The deadliest snake according to ethnobiological perception of the population of the Alto Juruá region, western Brazilian Amazonia

Jessyca Lima da Silva Ageane Mota da Siva Gardênia Lima Gurgel do Amaral Givanildo Pereira Ortega Wuelton Marcelo Monteiro Paulo Sérgio Bernarde About the authors

Abstract

INTRODUCTION:

We examined the ethnobiological perception of the population of the Alto Juruá region about different snake species, in terms of their dangerousness and manifestations of envenomation.

METHODS:

We interviewed 100 villagers who were active in the forests.

RESULTS:

Lachesis muta was considered the most venomous snake, and Bothrops atrox appeared to be the most feared snake species.

CONCLUSIONS:

The high incidence, severity, and mortality of B. atrox bites and the severity and mortality of L. muta bites were the factors that contributed to these species being perceived as the most feared and venomous snakes.

Keywords:
State of Acre; Snakes; Snakebites; Ophidism; Envenomation

Snakebites do not have epidemic potential like infectious and vector-borne parasitic diseases, however, the annual global mortality due to snake envenomation is by far higher than that attributed to several currently neglected tropical diseases including dengue hemorrhagic fever, cholera, leishmaniasis, schistosomiasis, Japanese encephalitis, and Chagas disease11. Williams D, Gutiérrez JM, Harrison R, Warrell DA, White J, Winkel KD, et al. The Global Snake Bite Initiative: an antidote for snake bite. Lancet. 2010;375(9708):89-91.. Snakebites are thus considered an important issue regarding incidence and severity, and the clinical manifestations of snakebites encouraged the World Health Organization to recognize and include snakebites in the category of Neglected Tropical Diseases in 201722. Chippaux JP. Snakebite envenomation turns again into a neglected tropical disease! J Venom Anim Toxins Incl Trop Dis. 2017;23:38. It is estimated that globally up to 5,500,000 snakebites occur per year, which result in 1,841,000 cases of envenomation and 94,000 deaths33. Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5(11):e218.. The most vulnerable victims are typically members of the poorest communities living in rural areas of various countries in Africa, Asia, and Latin America11. Williams D, Gutiérrez JM, Harrison R, Warrell DA, White J, Winkel KD, et al. The Global Snake Bite Initiative: an antidote for snake bite. Lancet. 2010;375(9708):89-91.,22. Chippaux JP. Snakebite envenomation turns again into a neglected tropical disease! J Venom Anim Toxins Incl Trop Dis. 2017;23:38.

In Brazil, snakebites are mainly associated with activities in agriculture, and in the Amazon region, beside extractive activities, there are also people living in forests (extractivist, riverine, indigenous)44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,55. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92.,66. Feitosa E, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(suppl.1):34-41.,77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.. In order to assess which snake is considered the most dangerous species, the number of deaths caused by each species and the severity of bites must be taken into account88. McCue MD. What is the most dangerous snake? J Venom Anim Toxins Incl Trop Dis . 2013;19:19.. There are four groups of venomous snakes in Brazil, of which the genus Crotalus is considered the most dangerous with 0.96% lethality, followed by the genus Lachesis (0.61% lethality), the genus Bothrops (0.37%), and the genus Micrurus (0.27%)99. Mota-da-Silva A, Bernarde PS, Abreu LC. Accidents with poisonous animals in Brazil by age and sex. J. Hum. Growth Dev. 2015;25(1):54-62.. Bothropic and lachetic envenomations are the main causes of morbidity and mortality associated with snakebites in the Brazilian Amazon region: 67% of reported snakebites and 65.8% of snakebite-related deaths are attributed to the genus Bothrops, and the genus Lachesis is reported to be responsible for 21.8% of snakebites and for 29.5% of snakebite-related deaths66. Feitosa E, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(suppl.1):34-41.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.. Therefore, although snakes of the genus Bothrops appear to bite more frequently, the species L. muta is associated with the highest lethality.

