Bite Site Research Articles

Real-Time Surveillance of Dog Bite Incidence in Islamabad: A Cross-Sectional Study from December 2019 to July 2020

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of <0.05. A total of 338 dog bite cases were captured in the World Veterinary Service (WVS) application, and most cases (n = 226, 85.6%) were reported in December 2019 with a male-to-female ratio of 2:1. Most cases were reported from the age group of 22 to 31 years (n = 178, 53%). Out of the total number of cases, 263 (78%) presented with a single anatomical location, and 174 (51%) had Category II wounds. All dog bite patients were given only the first dose of the anti-rabies vaccine at the hospital level. Real-time dog bite surveillance via a mobile-based application proved to be effective for the timely recording and management of dog bite cases. Young people were reported to be mostly affected by dog bites, and nearly half of the cases were managed in hospitals. Refresher training was conducted for medics and paramedics for mobile-based applications, dog bite management, and proper referral of cases to tertiary care hospitals.

Specific mRNA lipid nanoparticles and acquired resistance to ticks

Acquired resistance to ticks can develop when animals are repeatedly exposed to ticks. Recently, acquired resistance to Ixodes scapularis was induced in guinea pigs immunized with an mRNA-lipid nanoparticle vaccine (19ISP) encoding 19 I. scapularis proteins. Here, we evaluated specific mRNAs present in 19ISP to identify critical components associated with resistance to ticks. A lipid nanoparticle containing 12 mRNAs which included all the targets within 19ISP that elicited strong humoral responses in guinea pigs, was sufficient to induce robust resistance to ticks. Lipid nanoparticles containing fewer mRNAs or a single mRNA were not able to generate strong resistance to ticks. All lipid nanoparticles containing salp14 mRNA, however, were associated with increased redness at the tick bite site – which is the first manifestation of acquired resistance to ticks. This study demonstrates that more than one I. scapularis target within 19ISP is required for resistance to ticks, and that additional targets may also play a role in this process.

Evaluation of Clinical Profile and Complications Associated with Snake Bite among Such Patients at a Tertiary Care Hospital

Background: Snakebite occurs in Pakistan ofently mostly an occupational infection like farmers, plantation workers, fishers, and even among wildlife park rangers and military personnel. Monsoons are essential to farming, and most farmers are from lower-income backgrounds. Snake bite morbidity and fatality rates are species- and time-specific. The sufferers are often from lower socioeconomic classes, despite the absence of evidence to support their usage in the treatment of snake bite poisoning. Snake bites may be fatal if not treated quickly, thus having accurate data on the frequency and severity of these incidents is crucial for both diagnosis and policymaking. So, the study focuses on the evaluation of clinical profile and complications associated with snake bite among such patients at a tertiary care hospital. Objective: The objective of this study is to identify potential contributors to snake bite occurrences and also to determine the mortality and morbidity rates associated with snakebites and how they vary by snake species, venom type, bite location, and anti-venom use. Study Design: Observational Retrospective Study. Settings: This study is conducted in the department of Forensic Medicine and Toxicology, Sheikh Zayed Medical College, Rahim Yar Khan Pakistan. Duration: One year from Jan 2022 to Dec 2022. Methods: Both sexes from any age group and only suspected of snake bite were included. The poison illness other than snake bite were excluded from the study. Tertiary care facilities located in Pakistan included 150 snake bite cases were studied retrospectively between (study period). Using hospital records, researchers were able to learn specifics about snakebite-related mortality and morbidity, such as the species of snake if known, the method of envenomation, the victim's age, sex, residence, occupation, bite site, bite location, clinical manifestations of snakebite, initial treatment, and antivenom use. The admission and death registry were used to compile the historical record of data. Results: There were 96 male and 57 female enrolled in the study. The afternoon had the highest rate of bites (47% during the day), followed by the morning (28%), for a total of 78.5% during the day and 26.5% during the night. Seventy-five percent of the victims were alert when they were taken to the hospital, and most stayed there for between three and ten days as part of their surveillance, improvement, and recovery. The ages have been divided into different groups and we found that majority were from between 30 to 40 years. Pain, swelling, bleeding, tingling, numbness, and a blackened discoloration of the skin were all seen locally in 92 percent of the cases. Conclusion: Surveillance of envenomation’s is crucial for defining standards, arranging therapeutic supplies, and teaching medical personnel on Snakebite treatment since under-reporting of Snake bite occurrences has led to variances in observed rates of it. In addition, it has been noted that snake bites continue to be a significant occupational (farming) danger for people of working age, particularly men, in rural areas.

