SNAKE BITES BY THE JARARACUCU (BOTHROPS-JARARACUSSU) - CLINICOPATHOLOGICAL STUDIES OF 29 PROVEN CASES IN SAO-PAULO STATE, BRAZIL

The jararacucu, one of the most dreaded snakes of Brazil, southern Bol ivia, Paraguay and northeastern Argentina, is a heavily-built pit vipe r which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of h ighly-lethal venom may be milked from its venom glands on a single occ asion. It has accounted for 0.8% to 10% of series of snake bites in Sa o Paulo State, Brazil. We examined 29 cases of proven jararacucu bites recruited over a 20-year period in two Sao Paulo hospitals. Severe si gns of local and systemic envenoming, (local necrosis, shock, spontane ous systemic bleeding, renal failure) were seen only in patients bitte n by snakes longer than 50 cm; bites by shorter specimens were more li kely to cause incoagulable blood. Fourteen patients developed coagulop athy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after be ing bitten, with respiratory and circulatory failure despite large dos es of specific antivenom and intensive-care-unit management. In two pa tients, autopsies revealed acute renal tubular necrosis, cerebral oede ma, haemorrhagic rhabdomyolysis at the site of the bite and disseminat ed intravascular coagulation. In one survivor with chronic renal failu re, renal biopsy showed bilateral cortical necrosis; the patient remai ns dependent on haemodialysis. Effects of polyspecific Bothrops antive nom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.