SNAKEBITES: PHYSIOPATHOLOGY
BENEDITO BARRAVIERA
Full Professor of Tropical Diseases - Botucatu Medical School - UNESPResearch from The Center for the Study of Venoms and Venomous Animals – CEVAPSão Paulo State University - UNESP - Brazil
CONTENTS
1-The São Paulo State University history;
2-The Center for the Study of Venoms and Venomous Animals – CEVAP – facilities;
3-Main Brazilian venomous and nonvenomous snakes;
4-Classification and Epidemiology;
5-Clinical manifestations and physiopathology;
São Paulo State University campuses
São Paulo State University – UNESP
Based in São Paulo citySupported by São Paulo State Government Annual Budget – U$ 750,000,000 / year (R$ 1.370.788.000,00 - 2008)
UNESP has 23 University Campuses (32 Colleges, 7 Research Centers and 3 Technical schools)
168 Undergraduate courses – 34,425 students108 Graduate courses – 12,031 students3,354 Professors and Researchers6,984 Employees
30 Libraries, 5 Farms, 2 Medical Hospitals, 3 Veterinary Hospitals and1,900 Research and Teaching laboratories
The Center for the Study of Venoms and Venomous
Animals – CEVAP
CEVAP was created in 1993. It is based at Lageado Experimental Farm adjoining Botucatu School of Agronomical Sciences.
It is a Research Institution focusing Toxinology. The multicampus structure of UNESP allows the interaction among Learning, Research, Continuing education and Extension.
The Center for the Study of Venoms and Venomous
Animals – CEVAP
CEVAP count on the following partners: Botucatu Medical School , Botucatu School of Veterinary Medicine and Animal Husbandry, Botucatu and Rio Claro Institute of Biosciences and Araraquara School of Pharmaceutical Sciences.
Total farm area – 2,000 hectares (600 hectares of native forests).
The Center for the Study of Venoms and Venomous Animals - CEVAP
CEVAP Laboratories and Serpentariums
Serpentariums
Extension activities
MAIN BRAZILIAN SNAKES
From Public Health point of view
1-Venomous snakes (about 58 species)
Viperidae family – Bothrops sp (28 species) Crotalus sp (6 sub-species) Lachesis sp (2 species)
Elapidae family – Micrurus sp (22 species)
2-Nonvenomous snakes (about 250 species)
Boidae family - Boa constrictor, Eunectus murinus, Corallus caninus, Epicrates cenchria (11 species)
Colubridae family – Clelia clelia, Liophis frenatus, Philodryas olfersii, Dipsas albifrons, Spilotis pullatus, Waglerophis merremii, Mastigodryas bifossatus, etc. (239 species)
MAIN BRAZILIAN VENOMOUS SNAKES
Viperidae family
– Bothrops sp – Bothrops jararaca, B. alternatus, B. moojeni, B.
atrox (from Amazon region), B. cotiara, B. erytromelas, etc.
-Responsible for 80 to 90% of accidents in Brazil
-Crotalus sp – Crotalus durissus terrificus, C. d. collilineatus, C.
d. marajoensis, C. d. cascavella, C. d. trigonicus, C. d. ruruima
-Responsible for 10 to 20% of accidents in Brazil
-Lachesis sp – Lachesis muta muta, Lachesis muta rhombeata
-Responsible for 3% of accidents in the Amazon region - Brazil.