Rickettsia species in Dermacentor reticulatus ticks feeding on human skin and clinical manifestations of tick-borne infections after tick bite

Dermacentor reticulatus ticks are sporadically removed from human skin and therefore the medical consequences of their feeding are neglected compared to Ixodes ricinus. We investigated the prevalence of pathogens in D. reticulatus removed from human skin and possible clinical manifestations suggestive of tick-borne diseases after a tick bite. A total of 2153 ticks were studied and of these only 34 were D. reticulatus. The mean prevalence of Rickettsia in D. reticulatus was 50.0% and R. raoultii was identified in 82.4% of infected D. reticulatus ticks. We confirmed the first case of R. aeschlimannii infection in D. reticulatus ticks. Among participants bitten by D. reticulatus, 13.3% reported reddening around the tick bite site and flu-like symptoms, including lymphadenopathy and 3.3% reported eschar on the tick site bite. All of the participants with flu-like symptoms after tick removal were bitten by ticks infected with R. raoultii. The results of this study indicate that even though D. reticulatus ticks bite humans sporadically, pathogenic Rickettsia have a remarkably high prevalence in this tick species. We can expect that the incidence of tick-borne lymphadenopathy might increase with the reported expansion of the D. reticulatus into new areas and its growing abundance in Central Europe.

A Critical Review on Mooshika Dansha[Rat Poisoning] in Agad Tantra

Ayurveda is an ancient Indian system of medicine having eight important branches. Agadtantra is among oneof them which deals with Visha (poison) and its toxicological conditions and their management. AcharyaSusruta in Kalpa Sthana of Susruta Samhita, and Acharya Vagbhata in Uttaratantra of Ashtanga Hridaya,moreover in other classics and regional texts have recited concerning the origin of Visha and mooshikaVisha.There are eighteen types of Mooshika, signs and symptoms of their bite and its treatment is described bySushrutaacharya and Vaagbhataacharya. There are five modes of spread of Mooshika (rat) VISHA that areShukra[Semen], Purisha[Feaces], Mutra[Urine],Nakh [scratches by nails] and Dant[ bites with teeth ofMooshika] are poisonous. In case of Mooshika Visha, Dansha sthan [bite site] should be cauterized andRaktamokshana by blood letting should be done. After this various drugs paste should be applied on bite site.Various putrifictory therapies should be givene.g.Lepan, Vamana(Vomiting), Virechana(Purgation) Nasya(Nasalmedication), Anjana (Collyrium) etc. Various Kalpanas [drug preparations] like Sanskarit Ghrita[medicatedghee], Kwath [decoctions], Kalka[paste of drugs], Swarasa [juice of drugs] aremetionedwheresource of infection is rat treatment of Mooshika Visha can be given.

