcântara J, de Almeida Gonçalves Sachett J, Soares Villas Boas T, Saraiva I, Sergio Bernarde P, Freire Valente Magalhães S, Cardoso de Melo G, Maia Peixoto H, Regina Oliveira M, Sampaio V, Marcelo Monteiro W. Rattlesnakes bites in the Brazilian Amazon: Clinical epidemiology, spatial distribution and ecological determinants. Acta Trop 2019; 191:69-76. [PMID: 30579811 DOI: 10.1016/j.actatropica.2018.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/25/2022]
Abstract
Crotalus bites are considered a public health problem especially in Latin America. This study was performed to describe the epidemiology, spatial distribution and environmental determinants of Crotalus durissus bites in the Brazilian Amazon. Crotalus durissus envenomings official database included cases reported from 2010 to 2015. A total of 70,816 snakebites were recorded in the Amazon Region, 3058 (4.3%) cases being classified as crotalid, with a mean incidence rate of 11.1/100,000 inhabitants/year. The highest mean incidence rates were reported in Roraima, Tocantins and Maranhão. Area covered by water bodies, precipitation and soil humidity were negatively associated to rattlesnake encountering. Rattlesnake bites incidence was positively associated to tree canopy loss and altitude. In the Amazon, severe manifestations at admission, delayed medical assistance, lack of antivenom administration and ages ≥61 and 0-15 years were predictors of death in C. durissus snakebites. Spatial distribution of rattlesnake bites across the Brazilian Amazon showed higher incidence in areas of transition from the equatorial forest to the savanna, and in the savanna itself. Such results may aid focused policy-making in order to mitigate the burden, clinical complications and death as well as to manage Crotalus rattlesnake populations in the Brazilian Amazon.
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Costa MKBD, Fonseca CSD, Navoni JA, Freire EMX. Snakebite accidents in Rio Grande do Norte state, Brazil: Epidemiology, health management and influence of the environmental scenario. Trop Med Int Health 2019; 24:432-441. [DOI: 10.1111/tmi.13207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mikaelle Kaline Bezerra da Costa
- Curso de Doutorado em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Camilla Siqueira da Fonseca
- Programa Regional de Pós‐Graduação em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Julio Alejandro Navoni
- Curso de Doutorado em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
- Programa Regional de Pós‐Graduação em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
- Programa de Pós‐Graduação em Uso Sustentável de Recursos Naturais Instituto Federal de Educação Tecnológica do Rio Grande do Norte Natal Rio Grande do Norte Brazil
| | - Eliza Maria Xavier Freire
- Curso de Doutorado em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
- Programa Regional de Pós‐Graduação em Desenvolvimento e Meio Ambiente Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
- Departamento de Botânica e Zoologia Universidade Federal do Rio Grande do Norte Natal Rio Grande do Norte Brazil
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Strauch MA, Tomaz MA, Monteiro-Machado M, Cons BL, Patrão-Neto FC, Teixeira-Cruz JDM, Tavares-Henriques MDS, Nogueira-Souza PD, Gomes SLS, Costa PRR, Schaeffer E, da Silva AJM, Melo PA. Lapachol and synthetic derivatives: in vitro and in vivo activities against Bothrops snake venoms. PLoS One 2019; 14:e0211229. [PMID: 30689661 PMCID: PMC6349327 DOI: 10.1371/journal.pone.0211229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/09/2019] [Indexed: 01/18/2023] Open
Abstract
Background It is known that local tissue injuries incurred by snakebites are quickly instilled causing extensive, irreversible, tissue destruction that may include loss of limb function or even amputation. Such injuries are not completely neutralized by the available antivenins, which in general are focused on halting systemic effects. Therefore it is prudent to investigate the potential antiophidic effects of natural and synthetic compounds, perhaps combining them with serum therapy, to potentially attenuate or eliminate the adverse local and systemic effects of snake venom. This study assessed a group of quinones that are widely distributed in nature and constitute an important class of natural products that exhibit a range of biological activities. Of these quinones, lapachol is one of the most important compounds, having been first isolated in 1882 from the bark of Tabebuia avellanedae. Methodology/Principal findings It was investigated the ability of lapachol and some new potential active analogues based on the 2-hydroxi-naphthoquinone scaffold to antagonize important activities of Bothrops venoms (Bothrops atrox and Bothrops jararaca) under different experimental protocols in vitro and in vivo. The bioassays used to test the compounds were: procoagulant, phospholipase A2, collagenase and proteolytic activities in vitro, venom-induced hemorrhage, edematogenic, and myotoxic effects in