In Alto Juruá, a region in the western Brazilian Amazonia, snakebites are considered an important issue of which predominantly communities in rural areas and forests are affected44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.,1111. Mota-da-Silva A, Sachett J, Monteiro WM, Bernarde PS. Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon. Rev Soc Bras Med Trop . 2019;52:e-20180195.. We describe here the ethnobiological perception of dangerousness of different snake species by the population of the rural areas of Alto Juruá regarding. Moreover, we summarize clinical manifestations of bites by the mentioned snake species.

We conducted a transversal study with consecutive data collection from March to April 2019. We interviewed people living near the forest close to the lower Moa River and who pursued activities such as extractivism, fishing, and hunting in forests in the region located in the municipality of Cruzeiro do Sul, Alto Juruá, in the west of the state of Acre. The predominant activities of the local population are fishing, fish farming, manioc production, extractivism, and crop farming77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140..

Interviews were conducted individually and anonymously using a semi-structured script based on several previously chosen topics, which facilitated collecting large amounts of information with minimum bias1212. Huntington HP. Observations on the utility of the Semi-directive interview for documenting traditional ecological knowledge. Artic. 1998;51(3):237-42.. Members of the community were interviewed if they pursued any activity in the forests on a regular basis. After each interview, the interviewee was asked to indicate other people who also frequented the forests. The following three questions were asked: 1) do you know what happens to a person when they are bitten by one of these snakes: jararaca, surucucu, papagaia, pico de jaca, and coral, 2) which of these is the most venomous, and 3) which of these are you most afraid of? The regionally used common names correspond to species involved in snakebites in the region77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1111. Mota-da-Silva A, Sachett J, Monteiro WM, Bernarde PS. Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon. Rev Soc Bras Med Trop . 2019;52:e-20180195.: jararaca - juvenile B. atrox, surucucu - adult B. atrox, papagaia - B. bilineatus smaragdinus, pico-de-jaca - L. muta, and coral - Micrurus spp. The consequences of snakebite were recorded exactly as reported, according to the respective dialect, and were re-phrased in a more technical manner here. Re-phrasing included terms such as "rotting" (necrosis), "swelling" (edema), "crippling" (amputation), "blood coming out through the nose" (epistaxis), "spitting blood" (gingival bleeding), and “coughing up blood" (hemoptysis).

This study is part of the project "The Ethnoherpetology Study in Alto Juruá - Acre", approved by the Ethics Review Board for Research with Human Subjects at the União Educacional do Norte Ltda - UNINORTE, Rio Branco (approval number: 2,092,523).

One-hundred people aged 13-91 years (mean age 43 years) were interviewed (79 men and 21 women; Table 1). L. muta snakes were considered most venomous (by 61%), and B. atrox was the most feared snake (by 47%; Table 1). Regarding consequences of snakebites, people knew most about juvenile and adult B. atrox (85% and 84% answered, respectively), followed by L. muta (62%), B. bilineatus smaragdinus (46%), and Micrurus spp. (24%; Table 2; Figure 1). The respective predominant symptoms or consequences were reported as follows - juvenile B. atrox: bleeding, pain, and edema; adult B. atrox: pain, edema, and dizziness; B. b. smaragdinus: pain, edema, and thirst; L. muta: amputation, death, and pain; Micrurus spp.: pain, edema, headache, and thirst (Table 2). Regarding hemorrhages caused by juvenile B. atrox, interviewees described different forms of bleeding: through the pores of the skin (24%), at the location of the bite (19%), gingival bleeding (15%), through hair roots (15%), from all orifices (2%), through the nose (1%), hematemesis (1%), otorrhagia (1%), hematuria (1%), hemoptysis (1%), and from the fingernail beds (1%).

TABLE 1:
Perception of the peoples of the lower Moa River region (Cruzeiro do Sul - AC) on the dangerousness of venomous snakes.

TABLE 2:
Consequences of snakebites according to the peoples of the lower Moa River region (Cruzeiro do Sul - AC).

FIGURE 1:
A) Jararaca (juvenile Bothrops atrox); B) Surucucu (adult B. atrox); C) Papagaia (B. bilineatus smaragdinus); D) Pico de jaca (Lachesis muta); E) Coral (Micrurus spixii); F) Coral (M. surinamensis). Photos: Paulo Bernarde.