A Case Report of Venezuelan Suntiger Tarantula (Psalmopoeus Irminia) Envenomation and Review of Tarantula Exposures

BackgroundTarantula envenomations are encountered infrequently but may increase with increased exotic animal ownership. This case report presents the first documented toxicity from a Venezuelan suntiger tarantula (VST), Psalmopoeus irminia, and provides a general framework for approaching patients with tarantula exposures. Case ReportA 35-year-old man presented to an emergency department 4 h after experiencing a bite from his pet VST. He developed erythema, pain, and edema to the bite site on the left thenar eminence that extended proximally. Within 4 h, he developed abdominal pain, nausea, vomiting, throat itching, and tightness. The patient had a blood pressure of 131/105 mm Hg, heart rate of 102 beats/min, 36.6°C, respiratory rate of 20 breaths/min, and SpO2 of 94%. Laboratory evaluations were within normal limits (other than chronically elevated but improved transaminases). The patient received 0.5 mg epinephrine intramuscularly, 50 mg diphenhydramine IV, 20 mg famotidine IV, 0.4 mg ondansetron IV, and 1 L of normal saline for a suspected anaphylactic reaction. Shortly after epinephrine administration, his gastrointestinal and upper airway symptoms resolved. All symptoms resolved within 1 week. Why Should an Emergency Physician Be Aware of This?Little is known about VST toxicity. Therefore, providers should rely on a general framework for approaching patients with tarantula exposures. Morbidity from tarantula exposures is mediated by mechanical injury, venom effects, and hypersensitivity reactions. Typical clinical findings include local pain, pruritis, edema, erythema, and burning. Muscle cramping, ophthalmia nodosa, and hypersensitivity reactions may occur. Treatment is primarily supportive and includes decontamination, cool compresses, analgesia, treatment of anaphylaxis, and ophthalmology evaluation if ocular exposure.

Engineered Human Tissue as A New Platform for Mosquito Bite-Site Biology Investigations.

Vector-borne diseases transmitted through the bites of hematophagous arthropods, such as mosquitoes, continue to be a significant threat to human health globally. Transmission of disease by biting arthropod vectors includes interactions between (1) saliva expectorated by a vector during blood meal acquisition from a human host, (2) the transmitted vector-borne pathogens, and (3) host cells present at the skin bite site. Currently, the investigation of bite-site biology is challenged by the lack of model 3D human skin tissues for in vitro analyses. To help fill this gap, we have used a tissue engineering approach to develop new stylized human dermal microvascular bed tissue approximates-complete with warm blood-built with 3D capillary alginate gel (Capgel) biomaterial scaffolds. These engineered tissues, termed a Biologic Interfacial Tissue-Engineered System (BITES), were cellularized with either human dermal fibroblasts (HDFs) or human umbilical vein endothelial cells (HUVECs). Both cell types formed tubular microvessel-like tissue structures of oriented cells (82% and 54% for HDFs and HUVECs, respectively) lining the unique Capgel parallel capillary microstructures. Female Aedes (Ae.) aegypti mosquitoes, a prototypic hematophagous biting vector arthropod, swarmed, bit, and probed blood-loaded HDF BITES microvessel bed tissues that were warmed (34-37 °C), acquiring blood meals in 151 ± 46 s on average, with some ingesting ≳4 µL or more of blood. Further, these tissue-engineered constructs could be cultured for at least three (3) days following blood meal acquisitions. Altogether, these studies serve as a powerful proof-of-concept demonstration of the innovative BITES platform and indicate its potential for the future investigation of arthropod bite-site cellular and molecular biology.

Karakteristik Pendertia Snakebite Disertai Gangguan Hemodinamik dan Asidosis Respiratorik pada Pasien Anak dan Dewasa

Snakebite or snakebite is a defense mechanism for snakes and can become a medical emergency. Snakebites are a significant cause of morbidity and mortality worldwide, especially in South and Southeast Asia, sub-Saharan Africa and Latin America. The snakebite can be life-threatening if it has a neurotoxic, cytotoxic and hemotoxic effect. Complications from snakebite include hemodynamic disturbances and respiratory acidosis. International online databases (PubMed and Google Scholar) were used to search for articles in this systematic review. A total of 24 related research articles indexed by Scopus have been published in the last ten years. This research is a literature systematic review. Research sources were taken in the last 10 years from 2012 to 2022, taken from PubMed and Google Scholar. After exclusion, 24 articles and studies that met the exclusion and inclusion criteria were considered for systematic review. Of all the journals reviewed, there are many that explain snake bite associated with hemodynamic disturbances and respiratory acidosis. Snakebite is proven to provide long-term complications in the form of hemodynamic disturbances around the bite site. Another complication that has been proven to occur in snakeibite victims is cardiac shock, especially impaired cardiac return. Pathophysiology, symptoms, and diagnosis of snakebite in pediatric and adult patients are the same. The majority of journals discuss heart disorders and infections, necrosis of muscles and bones related to venomous snake bites. Hemodynamic disturbances and respiratory acidosis are complications that can occur in snakebite victims. There are similarities in symptoms and management of venomous snake bites in children and adults.

