SNAKEBITES IN CHILDREN IN COSTA-RICA - EP IDEMIOLOGY AND RISK-FACTORSRELATED TO THE OCCURRENCE OF ABSCESS AND NECROSIS IN 80 CASES

A retrospective epidemiological analysis is presented of 80 snakebites in children admitted to the Pediatrics Service of Tony Facio Hospital in Limon, Costa Pica, between 1985 and 1995. An overall incidence rat e of 20 snakebite accidents per 100,000 inhabitants per year was calcu lated for the region in that period. However, a higher incidence was d escribed in some counties (36 and 30 cases per 100,000 inhabitants in Talamanca and Siquirres, respectively). Most of the cases occurred in February and November, between 16:00 and 19:00 hr. The mean age of the affected children was 8.67 +/- 2.66 years. No significant difference was found between genders. Thirty-three children affected (41.2%) were members of the local indigenous groups and 31 (38.8%) were residents of Talamanca County. The species of snake responsible were identified in 58.4% of cases, with Bothrops asper being the most important. The l ower extremities were the most important primary site affected (86.3%) . The most common clinical complications described in the study group were abscess formation (11.25%), necrosis (10%), renal failure (3.75%) , compartmental syndrome (2.5%) and anaphylactic shock (1.25%). The ov erall mortality was 2.5%. Statistical analysis of the risk factors rel ating to the two most common complications showed that the condition o f (P = 0.02), damage in the proximal extremities (P = 0.02), a prothro mbin time < 2% (P = 0.01) and serum fibrinogen levels < 100 g/dl (P = 0.01) were risk factors for the development of abscesses. The grade of severity of the snakebite (P = 0.018) and serum fibrinogen levels < 1 00 g/dl were associated with development of necrosis. All of the patie nts with necrosis and abscesses also experienced two or more of the ri sk factors that correlated with a sensitivity of 100% and a specificit y of 67% for the development of abscess, and 87% sensitivity and 88% s pecificity for necrotic complications. According to these data, snakeb ite complications are a relevant health problem in Costa Rica. (C) 199 8 Elsevier Science Ltd. All rights reserved.