Snakebites in the Brazilian Amazon: Current Knowledge and Perspectives

Abstract

Although important efforts were carried out during the past decades in Brazil to understand and control snakebite envenomings, important gaps remain for the fulfillment of these goals, particularly in the Amazon region. Bothrops atrox is the most important venomous snake in the Brazilian Amazon, causing 80–90 % of the snake envenomings in the region. In the Brazilian Amazon, Bothrops envenoming shows pain, swelling, regional lymphadenopathy, ecchymosis, blistering, and necrosis as the most common local clinical manifestations. Secondary bacterial infections were observed in around 40 % of the Bothrops snakebites. Spontaneous systemic bleeding and acute renal failure are common systemic complications after Bothrops envenomings. It is difficult for riverine and indigenous populations to reach health centers for treatment of snakebites. As a result, the number of cases detected officially is probably underestimated. Current antivenoms (AVs) require conservation in adequate facilities, which are not always available in remote settings. In addition, training of multidisciplinary teams is not always appropriate for indigenous health services regarding AV administration, side effect management, and case monitoring and surveillance. Although clinical research related to venomous animal injuries has increased, most publications are based on case reports and lack methodological rigor. Moreover, outcome definitions, such as severity ranking criteria, were empirically established, making the results even less generalizable. Clinical research from hospital-based studies and community observational studies are needed. In addition to all the above recommendations, the importance of international cooperative efforts toward the control of these neglected health problems through international partnerships, namely, with other Amazonian countries, is highlighted.