Russell’s Viper Bite and Its Immediate Outcome In Bangladesh

Background: Russell’s viper (Daboia russelii) is found in Asia, throughout Indian subcontinent, much of South East Asia, Southern China and Taiwan. Russell’s viper was seemed to be rare in Bangladesh. Anecdotes suggest that Russell’s viper (Daboia russelii) was an important cause of mortality in the 1920s, but no case of envenoming by this species has since been reported in Bangladesh. Russell’s viper bite has been reported and it is the one of the common snake bite at Rajshahi region which has great morbidity and mortality as well. Methods: This is a prospective observational study was conducted in the Medicine department of Rajshahi Medical College Hospital. We treated total 171 patients from 2013 to December 2022. Russell’s viper envenomation confirmed either by brought dead or live snake specimen, photograph, bedside 20MWBCT and other symptoms. Results: In the management of RV bite patient in the Rajshahi Medical College Hospital, we found that most of the patients are delayed in getting hospitalization after bite due to visit to traditional healer. In our study 96% were male, and 4% were female, mostly farmer and 90% bite site in the lower limb during work in the paddy field. The clinical presentation was pain and local swelling (100%), blood oozing from local site (77%), bruising (44%), haematuria (25%), hypotension (30%), oliguria and few with DIC. In lab findings, coagulopathy (24%), raised CPK (60%), 67% Patients had AKI (raised creatinine and RBC in urine), among them 50% needed dialysis. Few patients also develop multiorgan failure. All patients received polyvalent Anti-venomsupplied by GOB (Incepta Bangladesh Ltd.) which works against cobra, krait, Russell’s viper bite. Despite maximum available support at RMCH, around 30% patient died. Conclusion: It’s high mortality indicates that this polyvalent antivenom might not be working properly. We may need to increase the initial dose or we need to provide monovalent antivenom specific to RV in Bangladesh and early treatment at Upazila Health Complex to reduce the rate of death due to Russell’s viper bite. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 204

Plasmodium-infected mosquito bite elicits an immune response at the bite site

Abstract To induce long-lasting immunity, the host’s immune system must recognize and respond to an invading pathogen upon first encounter. Plasmodium sporozoites, the infective stage of the malaria parasite, are inoculated into the skin by infected mosquitoes as they probe for blood. Only 20% of sporozoites reach the liver, while the rest either reach the draining lymph nodes (dLN) or remain in the infected area for at least 6 hours, shedding an abundant amount of their major surface protein, the circumsporozoite protein (CSP). Yet, sterile immunity against sporozoites or CSP does not occur, despite the presence of the foreign antigens in the skin and the dLN, and repeated exposures, suggesting that Plasmodium sporozoites may modulate the host immune response. In this study we investigate the immune response elicited by P. berghei-infected mosquito bite at the bite site in-vivo. Using intravital imaging of sporozoites inoculation by a mosquito bite to a LysM-CRE GFP expressing mouse, we can observe neutrophil recruitment to the bite site in real time. When investigating the expression of pro- and anti-inflammatory genes in the skin, we find a specific expression patten that is elevated in response to a P. berghei-infected mosquito bite, when compared to a bite of an uninfected mosquito. Here we show fast immune cells recruitment as well as specific immune response to Plasmodium infection, suggesting a quick recognition of infection by the immune system. Nonetheless, gene expression analysis suggests a mechanism by which Plasmodium sporozoites may suppress the immune response to their presence. Kindly supported by grants from NIH (R01 AI132359) and JHMRI.

