Epidemiology of the Injury with Venomous Animals in the State of Rio Grande Do Norte, Northeast of Brazil Epidemiologia Dos Acid
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DOI: 10.1590/1413-81232020255.16572018 1967 T E Epidemiology of the injury with venomous animals M A in the state of Rio Grande do Norte, Northeast of Brazil S LIV RE Epidemiologia dos acidentes com animais peçonhentos S F no estado do Rio Grande do Norte, Nordeste do Brasil REE TH E M E S Aluska Vieira Tavares (https://orcid.org/0000-0003-1744-2203) 1 Kalianny Adja Medeiros de Araújo (https://orcid.org/0000-0002-4835-177X) 1 Michael Radan de Vasconcelos Marques (https://orcid.org/0000-0003-2141-7924) 1 Renner Leite (https://orcid.org/0000-0003-0052-3840) 1 Abstract This report is an investigation of the Resumo Este estudo é uma investigação das ca- epidemiological features of injuries with venom- racterísticas epidemiológicas dos acidentes com ous animals in the Rio Grande do Norte state, animais peçonhentos no estado do Rio Grande do Northeastern Brazil, from 2007 to 2014. A total Norte, Nordeste do Brasil, de 2007 a 2014. Um of 30,429 cases were analyzed. Cases were distrib- total de 30.429 casos foram analisados. Os casos uted over all months of the period studied and foram distribuídos em todos os meses do período occurred mainly in urban areas. Scorpion stings estudado e ocorreram principalmente em áreas ur- showed the highest percentage of cases, but the banas. Os acidentes escorpiônicos representaram chance of death among snakebites was higher. maior percentual de casos, entretanto, a chance de Envenomation predominated in females with age morte entre acidentes ofídicos foi maior. Os enve- between 20 and 49 years old. Children and elder- nenamentos predominaram em mulheres com ida- ly showed a higher chance of death. Most victims de entre 20 e 49 anos. Crianças e idosos exibiram were bitten on the extremities of the limbs and maiores chances de morte. A maioria das vítimas received medical care within 0-1 hour after being foi picada nas extremidades dos membros e recebeu bitten. The main local and systemic symptoms re- assistência médica entre 0-1 hora após o incidente. ported were pain and headache, respectively. Cas- Os principais sintomas locais e sistêmicos reporta- es were mostly classified as mild and progressed to dos foram dor e cefaléia, respectivamente. Os casos cure. Few victims show local and systemic compli- foram principalmente classificados como leves e cations. The high number of accidents with ven- progrediram para cura. Poucas vítimas manifes- omous animals shows that Rio Grande do Norte taram complicações locais e sistêmicas. O elevado may be an important risk area for such injuries. número de acidentes com animais peçonhentos in- Furthermore, this study provides data for the de- dica que o estado do Rio Grande do Norte pode ser velopment of health actions to promote control uma importante área de risco para tais acidentes. and prevention of these injuries in this region. Além disso, este estudo fornece dados que poderão Key words Venomous animals, Envenomation, ser utilizados para a elaboração de ações em saúde, Public health a fim de promover o controle e a prevenção desses 1 Centro de Educação e acidentes nesta região. Saúde, Unidade Acadêmica de Saúde, Universidade Palavras-chave Animais peçonhentos, Envene- Federal de Campina namento, Saúde pública Grande. Olho D’água da Bica s/n. Cuité PB Brasil. [email protected] 1968 et al. Tavares AV AV Tavares Introduction the name given to injuries caused by caterpillars of Lepidoptera in humans. The families mainly Accidents with venomous animals are a public associated with injuries in Brazil are Megalopy- health problem in Brazil due to high frequency in gidae, Saturniidae, Limacodidae and Arctiidae14. all regions of the country and potential severity1,2. Caterpillars of genus Lonomia (Saturnidae fam- In some cases, especially those caused by snakes, ily) have a greater relevance for public health, be- victims may develop sequelae that cause tempo- cause they may provoke severe accidents or even rary or permanent incapacity to perform work deaths due hemorrhagic syndrome15. Chippaux3 and/or delays, or lead to death3. According to the shows that caterpillars, mainly those belonging Brazilian Health Ministry, cases of accidents with to the genus Lonomia, were responsible for 4% venomous animals have increased in recent years, of envenomation and 1% of deaths provoked from 31,746 in 2000 to 171,705 in 2016, with a by venomous terrestrial animals. Envenomation total of 1,924,406 cases in this period4. There has predominated in males with no variation in inci- also been an increase in the number of deaths, dence as a function of age, and cases were mostly which increased from 83 in 2000 to 326 in 2016, classified as mild3. totaling 3,645 deaths5. The Northeast region has The State of the Rio Grande do Norte, whose the highest incidence of cases (94/100,000 in- capital is Natal, is a federal unit that integrates the habitants), followed by the South (93.8/100,000 Northeast region of Brazil. It is composed of 167 inhabitants), North (85.3/100,000 