Snakebites by Crotalus durissus ssp in children in Campinas, São Paulo, Brazil

Authors

  • Fábio BUCARETCHI Universidade Estadual de Campinas; Faculdade de Ciências Médicas e Hospital das Clínicas; Centro de Controle de Intoxicações
  • Sílvia Regina Fontoura HERRERA Universidade Estadual de Campinas; Faculdade de Ciências Médicas
  • Stephen HYSLOP Universidade Estadual de Campinas; Faculdade de Ciências Médicas; Departamento de Farmacologia
  • Emílio Carlos Elias BARACAT Universidade Estadual de Campinas; Faculdade de Ciências Médicas; Departamento de Pediatria
  • Ronan José VIEIRA Universidade Estadual de Campinas; Faculdade de Ciências Médicas e Hospital das Clínicas; Centro de Controle de Intoxicações

Keywords:

Antivenom, Children, Crotalus durissus ssp, Rhabdomyolysis, Snakebites

Abstract

From January, 1984 to March, 1999, 31 children under 15 y old (ages 1-14 y, median 8 y) were admitted after being bitten by rattlesnakes (Crotalus durissus ssp). One patient was classified as "dry-bite", 3 as mild envenoming, 9 as moderate envenoming and 18 as severe envenoming. Most patients had neuromuscular manifestations, such as palpebral ptosis (27/31), myalgia (23/31) and weakness (20/31). Laboratory tests suggesting rhabdomyolysis included an increase in total blood creatine kinase (CK, 28/29) and lactate dehydrogenase (LDH, 25/25) levels and myoglobinuria (14/15). The main local signs and symptoms were slight edema (20/31) and erythema (19/31). Before antivenom (AV) administration, blood coagulation disorders were observed in 20/25 children that received AV only at our hospital (incoagulable blood in 17/25). AV early reactions were observed in 20 of these 25 cases (9/9 patients not pretreated and 11/16 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). There were no significant differences in the frequency of patients with AV early reactions between the groups that were and were not pretreated (Fisher's exact test, p = 0.12). Patients admitted less than and more than 6 h after the bite showed the same risk of developing severe envenoming (Fisher's exact test, p = 1). No children of the first group (< 6 h) showed severe complications whereas 3/6 children admitted more than 6 h post-bite developed acute renal failure. Patients bitten in the legs had a higher risk of developing severe envenoming (Fisher's exact test, p = 0.04). There was a significant association between both total CK and LDH blood enzyme levels and severity (p < 0.001 for CK and p < 0.001 for LDH; Mann-Whitney U test). No deaths were recorded.

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Published

2002-01-01

Issue

Section

Animal Envenomation

How to Cite

BUCARETCHI, F., HERRERA, S. R. F., HYSLOP, S., BARACAT, E. C. E., & VIEIRA, R. J. (2002). Snakebites by Crotalus durissus ssp in children in Campinas, São Paulo, Brazil . Revista Do Instituto De Medicina Tropical De São Paulo, 44(3), 133-138. https://revistas.usp.br/rimtsp/article/view/30573