Snakebite envenomation is a worldwide problem and in Costa Rica. The following is a retrospective review of 79 patients admitted to the Hospital Nacional de Niños (HNN) from January 1985 to September 1996. Child's age ranged from 9 months to 14 years. The M: F ratio was 1.5:1. Sixty percent of the patients lived in remote rural areas. The most common clinical signs at the time of hospitalization were pain and edema. Fifty patients (63,29%) showed moderate to severe envenomation grades. Fifty-one (64,55%) was caused by Bothrops asper. Complications during hospitalization were compartment syndrome and secondary infection. Three children died, one from disseminated intravascular coagulation, another from renal insufficiency, and the third from a perforated duodenal ulcer. Patients who underwent early fasciotomy had significantly less hospitalization and fewer infectious complications, (p < 0.001). There was no relationship between the envenomation grade and length of hospitalization (p = 0.4). The most common pathogen isolated was S. aureus. Early fasciotomy seemed to reduce the complications seen in these patients. Further studies are necessary to identify the factors that may help clinicians to decide those who should undergo fasciotomy, as well as the best moment to perform it.
In Costa Rica, approximately 700 snakebite cases occur each year, 5 to 10 of which result in death. At the Hospital Nacional de Niños (HNN), 6 to 10 cases are reported annually, more than half of these cases and nearly all deaths are result from Bothrops asper snakebite. This venomous snake, popularly known as the "terciopelo", most often attacks the lower or upper limbs and characteristically produces local tissue damage, which can be severe. The following is a report of the first case of a non-fatal and unusual facial bite caused by Bothrops asper in our country.