Acidentes por serpente falsa coral Oxyrhopus guibei (Hoge &Romano, 1978): estudo retrospectivo de 205 casos atendidos no Hospital Vital Brazil no período de 1945 a 2018

Abstract

A total of 205 proven cases of Oxyrhopus guibei bites, a false coral snake, admitted to Hospital Vital Brazil (HVB) of Butantan Institute, in São Paulo, Brazil, between 1945 and 2018, were retrospectively analyzed. The cases included were those in which the snake was brought to HVB and was correctly identified. Of the 205 cases of snake bites, it was possible to describe the sex of the snake in 172 cases; 40 (65.5%) snakes were female. Only 83 snakes out of 205 could be studied because of their preservation status. The length of snakes (snout–vent length) ranged from 200 to 1250 mm. Of the 205 snakes, 172 could be distinguished as juveniles (n = 116, 68.4%) or adults (n = 56, 31.6%). Most bites occurred in the autumn and spring seasons (n = 127, 62.0%) and in the early evening (n = 84, 41.8%), between 6 PM and 12 PM. The mean (± standard deviation) age of the victims was 26.6 ± 15.9 years, and 130 (63.4%) were men. Approximately 75% of the patients sought medical care within 6 h after the bite. Both lower (n = 92, 49.8%) and upper (n = 86, 46.5%) limbs were the most frequently bitten, particularly the feet and hands (n = 135, 73.0%). The local clinical manifestations were pain (n = 101, 49.3%), transitory bleeding (n = 39, 19.0%), erythema (n = 31, 15.1%), edema (n = 21, 10.2%), paresthesia (n = 17, 8.3%), severe pain (n = 9, 4.4%), radiating pain (n = 8, 3.9%), and ecchymosis (n = 1, 0.5%). Only 38 (18.5%) patients reported nom-specific systemic symptoms characterized by transient dizziness or mild headache, and 69 (33.7%) patients showed no evidence of envenomation. A 20 min whole blood clotting test was performed in 36 (17.6%) patients on admission and all of them had coagulable blood. Supportive treatment was offered to 80 (39.0%) of patients, namely, antiseptic (n = 43, 21.0%), antihistamines (n = 25, 12.2%), and analgesics (n = 24, 11.7%). Fourteen (6.8%) patients were inappropriately treated with antivenom. No sequelae or relevant complications were observed in patients, and the prognosis was benign. Therefore, although O. guibei bites can cause mild local symptomatology, it can be confused with corals snakes (mimics the highly venomous coral snake Micrurus frontalis). Then, it very is important that health professionals know how to make the correct diagnosis to avoid unnecessary use of antivenom.