mice. Proteolytic and collagenase activities of Bothrops atrox venom were shown to be inhibited by lapachol and its analogues 3a, 3b, 3c, 3e. The inhibition of these enzymatic activities might help to explain the effects of the analogue 3a in vivo, which decreased skin hemorrhage induced by Bothrops venom. Lapachol and the synthetic analogues 3a and 3b did not inhibit the myotoxic activity induced by Bothrops atrox venom. The negative protective effect of these compounds against the myotoxicity can be partially explained by their lack of ability to effectively inhibit phospholipase A2 venom activity. Bothrops atrox venom also induced edema, which was significantly reduced by the analogue 3a. Conclusions This research using a natural quinone and some related synthetic quinone compounds has shown that they exhibit antivenom activity; especially the compound 3a. The data from 3a showed a decrease in inflammatory venom effects, presumably those that are metalloproteinase-derived. Its ability to counteract such snake venom activities contributes to the search for improving the management of venomous snakebites.
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Affiliation(s)
- Marcelo A. Strauch
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- Instituto Vital Brazil, Niterói-RJ, Brazil
- * E-mail: (MAS); (MAT); (PAM)
| | - Marcelo Amorim Tomaz
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- * E-mail: (MAS); (MAT); (PAM)
| | - Marcos Monteiro-Machado
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Bruno Lemos Cons
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Fernando Chagas Patrão-Neto
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Jhonatha da Mota Teixeira-Cruz
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Matheus da Silva Tavares-Henriques
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Pâmella Dourila Nogueira-Souza
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Sara L. S. Gomes
- Laboratório de Química Bioorgânica, Instituto de Pesquisas de Produtos Naturais Walter Mors-Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- Laboratório de Catálise Orgânica, Instituto de Pesquisas de Produtos Naturais Walter Mors-Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Paulo R. R. Costa
- Laboratório de Catálise Orgânica, Instituto de Pesquisas de Produtos Naturais Walter Mors-Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Edgar Schaeffer
- Laboratório de Química Bioorgânica, Instituto de Pesquisas de Produtos Naturais Walter Mors-Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Alcides J. M. da Silva
- Laboratório de Química Bioorgânica, Instituto de Pesquisas de Produtos Naturais Walter Mors-Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Paulo A. Melo
- Laboratório de Farmacologia das Toxinas, Instituto de Ciências Biomédicas—Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- * E-mail: (MAS); (MAT); (PAM)
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Alcântara JA, Bernarde PS, Sachett J, da Silva AM, Valente SF, Peixoto HM, Lacerda M, Oliveira MR, Saraiva I, Sampaio VDS, Monteiro WM. Stepping into a dangerous quagmire: Macroecological determinants of Bothrops envenomings, Brazilian Amazon. PLoS One 2018; 13:e0208532. [PMID: 30521617 PMCID: PMC6283637 DOI: 10.1371/journal.pone.0208532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/18/2018] [Indexed: 11/18/2022] Open
Abstract
Despite significant and successful efforts in Brazil regarding snakebites in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, little is known about determinants of snakebites incidence in order to further plan interventions to reduce the impact of this medical condition. Understanding the complexity of ecological interactions in a geographical region is important for prediction, prevention and control measures of snakebites. This investigation aims to describe spatial distribution and identify environmental determinants of human envenoming by lancehead pit vipers (Bothrops genus), in the Brazilian Amazon. Aggregated data by the municipality was used to analyze the spatial distribution of Bothrops bites cases and its relationship with geographic and environmental factors. Eight geo-environmental factors were included in the analysis as independent variables: (1) tree canopy loss increase; (2) area with vegetation cover; (3) area covered by water bodies; (4) altitude; (5) precipitation; (6) air relative humidity; (7) soil moisture; and (8) air temperature. Human envenoming by lancehead pit vipers (Bothrops genus) in the Amazon region is more incident in lowlands [Adjusted regression coefficient [ARC] -0.0007 (IC95%: -0.001; -0.0006), p<0.0001], with high preserved original vegetation cover [ARC 0.0065 (IC95%: 0.0071; 0.0060), p<0.0001], with heaviest rainfall [ARC 0.0001 (IC95%: 0.00009; 0.0001), p<0.0001] and higher air relative humidity [ARC 0.0082 (IC95%: 0.0108; 0.0056), p<0.0001]. This association is interpreted as the result of the higher prey availability and further abundance of pit vipers in such landscapes.