L. muta, which causes the highest lethality, was considered the most venomous species due to the severity of its bites with 25-24% of amputations and deaths, respectively. Bites by the genus Lachesis occur infrequently, and L. muta snakes inhabit regions of low population density1313. Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42., however, this species is commonly known to be dangerous55. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92., probably due to the severity of its bite and because of its large size which can exceed three meters.

Despite not being considered the most venomous snake, B. atrox was regarded as the most feared snake in this study, particularly adult individuals, regionally termed surucucu77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.. This may be because this species is responsible for the most snakebites with the highest morbidity and mortality1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.. B. atrox was most frequently reported to cause pain (35% of the interviewees), edema (31%), and necrosis (14%), all of which is typically associated with its bites1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1313. Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42.,1414. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RRD, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian Western Amazonia. Rev Soc Bras Med Trop . 2018;51(3):338-46.. In a study conducted at the Baixo Purus river in the Amazon region, B. atrox and L. muta snakes were also the species that were most feared by the riverine population55. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92.. At the Baixo Purus river, L. muta was considered less aggressive than B. atrox55. Waldez F, Vogt RC. Aspectos ecológicos e epidemiológicos de acidentes ofídicos em comunidades ribeirinhas do baixo rio Purus, Amazonas, Brasil. Acta Amaz. 2009;39(3):681-92., which is less aggressive may therefore have been considered the second most-feared species by the subjects in the present study.

Most reported consequences of snakebites (pain, edema, hemorrhage, necrosis, headache, dizziness, blurred vision, thirst, vomiting, paresthesia, death, amputation, muscular atrophy, sweating, fever, bruising, changes in heart rate, nausea, fainting, burning, erythema, blisters, scarring, weakness, infection, hypersalivation and shortness of breath) may indeed occur44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,66. Feitosa E, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(suppl.1):34-41.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1313. Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42.,1414. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RRD, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian Western Amazonia. Rev Soc Bras Med Trop . 2018;51(3):338-46., however, the consequence was not always attributed to the correct species by the interviewees. Several reported consequences seemed not to be physiologically related to envenomation, but rather to psychological reactions (mental confusion, fear, and distress) or originate from misinformation (loss of speech and the assumption that "venom rises through the body"). Symptoms caused by B. atrox were reported more accurately than those cause by other species, particularly regarding those caused by L. muta and Micrurus spp., probably because B. atrox bites occur considerably more frequently in this region than bites by other species44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.,1111. Mota-da-Silva A, Sachett J, Monteiro WM, Bernarde PS. Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon. Rev Soc Bras Med Trop . 2019;52:e-20180195.. Juvenile B. atrox feed predominantly on amphibians and lizards, whereas adults preferably prey on rodents, and this dietary change may be associated with differences in venom composition1515. Saldarriaga MM, Otero R, Nunez V, Toro MF, Diaz A, Gutierrez JM. Ontogenetic variability of Bothrops atrox and Bothrops asper snake venoms from Colombia. Toxicon . 2003;42(4):405-11.. Juvenile B. atrox inject a smaller amount of venom per bite, however, their bites may cause prominent vasculotoxic effects such as hemorrhage and edema1515. Saldarriaga MM, Otero R, Nunez V, Toro MF, Diaz A, Gutierrez JM. Ontogenetic variability of Bothrops atrox and Bothrops asper snake venoms from Colombia. Toxicon . 2003;42(4):405-11.. Juvenile and adult specimens of B. atrox are perceived as belonging to different species77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140., and interviewees differentiated between the effects of bites by juveniles (more hemorrhagic) and adults (increased probability of necrosis) and detailed potential forms of bleeding (e.g., local bleeding, nose bleeds, hematemesis, otorrhagia, hematuria, and hemoptysis1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1313. Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42.,1414. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RRD, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian Western Amazonia. Rev Soc Bras Med Trop . 2018;51(3):338-46.).

