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PubMed1998

A clinico-epidemiological study of snake bite in Nepal.

Envenoming from snake bite is an important medical condition, frequently encountered at the emergency department of BPKIHS hospital (Dharan, Nepal). This is a retrospective study of 52 cases of suspected snake bite who presented at the department from August 1993 to November 1994. Analysis of the data showed that snake bite was more frequent between the ages of 11 to 20 years (36.7%) and 2.5 times more common in males. Fifty-seven per cent of the bites occurred between 1600 h and midnight with highest incidence (51%) occurring during the monsoon (August-October). Twenty per cent of the patients were able to identify the snake species as venomous and 90% of them presented to the hospital within 3 h of being bitten. Sixty per cent of the bites were in the lower limb. Neurotoxicity due to envenoming was recorded in nine patients (17%). No case of coagulopathy was recorded. The overall case fatality was 3.8% but mortality amongst those exhibiting signs of neurotoxicity was 22%.

Adolescent↗
PubMed1992

Epidemiology of snake bite in the district of Burdwan, West Bengal.

An epidemiological field survey on snake bite was conducted on 26 randomly selected villages with a population of 18,892 in the district of Burdwan, West Bengal to assess the magnitude of the problem in a decade (1980-1989). Total number of snake bite, number of presumably poisonous snake bite and deaths due to snake bite poisoning were 307, 48 and 31 respectively. The death rate among snake bite victims was 10.09%. Males (54.72%) were bitten more than females (45.23%) and highest incidence of snake bite was found in the age group of 21-30 years and during the months of July and August. Majority of the snake bites (53%) were encountered in the lower extremities. Among the snake bite patients 201 (65.47% went to the traditional healers (ozhas) and 68 (22.14%) persons received hospital treatment, while 12 (3.09%) people neither went to the ozhas nor to hospital and 26 (8.46%) persons went to hospital after consulting the ozhas. If the present data are extrapolated for the total population of the district, average number of snake bite and death per year would be 7,857 (0.16%) and 793 (0.016%) respectively. Deaths due to snake bite per 100,000 population varied from 5.28 to 31.75 (average 16.4) over 10 years.

Adolescent↗
PubMed1998

Venomous snake bite of a child.

Venomous snake bites account for 9 to 15 deaths yearly. This is a low number considering that approximately 8,000 venomous snake bites occur each year. These deaths may be prevented by proper and timely medical treatment.

Child, Preschool↗
PubMed1974

Immunodiagnosis of snake bite.

Management of a patient with snake bite is influenced by the nature of the offending snake. Species diagnosis based on the patient's history and physical signs is often unreliable and the possibility of making a species diagnosis by immunological means has therefore been investigated. Wound aspirates, blister fluids, sera, and urine samples from patients with snake bite were examined for the presence of species-specific venoms using immunodiffusion. A positive species diagnosis was made in 40 out of 101 patients. Immunodiagnosis was especially successful in patients bitten by the puff adder, Bitis arietans, and the African spitting cobra, Naja nigricollis. A higher success rate could probably be achieved using more specific antisera and more sensitive assay techniques.

Animals↗
PubMed1998

[Clinical picture and treatment of venomous snake bites in Yugoslavia].

Snakes of the Balkan peninsula represent an important part of the fauna of this part of Europe. Due to its biochemical complexity, snake venom cannot be compared with venoms of any other venomous animals. The primary effect of venoms of snakes of this region (Viperina) is local (myonecrosis and hemorrhage) and hemotoxic. Following the bite local signs occur very soon: pain, edema, erythema, signs of hemolysis as well as systemic: nausea, vomiting, hemorrhages in vital organs, sweating, prostration. Systemic manifestations following viperine bite, edema and hemorrhagic complications mostly disappear within a week, while coagulation disorders may persist for two or three weeks. The management of snake bites starts with application of a specific antitoxin, in our country being produced at the Institute of Immunology and Virology TORLAK in Belgrade.

Humans↗
PubMedDate not supplied

Management of snake-bite in rural Maharashtra: a 10-year experience.

