Manejo clínico de un accidente ofídico por serpiente de cascabel mesoamericana (Crotalus simus) en Costa Rica
DOI:
https://doi.org/10.51481/amc.v68i1.1525Palabras clave:
antiveneno, fasciotomía, mordedura de serpiente, Crotalus, veneno de cascabel, veneno de serpienteResumen
Snakebite envenomation is a relevant public health problem in Costa Rica, a country with high snake diversity and an annual incidence of 12 to 19 cases per 100,000 inhabitants. However, due to the national production of antivenom, its universal availability in public hospitals, and decades of research on snake envenomation, morbidity and mortality rates are low. Despite representing approximately 1% of cases in the country, envenomations caused by Crotalus simus are clinically relevant due to their severity, the broad geographic distribution of this species, and abundance of specimens. We present a case report of a snakebite envenomation caused by an adult C. simus (Mesoamerican rattlesnake) in northwestern Costa Rica. The patient was a 40-year-old man weighing 100 kg who was bitten on the right hand with both fangs. Following the event, the patient was transferred to Hospital de la Anexión de Nicoya, where he received 20 vials of PoliVal-ICP antivenom. The main clinical manifestations included local pain, edema, erythema, and paresthesia. In addition, laboratory tests revealed hematological and coagulation abnormalities consistent with the venom composition of adult individuals of this species, which is rich in snake venom metalloproteinases. On the second day, the patient was transferred to Hospital Calderón Guardia, a higher-level medical facility in the capital city of San José, where he was reevaluated due to persistent edema. On the third day, the medical team decided to perform a fasciotomy and initiate antibiotic therapy. In the following days, the patient underwent surgical washouts and vacuum-assisted closure therapy. Additionally, the patient developed serum sickness on the sixth day. On the tenth day, the VAC system was removed, and the patient remained under observation until day 14, when he was discharged. Finally, the patient attended subsequent rehabilitation therapy sessions to restore motor function. This case highlights the importance of timely hospital transfer and early antivenom administration as key strategies to reduce morbidity and mortality associated with snakebite envenomation. However, it also demonstrates the need to strengthen surveillance and standardize national hospital protocols to prevent unnecessary surgical interventions.
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