Snakebite envenoming in Brazilian children: clinical aspects, management and outcomes

Abstract

Snakebite envenoming is currently considered a neglected tropical disease, which affects over 5 million people worldwide, and causes almost 150 000 deaths every year, as well as severe injuries, amputations and other sequelae. Snakebite envenoming in children, although proportionally less frequent, is generally more severe, and represents an important challenge for pediatric medicine, since they often result in worse outcomes. In Brazil, given its ecological, geographic and socioeconomic characteristics, snakebites are considered an important health problem, presenting approximately 30 000 victims per year, approximately 15% of them in children. Even with low snakebite incidence, children tend to have higher snakebite severity and complications due to the small body mass and same venom volume inoculated in comparison to adults, even though, due to the lack of epidemiological information about pediatric snakebites and induced injuries, it is difficult to measure the treatment effectiveness, outcomes and quality of emergency medical services for snakebites in children. In this review, we report how Brazilian children are affected by snakebites, describing the characteristics of this affected population, clinical aspects, management, outcomes and main challenges.

Keywords: child; disabilities; envenomation; infants; snakebite; venom.

Figure 1

Snakebite envenomings in children and health facilities in Brazil. The mean percentage of snakebites (A), pediatric intensive care units (B), mean numbers of pediatricians (C), severe cases (D) and cases in which the patient took >3 h from health care to receive appropriate care were calculated (E). Finally, the distribution of the mean percentage of children up to 14 years old in Brazil was established (F). Data regarding the number of pediatricians and pediatric intensive care units (ICU-ped) in Brazil were obtained from the National Register of Health Establishments (CNES, http://cnes.datasus.gov.br/), while the estimated population up to 14 years old was obtained from the Department of Informatics of the Unified Health System (DATASUS, https://datasus.saude.gov.br/). Information regarding snakebites involving individuals aged up to 14 years old from 2012 to 2020, cases classified as severe, and time to reach health care facilities were collected from the Notifiable Diseases Information System [27]. The cartographic bases of Brazil and the macro-regions were obtained from the Brazilian Institute of Geography and Statistics (IBGE, https://www.ibge.gov.br/geociencias/downloads-geociencias.html). All descriptive analyses were performed using the R Studio software Version 1.4.1106, and the results were plotted on choropleth maps using the QGIS software version 3.18.

Figure 2

Distinct clinical aspects compared between children (under 14 years old), adults (between 15 and 59 years old) and the elderly (over 60 years old) in Brazil from 2007 to 2020. Comparison of outcome rates between age groups was made using Chi-square test, corrected by Fisher’s exact test if necessary. Group of adults (15–59 years old, in blue) was the reference for comparisons. Statistical significance was considered if p < 0.05 in statistical tests. The analysis was performed using STATA software (StataCorp. 2013: Release 13. College Station, TX, USA). Red asterisks indicate that the group had a significantly lower frequency than the reference group. Black asterisks indicate that the group had a significantly higher frequency than the reference group. *p < 0.01; **p < 0.001; ***p < 0.0001.