BACKGROUND: A high incidence of snake-bite envenomation has been reported from Marathwada, Maharashtra. This study analysed the pattern of snake-bites and their management in a rural area of India over a 10-year period. METHODS: A total of 633 patients with snake-bite admitted to the Rural Community Centre and Punde Hospital in Mukhed taluka, Nanded district (Marathwada) of Maharashtra, between 1992 and 2001, were analysed retrospectively. The local and systemic manifestations of snake-bite, response to antisnake venom, atropine and neostigmine, the treatment of complications and the outcome were analysed. RESULTS: Of the 633 patients, 427 (67.5%) had been bitten by poisonous snakes and 206 (32.5%) by non-poisonous snakes. The majority of snake-bites (68.9%) occurred between May and November. Those affected were mainly farmers (228 [36%]), students (191 [30.2%]) and housewives (175 [27.6%]). Of the 427 envenomed by poisonous snakes, 274 (64.2%) were by Echis carinatus (saw-scaled viper), 71 (16.6%) by cobra, 42 (9.8%) by krait and 40 (9.4%) by Russell viper. The requirement of antisnake venom for treating neurotoxic envenomation was 40-320 ml and for Echiscarinatus and Russell viper bites it was 20-250 ml. Among those envenomed by poisonous snakes, the mortality was 4.7% (n=20). CONCLUSION: Snake-bite is a common life-threatening emergency in the study area. We observed an occupational risk and a seasonal incidence of snake-bite. Knowledge of the varied clinical manifestations of snake-bite are important for effective management. Ready availability and appropriate use of antisnake venom, close monitoring of patients, institution of ventilatory support and early referral to a larger hospital when required help in reducing the mortality. Most patients with snake-bites can be successfully managed even in small rural hospitals with limited facilities.

Adult↗
PubMedDate not supplied

A case report of scrotal gangrene from snake bite.

A case of snake bite of the scrotum in a 43-year-old male Fulani farmer cum herdsman is presented. Gangrene of the scrotum developed 4 days after the bite together with an increase in size of the scrotum to about 59cm in circumference. The patient received polyvalent snake anti venom almost 10 hours after the bite. Surgery to excise the gangrenous part, together with multiple longitudinal skin incisions of scrotum and penis were carried out The scrotal size reduced to almost half of the morbid size within 48 hours of surgery.

Adult↗
PubMed1986

[Acute compartment syndrome following snake bite].

The experience with snake bites, causing local complications is discussed. Whenever systemic envenomation occurs, antivenin is the treatment of choice. Tissue necroses are treated by early debridement and a possible closed compartment syndrome demands the open fasciotomy.

Acute Disease↗
PubMed1987

Epidemiological studies of snake bite in French Guiana.

The incidence of snake bite and the presence of venom antibody in previous snake bite victims was investigated in French Guiana. The incidence proved to be highest (600/100,000) in inhabitants of bush regions and lowest (45/100,000) in urban areas. Of 43 sera tested for specific venom antibody 22 (51%) were positive, and most of these individuals suffered severe or moderate poisoning. The main species involved, as assessed by detection of venom antibody by ELISA, were Lachesis muta, Bothrops brazili, B. bilineatus and B. atrox. The significance of these findings is discussed.

Antibodies↗
PubMed1997

[Pedicled thoraco-abdominal skin flap applied in early repair of deep ulcer of upper extremity resulting from snake-bite injury].

The ulcer resulting from snake-bite injury was characterized by deep and wide tissue necrosis and secondary infection. The patient was at high risk of loss of function of his extremity. From 1989 to 1996, 16 cases with deep ulcer of the upper extremity resulting from snake-bite injury were treated with different types of axial thoraco-abdominal skin flaps, depending on the location of the ulcer. Thoraco-umbilical skin flap was used in 2 cases, lateral thoracoabdominal skin flap in 1 case, iliolumbar skin flaps in 5 cases, lower abdominal skin flaps in 6 cases, lower abdominal divided foliated skin flap in 1 case and Y-shaped hypogastric skin flap in 1 case. Reparative operation was carried out within 3 weeks after injury and primary repair were undertaken in 6 of them. The pedicles were divided in 17 to 24 days after operation. Twelve flaps survived. Three of the 6 flaps had mild signs of inflammation which disappeared after administration of antibiotics. One had necrosis of the distal part of the flap, and was healed with split skin graft. This type of skin flap was an ideal method for the treatment of snake-bite injury of the upper extremity.

Adolescent↗
PubMed1985

Prolonged intensive therapy after snake bite. A probable case of envenomation by the rough-scaled snake.

A case of snake-bite envenomation, probably by the rough-scaled snake (Tropidechis carinatus), in a 9-year-old boy is reported which we believe to represent the most severe and prolonged case yet of non-fatal snake-bite envenomation in a human. The initial clinical features included loss of consciousness within minutes of the bite, followed by a period of partial recovery. The child subsequently developed total body paralysis, acute renal failure, and gross rhabdomyolysis. Artificial ventilation was maintained for 10 weeks; muscle paralysis and paresis persisted for 18 weeks before neuromuscular function returned to normal. Recovery occurred in centripetal fashion, the respiratory muscles and the palatal muscles being the last to recover. Acute renal failure persisted for 18 days and was treated by peritoneal dialysis. Some beneficial effects were seen even when antivenom was given 90 hours after the bite, but gross rhabdomyolysis caused by this species is not prevented by the administration of antivenom after 60 hours. It is concluded that if life can be sustained for 10 weeks by artificial ventilation, normal intellectual and neuromuscular recovery is possible in such cases.