Research progress toward the influence of mosquito salivary proteins on the transmission of mosquito-borne viruses.

Mosquito-borne viruses (MBVs) are a large class of viruses transmitted mainly through mosquito bites, including dengue virus, Zika virus, Japanese encephalitis virus, West Nile virus, and chikungunya virus, which pose a major threat to the health of people around the world. With global warming and extended human activities, the incidence of many MBVs has increased significantly. Mosquito saliva contains a variety of bioactive protein components. These not only enable blood feeding but also play a crucial role in regulating local infection at the bite site and the remote dissemination of MBVs as well as in remodeling the innate and adaptive immune responses of host vertebrates. Here, we review the physiological functions of mosquito salivary proteins (MSPs) in detail, the influence and the underlying mechanism of MSPs on the transmission of MBVs, and the current progress and issues that urgently need to be addressed in the research and development of MSP-based MBV transmission blocking vaccines.

Management of scorpion bite through Ayurveda: A case report

Abstract: Agadatantra, the branch of toxicology in Ayurveda, refers to various methods of eliminating toxins from the body that arises from animate, inanimate, and artificial poisons. Scorpion stings are a serious health concern in rural areas. In Agadatantra, the symptoms of scorpion sting are explained under Vrischika visha (~scorpion venom poisoning). The main characteristics of scorpion venom poisoning are Vahnivat dahanam (~burning sensation like fire), Kshipram urdhvarohanam (~quick spreading in an upward direction), Danshe ruja tishthati (~pain remains at bite site), Sadyah ati ruk (~instant severe pain), Danshashyavata (~brownish discoloration of bite site), and Dansha toda (~ pricking type of pain at bite site). This is a case report of a 24-year-old male, who had an episode of Vrischika damsha (~scorpion bite) and presented to the outpatient department with complaints of severe edema, pain and redness, and itching. The first line of management for scorpion stings is typically symptomatic including strong analgesics, which can be systemic (opiates or paracetamol) or localized (such as a cold compress). Antivenom is the specific treatment for scorpion envenomation that is used in conjunction with supportive measures. In Ayurveda classics, Hinguadi gulika is one of the formulations mentioned in Vrischikavisha prakarana, which has been referred to as the most potent Lepana (~anointment) for scorpion venom poisoning. In comparison to existing conventional treatment modalities, Hinguadi gulika lepana is a very simple and very cost-effective procedure. Hinguadi gulika was given in combination with Kulakadi kashaya which is widely practiced in all Visha (~poison) conditions. In the present case, Hinguadi gulika and Kulakadi kashayam have shown assuring results in the management of acute scorpion envenomation.

A case report on the management of Luta visha (~spider bite poisoning) through Ayurveda strategies

Abstract: Spider bites are commonly reported from many parts of the world. Clinical manifestations of spider bites reported range from simple local irritations and dermonecrotic lesions to potentially lethal neurotoxicity and intravascular hemolysis. In Agada Tantra, spider envenomation is coined as Luta visha (~spider bite poisoning), and a detailed description of different types of spider bites with their treatment is available in the literature. A 28-year-old female with a history of spider envenomation, presented with two reddish lesions with pale blue depression at the center associated with pain, burning sensation, and itching on the dorsum of her left leg. The lesion was a fast-progressive necrotic lesion and was diagnosed as Pitta-kapha predominant manifestation due to the spider bite. She was administered Guduchyadi kashayam (15 mL) and Vilwadi agada (1000 mg) thrice daily and external Shatadhouta ghrita application after washing with Triphala kashaya. On the fifth day of the bite, when the pain increased and was associated with a mild fever, Sooryaprabha gutika (125 mg) thrice daily was given. The lesion was fully necrosed by the seventh day of the bite. The necrosed tissue was removed, and Mahatiktaka ghrita was applied. By the 17th day of the bite, the wound was healed with no pain on palpation. After 21 days of bite, all the medications were stopped. Dooshivishari agada (500 mg) and Haridrakhandam (5 g) twice daily were prescribed to eliminate residual poison, if any. Eladi kera thailam was administered externally to reduce the blackish discoloration of the bite site. This fast-progressive necrotic lesion was solely managed by Ayurvedic medicines.

