Bites by coral snakes (Micrurus spp.) in Campinas, State of São Paulo, Southeastern Brazil Acidentes por serpentes corais (Micrurus spp.) em Campinas, Estado de São Paulo, sudeste do Brasil

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Fábio Bucaretchi, Stephen Hyslop, Ronan José Vieira, Adriana Safioli Toledo, Paulo Roberto Madureira, Eduardo Mello de Capitani
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2006
• Subjects: Antivenom; Anticholinesterase; Coral snakes; Envenomation; Micrurus spp; Snakebites; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic; Sudeste
• Online Access: https://doi.org/10.1590/S0036-46652006000300005; https://doaj.org/article/5fcaf92f15c04d4e8b71dbedad8b5105

Coral snakes (Micrurus spp.) are the main representatives of the Elapidae in South America. However, bites by these snakes are uncommon. We retrospectively reviewed the data from 11 individuals bitten by coral snakes over a 20-year period; four were confirmed (snake brought for identification) and seven were highly suspected (neuromuscular manifestations) cases of elapid envenoming. The cases were classified as dry-bite (n = 1, caused by M. lemniscatus; did not receive antivenom), mild (n = 2, local manifestations with no acute myasthenic syndrome; M. frontalis and Micrurus spp.), moderate (n = 5, mild myasthenia) or severe (n = 3, important myasthenia; one of them caused by M. frontalis). The main clinical features upon admission were paresthesia (local, n = 9; generalized, n = 2), local pain (n = 8), palpebral ptosis (n = 8), weakness (n = 4) and inability to stand up (n = 3). No patient developed respiratory failure. Antivenom was used in ten cases, with mild early reactions occurring in three. An anticholinesterase drug was administered in the three severe cases, with a good response in two. No deaths were observed. Despite the high toxicity of coral snake venoms, the prognosis following envenoming is good. In serious bites by M. frontalis or M. lemniscatus, the venom of which acts postsynaptically, anticholinesterases may be useful as an ancillary measure if antivenom is unavailable, if there is a delay in obtaining a sufficient amount, or in those patients given the highest recommended doses of antivenom without improvement of the paralysis or with delayed recovery. As serpentes corais (Micrurus spp.) são as principais representantes dos elapídeos na América do Sul. Todavia, acidentes com essas serpentes são raros. Foram revisados retrospectivamente os prontuários de 11 pacientes mordidos por corais num período de 20 anos. Destes 11 casos, quatro foram casos confirmados por identificação da serpente e sete como casos altamente suspeitos de envenenamento elapídico por apresentarem manifestações ...