Osteomyelitis by Proteus spp after snake bite – Account of a still neglected tropical illness

Abstract

Background: Serum therapy is used in accidents intervention. After the bite, the proposed treatment is based on the snake's type and size, on symptomatology for light, moderate or grave ones. Despite serum therapy's beneficial evidence, there is the need for monitoring and systematic follow-up on the first seven days after the accident. Aim: To report the case intervention with emergence of osteomyelitis by Proteus spp. occurred five weeks immediately after the snake bite.  Methods: Case report of an adolescent individual aged 17, male, bitten at the proximal third of the lower left limb (LLL) living at rural zone at Mato Grosso (MT) countryside, Brazil. Immediate intervention was made with antiphospholipid serum 20 minutes after the bite. A single dose of Benzetacil® (Benzathine benzylpenicillin) was prescribed 48 hours after the accident, associated with anti-inflammatory and corticosteroid. The patient's re-internment with antibiotic therapy after the fifth day could not prevent the osteomyelitis at the tibia bone. To solve the case, two surgical interventions were required. For data analysis, initial and final moments of exams' values were compared, concurring to the assessment by MRI imaging. Results: It was found osteomyelitis in 3,5 cm of the tibia at nuclear MRI, in the result of anterior and fibular tibial muscle culture, and on the bone fragment of the tibia, by Proteus spp bacteria. Conclusions: It is possible to conclude that, in ophidic accidents, one must take into account the possibility the immune system may not respond to the bacterian microorganisms infected on the patient, being needed administration of antibiotics for either positive and negative gram. Such measures would avoid systemic wounds, longer internments and installation of physical deficiencies with increase of health costs.