A Study of Clinico-social Profile of Animal Bite Patients Attending the Antirabies Clinic of BRD Medical College, Gorakhpur

Background: Rabies is one of zoonotic viral disease, estimated to cause 59000 human deaths annually in over 150 countries, of which 20,000 are from India alone; about 40% of which are in children under the age of 15. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound washing, anti-rabies vaccination and rabies immunoglobulin. Objective: To describe the clinico-social profile of animal bite patients attending the anti-rabies clinic of BRD Medical College, Gorakhpur. Methodology: A cross-sectional study was conducted in the anti-rabies clinic of Nehru hospital, BRD Medical College, Gorakhpur from January 2022 to May 2022. Study participants were interviewed by using a pre-phrased, pre-designed and pre-tested questionnaire. Data regarding socio-demographic and clinical profile of the study participants following animal bite exposure was collected. Results: The total number of animal bite victims were 250, in which majority of them were males (76.77%) and highest percentage was of adult population (20-59 years). Maximum number of victims were from rural area (78.70%). 19.35% were working and 39.35% were students. 77.43% were category III bites and in 50.96% cases lower limb was the site of bite and dogs were responsible for 89.67% of the bites. 60.64% victims did not wash the wound properly before reaching the anti-rabies clinic. Conclusion: This study concludes that as majority of the animal bite victims were students and majority of victims were unaware about the importance of wound care, therefore a step can be taken to create awareness in various schools.

On a bite case of Steatoda triangulosa (Walckenaer) (Arachnida: heridiidae) on a human being

The second case of a bite by the “triangulate false widow” Steatoda triangulosa is reported on a human being. The case occurred in San Vicente, Buenos Aires, Argentina on a female 31 years old victim, who woke up felling a nuisance and spotting the spider on her arm. The spider inflicted two bites causing typical steatodism symptoms including local and radiating pain and malaise which lasted for about a day. In addition, the appearance of an erythema on each bite side that lasted about 10 days plus a haematoma in the first bite site which lasted for 3 days. The implications of the case in the context of current research in steatodism is discussed.

A cross sectional study on pattern of animal bites and their post exposure management in a tribal district of Mayurbhanj, Northern Odisha, India

Background: Rabies is an enzootic and epizootic disease of worldwide. Rabies is a fatal but preventable viral disease. Rabies is one of the neglected tropical diseases that predominantly affects poor and vulnerable populations who live in remote rural locations. Objectives of current study was to assess the prevalence of animal bite cases and its associated factors in a tribal district of Northern Odisha and to study the first aid management of people after dog bite. Methods: It was a cross sectional study. This study was conducted at PRM medical college, Baripada, Odisha in anti-rabies vaccination (ARV) OPD clinic. The study period was March 2021 to September 2021. The sampling techniques was consecutive sampling. The study population was all animal bite case attending ARV clinic. Data was analyzed by appropriate statistical tool. Results: Majority 54.9% victims are dog bite victims and the most common site of bite was lower limb (53.6%). The main source of information was family and friends followed by doctors and health workers. Conclusions: Majority of people especially in rural and tribal area were illiterate and they don’t have any knowledge about animal bite or its management. This study had found that those who are literate had done a proper wound management before coming to ARV clinic. So, literacy proved to have a major impact on wound management. Behavior changes communication (BCC) along with health education is a vital weapon for controlling rabies especially in developing country like India.

A Widefield Light Microscopy-Based Approach Provides Further Insights into the Colonization of the Flea Proventriculus by Yersinia pestis.