Bothrops jararaca
Bothrops alternatus
Bothrops moojeni
Bothrops sp distribution
Bothrops moojeni
Crotalus sp distribution
Crotalus durissus terrificus(South American rattlesnake)
Crotalus durissus terrificus
MAIN BRAZILIAN VENOMOUS SNAKES IN AMAZON REGION
MAIN BRAZILIAN VENOMOUS SNAKES IN THE AMAZON REGION
Bothrops atrox *Bothrops braziliBothriopsis bilineataBothriopsis teniata
Lachesis muta muta *
MAIN BRAZILIAN VENOMOUS SNAKES IN THE AMAZON REGION
Lachesis muta muta
Bothriopsis bilineata
Bothrops atrox
Lachesis muta muta
MAIN BRAZILIAN VENOMOUS SNAKES
Elapidae family
-Micrurus sp – Micrurus frontalis, M. corallinus, M. paraensis, M. spixii, M. filiforms, etc.-Responsible for less than 1% of accidents in Brazil
Micrurus corallinus
Micrurus sp distribution
Micrurus frontalis
Boa constrictor
Corallus caninusEunectus murinus
Boidae family
Nonvenomous snakes
Colubridae family Nonvenomous snakes
Spilotes pullatus
Liophis miliaris
Philodryas olfersii
Accidents caused by venomous animals in Brazil
Snakes – 30,000/year
Scorpions – 40,000/year
Spiders – 19,500/year
Bees and wasps – 1,500/year
Catterpilars – 500/year
São Paulo State – 2,000/year
Botucatu – 100/year
EPIDEMIOLOGY
Main seasonSummer – from December to March
Patient´s characteristicsRural workers, Male (74.84%) , 15 to 49 years old, lower limbs (62.75%)
Snakes characteristics87.33% Bothrops sp envenoming7.43% Crotalus sp envenoming1.37% Lachesis sp envenoming0.41% Micrurus sp envenoming
The Amazon region – 3,000 cases/year90% Bothrops sp envenoming10% Lachesis sp and others
EPIDEMIOLOGY
Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
1-Coagulative activity – cause bleeding and clotting disturbances
Patient
with
severe
gingival
bleeding
Bothrops alternatus
Mild bothropic envenomings
Bothrops alternatus
Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
Venom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
Bothrops alternatus
Moderate bothropic
envenomings
Bothropic envenoming
Clinical aspects
Severe bothropic envenomings
Bothrops alternatus
Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
Venom activity – Bothrops sp
3-Hemorrhaging activity – spontaneous hemorrhage by damaging vascular endothelium
Patients develop local or distant
hemorrhage
Bothrops alternatus
Bothropic envenoming
Clinical aspects
Venom activity – Crotalus sp
1-Neurotoxic activity – neurotoxic symptoms
Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
MidriasisLocal bite
Ptosis, Diplopia and blurred vision
Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
Rhabdomyolysis
Increase of CPK, DHL, AST and ALT
enzymes
Myoglobinuria
Venom activity – Crotalus sp
2-Systemic rhabdomyolyses – skeletal muscle
Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
Tubular necrosis causing renal failure
Venom activity – Crotalus sp
3-Renal failure
Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
Liver cells with mitochondrial edemaIncrease of Alanine aminotransferase enzyme Liver necrosis
Venom activity – Crotalus sp
4-Liver toxicity
Liver with edema
Lachetic envenoming Clinical aspects
Venom activities – like Bothrops sp
1-Coagulative – cause bleeding and clotting disturbances
2-Citotoxic – citotoxicity - capacity to destroy tissues
3-Hemorrhagic – spontaneous hemorrhage by damaging vascular endothelium
4-Neurotoxic – bradicardia, diarrhea and arterial hipotension including shock
Elapidic envenoming Clinical aspects
This venom- low molecular weight neurotoxins - neurotoxic facial expression (bilateral ptosis)- respiratory muscle paralysis.
The most severe Brazilian ophidic accident!
Micrurus corallinusNeurotoxic facial
expression
NONVENOMOUS SNAKE ACCIDENTS
Boidae family
No envenomation
Wash the bite area with soap and water;
Inform the patient thatantivenom treatment is not necessary.
Accident with Boa constrictor
NONVENOMOUS SNAKE ACCIDENTS
Colubridae family
-Rare envenomation;
-Rare pain and local swelling;
-Rare partial defibrination;
-Controversial antibotropictreatment.
Envenomation by Philodryas olfersii
Thank you very much!This lecture is available at:http://www.barraviera.med.br
[email protected]@gnosis.com.br
