REGISTRO DOI: 10.69849/revistaft/ma10202601201453
Main Author: Kelly Schlotte
Co-authors: Yuseiny Espinosa Venegas; Diorvis Fernandez Leyva; Alianne González Luís Nobrega; Yeleni Cruz Tamayo; Raikov Adrian Carvajal Esquivel; Jessica Salum Calzada; Maibel Martínez Verea; Danay Vigo Rodriguez.
Abstract: Accidents caused by snakes of the genus Micrurus, popularly known as coral snakes, are considered potentially serious due to the toxicity of their venom and the risk of death from respiratory failure. They are also seen as a serious hospital health problem, as well as a social and economic one. Treatment consists of administering antielapidic serum, and the prognosis is usually good. This work aims to report the case of a patient who was bitten by a coral snake on her right hand.
Keywords: Micrurus snake, venom, antielapidic serum.
INTRODUCTION:
Accidents involving venomous snakes are a major global health problem, especially in countries with tropical regions, with high morbidity and mortality rates. In Brazil, there are four species of snakebite accidents of public interest: bothropic, crotalic, lachesis, and elapid. (1,2)
Accidents caused by snakes of the genus Micrurus are known as elapid accidents and have higher morbidity and mortality rates compared to crotalic and bothropic accidents. This is due to respiratory failure, which can lead to death. Their venom is neurotoxic, causing paresthesia in the area of the bite, respiratory failure, muscle paralysis, and blurred vision. (3,4)
This work reports a case of a teenager who was bitten by a coral snake on her right hand and needed to seek hospital treatment.
CASE REPORT:
A sixteen-year-old girl, previously healthy, was tending to her garden at home when she was unexpectedly bitten on the back of her right hand by a snake that she recognized as a coral snake due to the coloration of its stripes. The snake fled, and the girl then began to manifest symptoms such as discomfort at the bite site, blurred vision, profuse sweating, progressing to dysarthria of speech and paresthesia throughout her right upper limb. She was taken to the hospital in her municipality and treated by the medical team. At the hospital, ten ampoules of anti-elapid serum were administered, and the patient was monitored. After the administration of the serum therapy, the patient’s symptoms improved, without the need for additional ampoules. She did not require mechanical ventilation, as she did not develop respiratory failure, and all tests were normal. She was discharged from the hospital thirty-six hours after admission in good general condition.
DISCUSSION:
The venom of the micrurus snake is considered highly toxic. Clinical manifestations may include pain of varying intensity in the area of the bite, most often accompanied by paresthesia, in addition to systemic symptoms characterized by the pre- and postsynaptic neurotoxic activity of the venom at the neuromuscular junction, triggering the action of acetylcholine (ACh), which causes the appearance of an acute myasthenic syndrome, similar to that observed in myasthenia gravis. The condition is serious due to the high incidence of sudden-onset respiratory paralysis, which can lead to death if not properly treated. (2,5)
Other neurotoxic symptoms may occur, such as myasthenic facies, palpebral ptosis, and flaccid paralysis of limbs. The accident is serious due to the high incidence of sudden onset respiratory paralysis, which can lead to cardiorespiratory arrest if not treated adequately. (1,6)
The treatment used to neutralize the venom is the administration of antivenom, specifically anti-elapid serum, and it is usually effective. The serum consists of an injectable solution of specific immunoglobulins, which confer passive immunity. They are derived from plasma of various animals, mainly equines, hyper-immunized with snake venoms. In addition to antivenom directed at the etiological agent, hydration with crystalloid should be instituted to prevent kidney injury, control diuresis, and keep the limb extended. (2,7)
CONCLUSION:
Accidents involving snakes of the genus Micrurus are a significant public health problem due to their high morbidity and mortality. Snake identification, accurate diagnosis, and early treatment are crucial factors in reducing complications and improving recovery.
The use of specific antivenom and supportive measures are fundamental, aiming at the proper management of the accident and reduction of complications. The prognosis for patients bitten by this type of snake is usually good if all measures are carried out properly.
The patient in question, a victim of the accident, recognized the snake after the bite, immediately seeking hospital care before more serious symptoms such as respiratory paralysis manifested. Upon arrival at the hospital, she received specific antivenom and progressed well, with improvement in clinical symptoms, being an example of a Micrurus snakebite with good recovery.
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