Snakebite poisoning in Costa Rica in 1996: Epidemiology and clinical considerations
DOI:
https://doi.org/10.51481/amc.v41i4.528Keywords:
Envenenamiento ofídico, serpiente, veneno, epidemiología, sueros antiofídicosAbstract
Aim: This study was carried out with the aim of having a complete and updated view of the main epidemiological features of snakebite envenomation in Costa Rica. In addition, some clinical parameters were studied.
Methods: The case histories of all patients admitted with the diagnosis of snakebite in Costa Rican hospitals in 1996 were investigated. Information was collected in a formulary that included both epidemiological and clinical parameters. In addition, the information concerning snakebite envenomations from the Medical Statistics Department of Caja Costarricense de Seguro Social was also obtained.
Results: An incidence of 15,6 cases/100.000 population was estimated, with a mortality rate of 0,031100.000 and a lethality rate of O, 18%. Young males performing agricultural work in rural areas constitute the most affected group. The majority of bites (50%) occurred in the feet, whereas 29% were in the hands. The highest incidence was observed during the rainy season, although cases were reported throughout the year. The species Bothrops
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asper, locally known as "terciopelo", was responsible for almost 50% of the cases, and only 6 bites by coral snakes (Micrurus sp) were reported. The most frequent signs and symptoms were pain, edema, local bleeding and coagulopathies. The majority of the cases were graded as mild or moderate, with only few severe envenomations, usually associated with delays in arrival to the hospital. Few patients received empirical first-aid measures, and hospital treatment was based on early administration of polyvalent antivenom, together with ancillary therapy (tetanus toxoid, antibiotics, analgesics, debridement, abscess drainage and, in some cases, fasciotomy). Only 12% patients developed mild early adverse reactions to antivenom administration.
Conclusions: When compared with a similar study performed in 1979, a reduction in both incidence and mortality were observed, although the total number of cases was similar. Other epidemiological parameters behaved similarly in 1979 and 1996. The low number of cases that received empirical attention out of health facilities, together with the rapid arrival to the hospital and an adequate clinical management are probably responsible for the favorable clinical evolution of the majority of the cases. The low incidence of early adverse reactions to antivenom administration may be related to improvements in the quality of antivenom manufactured in Costa Rica
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