Abstract
BackgroundSnakebite is a major public health problem in agricultural communities in the tropics leading to acute local and systemic impairments with resultant disabilities. Snakebite related long-term musculoskeletal disabilities have been a neglected area of research. We conducted a population-based, cross-sectional study in an agricultural community to describe the chronic musculoskeletal disabilities of snake envenoming.Methodology/Principal FindingsA sample representative of residents of a single district in a region of high incidence of snake envenoming was recruited to identify ever snakebite victims. They were evaluated for chronic musculoskeletal disabilities that had developed immediately or within four weeks after the snakebite and persisted over three months. In-depth interviews, validated musculoskeletal functional assessment criteria and specialists’ examinations were utilised. Among the 816 victims, 26 (3.2%, 95% confidence interval: 2.2–4.6%) had musculoskeletal disabilities, persisting on average for 13.4 years (SD = 14.4). The disabilities were mostly in lower limbs (61.5%) and ranged from swelling (34.6%), muscle wasting (46.1%), reduced motion (61.5%), reduced muscle power (50%), impaired balance (26.9%), chronic non-healing ulcers (3.85%), abnormal gait (3.85%), fixed deformities (19.2%) to amputations (15.4%). Based on disability patterns, six snakebite-related musculoskeletal syndromes were recognised. The offending snakes causing disabilities were cobra (30.8%), Russell’s viper (26.9%) and hump-nosed viper (7.7%). Cobra bites manifested muscle wasting (87.5%), reduced muscle power (87.5%), joint stiffness (62.5%) and deformities (37.5%) while viper bites manifested impaired balance (42.8%), pain (71.4%) and swelling (71.4%).Conclusions/SignificanceSnakebite envenoming is associated with considerable long-term musculoskeletal disabilities. Facilities for specialized care and rehabilitation need to be established in high risk areas.
Highlights
Snake envenoming is a serious public health problem among people who live in tropical and sub-tropical regions of the world
Given the known acute effects of snake venom on the musculoskeletal system, we undertook a population-based study to assess the long-term musculoskeletal sequelae including disabilities in an agricultural community in Sri Lanka, which is a country with a high incidence of snakebites
Among 816 victims of snake envenoming in a single district, we found 26 (3.2%) to have musculoskeletal disabilities persisting for months to years since the snakebite
Summary
Snake envenoming is a serious public health problem among people who live in tropical and sub-tropical regions of the world. Sri Lanka, which is a tropical island positioned between Northern latitudes 5° and 10°, provides shelter to 105 terrestrial species of snakes. Polypeptide toxins and other factors increase permeability resulting in local swelling They may destroy cell membranes and tissues. Haemolytic and myolytic phospholipase A2 enzymes damage cell membranes, endothelium, skeletal muscle, nerves and red blood cells [4]. These effects mediated by snake venom toxins in the acute phase have been widely studied and well characterised in practice as clinical syndromes [2]. Snakebite is a major public health problem in agricultural communities in the tropics leading to acute local and systemic impairments with resultant disabilities. We conducted a population-based, cross-sectional study in an agricultural community to describe the chronic musculoskeletal disabilities of snake envenoming
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