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Affiliation(s)
- João Arthur Alcântara
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Paulo Sérgio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, AC, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Ageane Mota da Silva
- Instituto Federal do Acre, Campus de Cruzeiro do Sul, Cruzeiro do Sul, Acre, Brazil
| | | | | | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Ivan Saraiva
- Centro Gestor e Operacional do Sistema de Proteção da Amazônia, Ministério da Defesa, Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Sala de Análise de Situação em Saúde, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- * E-mail:
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Alves N, Ximenes R, Jorge R, Silveira J, Santos J, Rodrigues F, Costa P, Xavier F, Evangelista J, Havt A, Soares V, Toyama M, Oliveira A, Araújo R, Alves R, Monteiro H. Anti-ophidian activity of Bredemeyera floribunda Willd. (Polygalaceae) root extract on the local effects induced by Bothrops jararacussu venom. Braz J Med Biol Res 2018; 52:e7581. [PMID: 30517287 PMCID: PMC6293447 DOI: 10.1590/1414-431x20187581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/08/2018] [Indexed: 12/04/2022] Open
Abstract
Bredemeyera floribunda roots are popularly used to treat snakebites in the semiarid region of Northeast Brazil, and previous studies indicate the anti-ophidian actions of triterpenoid saponins found in its roots. To assess B. floribunda root extract (BFRE) activity against the effects of Bothrops jararacussu venom (BjuV), antiphospholipasic, antiproteolytic, antihemorrhagic, antinecrotic, and anti-edematogenic activities were investigated in mice. Phytochemical analysis revealed the presence of saponins, flavonoids, and sugars, with rutin and saccharose being the major constituents of BFRE. Acute toxicity was determined and BFRE was nontoxic to mice. Phospholipase A2 and proteolytic activities induced by BjuV were inhibited in vitro by BFRE at all concentrations tested herein. BFRE (150 mg/kg) inhibited paw edema induced by BjuV (50 µg/animal), reducing total edema calculated by area under the curve, but carrageenan-induced paw edema was unchanged. Hemorrhagic and necrotizing actions of BjuV (50 µg/animal) were considerably decreased by BFRE treatment. Thus, BFRE blocked the toxic actions of B. jararacussu venom despite having no anti-inflammatory activity, which points to a direct inhibition of venom's toxins, as demonstrated in the in vitro assays. The larger amounts of rutin found in BFRE may play a role in this inhibition, since 3',4'-OH flavonoids are known inhibitors of phospholipases A2.