Acute Kidney Injury↗
PubMedDate not supplied

Profile of cardiac complications of snake bite.

The present study was conducted in 30 cases of snake bite to understand fully the intricacies of the cardiac profile and to render help in the management of the problem arising out of them. All were subjected to routine and specific investigations (ECG, X-ray Chest, SGOT). The present study concluded that 57 per cent of patients of snake bite were in 2nd and 3rd decades of life. Viperine snake bite occurred in 93 per cent and elapide snake bite in 7 per cent of cases. Cardiotoxicity was seen in only 25 per cent patients with viperine bite. Seventy-six per cent of the patients presented within 24 hours of the bite. Seventy per cent of patients had haemorrhagic manifestations and 30 per cent had cardiotoxicity. The disturbance in heart rate was seen in 47 per cent, rhythm disturbance in 6.7 per cent, tachycardia in 36.7 per cent and bradycardia in 10 per cent cases. Hypertension was found in 6.7 per cent, hypotension in 16.7 per cent. Thirty per cent of patients had gallop rhythm and it persisted in 16.6 per cent patients till discharge. One patient had evidence of pulmonary edema and one had basal congestion. Cardiomegaly on chest X-ray was found in one patient and elevated SGOT titres were found in ten per cent. Common electrocardiographic changes were sinus tachycardia, sinus arrhythmia (6.6%), sinus bradycardia (10%), tall T-wave in V2 (3.3%), pattern suggestive of acute anterior wall infarction with reciprocal changes (3.3%), myocardial ischemia (10%), non-specific ST-T changes (16.7%) and atrioventricular block (3.3%). The mortality rate was 10 per cent and all these patients had bleeding manifestations and abnormal electrocardiograms.

Adult↗
PubMed1988

Factors contributing to fatal snake bite in the rural tropics: analysis of 46 cases in Thailand.

Records of 46 cases of fatal bites by identified snakes from 15 provincial hospitals throughout Thailand contained sufficient information for detailed analysis. Bungarus candidus and Calloselasma rhodostoma were each responsible for 13 deaths, Naja kaouthia for 12, Vipera russelli for 7 and B. fasciatus for one. Major causes of death among elapid victims were respiratory failure (26) and complications of prolonged mechanical ventilation (10), and among viper victims shock (12), intracranial haemorrhage (9), complications of local wound necrosis (7) including tetanus (2), and renal failure (2). Factors contributing to fatal outcome included inadequate dose of antivenom (15 cases), misidentification of the snake leading to use of the wrong antivenom (12), problems associated with mechanical ventilation (10), and delayed arrival in hospital after traditional (herbal) treatment (10). Similar problems have been identified in other tropical countries. Education of medical staff and the patient population at highest risk could reduce snake bite mortality.

Adolescent↗
PubMed1997

The painful experience of inappropriate therapy of snake bites: a report of two cases.

Recognizing the exact species of snake and specific antivenin administration are the most important modality of treatment for poisonous snake bites. In Taiwan, there are six kinds of medically important snakes--two species of Elapidae and four species of Viperidae. Two kinds of polyvalent antivenins and one monovalent antivenin are available. But for snake bites, questions about the prescription of antivenins are still the major problems addressed to the Poison Control Center. Improper use of antivenin may delay a patient's recovery from snake poisoning and even lead to mortality. Here, two cases of snake bites are presented. Each had severe complications and mortality as a result of inappropriate therapy, and the most rational management of snake bite in Taiwan is discussed, too.

Adult↗
PubMed2004

Impact of snake bites and determinants of fatal outcomes in southeastern Nepal.

Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained field workers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 am were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.

Adult↗
PubMed2004

Anticholinesterase therapy for patients with ophthalmoplegia following snake bites: report of two cases.

Although ophthalmoplegia following snake bites is not indicative of a serious neurotoxic complication, symptoms of diplopia, dizziness and ocular discomfort can be emotionally devastating for patients. The authors experienced two cases of ophthalmoplegia following snake bites in Korea. The patients complained of diplopia that had developed several hours after the snake bites. The diplopia did not improve with antivenom treatment, but resolved completely after several injections of neostigmine.

Adolescent↗
PubMed2000

[Snake bites and calcium preparations].

Exact statistical data about snake bites are mostly coming from developed countries. In the United States, for example, 10 to 15 persons die because of a snake bites per annum. In the whole world, according to WHO data from 1983, 10,000 individuals die per annum. In Europe, one case of death occurs in 2 to 3 years. Epidemiological studies, carried out in different countries, showed that a half of the victims came in Emergency Medical Service (EMS) with mild signs of poisoning or without any sign at all. In Mostar, 189 patients were admitted for medical treatment in ten years period (1972-1983) and there was no death case. In the period 1998-2000, increased number of cases snake bites was notified. Two cases were with severe clinical signs and we want to present them in our paper.

Aged↗