Acidentes ofídicos em Angola
Resumo
Introdução: Os acidentes ofídicos constituem um problema de saúde pública negligenciado, que afecta os países tropicais de África, Ásia e América Latina. A Organização Mundial da Saúde (OMS) estima que a cada ano ocorram 5,4 milhões de mordeduras por serpentes que são responsáveis por 1,8 a 2,7 milhões de envenenamentos, que causam entre 81.000 e 138.000 mortes e o triplo de amputações e outras incapacidades permanentes. Em África calcula-se que ocorram mais de 500 mil acidentes e 20 mil mortes anualmente. O cenário epidemiológico em Angola é, até ao momento, desconhecido. Os pacientes sobretudo nas áreas rurais, não buscam ou não têm acesso aos serviços de saúde, tornando difícil o registo oficial dos casos e consequente provisão de soros, que também é inexistente nos hospitais públicos e quando existem são de segurança e eficácia duvidosa. As serpentes causadoras dos acidentes mais frequentes no país são as Naja spp, Bitis arietans e Dendroaspis spp.Objetivos: Abordar o espectro clínico de envenenamentos por serpentes de maior importância médica em Angola.
Materiais e métodos: Trata-se de um estudo descritivo e retrospetivo de três casos de mordeduras de serpentes de maior importância médica em Angola com desfechos clínicos distintos.
Resultados: No caso clínico ocorrido com a serpente da espécie Bitis arietans, foi necessário realizar-se fasciotomia, devido ao síndrome compartimental que desenvolveu e nove cirurgias realizadas, tendo o doente ficado internado por 92 dias. O segundo caso clínico foi causado por naja nigricollis, a criança de 2 anos, acabou por falecer após 4 dias de internamento, devido à fasceíte necrotizante do pescoço e perna direita, choque séptico e anemia grave. O terceiro caso clínico, causado pela espécie Dendroaspis polylepis, a paciente evoluiu com envenenamento neurotóxico tardio, devido ao golpe autoinfligido logo após a picada desenvolveu um quadro clínico grave, que foi corrigido com a administração de seis unidades de soro antiofídico e internamento em unidade de cuidados intensivos.
Conclusão: O espectro multivariado de complicações clínicas desenvolvidas nos três casos clínicos, demonstram que os acidentes ofídicos possuem características únicas que tornam a sua prevenção e controle desafiadores, por isso é importante que se continue a educar as populações em relação à crença do uso de terapia tradicional. É imperioso a disponibilização de soros nas unidades de saúde, para o tratamento oportuno e eficaz dos envenenamentos, evitando-se, desta forma, os internamentos prolongados, amputações e a morbimortalidade aumentada que constituem um custo elevado para o País.
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