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Affiliation(s)
- N.T.Q. Alves
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - R.M. Ximenes
- Departamento de Antibióticos, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - R.J.B. Jorge
- Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, PE, Brasil
| | - J.A.M. Silveira
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - J.V.A. Santos
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - F.A.P. Rodrigues
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - P.H.S. Costa
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - F.A.F. Xavier
- Faculdade de Veterinária, Universidade Estadual do Ceará, Fortaleza, CE, Brasil
| | | | - A. Havt
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - V.C.G. Soares
- Universidade Paulista, Campus Jundiaí, Jundiaí, SP, Brasil
| | - M.H. Toyama
- Instituto de Biociências, Universidade Estadual Paulista, São Vicente, SP, Brasil
| | - A.N.A. Oliveira
- Instituto de Química, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
| | - R.M. Araújo
- Instituto de Química, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil
| | - R.S. Alves
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - H.S.A. Monteiro
- Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Epidemiologic prediction of snake bites in tropical south Iran: Using seasonal time series methods. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Brito Sousa JD, Sachett JAG, de Oliveira SS, Mendonça-da-Silva I, Marques HO, de Lacerda MVG, Fan HW, Monteiro WM. Accuracy of the Lee-White Clotting Time Performed in the Hospital Routine to Detect Coagulopathy in Bothrops atrox Envenomation. Am J Trop Med Hyg 2018; 98:1547-1551. [PMID: 29611503 DOI: 10.4269/ajtmh.17-0992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Snake envenomation is a major public health problem in Brazil. Systemic complications that may arise from snakebites are mainly related to coagulopathy. The Lee-White clotting time (LWCT) is a simple and inexpensive test and available even in remote health facilities. However, the diagnostic value of such test needs to be evaluated to accurately diagnose coagulopathy in the clinical practice. This study aimed to assess the reliability of the LWCT performed in hospital routine to diagnose venom-induced coagulopathy. We studied 186 patients admitted at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil, with Bothrops envenomation diagnosis. At admission, blood samples were collected for performing LWCT and the concentration of fibrinogen. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio, and accuracy were calculated with 95% confidence intervals. From the total, 85.5% had hypofibrinogenemia. The sensitivity of the LWCT to the diagnosis of hypofibrinogenemia was 78.0% and the specificity 40.7%. The accuracy of the test was 72.6%, and patients with a prolonged LWCT had 2.4 higher odds of developing hypofibrinogenemia. In addition, the LWCT was also compared with venom antigen levels and systemic hemorrhage. The LWCT showed moderate sensitivity to detect consumption coagulopathy and constitutes a valuable tool for the diagnosis of Bothrops snake envenomation and indication of antivenom therapy.
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Affiliation(s)
- Jose Diego de Brito Sousa
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Sâmella Silva de Oliveira
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Iran Mendonça-da-Silva
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcus Vinicius Guimarães de Lacerda
- Instituto de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil.,Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Wuelton Marcelo Monteiro
- Instituto de Pesquisa Clinica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
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da Silva Souza A, de Almeida Gonçalves Sachett J, Alcântara JA, Freire M, Alecrim MDGC, Lacerda M, de Lima Ferreira LC, Fan HW, de Souza Sampaio V, Monteiro WM. Snakebites as cause of deaths in the Western Brazilian Amazon: Why and who dies? Deaths from snakebites in the Amazon. Toxicon 2018; 145:15-24. [PMID: 29490236 DOI: 10.1016/j.toxicon.2018.02.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/29/2018] [Accepted: 02/22/2018] [Indexed: 01/08/2023]
Abstract
Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil. All deaths from snakebites reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) and to the Mortality Information System (SIM; ICD10-10th revision, X.29), from 2007 to 2015, were included. Variables were assessed by blocks with distal (ecological variables), intermediate (demographics) and proximal (clinical variables) components to identify predictors of case fatality. A total of 127 deaths from snakebites were recorded, with 58 pairs found through linkage of the SINAN and SIM databases (45.7%), 37 (29.1%) deaths found only in SINAN and 32 (25.2%) found only in the SIM. Deaths occurred mostly in males (95 cases; 74.8%) living in rural areas (78.6%). The most affected age group was the ≥61 years old (36 cases; 28.4%). Snakebites were presumably due to Bothrops snakes in 68.5% of the cases and Lachesis in 29.5% based on clinico-epidemiological diagnosis. A proportion of 26.2% of the cases received treatment over 24 h after the bite ocurred. On admission, cases were mostly classified as severe (65.6%). Overall, 28 patients (22.0%). Deceased without any medical assistance Antivenom was given to 53.5%. In the multivariate analysis, a distance from Manaus >300 km [OR = 3.40 (95%CI = 1.99-5.79); (p < 0.001)]; age ≥61 years [OR = 4.31 (95%CI = 1.22-15.21); (p = 0.023)] and Indigenous status [OR = 5.47 (95%CI = 2.37-12.66); (p < 0.001)] were independently associated with case fatality from snakebites. Severe snakebites [OR = 16.24 (95%CI = 4.37-60.39); (p < 0.001)] and a lack of antivenom administration [OR = 4.21 (95%CI = 1.30-13.19); (p = 0.014)] were also independently associated with case fatality. Respiratory failure/dyspnea, systemic bleeding, sepsis and shock were recorded only among fatal cases. In conclusion, i) death from snakebites was underreported in the mortality surveillance system; ii) older age groups living in remote municipalities and indigenous peoples were the population groups most prone to death; iii) lack or underdosage of antivenom resulted in higher case fatality and iv) systemic bleeding, circulatory shock, sepsis and acute respiratory failure were strongly associated to fatal outcome.
