UN CASO CLÍNICO DE ENVENENAMIENTO POR LA SERPIENTE Coniophanes Piceivittis COPE, EN HONDURAS Leonel Marineros¹ Y Edgardo Marineros-Banegas²

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UN CASO CLÍNICO DE ENVENENAMIENTO POR LA SERPIENTE Coniophanes Piceivittis COPE, EN HONDURAS Leonel Marineros¹ Y Edgardo Marineros-Banegas² Marineros, L. y E. Marineros-Banegas, 2019 UN CASO CLÍNICO DE ENVENENAMIENTO POR LA SERPIENTE Coniophanes piceivittis COPE, EN HONDURAS Leonel Marineros¹ y Edgardo Marineros-Banegas² ¹ Biólogo especialista en Vida Silvestre, investigador asociado al INCEBIO ² Facultad de Medicina, UNAH causing mild poisoning, characterized by Recibido: 23 de septiembre del 2019 inflammation and burning that can confuse Aceptado: 20 de diciembre del 2019 medical emergency care personnel; as if it Publicado: 31 de diciembre del 2019 were a bite by a vipérid. In this note, there Autor de correspondencia: Leonel Marineros: [email protected] is an official accident caused by the bite of Cita: Marineros, L. y E. Marineros- the snake Coniophanes piceivittis, known Banegas. 2019. Un caso clínico de as "guardacaninos black" happened on the envenenamiento por la serpiente periphery of Tegucigalpa. It is estimated as Coniophanes piceivittis Cope, En a moderate degree, the effects and clinical Honduras. Scientia hondurensis:2(2):29-33 care provided until the end of the symptoms are described. RESUMEN KEY WORDS: Colubrid, opistoglifa, Muchos colúbridos, conocidos como no toxic saliva, snake management venenosos, presentan saliva tóxica, aunque no mortal, sus componentes son capaces Los accidentes ofídicos representan un de causar un envenenamiento leve, serio problema de salud pública a nivel caracterizado por inflamación y ardor que mundial. Se estima que en Honduras puede confundir al personal de atención de ocurren más de 100 casos anuales, muchos emergencias médicas; como si se tratase de los cuales llegan a ser fatales; sin de una mordedura por un vipérido. En esta embargo, esta estadística no corresponde a nota, se presenta un accidente ofídico la realidad, ya que muchos de estos ocasionado por la mordedura de la accidentes no son registrados en las serpiente Coniophanes piceivittis, estadísticas hospitalarias (Marineros et al., conocida como “guardacaminos negra” 2012). sucedido en la periferia de Tegucigalpa. Se Las serpientes de dentición opistoglífos; estima como grado moderado, se es decir, aquellas que presentan colmillos describen los efectos y la atención clínica venenosos en el fondo de la arcada dental brindada hasta el fin de los síntomas. superior, representan una buena cantidad de la diversidad de especies presentes en PALABRAS CLAVES: colúbrido, Honduras. Estas serpientes presentan opistoglifa, saliva toxica, manejo de dificultad para inyectar su veneno, serpientes precisamente por ese detalle de la ubicación de sus los colmillos. ABSTRACT En los trabajos documentados por Many colubrid, known as non- Marineros 2000 y Marineros et al. 2012, se poisonous, have toxic saliva, although not presenta una lista de serpientes con saliva fatal, its components are capable of 29 Scientia hondurensis 2(2), Año 2019 tóxica capaces de ocasionar inflamación y minutos y luego cada hora el primer día; al ardor. Estos trabajos también presentaron mismo tiempo que se documentó material fotográfico para brindar el fotográficamente el desarrollo del evento. reconociendo rápido en caso de emergencia. Es fácilmente identificada por su coloración dorsal de líneas negras gruesas brillantes con dos líneas amarillentas delgadas y por la presencia de 23 a 25 hileras de escamas dorsales (McCranie 2011). En la revisión bibliográfica, no se lograron encontrar casos clínicos registrados para la mayoría de las especies registradas como opistoglifas en Honduras. El objetivo de esta nota es Figura 2. Inserción de los dientes opistoflifos. La presentar la documentación de un caso de serpiente estuvo prendida por unos 30 segundos. accidente ofídico ocasionado por la serpiente opistoglífa Coniophanes El 27 de junio 2019 un ejemplar cautivo piceivittis. de Coniophanes piceivittis fue liberado El ejemplar de C. piceivittis fue exactamente a las 10:00 am cerca de encontrada en el dormitorio de una casa de Tegucigalpa; antes de soltarla, la serpiente habitación en un barrio periférico de mordió al primer autor logrando introducir Tegucigalpa (Altos de la Centroamérica), ambos colmillos opistoglífos e inocular a 1160 m de elevación, en una región veneno en la porción proximal de la cara cercana a zacatales en los alrededores y posterior del segundo dedo de la mano entregada al primer autor (Figura 1). izquierda (Figura 2). La inserción de los dientes causó un dolor inmediato (Figura 2 y Figura 3). La serpiente quedó prendida por cerca de 30 segundos y logró introducir los dientes opistoglífos ubicados en el fondo de su cavidad bucal, con ello logró inyectar la toxina de sus glándulas de Duvernoy. Figura 1. Manipulación del espécimen en referencia de C. piceivittis El paciente conducía solitario un automóvil de camino entre Tegucigalpa y el pueblo de Aramecina (departamento de Valle), y trató de documentar el desenvolvimiento del evento con su teléfono celular. Se hicieron grabaciones Figura 3. Marca de los dos colmillos opistoglífos que pueden confundir al equipo médico con la descriptivas de video al principio cada 10 marca dejada por una víbora. 