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Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon
BACKGROUND: A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Am...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881914/ https://www.ncbi.nlm.nih.gov/pubmed/27227455 http://dx.doi.org/10.1371/journal.pone.0156386 |
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author | Sampaio, Vanderson Souza Gomes, André Alexandre Silva, Iran Mendonça Sachett, Jacqueline Ferreira, Luiz Carlos Lima Oliveira, Sâmella Sabidò, Meritxell Chalkidis, Hipócrates Barbosa Guerra, Maria Graças Vale Salinas, Jorge Luis Wen, Fan Hui Lacerda, Marcus Vinícius Guimarães Monteiro, Wuelton Marcelo |
author_facet | Sampaio, Vanderson Souza Gomes, André Alexandre Silva, Iran Mendonça Sachett, Jacqueline Ferreira, Luiz Carlos Lima Oliveira, Sâmella Sabidò, Meritxell Chalkidis, Hipócrates Barbosa Guerra, Maria Graças Vale Salinas, Jorge Luis Wen, Fan Hui Lacerda, Marcus Vinícius Guimarães Monteiro, Wuelton Marcelo |
author_sort | Sampaio, Vanderson Souza |
collection | PubMed |
description | BACKGROUND: A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. METHODOLOGY/PRINCIPAL FINDINGS: We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95%CI = 0.30–0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI >median [OR = 0.64 (95%CI = 0.39–0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95%CI = 1.49–2.94; p<0.001)], Indigenous status [OR = 2.15 (95%CI = 1.19–3.86; p = 0.011)] and living in a municipality located >300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28–2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located >300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15–2.02; p = 0.003)] and living in a municipality with a MHSPI <median [OR = 1.91 (95%CI = 1.28–2.47; p = 0.002)] increased the odds of antivenom underdosage. CONCLUSIONS: Spider bites is prevalent across the study region with a higher incidence in the rainy season in rural areas. Spider bites can be painful and lead to local manifestations but rarely result in life-threatening envenoming. Major local complications were dermonecrosis and secondary infection in cases diagnosed as Loxosceles bites. Based on the correlations shown here, envenomings occurring in remote rural areas, Indigenous status and living in a municipality located >300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage. |
format | Online Article Text |
id | pubmed-4881914 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-48819142016-06-10 Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon Sampaio, Vanderson Souza Gomes, André Alexandre Silva, Iran Mendonça Sachett, Jacqueline Ferreira, Luiz Carlos Lima Oliveira, Sâmella Sabidò, Meritxell Chalkidis, Hipócrates Barbosa Guerra, Maria Graças Vale Salinas, Jorge Luis Wen, Fan Hui Lacerda, Marcus Vinícius Guimarães Monteiro, Wuelton Marcelo PLoS One Research Article BACKGROUND: A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. METHODOLOGY/PRINCIPAL FINDINGS: We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95%CI = 0.30–0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI >median [OR = 0.64 (95%CI = 0.39–0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95%CI = 1.49–2.94; p<0.001)], Indigenous status [OR = 2.15 (95%CI = 1.19–3.86; p = 0.011)] and living in a municipality located >300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28–2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located >300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15–2.02; p = 0.003)] and living in a municipality with a MHSPI <median [OR = 1.91 (95%CI = 1.28–2.47; p = 0.002)] increased the odds of antivenom underdosage. CONCLUSIONS: Spider bites is prevalent across the study region with a higher incidence in the rainy season in rural areas. Spider bites can be painful and lead to local manifestations but rarely result in life-threatening envenoming. Major local complications were dermonecrosis and secondary infection in cases diagnosed as Loxosceles bites. Based on the correlations shown here, envenomings occurring in remote rural areas, Indigenous status and living in a municipality located >300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage. Public Library of Science 2016-05-26 /pmc/articles/PMC4881914/ /pubmed/27227455 http://dx.doi.org/10.1371/journal.pone.0156386 Text en © 2016 Sampaio et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Sampaio, Vanderson Souza Gomes, André Alexandre Silva, Iran Mendonça Sachett, Jacqueline Ferreira, Luiz Carlos Lima Oliveira, Sâmella Sabidò, Meritxell Chalkidis, Hipócrates Barbosa Guerra, Maria Graças Vale Salinas, Jorge Luis Wen, Fan Hui Lacerda, Marcus Vinícius Guimarães Monteiro, Wuelton Marcelo Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title | Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title_full | Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title_fullStr | Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title_full_unstemmed | Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title_short | Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon |
title_sort | low health system performance, indigenous status and antivenom underdosage correlate with spider envenoming severity in the remote brazilian amazon |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881914/ https://www.ncbi.nlm.nih.gov/pubmed/27227455 http://dx.doi.org/10.1371/journal.pone.0156386 |
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