Aspects épidémiologiques, cliniques et thérapeutiques des morsures de serpent dans les hôpitaux nationaux Gabriel-Touré et de Kati du Mali: étude rétrospective sur dix ans

Abstract

A retrospective study has been performed on snakebites from January 1993 to December 2002 in the national hospitals Gabriel-Touré, in Bamako, and Kati. It aimed to establish a synthesis of epidemiological, clinical, and therapeutic aspects from snakebites. Eight hundred thirty-two snakebites were recorded during this period. Men were mostly represented: 72 versus 28% of women. The average age was 28 ± 18 years. Farmers were most affected (28%). Most bites occurred between 16 and 20 hours, during the fieldwork and pasture in 44% cases. Lower limbs (73.8%) were more involved than hands (25.8%). Although the type of snake has not been determined, the clinical picture was that of viper syndrome, the severity of which was assessed by the grade of bleeding, edema, renal involvement (15.8%), and neurological disorders (13.3%). Antivenom was administered to 40.6% of patients whose case fatality rate was 2.8%, whereas it was 8.1% in its absence. The case fatality rate associated with serum therapy varied according to the antivenin, 1.5% with the antivenoms manufactured in Europe and 4% with those manufactured in Asia. Five parturients had a favorable outcome with antivenom. The initial management was carried out by traditional healers in 49.7% of cases. The annual case fatality rate decreased gradually from 12% in 1995 to 3% in 2002. The incidence of snakebite is greatly underestimated in hospitals because of inadequate records.