Severe tissue complications in patients of <i>Bothrops</i> snakebite at a tertiary health unit in the Brazilian Amazon: clinical characteristics and associated factors

Silva, Flavio Souza; Ibiapina, Hiochelson Najibe Santos; Neves, Juliana Costa Ferreira; Coelho, Kerolaine Fonseca; Barbosa, Fabiane Bianca Albuquerque; Lacerda, Marcus Vinicius Guimarães; Sachett, Jacqueline Almeida Gonçalves; Malheiro, Adriana; Monteiro, Wuelton Marcelo; Costa, Allyson Guimarães

doi:10.1590/0037-8682-0374-2020

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 54 • 2021 • https://doi.org/10.1590/0037-8682-0374-2020 copy

Severe tissue complications in patients of Bothrops snakebite at a tertiary health unit in the Brazilian Amazon: clinical characteristics and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Snakebites in the Brazilian Amazon are caused mostly by snakes from the Bothrops genus and envenomated patients may suffer from tissue complications.

METHODS:

This study aimed to identify risk factors for severe tissue complications (STC) in patients with Bothrops snakebite in the Amazonas state, Brazil.

RESULTS:

Snakebites that were classified as severe and affected female patients with comorbidities presented greater risks of developing STCs. In addition, hospitalizations of patients with STC exceeded 5 days.

CONCLUSIONS:

Clinical and epidemiological characteristics can prove essential for assessing the evolution of STC and clinical prognosis of patients with Bothrops snakebites.

Keywords:
Bothrops snakebites; Envenomation; Severe tissue complication; Associated factors; Brazilian Amazon

Characteristics (Completeness)	n (%)
Age group in years	307 (100)
0-15	33 (11)
16-45	176 (57)
46-65	72 (24)
>65	26 (8)
Sex	307 (100)
Male	242 (79)
Female	65 (21)
Zone of occurrence	246 (80)
Rural	177(72)
Urban	69 (28)
Anatomical site of the snakebite	298 (94)
Upper limb	34 (12)
Lower limb	254 (88)
Snakebite classification	307 (100)
Mild	38 (12)
Moderate	194 (63)
Severe	75 (25)
Antivenom therapy	307 (100)
Bothrops antivenom	292 (95)
Bothrops/Lachesis antivenom	15 (5)
Comorbidities	307 (100)
No	300 (98)
Yes	7 (2)
Days of hospitalization	289 (94)
1-2	137 (47)
3-5	84 (29)
>5	68 (24)
Local complication	307 (100)
No	248 (81)
Yes	59 (19)
Description of the local complication	307 (100)
Bruising	25 (8)
Abscess	20 (7)
Blister	15 (5)
Necrosis	6 (2)
Compartmental Syndrome	4 (1)

Variables	STC		Crude OR	p-value	Adjusted OR	p-value*
	Yes (%)	No (%)	(CI 95%)		(CI 95%)
Age group in years
0-15	8 (13)	25 (10)	-	1	-	1
16-45	27 (46)	149 (60)	0.57	0.213	-	1
			(0.23-1.39)
46-65	17 (29)	55 (22)	0.97	0.944	-	1
			(0.37-2.53)
>65	7 (12)	19 (8)	1.15	0.814	-	1
			(0.35-3.73)
Sex
Male	39 (66)	203 (82)	-	1	-	1
Female	20 (34)	45 (18)	2.31	0.0009	2.63	0.006
			(1.23-4.33)		(1.32-5.26)
Zone of occurrence
Rural	31 (66)	146 (73)	-	1	-	1
Urban	16 (34)	53 (27)	1.42	0.311	-	1
			(0.72-2.81)
Anatomical site of the snakebite
Upper limb	8 (14)	26 (11)	-	1	-	1
Lower limb	49 (86)	204 (89)	0.78	0.569	-	1
			(0.33-1.82)
Snakebite classification
Mild	2 (3)	36 (14)	-	1	-	1
Moderate	34 (58)	160 (65)	3.82	0.074	3.31	0.118
			(0.88-16.56)		(0.74-14.84)
Severe	23 (39)	52 (21)	7.96	0.007	2.40	0.008
			(1.77-35.90)		(1.26-4.58)
Antivenom therapy
Bothrops antivenom	54 (92)	238 (96)	-	1	-	1
Bothrops/Lachesis antivenom	5 (8)	10 (4)	2.20	0.164	1.64	0.480
			(0.72-6.71)		(0.42-6.43)
Comorbidities
No	55 (93)	245 (99)	-	1	-	1
Yes	4 (7)	3 (1)	5.93	0.022	8.53	0.022
			(1.29-27.30)		(1.37-53.14)
Days of hospitalization
1-2	17 (31)	120 (51)	-	1	-	1
3-5	17 (31)	67 (29)	1.79	0.121	1.79	0.142
			(0.86-3.74)		(0.82-3.89)
>5	21 (38)	47 (20)	3.15	0.002	2.70	0.003
			(1.53-6.50)		(1.39-5.23)

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[1] Corresponding author: Allyson Guimarães da Costa. e-mail:allyson.gui.costa@gmail.com