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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
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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;
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São Paulo State University campuses
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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
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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.
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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).
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The Center for the Study of Venoms and Venomous Animals - CEVAP
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CEVAP Laboratories and Serpentariums
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Serpentariums
Extension activities
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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)
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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.
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Bothrops jararaca
Bothrops alternatus
Bothrops moojeni
Bothrops sp distribution
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Bothrops moojeni
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Crotalus sp distribution
Crotalus durissus terrificus(South American rattlesnake)
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Crotalus durissus terrificus
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MAIN BRAZILIAN VENOMOUS SNAKES IN AMAZON REGION
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MAIN BRAZILIAN VENOMOUS SNAKES IN THE AMAZON REGION
Bothrops atrox *Bothrops braziliBothriopsis bilineataBothriopsis teniata
Lachesis muta muta *
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MAIN BRAZILIAN VENOMOUS SNAKES IN THE AMAZON REGION
Lachesis muta muta
Bothriopsis bilineata
Bothrops atrox
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Lachesis muta muta
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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
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Micrurus sp distribution
Micrurus frontalis
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Boa constrictor
Corallus caninusEunectus murinus
Boidae family
Nonvenomous snakes
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Colubridae family Nonvenomous snakes
Spilotes pullatus
Liophis miliaris
Philodryas olfersii
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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
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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
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Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
1-Coagulative activity – cause bleeding and clotting disturbances
Patient
with
severe
gingival
bleeding
Bothrops alternatus
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Mild bothropic envenomings
Bothrops alternatus
Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
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Venom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
Bothrops alternatus
Moderate bothropic
envenomings
Bothropic envenoming
Clinical aspects
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Severe bothropic envenomings
Bothrops alternatus
Bothropic envenoming
Clinical aspectsVenom activity – Bothrops sp
2-Citotoxic venom activity – citotoxicity - capacity to destroy tissues
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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
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Venom activity – Crotalus sp
1-Neurotoxic activity – neurotoxic symptoms
Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
MidriasisLocal bite
Ptosis, Diplopia and blurred vision
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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
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Crotalic envenoming Clinical aspects
Crotalus durissus terrificus
Tubular necrosis causing renal failure
Venom activity – Crotalus sp
3-Renal failure
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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
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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
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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
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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
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NONVENOMOUS SNAKE ACCIDENTS
Colubridae family
-Rare envenomation;
-Rare pain and local swelling;
-Rare partial defibrination;
-Controversial antibotropictreatment.
Envenomation by Philodryas olfersii
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Thank you very much!This lecture is available at:http://www.barraviera.med.br
[email protected]@gnosis.com.br