Dabor RESIERE

Our work focuses on viperine envenomations by Bothrops lanceolatus, a member of the Viperidae family of the crotalinae type, the only snake responsible for envenomations in Martinique, the only island in the world where it is present. Any bite by this snake can cause thrombotic complications such as cerebral, pulmonary or myocardial infarction, which can be life-threatening or even fatal. The composition of the venom and the mechanism of injury are still debated. The first specific anti-venomous serum (SAV), Bothrofav1®, which became available in 1991, led to a significant reduction in morbidity and mortality. However, in 2004, a resurgence in the number of ischaemic strokes induced by envenomation, despite the early administration of VAS, called its effectiveness into question and led to the production of a second specific VAS, Bothrofav2®, available since February 2011. The reasons for the failure of the 1st SAV are still hypothetical, and the efficacy of the 2nd SAV is currently being evaluated. This article provides an update on this rare envenomation, which affects one of our overseas departments, and raises fascinating scientific and medical issues.

In French Guiana, Bothrops atrox, Bothrops brazili, Bothrops bilineatus, Lachesis muta and Micrurus sp are responsible for most cases of snakebite envenomation. The clinical features of patients suffering from envenomations by Viperidae snakes involve local tissue lesions and systemic manifestations, such as haemorrhages, coagulopathies and haemodynamic instability.

In this study, we investigated the epidemiology and characteristics of adult patients with severe acute intoxication in Martinique and French Guyana. We conducted a retrospective study from 1 January 2000 to 31 December 2010 in the emergency department (ED) of the Martinique University Hospital, and the public hospitals of Le Lamentin and La Trinité. During the study period, 291 patients were admitted for severe intoxication, representing an incidence rate of 7.7 severe cases/100,000 inhabitants. The mean age was 46 ± 19 years and 166 (57%) were male. Psychiatric disorders were recorded in 143 patients (49.8%). The simplified acute psychological score (SAPS II) on admission was 39 ± 23 points and the poisoning severity score (PSS) was 2.7 ± 0.8 points. Death occurred in 30 (10.3%) patients and the length of hospital stay was 6 ± 7 days. The mode of intoxication was intentional self-poisoning in 87% of cases and drug overdose was recorded in 13% of cases. The toxic agent involved was a therapeutic drug in 58% of cases and a chemical product in 52% of cases. The predominant clinical manifestations were respiratory failure (59%), haemodynamic failure (27%), neurological failure (45%), gastrointestinal manifestations (27%) and renal failure (11%). Polypnoea, shock, ventricular fibrillation or tachycardia and gastrointestinal disorders were the main symptoms associated with death. The main laboratory abnormalities associated with death in our patients were metabolic acidosis, hypokalaemia, hyperlactaemia, hypocalcaemia, kidney damage, rhabdomyolysis, increased aspartate aminotransferases and thrombocytopenia. Extracorporeal membrane oxygenation (ECMO) was used in three patients and specific antidotes were used in 21% of patients. We concluded that acute poisoning is a major public health problem in Martinique, with epidemiological characteristics that differ from those in mainland France, with a high incidence of poisoning by rural and domestic toxins. This epidemiology is similar to that of French Guyana. Overall, my involvement in research has enabled me to explore different aspects of intensive care practice in the fields of epidemiology, healthcare-associated infection, clinical and environmental toxicology, and emerging and re-emerging infections. This experience has also enabled me to familiarise myself with the management of scientific work presented in the form of theses or dissertations and published in scientific journals. Future work will focus on exploring the epidemiology of intoxications in the Antilles-Guyane (AG), French overseas departments located in the region of the American continent. These include the two island regions of the French West Indies, Guadeloupe and Martinique, and the mainland region of French Guiana (in the middle of the Amazon rainforest). There is little epidemiological data on intoxication in the French overseas departments.

Key words: Envenomation; Acute poisoning, epidemiology, Antivenom immunotherapy; French Guiana; Martinique, Bothrops atrox; Bothrops lanceolatus.