Yersinia pestis (the agent of flea-borne plague) must obstruct the flea's proventriculus to maintain transmission to a mammalian host. To this end, Y. pestis must consolidate a mass that entrapped Y. pestis within the proventriculus very early after its ingestion. We developed a semiautomated fluorescent image analysis method and used it to monitor and compare colonization of the flea proventriculus by a fully competent flea-blocking Y. pestis strain, a partially competent strain, and a noncompetent strain. Our data suggested that flea blockage results primarily from the replication of Y. pestis trapped in the anterior half of the proventriculus. However, consolidation of the bacteria-entrapping mass and colonization of the entire proventricular lumen increased the likelihood of flea blockage. The data also showed that consolidation of the bacterial mass is not a prerequisite for colonization of the proventriculus but allowed Y. pestis to maintain itself in a large flea population for an extended period of time. Taken as the whole, the data suggest that a strategy targeting bacterial mass consolidation could significantly reduce the likelihood of Y. pestis being transmitted by fleas (due to gut blockage), but also the possibility of using fleas as a long-term reservoir. IMPORTANCE Yersinia pestis (the causative agent of plague) is one of the deadliest bacterial pathogens. It circulates primarily among rodent populations and their fleas. Better knowledge of the mechanisms leading to the flea-borne transmission of Y. pestis is likely to generate strategies for controlling or even eradicating this bacillus. It is known that Y. pestis obstructs the flea's foregut so that the insect starves, frantically bites its mammalian host, and regurgitates Y. pestis at the bite site. Here, we developed a semiautomated fluorescent image analysis method and used it to document and compare foregut colonization and disease progression in fleas infected with a fully competent flea-blocking Y. pestis strain, a partially competent strain, and a noncompetent strain. Overall, our data provided new insights into Y. pestis' obstruction of the proventriculus for transmission but also the ecology of plague.

The Effectiveness of Antibiotics in Managing Bacterial Infections on Bite Sites following Snakebite Envenomation.

Snakebite envenomation (SBE) is a life-threatening medical emergency with a high mortality rate. Common secondary complications following SBE, such as wound infections, are significant due to their impact on worsening local tissue damage and causing systemic infection. Antivenoms are not effective to treat wound infections following SBE. Moreover, in several rural clinical settings, broad-spectrum antibiotics are often used without clear guidelines or based on limited laboratory data, resulting in undesirable side effects and exacerbated treatment costs. Therefore, robust antibiotic strategies should be developed to tackle this critical issue. Currently, there is limited information available on the bacterial profiles of SBE-induced infections and antibiotic susceptibility. Hence, it is essential to improve the knowledge of bacterial profiles and their antibiotic sensitivity in SBE victims to develop better treatment strategies. This study aimed to address this issue by examining the bacterial profiles of SBE victims with a specific focus on Russell's viper envenomation. The most frequently found bacteria in the bites of SBE victims were Staphylococcus aureus, Klebsiella sp., Escherichia coli, and Pseudomonas aeruginosa. Linezolid, clindamycin, colistin, meropenem, and amikacin were some of the most effective antibiotics for commonly grown bacteria in SBE victims. Similarly, ciprofloxacin, ampicillin, amoxiclave, cefixime, and tetracyclin were the least effective antibiotics for common bacteria found in the wound swabs of SBE victims. These data provide robust guidance for infection management following SBE and offer useful insights to aid in designing effective treatment protocols for SBE with serious wound infections in rural areas where laboratory facilities may not be readily available.

Selective sensory nerve blocks for effective pain management in the emergency department for a term pregnant cobra snake envenomation patient.