All species of venomous snakes that occur in the Alto Juruá region can cause death1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99., however, several factors need to be considered regarding the outcome of a snakebite (e.g., elapsed time between envenomation and serum therapy, age and bodyweight of the victim, species and size of the snake, amount of venom, anatomical region of the bite, quality of health care, co-morbidity66. Feitosa E, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(suppl.1):34-41.,88. McCue MD. What is the most dangerous snake? J Venom Anim Toxins Incl Trop Dis . 2013;19:19.,99. Mota-da-Silva A, Bernarde PS, Abreu LC. Accidents with poisonous animals in Brazil by age and sex. J. Hum. Growth Dev. 2015;25(1):54-62.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.). Several snakes which produce comparably stronger venom may cause fewer accidents when population density and their propensity to bite are taken into account and may thus be responsible for fewer deaths in a given region than other snakes88. McCue MD. What is the most dangerous snake? J Venom Anim Toxins Incl Trop Dis . 2013;19:19.. L. muta is responsible for comparably few snakebites, and it is a rare species in forest environments, however, the severity of its bites1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.seems to have given rise to its reputation as most venomous species in this region. In contrast, B. atrox is the most abundant species of venomous snakes in various environments such as forests, crop fields, and pastures, and it is responsible for a larger proportion of snakebite-related morbidity and mortality in the Amazon region44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1111. Mota-da-Silva A, Sachett J, Monteiro WM, Bernarde PS. Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon. Rev Soc Bras Med Trop . 2019;52:e-20180195.,1414. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RRD, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian Western Amazonia. Rev Soc Bras Med Trop . 2018;51(3):338-46., which is why this species was the most feared snake in the Alto Juruá region and was considered the most dangerous one.

Local people were more aware of the effects of B. atrox bites, including differences between bites by juvenile and adult specimens, probably because it is the most abundant venomous snake species in the Alto Juruá region. The lower frequency of bites by other species probably explains the lack of knowledge on the respective effects. Regarding morbidity, mortality, and severity, B. atrox is the most important venomous snake in the Brazilian Amazon44. Pierini SV, Warell DA, De Paulo A, Theakston RDG. High incidence of bites and stings by snakes and other animals among rubber tappers and Amazonian indians of the Juruá Valley, Acre state, Brazil. Toxicon. 1996;34(2):225-36.,66. Feitosa E, Sampaio V, Sachett J, Castro DB, Noronha MDN, Lozano JLL, et al. Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas. Rev Soc Bras Med Trop. 2015;48(suppl.1):34-41.,77. Mota-da-Silva A, Monteiro WM, Bernarde PS. Popular names for bushmaster (Lachesis muta) and lancehead (Bothrops atrox) snakes in the Alto Juruá region: repercussion to clinical-epidemiological diagnosis and surveillance. Rev Soc Bras Med Trop . 2019;52:e-20180140.,1010. Oliveira SS, Sampaio VS, Sachett JAG, Alves EC, Silva VC, Lima JAA, Silva IM, Ferreira LCL, Bernarde PS, Fan HW, Lacerda MVG, Monteiro WM. Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives. In: Vogel CW, Seifert SA, Tambourgi DV, organizers. Clinical Toxinology in Australia, Europe, and Americas.Toxinology. 1nd ed. New York: Springer Publishing; 2018. p. 73-99.,1313. Pardal PP, Souza SM, Monteiro MR, Fan HW, Cardoso JL, França FO, et al. Clinical trial of two antivenoms for the treatment of Bothrops and Lachesis bites in the north eastern Amazon region of Brazil. Trans R Soc Trop Med Hyg. 2004;98(1):28-42.,1414. Roriz KRPS, Zaqueo KD, Setubal SS, Katsuragawa TH, Silva RRD, Fernandes CFC, et al. Epidemiological study of snakebite cases in Brazilian Western Amazonia. Rev Soc Bras Med Trop . 2018;51(3):338-46. and, in this study, this species was the most feared snake by the residents of Alto Juruá. In comparison, L. muta was considered the most venomous snake in this region, probably due to the severity and lethality of its bites.

REFERENCES

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Publication Dates

  • Publication in this collection
    20 Dec 2019
  • Date of issue
    2020

History

  • Received
    17 June 2019
  • Accepted
    06 Sept 2019
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