Accidente ofídico en Antioquia y Chocó

Aspectos clínicos y epidemiológicos (marzo de 1989 -febrero de 1990)

Abstract

The epidemiological and clinical features of 244 snake bites seen during a one year period in Antioquia (190) and Chocó (54), Colombia, are reported. The incidence per 10.000 inhabitants was twice as much in Chocó as compared to Antioquia. Snake bites were commonest in young farmers (45,9%); 71% affected lower limbs, specially feet (52,5%). Bothropic accident was the commonest (89;4%) followed by nonpoisonous snakes (7,0%), L. muta (2%), Micrurus species (0,8%) and C.d. terríficus (0,8%), the later in handlers of this snake. B. atrox was the prevalent specie (44,5%). Edema (97,2%) and defibrination (61,8%) were the classic features of bothropic poisoning. Nevertheless, necrosis only ocurred in 9,2% of the patients and 35,8% did not have systemic manifestations. In bites by L. muta, all the patients (5) had local and systemic poisoning, three were severe, but hemorrhagic symptoms were rare (1). Soft tissue infection and acute renal failure were the most frequent complications in both accidents. In C.d. terrificus bites local symptoms were moderate, but one patient had severe systemic poisoning. In Micrurus bites neurologic symptoms were trivial or moderate in 2 patients. Bites by nonpoisonous snakes (Colubridae) did not cause clinical manifestations. Twelve patients died (5,3%), 11 (5%) with bothropic and one with crotalic accident. Sixteen had some residual complications (7%), 13 (6%) by Bothrops and 3 by L. muta bites, mainly as result of necrosis. There was statistically significant association (p < 0,05) between traditional medicine and six or more hours of delay to arrive to the Hospital, and severe bothropic poisoning; and between mortality and residual complications and > 12 hours of delay to beging specific treatment. First aid practices did not change the course of poisoning.