Snake Bites in Colombia

Abstract

Thirty coralsnake species there are in Colombia, distributed up to 2200 m.a.s.l. Nevertheless, only a little group of them arranged into three colour patterns (bicolor, monadal, triads of black rings) and inhabiting the five natural regions of the country, inflicts 0.4%-0.8% of the 4300 snakebites arereported every year in Colombia. Neurotoxicity of early initiation (2-14 hr after the bite) is the main characteristic of this envenomation. New coralsnake bites occurring in different places of Colombia, within a 32-years period, mainly in Antioquia department hospitals, were included in the study. The diagnosis and treatment of patients were always performed by the author or through directions offered by phone or by e-mail to the physicians in the hospitals. The snake were captured alive or dead and transferred to the hospital in some cases. Informed consent was obtained from all patients or their relatives. The following data were registered: age of the patient, anatomical site of the bite, snake species, time interval to arrive to the hospital, signs of envenoming, laboratory results, antivenom administered, complications of envenoming and outcome. Thirty patients from one to 57 years old (36.7% were children), with coralsnake bites, were seen in different hospitals from 10 of the 32 (31.3%) departments, all of them located in the five natural regions of the country, mainly in Antioquia department (60%). The main sites of the bites were the feet (53.4%), the hands (30%), genitals (penis 3.3%) and the patients sought medical attention 5.0 ±3.5 hr after the bite. The responsible coralsnakes were Micrurus mipartitus (36.7%); M. dumerilii (40%); M. nigrocinctus (6.7%); M. isozonus (6.7%); M. dissoleucus (3.3%); M. surinamensis (3.3%) and one case by an unknown snake spp. Sixty per cent had paresis of respiratory muscles (two cases with apnea), 63.3% palpebral ptosis / ophthalmoplegia, 36.7% mild quadriparesis and 53.3% required respiratory support during 3-6 days. Fifteen patients (50%) received the Suero Anti-Coral from ICP (Costa Rica), nine (30%) the Soro Antielapídico from Instituto Butantan (São Paulo, Brasil), three (10%) the Suero Antiofídico Anticoral Liofilizado from Laboratorios Probiol (Bogotá) and three (10%) did not receive antivenom by different reasons. Four patients had complications: atelectasis (6.7%) and pneumonia (6.7%). Five patients (16.7%) died.Coralsnake bites occur in any geographical region of the country and at any group of age. Almost one-half of the affected patients (40%) did not suffer respiratory paralysis, but paralytic manifestations develop earlier in children (2-4 hr) than in adults (4-14 hr). They are life threatening. Twenty seven per cent of patients did not present clinical signs of envenoming as a consequence of early specific treatment (within the first two hr) or by a dry bite. It is urgent to enhance the distribution of antivenoms against coralsnake bites all over the country, to promote the research and education on this field and the rapid manufacture of potent antivenoms against the three groups of coralsnakes inhabiting Colombia.