30 Marineros, L. y E. Marineros-Banegas, 2019 se negó a recibir antinflamatorios ni La figura 1 muestra la especie y su analgésicos. tamaño comparativo con la mano del paciente. Se trata de una “guardacaminos negra”, conocida así para diferenciarla de la “guardacaminos blanca” o Conophis lineatus, otra especie de colúbrido también opistoglífa perteneciente a la misma familia Dipsadidae. La figura 2 muestra el momento de la mordedura, en este caso se le permitió a la culebra introducir sus colmillos traseros que son de mayor tamaño que los dientes sujetadores y aglifos. Figura 4. Inflamación comparativa al segundo día. La figura 3 muestra la marca dejada posterior a la mordedura, se aprecia las Día 2: Los cambios inflamatorios marcas dejadas por los colmillos persisten hasta el tercio distal del inoculadores, los dientes aglifos dejaron antebrazo izquierdo. El paciente describe una marca poco visible. dolor leve de tipo punzante y se mantiene La fotografía 3 muestra la inflamación es la imposibilidad para realizar un puño y evidente que se comenzó a los pocos dificultad al movimiento de dedos. minutos posteriores al incidente y que se Día 5: La inflamación persistió, pero en incrementó en las horas próximas, siendo menor grado, y se limitó al dorso de la plena al segundo día. mano izquierda. El resto de las A continuación, se describen las manifestaciones persistieron igual. manifestaciones clínicas presentadas por Día 8: La inflamación ya era casi el paciente hasta la resolución total del imperceptible, pero se mantuvo levemente cuadro. en el dorso de la mano. El dolor solo estaba Día 1: En los primeros 5 minutos, el presente al realizar un puño o realizar paciente manifestó haber sentido dolor de presión sobre el dedo afectado, y se ha tipo urente en el sitio de la mordedura, que recobrado la movilidad completa de los en un inicio describe como muy intenso, dedos, exceptuando el 2do. pero este fue aumentando con el paso de Día 12: La inflamación estaba localizada pocos minutos acompañándose de al dorso del 2do dedo de la mano izquierda nauseas, arcadas, e hiperalgesia en el dorso y aún se encontró dificultad a la de la misma mano (Figura 4). movilización de este dedo. Dolor leve al Adicionalmente se desarrollaron cambios realizar presión sobre el dedo. inflamatorios progresivos, llegando el Día 14: Paciente manifestó leve dolor en edema hasta el tercio distal del antebrazo el dedo afectado al tratar de realizar un al cabo de pocas horas. Esto le impedía puño, pero la inflamación ha desaparecido. realizar un puño y dificultaba la movilidad Día 15: Resolución total del cuadro. de sus dedos. Paciente ya era capaz de realizar un puño El paciente fue atendido en una clínica sin dificultad ni dolor aparente, los privada del pueblo de Aramecina, donde se movimientos se encontraron normales y la realizó su respectiva evaluación médica, inflamación cedió. asepsia y antisepsia de la herida, además se colocó profilaxis antitetánica. El paciente 31 Scientia hondurensis 2(2), Año 2019 Día 32: El paciente manifestó sentir leve prolongado para lograr morder ardor detectable en el dorso de la mano eficientemente e introducir los colmillos afectada solamente al apretar fuertemente de veneno a sus presas, como todas las que el puño. pertenecen a la familia Dipsadidae. Angarita-Sierra et al. (2019), menciona Jorge Porras (comunicación personal) algunos casos de accidentes ofídicos con nos mencionó un caso parecido en el colúbridos de América tropical, y zoológico de El Salvador y presenció un comentan que, de las más de 780 especies caso clínico con la serpiente Coniophanes de colúbridos, menos del 5% fissidens que mordió a un empleado del (aproximadamente 35 especies) se han lugar. documentado casos de envenenamiento, En Honduras, McCranie (2011), describe entre otras mencionada a los géneros y que esta serpiente se ha encontrado en la especies Chironius, Clelia, Coniophanes mitad occidental del país, en los imperialis, Conophis lineatus, departamentos de Cortés, Copán, Crissantophis nevermanni, Cubophis Comayagua, Francisco Morazán y Valle. cantherigerus, Erythrolamprus, Este mismo autor comenta que la especie Leptophis ahaetulla, Leptodeira annulata, se alimenta de lagartijas y anfibios L septemtrionalis, Mastigodryas spp, ocupando ecosistemas que van desde las Oxybelis aneus , Urotheca y Xenodon. formaciones secas (como las llanuras del Los envenenamientos por colúbridos en pacifico de Honduras), hasta los bosques Honduras son poco conocidos,
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