inhabitants), municipalities, covering an area of 52,811,126 Southeast (76.6/100,000 inhabitants) and Mid- km². These municipalities are distributed in four west (59.3/100,000 inhabitants)6. regions: Oeste Potiguar, Central Potiguar, Agreste Among the venomous animals responsible Potiguar and Leste Potiguar. According to Institu- for most envenomation of medical importance to Brasileiro de Geografia e Estatística (IBGE), the there are snakes, scorpions, spiders, bees and cat- total resident population of state is of 3,168,027 erpillars1. Scorpions are responsible for the largest inhabitants, with 2,464,991 living in urban areas number of accidents in Brazil3. They occur pre- and 703,036 in rural areas. The population densi- dominantly in urban areas7, with a higher risk of ty is of 60 inhabitants/km². Regarding gender, its death in children8. The species of scorpions rec- population consists of about 1,548,887 men and ognized for their medical importance in Brazil 1,619,140 women16. In Rio Grande do Norte there belong to the genus Tityus, namely T. serrulatus, are two climatic types: tropical and semiarid. T. bahiensis, T. obscurus, T. silvestris, T. metuendus, The first takes place on the east coast, with more T. stigmurus and T. pusillus7. Snakebites mainly af- abundant rainfall, while the latter dominates al- fects men living and working in rural areas9. Most most all areas of the state, including the north cases are caused by snakes of the genera Bothrops, coast. In the region of semiarid climate, rainfall Crotalus, Lachesis and Micrurus. Bothrops acci- is scarce and irregular. The majority of the terri- dents are the most frequent in all regions of Bra- tory of the Rio Grande do Norte (98%) is located zil, but Crotalus cases show the highest lethality within the “Drought Polygon”, an area that is af- rate10. There are three genus of spiders of medical fected annually by prolonged periods of drought. importance in Brazil: Phoneutria, Loxosceles and Almost the entire region has a low rainfall rate, Latrodectus11. Envenomation by spiders of the high average temperatures, acute water deficits, genus Loxosceles is characterized as the most se- generally thin and often salty soils, and caatinga vere and frequent, especially in the southern and vegetation. The average annual temperature in southeastern regions of the country1,3. the state is 26°C, with a maximum of 31ºC and African bees (Apis mellifera scutellata), char- minimum of 21°C. The rainy season occurs be- acterized by their aggressive nature and high hon- tween the months of April to July and rainfall is ey production, were introduced in Brazil in 1956. below 600 mm annually17. In the following year, there was an accidental re- Although there is information provided by lease of some queens of this species, resulting in Brazilian Health Ministry on the annual inci- the hybridization or africanization of European dence of the accidents with venomous animals in bees (Apis mellifera mellifera and Apis mellifera the State of Rio Grande do Norte, there is a lack ligustica) and uncontrolled mixed breeding of of updated local and/or regional epidemiological the Africanized species in the Brazilian envi- information consistent with the medical impor- ronment. The frequency of serious and/or fatal tance of such envenomation. Moreover, there are envenomation caused by Africanized honey bee few epidemiological studies on these injuries in stings have increased since 196012,13. Erucism is the Northeastern Brazil, some cases are underre- 1969 Ciência & Saúde Coletiva, 25(5):1967-1978, 2020 25(5):1967-1978, Coletiva, & Saúde Ciência ported and the epidemiological data collection is Statistical analysis deficient. Finally, many social and environmen- tal changes occurring in this region during re- Statistical analyses were performed using cent decades have indicated that new research is the Chi-square (Likelihood Ratio Chi-Square) needed to update the knowledge on this topic. To test and Correspondence Analysis (ANACOR), address this shortcoming, the current study an- Mann-Whiney and Kruskal-Wallis and Odds Ra- alyzed epidemiological data regarding accidents tio tests. The level of significance was p < 0.05. with venomous animals recorded between 2007 All statistical analyses were performed using the and 2014 in the State of Rio Grande do Norte, software SPSS® version 22.0 (Statistical Package northeastern Brazil. for Social Sciences) for Windows. Ethical clearance Methods This study was carried out on the basis of sec- Study area ondary database. The authors did not have access to the nominal data of the accident victims or any The State of Rio Grande do Norte. other data that would allow identification and they were in compliance with ethics legislation/ Data collection recommendations of research in the country. Injury with venomous animals are manda- torily recorded by the National System of Noti- Results fiable Diseases [Sistema Nacional de Agravos de Notificação (SINAN)]18 based on medical records There have been reported 30,429 cases of acci- used in the investigation and follow-up of cases dents with venomous animals in the State of Rio of injury with venomous animals.