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Pujo JM, Houcke S, Fremery A, Lontsi-Ngoula G, Burin A, Mutricy R, Hommel D, Resiere D, Kallel H. Les envenimations vipérines en Guyane française. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données récentes de la littérature sur l’épidémiologie et la prise en charge de l’envenimation vipérine en Guyane française. La Guyane est un département français presque entièrement recouvert par une forêt tropicale. Elle abrite une herpétofaune très riche comportant notamment les espèces du genre Bothrops (famille des Viperidae) qui provoquent le plus grand nombre de morsures et d’envenimations. La gestion des envenimations vipérines représente un défi de santé publique. En effet, la plupart des envenimations se produisent dans des zones rurales éloignées où l’accès aux soins est le plus compliqué, avec la présence d’un personnel médical peu formé à la prise en charge et l’indisponibilité de l’antivenin, ce qui constitue une véritable perte de chance pour les patients. En conclusion, dans un contexte d’efforts mondiaux visant à réduire l’impact des envenimations vipérines, la coopération internationale et l’engagement des autorités locales de santé et de la société civile sont nécessaires. En Guyane, la mise en place d’une véritable filière de soins et la mise à disposition de l’antivenin dans les structures sanitaires les plus isolées constitueraient un réel progrès sanitaire.
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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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Heckmann X, Lambert V, Mion G, Ehrhardt A, Marty C, Perotti F, Carod JF, Jolivet A, Boels D, Lehida Andi I, Larréché S. Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana. Clin Toxicol (Phila) 2020; 59:193-199. [PMID: 32609546 DOI: 10.1080/15563650.2020.1786108] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn Tri TM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. METHODS This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL-1. The antivenom group included patients receiving Antivipmyn Tri TM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. RESULTS 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. CONCLUSION Antivipmyn Tri TM as currently used did not show any benefit in recovery from coagulopathy.
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Affiliation(s)
- Xavier Heckmann
- Department of Emergency, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana.,French Red Cross, Cayenne, French Guiana
| | - Véronique Lambert
- Department of Obstetrics and Gynaecology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Georges Mion
- Department of Anaesthesiology, Cochin Hospital, Paris, France
| | | | | | - Frédérique Perotti
- Department of Pharmacy, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Jean-François Carod
- Department of Medical Biology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Anne Jolivet
- Department of Public Health, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - David Boels
- Poison Control Center, Angers University Hospital, Angers, France
| | - Ibrahim Lehida Andi
- Department of Anaesthesiology and Reanimation, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Sébastien Larréché
- Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France
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