Sir, Snake bites with envenomation are a rare life-threatening emergency during pregnancy.[1] We report a case of a young full-term parturient who reported intense localized pain at the cobra (Naza Naza) bite site which was managed successfully by selective sensory nerve blocks. She subsequently underwent a caesarean section under spinal anaesthesia and had an uneventful post-partum course. A 26-year-old eight month pregnant patient presented to the emergency department (ED) post-cobra bite. The patient was taken to a local hospital within 30 min of the event. The bite mark was present on the right foot near the 4th toe [Figure 1]. There was minimal localized swelling but intense pain in the bite area. She had an episode of vomiting 45 min post-snake bite (suggesting the onset of systemic symptoms) and was administered 10 vials of anti-snake venom and referred to our tertiary care set-up.Figure 1: Distribution of superficial peroneal nerve (a); Probe placement for USG-guided block (b); USG image showing the superficial peroneal nerve (c); Snake bite mark on foot of the patient (d)When she presented to our ED 3h post-bite, the swelling had increased considerably and 10 more vials of anti-snake venom were infused. The investigations revealed leucocytosis with mild thrombocytopenia and anaemia. Local site pain was unbearable even after intravenous paracetamol and diclofenac. A superficial peroneal nerve and sural nerve blocks to cover the dorsolateral aspect of the foot was planned. The nerves were localized using a linear transducer (8–13 MHz) and a 3.5 ml of 0.75% ropivacaine was deposited. [Figures 1 and 2] Within 5 mins, the numeric rating scale (NRS) fall to 2 from the initial score of 10. At 10h, the patient reported an NRS score of 6, and the same blocks were repeated and effective pain relief was reported. The patient underwent a caesarean section under spinal anaesthesia at 18h post-admission given foetal distress. The baby was kept on nasal continuous positive airway pressure for 18h in view of respiratory distress and both of them were discharged in stable condition on the 3rd day of admission.Figure 2: Distribution of sural nerve (a); Probe placement for USG-guided block (b); USG image showing the sural nerve (c)Snake bites are rare in pregnancy but maternal mortality and foetal loss remain high.[1] An early presentation and rapidity of treatment with anti-snake venom probably led to a good outcome in this case. Acute localized moderate-to-severe pain is often documented as the first sign of a venomous snake bite (VSB).[2,3] The presynaptic and postsynaptic neurotoxins may directly interact with the nerve endings or indirectly cause severe pain secondary to ischemia due to local oedema.[1] Antivenom treatment fails to alleviate the local pain which may last for 48–72 h.[3] Weak opioids such as tramadol or paracetamol often provide inadequate analgesia.[4] Systemic opioids and non-steroidal anti-inflammatory drugs may be harmful to the foetus in term pregnancy. Furthermore, opioids can increase the risk of respiratory depression in neurotoxic envenomation cases as seen in cobra bite.[4] Untreated pain can have adverse consequences on foeto-maternal circulation.[5] In our case, the patient had intense pain with an NRS of 10 despite analgesics and responded well to nerve blocks. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Scrub Typhus In A Tertiary Care Hospital In Chengalpattu District

Introduction: Orientia tsutsugamushi is the bacterium that causes scrub typhus. By being bitten by a larval trombiculid mite(chigger), it is transmitted. The incubation period is 10-14 days. Fever, headache, body aches, and sometimes rashes are the most common symptoms. The hallmark is the characteristic eschar lesion-scab at the site of chigger bite and regional lymphadenopathy. The severity of the illness varies from person to person ranging from fever to multi-organ involvement. Scrub typhus is diagnosed in the laboratory using serological tests such as ELISA IgM and Immunofluorescence IgM and molecular test -real-time PCR. Though the organism can be isolated using egg and cell culture is confined to the referral or research laboratories having biosafety level 3 facilities. The disease is managed with doxycycline or chloramphenicol and the organism does not respond to penicillins. Aim: To eloborate a case report of scrub typhus in a 41-year-old female patient in our tertiary care hospital. Materials and Methods: laboratory work up of a single patient with clinical suspicion of scrub typhus was carried out using TruNat,Molbio for detection of Orientia tsutsugamushi. All other differential diagnosis of fever including Dengue, were also evaluated to confirm the diagnosis Conclusion: Considering scrub typhus as differential diagnosis of fever is suggested.