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1.
Chaves LF, Chuang GW, Sasa M, Gutiérrez JM, 2015. Snakebites are associated with poverty, weather fluctuations, and El Niño. Sci Adv 1: e1500249.
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Otero-Patiño R, 2009. Epidemiological, clinical and therapeutic aspects of Bothrops asper bites. Toxicon 54: 998–1011.
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Sasa M, Wasko DK, Lamar WW, 2009. Natural history of the terciopelo Bothrops asper (Serpentes: Viperidae) in Costa Rica. Toxicon 54: 904–922.
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Solórzano JO, Aguilar NC, Banegas E, 2016. Mordedura de Serpiente. Boletín Epidemiológico Años 2014–2015. Tegucigalpa, Honduras: Secretaria de Salud.
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Gutiérrez JM, 2014. Current challenges for confronting the public health problem of snakebite envenoming in Central America. J Venom Anim Toxins Incl Trop Dis 20: 7.
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Gutiérrez JM, Rucavado A, Chaves F, Díaz C, Escalante T, 2009. Experimental pathology of local tissue damage induced by Bothrops asper snake venom. Toxicon 54: 958–975.
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Gutiérrez JM, 2010. Snakebite envenomation in Central America. Mackessy SP, ed. Handbook of Venoms and Toxins of Reptiles. Boca Raton, FL: CRC Press, 491–507.
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Gutiérrez JM, Escalante T, Rucavado A, 2009. Experimental pathophysiology of systemic alterations induced by Bothrops asper snake venom. Toxicon 54: 976–987.
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Escalante T, Rucavado A, Fox JW, Gutiérrez JM, 2011. Key events in microvascular damage induced by snake venom hemorrhagic metalloproteinases. J Proteomics 74: 1781–1794.
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Luzardo ML, 1962. Aspectos hemorrágicos de las mordeduras de serpientes. Hipofibrinogenemia como hallazgo importante. Investigación Clínica 3: 29–30.
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Singh V, Digra SK, Slathia SS, Kakkar T, 2012. Hemothorax following snakebite. Indian Pediatr 49: 242–243.
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Escalante T, Núñez J, Moura-da-Silva AM, Rucavado A, Theakston RDG, Gutiérrez JM, 2003. Pulmonary hemorrhage induced by jararhagin, a metalloproteinase from Bothrops jararaca snake venom. Toxicol Appl Pharmacol 193: 17–28.
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Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA, 2017. Snakebite envenoming. Nat Rev Dis Primers 3: 17079.
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Gutiérrez JM, Lomonte B, Sanz L, Calvete JJ, 2014. Immunological profile of antivenoms: preclinical analysis of the efficacy of a polyspecific antivenom through antivenomics and neutralization assays. J Proteomics 105: 340–350.
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Case Report: Hemothorax in Envenomation by the Viperid Snake Bothrops asper
Bothrops asper, a highly venomous pit viper distributed from Colombia and northwestern Peru in South America to southern Mexico, is responsible for most snake bites in Central America, affecting especially young agricultural workers. A 17-year-old male from a rural area in northern Honduras was admitted at San Francisco Hospital after a B. asper bite that had occurred 3 days earlier. The puncture wounds were located on the first toe of the right foot. On the second day of admission, the patient developed dyspnea. A physical examination revealed hypoventilation of the left lung with dullness on 75% of the left lung. Left pleural effusion, approximately 90%, was observed on the chest X-ray. The patient was diagnosed with hemothorax, and a thoracostomy drained 1,350 mL of serosanguineous fluid, followed by the installation of a wet suction control system (Pleur-evac®). After 10 days, the patient was discharged. This case illustrates the diversity of hemorrhagic manifestations in envenomations by B. asper.
Author Notes
Authors’ addresses: Luis José Pinto, Emergency Department, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, Juticalpa, Honduras, E-mail: luis.pinto@unah.hn. Linda Lee Fernández, Emergency Department, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, San Pedro Sula, Honduras, E-mail: linda.fernandez@unah.hn. José María Gutiérrez, Instituto Clodomiro Picado, Universidad de Costa Rica, E-mail: jose.gutierrez@ucr.ac.cr. Dany Samir Simón, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, Juticalpa, Honduras, E-mail: danyssa91@gmail.com. Ziomara Ceballos, Pediatrics Department, Hospital San Francisco, Catacamas, Honduras, E-mail: ziomaraceballos@yahoo.es. Luis Fernando Aguilar, Surgery Department, Hospital San Francisco, Tegucigalpa, Honduras, E-mail: fernando95215862@gmail.com. Manuel Sierra, Epidemiology Department, Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras, E-mail: manuel.sierra@unah.edu.hn.