Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview

• Main Authors: Jilvando M. Medeiros, Isadora S. Oliveira, Isabela G. Ferreira, Gabriel Melo Alexandre-Silva, Felipe A. Cerni, Umberto Zottich, Manuela B. Pucca
• Format: Article
• Language: English
• Published: MDPI AG 2020-04-01
• Series: Reports
• Subjects: snakebite envenomation; rattlesnake; Roraima; <i>Crotalus durissus ruruima</i>; antivenom; acute renal failure
• Online Access: https://www.mdpi.com/2571-841X/3/2/9

Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera <i>Bothrops</i> and <i>Crotalus</i> being the most studied and main responsible for severe and lethal envenomations. In the country, <i>Crotalus</i> genus (i.e., rattlesnakes) is represented by <i>Crotalus durissus</i> species, showing seven different subspecies distributed along the country, including <i>Crotalus durissus ruruima</i>, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by <i>C. d. ruruima</i> venom in Roraima state.