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High mortality due to snakebites in French Guiana: Time has come to re-evaluate medical management protocols

Article scientifique 2018 Anglais

Résumé

On January 15, 2017, a 39-year-old man died from uncontrollable hemorrhagic shock after being bitten by an unidentified venomous snake, presumably Bothrops atrox, in Cayenne, the main city of French Guiana.French Guiana is located in the Amazonian area on the northeastern coast of South America between Suriname and Amapa ´, Brazil.This event, relayed by regional and national media, took on an unexpected dimension amplified by political tensions at that time.The nonuse of antivenom (AV) in the Cayenne hospital was the focus of critics and presented as a reflection of mainland France's neglect of French Guiana.We discuss here the factors that led to this clinical situation and the resulting challenges.Among the hundred species of snakes identified in French Guiana, less than 15 are potentially dangerous for humans (6 species of Viperidae and 6 species of Elapidae) [1,2].The Viperidae are the most frequently responsible for attacks, mainly B. atrox, followed by B. brazili, B. bilineatus, and Lachesis muta.Bites from other species have been described but remain rare: Crotalus durissus is confined to the coastal savannahs, and bites by Micrurus sp.-theonly genus belonging to elapid family-are rare.However, it is difficult to have a precise estimation of the relative proportion of species incriminated in snakebites, as snake identification is possible in less than 5% of the cases; in most cases, patients consult at the emergency ward without the specimen [3].In recent publications in Manaus, Amazonas, Brazil, genus identification based on clinical and epidemiological criteria was reported in 91% of cases [4].The aim of this editorial is to synthesize the information available and to make clear proposals to the French health authorities to improve the management of snakebites in French Guiana.

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Mutricy, R., Heckmann, X., Douine, M., Marty, C., Jolivet, A., Perotti, F., Boels, D., Larréché, S., Chippaux, J., Nacher, M., Epelboin, L. (2018). High mortality due to snakebites in French Guiana: Time has come to re-evaluate medical management protocols. https://doi.org/10.1371/journal.pntd.0006482

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Auteur(s)

Rémi Mutricy Xavier Heckmann Maylis Douine Christian Marty Anne Jolivet Frédérique Perotti D. Boels Sébastien Larréché Jean‐Philippe Chippaux Mathieu Nacher Loïc Epelboin

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