Medical Management after Lancehead Snakebite in North Amazon: A Case Report of Long-Term Disability

Abstract

Snakebites are a major public health problem in indigenous communities in Brazil, leading to acute local and systemic damage with resulting deficiencies. Long-term musculoskeletal disabilities related to snakebites have been a neglected area of research. Bothrops (lancehead) snakes are responsible for most of the permanent sequelae related to snakebites in Latin America. Here, we present a case report of a 32-year-old male indigenous patient who was envenomed by a Bothrops species. The patient was clinically followed for a period of approximately 2 years and 6 months, during which time he experienced a loss of musculoskeletal tissue and required several medical procedures such as debridement, tissue reconstruction, and physical therapy, which resulted in a recovery of mobility, though with a permanent sequelae in gait. This case report shows how snakebites have a significant impact on health systems, as victims require physiotherapy, plastic surgery, and orthopedics services, as well as social support for reintegration into their local communities.

Keywords: Bothrops; Roraima; necrosis; sequelae; snakebite envenoming.

Figure 1

Yanomami Indigenous Land in northern Brazil. The Yanomami Indigenous Land (in red) occupies an area of 9665 hectares (96.65 km²) inhabited by the Yanomami and Ye’kwana indigenous communities. The Yanomami community population stands at 26,780 people (2021) and is the largest relatively isolated tribe in South America. The victim of the case report inhabits the region of Surucucu, which is where snakebite occurred (yellow star).

Figure 2

Timeline of snakebite injury of lower right limb. Necrosis evolution (day 14), lateral fasciotomy (days 28 and 33), wound reconstruction (days 57 and 73), and presence of an external fixator.

Figure 3

Laboratory analysis of the patient’s blood over months. Serum levels of (A) hemoglobin, (B) hematocrit, (C) calcium, (D) C-reative protein, (E) γ-glutamyl transferase, and (F) lactate dehydrogenase. Red spaces show normal values, which highlight that the patient’s serum levels are lower (A,B), and higher (D,E) than the reference range or vary between normal and altered values (C,F). Pink shade represents the reference range according to Laboratório Central de Roraima (LACEM—HGR), Boa Vista, Roraima, Brazil: hemoglobin: 12–16 g/dL; hematocrit: 40–50%; calcium: 1.17–1.32 mmol/L; C-reative protein: 0.0–8.0 mg/dL; γ-glutamyl transferase: 12–45 mg/dL; lactate dehydrogenase: 200–480 U/L.

Figure 4

Snakebite wound indicating infection approximately 2 years after the accident (photo from 24 January 2022).