Please use this identifier to cite or link to this item: http://ds.saudeindigena.icict.fiocruz.br/handle/bvs/5634
Title: Low health system performance, indigenous status and antivenom underdosage correlate with spider envenoming severity in the remote brazilian Amazon
Authors: 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
Affilliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil / Governo do Estado do Amazonas. Fundação de Vigilância em Saúde do Amazonas Doutora Rosemary Costa Pinto. Núcleo de Sistemas de Informação. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universitat de Girona. Faculty of Medicine. Department of Medical Sciences. Catalunya, Spain.
Faculdades Integradas do Tapajós. Curso de Ciências Biológicas. Santarém, PA, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Emory University. Department of Medicine. Atlanta, GA, USA.
Instituto Butantan. São Paulo, SP, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Rio de Janeiro, RJ, Brasil.
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Diretoria de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.
Abstract: 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.
Keywords: Spiders
Brazil
Epidemiology
Pain
Socioeconomic aspects of health
Abdominal pain
Edema
Rural areas
Keywords: Amazonas
Região Norte
Região Amazônica
Acidente por Animal Peçonhento
DeCS: Brasil
Índios Sul-Americanos
Saúde de Populações Indígenas
Ecossistema Amazônico
Epidemiologia
Fatores de Risco
Estudos Epidemiológicos
Animais Venenosos
Issue Date: 2016
Publisher: Public Library of Science
Citation: SAMPAIO, Vanderson Souza et al. Low health system performance, indigenous status and antivenom underdosage correlate with spider envenoming severity in the remote brazilian Amazon. PLoS ONE, v. 11, n. 5, p. 1-20, 26 May 2016.
metadata.dc.identifier.doi: 10.1371/journal.pone.0156386
Copyright: open access
Appears in Collections:EPI - Artigos de Periódicos

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