ABSTRACT
The epidemiology, patho-physiology and treatment of snakebite envenomation in Central America are reviewed. This neglected tropical disease constitutes a relevant public health problem in the region, where most of the accidents are inflicted by species of the family Viperidae, affecting mostly young agricultural workers. Only 1–2% of snakebite cases are inflicted by coral snakes (genus Micrurus), whose venoms do not induce local tissue damage but cause paralytic effects ending in respiratory paralysis in severe cases. In contrast, envenomations caused by viperid snakes, among which Bothrops asper (known as “terciopelo”, “barba amarilla” or “equis”) is the most important species, are characterized by a prominent local pathology including edema, blistering, hemorrhage and necrosis, often associated with infection. Moderate and severe viperid snakebite cases are characterized by systemic alterations, such as bleeding, coagulopathies, cardiovascular shock and acute kidney injury. After an initial diagnosis, based on the assessment of objective signs and symptoms of envenomation, the mainstay of the clinical management of these patients is based on the intravenous administration of either “polyvalent antivenom” (for pitviper bites) or “anticoral antivenom” (for coral snakebites) diluted in saline solution. Close monitoring of the patient is critical to detect the appearance of early adverse reactions to antivenom therapy and to monitor the evolution of the case. In addition, tetanus prophylaxis has to be considered, together with the administration of antibiotics in moderate and severe pitviper bites involving significant local tissue damage. Finally, the management of complications derived from envenomations has to be considered depending on the clinical features of each case.
