Envenoming by the rattlesnake Crotalus durissus ruruima in the state of roraima, Brazil

Mauro Shosuka Asato; Roberto Carlos Cruz Carbonell; Alessandra Galvão Martins; Cléria Mendonça de Moraes; Carlos Chávez-Olórtegui; Maria Apolonia da Costa Gadelha; Pedro Pereira de Oliveira Pardal

doi:10.1016/j.toxcx.2020.100061

Envenoming by the rattlesnake Crotalus durissus ruruima in the state of roraima, Brazil

Toxicon X. 2020 Oct 22:8:100061. doi: 10.1016/j.toxcx.2020.100061. eCollection 2020 Dec.

Authors

Mauro Shosuka Asato¹, Roberto Carlos Cruz Carbonell^{1

2}, Alessandra Galvão Martins¹, Cléria Mendonça de Moraes², Carlos Chávez-Olórtegui³, Maria Apolonia da Costa Gadelha⁴, Pedro Pereira de Oliveira Pardal⁴

Affiliations

¹ Hospital Geral de Roraima, Boa Vista-Roraima, Brasil. Av. Brigadeiro Eduardo Gomes, 3308, Aeroporto, CEP: 69305-455, Boa Vista, Roraima, Brazil.
² Universidade Federal de Roraima, Boa Vista - Roraima, Brasil. Av. Cap. Ene Garcês, n° 2413, Aeroporto, CEP: 69310-000, Boa Vista, Roraima, Brazil.
³ Universidade Federal de Minas Gerais, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas Belo Horizonte, Minas Gerais, Brasil. Av. Antônio Carlos 6627, CP:486, CEP:31270-901, Belo Horizonte, Minas Gerais, Brazil.
⁴ Universidade Federal do Pará, Empresa Brasileira de Serviços Hospitalares, Unidade de Informações Toxicológicas, Belém-Pará, Brasil. Rua dos Mundurucus, 4487, Guamá. CEP 66073-000, Belém, Pará, Brazil.

Abstract

The aim of this study was to evaluate the clinical-epidemiological factors associated with victims of rattlesnake envenoming in the state of Roraima, Brazil. In this location, rattlesnake accidents are caused by the subspecies Crotalus durissus ruruima. This is a prospective observational study carried out at the General Hospital of Roraima from april 2017 until july 2018. A total of 37 alleged rattlesnake victims had their medical records evaluated. However only one of them proved to be by C. d. ruruima. All individuals were residents from the savannas (lavrados) of Roraima. The town of Bonfim on the border between Brazil and Guyana had the highest occurrence of rattlesnake bites. The most affected group were males aged 13-20 years and farmers. The highest number of incidents occurred during daytime and lower limbs (feet) were the most major affected part of the body. Tourniquets were used as first aid after snake envenoming in 32.4% of victims. Out of 37 patients, 16.2% were classified as severe cases of snakebite envenoming and in 5.4% dry bites seem to have occurred. Among the symptomatic patients, 100% presented local manifestations and 70.3% presented systemic manifestations. The clinical setting showed local effects such as pain and edema while the systemic effects were blurred vision, myalgias, myasthenic facies, palpebral ptosis, muscle weakness and headache. Laboratory results of aspartate aminotransferase (62.2%), creatine phosphokinase (51.3%), lactic dehydrogenase (37.8%), urea level (32.4%) and serum creatinine (29.7%) were increased significantly in relation to the reference standards. In 16.2% of the cases, the victims presented acute kidney injury. Patients were treated with anticrotalic serum in 70.3% of the cases and antibotropic + anticrotalic serum in 24.3%. The victims of C. d. ruruima in Roraima showed a local symptomatology similar to Bothrops envenoming, while systemic symptoms and laboratory analysis proved kidney and muscular injuries, similar to envenoming by Crotalus d. terrificus in Brazil.

Keywords: Brazil; Crotalus; Crotalus durissus ruruima; Rattlesnake; Snake bites.