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Affiliation(s)
- Anderson da Silva Souza
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
| | - João Arthur Alcântara
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Monique Freire
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Maria das Graças Costa Alecrim
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Marcus Lacerda
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Instituto de Pesquisa Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Luiz Carlos de Lima Ferreira
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - Vanderson de Souza Sampaio
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Núcleo de Sistemas de Informação, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Mendonça-da-Silva I, Magela Tavares A, Sachett J, Sardinha JF, Zaparolli L, Gomes Santos MF, Lacerda M, Monteiro WM. Safety and efficacy of a freeze-dried trivalent antivenom for snakebites in the Brazilian Amazon: An open randomized controlled phase IIb clinical trial. PLoS Negl Trop Dis 2017; 11:e0006068. [PMID: 29176824 PMCID: PMC5720814 DOI: 10.1371/journal.pntd.0006068] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/07/2017] [Accepted: 10/24/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In tropical areas, a major concern regarding snakebites treatment effectiveness relates to the failure in liquid antivenom (AV) distribution due to the lack of an adequate cold chain in remote areas. To minimize this problem, freeze-drying has been suggested to improve AV stability. METHODS AND FINDINGS This study compares the safety and efficacy of a freeze-dried trivalent antivenom (FDTAV) and the standard liquid AV provided by the Brazilian Ministry of Health (SLAV) to treat Bothrops, Lachesis and Crotalus snakebites. This was a prospective, randomized, open, phase IIb trial, carried out from June 2005 to May 2008 in the Brazilian Amazon. Primary efficacy endpoints were the suppression of clinical manifestations and return of hemostasis and renal function markers to normal ranges within the first 24 hours of follow-up. Primary safety endpoint was the presence of early adverse reactions (EAR) in the first 24 hours after treatment. FDTAV thermal stability was determined by estimating AV potency over one year at 56°C. Of the patients recruited, 65 and 51 were assigned to FDTAV and SLAV groups, respectively. Only mild EARs were reported, and they were not different between groups. There were no differences in fibrinogen (p = 0.911) and clotting time (p = 0.982) recovery between FDTAV and SLAV treated groups for Bothrops snakebites. For Lachesis and Crotalus snakebites, coagulation parameters and creatine phosphokinase presented normal values 24 hours after AV therapy for both antivenoms. CONCLUSIONS/SIGNIFICANCE Since promising results were observed for efficacy, safety and thermal stability, our results indicate that FDTAV is suitable for a larger phase III trial. TRIAL REGISTRATION ISRCTNregistry: ISRCTN12845255; DOI: 10.1186/ISRCTN12845255 (http://www.isrctn.com/ISRCTN12845255).
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Affiliation(s)
- Iran Mendonça-da-Silva
- Escola Superior de Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Instituto de Biologia do Exército, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antônio Magela Tavares
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Jacqueline Sachett
- Escola Superior de Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - José Felipe Sardinha
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Lilian Zaparolli
- Instituto de Biologia do Exército, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcus Lacerda
- Escola Superior de Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Escola Superior de Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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