Abstract
Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.
Highlights
Snakebite envenoming (SBE) is a potentially life-threatening disease resulting from the injection of a mixture of different toxins that afflicts the poorest people living in developing countries with the worst quality of life [1]
(2) The diagnosis of SBE related death is challenging for the forensic pathologist since autopsy findings are mostly non-specific
The identification of snake species can be crucial for appropriate clinical management and can improve the prognosis
Summary
SBE is a potentially life-threatening disease resulting from the injection of a mixture of different toxins (venom) that afflicts the poorest people living in developing countries with the worst quality of life [1]. Given the socio-cultural and economic context of the territories, effective treatment is often delayed due to the lack of hospital infrastructure, the non-availability of a species-specific antivenom or delay in its injection caused by the not prompt identification of the offending snake, and the use of traditional healers or popular remedies [3,4]. Pathogenesis induced by snake venoms is complex and characterized by local and systemic alterations represented mostly by bleeding, dermo/myonecrosis, inflammation, and coagulation disorders. Mechanisms of toxicity remain poorly understood because the venoms are complex mixtures of components that induce different effects [5]. Cytotoxins, neurotoxins, and hemotoxins are commonly identified depending on the species of the offending snake
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