Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon.

Sâmella S Oliveira,Wuelton M Monteiro,Vanderson S Sampaio,Elizandra F Nascimento,José Diego De-Brito-Sousa,Eliane C Alves,Marcus V.G Lacerda,João Pedro T Pereira,Alessandra S Santos,Lybia Kássia S Sarraff,Ida S Sano-Martins,Jacqueline A.G Sachett

doi:10.3390/toxins11010022

Abstract

Bothrops snakebites usually present systemic bleeding, and the clinical–epidemiological and laboratorial factors associated with the development of this manifestation are not well established. In this study, we assessed the prevalence of Bothrops snakebites with systemic bleeding reported at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, in Manaus, Amazonas State, Brazil, and the clinical–epidemiological and laboratorial factors associated with systemic bleeding. This is an observational, cross-sectional study carried out between August, 2013 and July, 2016. Patients who developed systemic bleeding on admission or during hospitalization were considered cases, and those with non-systemic bleeding were included in the control group. Systemic bleeding was observed in 63 (15.3%) of the 442 Bothrops snakebites evaluated. Bothrops snakebites mostly occurred in males (78.2%), in rural areas (89.0%) and in the age group of 11 to 30 years old (40.4%). It took most of the patients (59.8%) less than 3 h to receive medical assistance. Unclottable blood (AOR = 3.11 (95% CI = 1.53 to 6.31; p = 0.002)) and thrombocytopenia (AOR = 4.52 (95% CI = 2.03 to 10.09; p < 0.001)) on admission were independently associated with systemic bleeding during hospitalization. These hemostatic disorders on admission increase the chances of systemic bleeding during hospitalization. Prospective studies are needed to clarify the pathophysiology of systemic bleeding in Bothrops snakebites in the Amazon region.

Highlights

Snakebite envenomation is a potentially life-threatening injury and a major public health problem in rural areas of tropical and sub-tropical countries of Africa, the Middle-East, Asia, Oceania, and LatinToxins 2019, 11, 22; doi:10.3390/toxins11010022 www.mdpi.com/journal/toxinsAmerica
Bothrops snake envenomation usually results in systemic effects such as coagulation disorders and systemic bleeding [7,22]
Systemic bleeding is a common clinical manifestation in Bothrops snakebites, the clinical–epidemiological and laboratorial factors associated with the development of this effect are not well known in relation to the envenomations that occur in the Amazon region

Summary

Introduction

Snakebite envenomation is a potentially life-threatening injury and a major public health problem in rural areas of tropical and sub-tropical countries of Africa, the Middle-East, Asia, Oceania, and LatinToxins 2019, 11, 22; doi:10.3390/toxins11010022 www.mdpi.com/journal/toxinsAmerica. Injuries occurring at a distance >300 Km from Manaus, the Amazonas State capital, the age of the victim ≥61 years, and indigenous status were factors that were independently associated with case fatality from snakebites [5]. Bothrops snakebite victims usually present local symptoms (i.e. pain, swelling, ecchymosis, and blistering) and systemic manifestations such as bleeding and coagulation disorders [7,8,9]. Complications such as necrosis, secondary bacterial infection, compartment syndrome, and acute renal failure may occur [8]. In fatal cases of Bothrops snakebites in the Amazonas State, systemic bleeding, circulatory shock, sepsis, and acute respiratory failure were usually observed [5].

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