Snakebites in Northeastern Brazil: accessing clinical-epidemiological profile as a strategy to deal with Neglected Tropical Diseases

BACKGROUND

Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019.

METHODS

Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão.

RESULTS

A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases).

CONCLUSIONS

The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.

Perceptions of nurses regarding the management of snakebite envenomations: Limits and possibilities

Snakebites can be caused by harmless or venomous snakes and, according to their severity and frequency, can be considered events of medical importance. In health facilities in remote areas, nurses work in the first line of care of patients that are victims of these envenomations. The aim was to discover the perception of nurses regarding the management of snakebites, its limitations and possibilities, with a view to professional empowerment in the context of primary health care. This is exploratory and descriptive research, with a qualitative approach, developed at FMT-HVD in Manaus, Amazonas state, Brazil, in the year 2021. The participants were nurses who work in basic health units in the municipalities of Careiro da Várzea, Ipixuna and Boa Vista do Ramos in the state of Amazonas. For data collection, the focus group strategy was adopted. Thematic content analysis was employed, which was carried out in the stages of pre-analysis; exploration or coding of the material; treatment of the results, inference and interpretation. After processing the data obtained, four topics emerged from the coding: Topic 1 - limitations in the primary care. Topic 2 - the need for infrastructure and personnel. Topic 3 - the need for continuing education. Topic 4 - the perception of training regarding the management of snakebite envenomations. The results showed a lack of antivenom in the healthcare units where nurses work. Another aspect highlighted by the nurses is the absence of a doctor in situ to perform the primary care or out of hours care in the units. The nurses' perceptions regarding the management of snakebite envenomations revealed the existence of failures in relation to the subject, such as the lack of antivenom, poor infrastructure in the units and the lack of a doctor, which must be solved, since the nurses are the most active professionals in primary health care, in addition to the high incidence of snakebite envenomations in the Brazilian Amazon.

History, challenges and perspectives on Loxosceles (brown spiders) antivenom production in Brazil

Antivenom is the only effective therapy for treating any envenomation. Despite its obvious public health importance, the laborious process of procuring, distributing and controlling the quality of such immunobiologicals is being neglected. Brazil is fully self-sufficient in the production of antivenoms. Since the 1950s, Loxoscelism, a syndrome with an onset after a spider bite from specimens of the Loxosceles genus occurs, is considered a public health issue. The Brazilian history in developing antivenom therapy, its production hindrances, and other challenges are discussed in this paper, as well as some promising novelties that can improve production and processing of Loxosceles antivenom.