Complication Of Snakebite Research Articles

Incidence of snake bite and utilization of antivenom in the University of Benin Teaching Hospital Benin City, Nigeria

Background: Bite resulting from animals seems to be a neglected disease. Since there were cases reported as emergency our institution, there is need to assess the incidence and drug utilization. Objective: To assess the incidence of snake bite and utilization of antivenom over 12 years in the Accident and Emergency Centre of the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: Data from medical record of snake bite and antivenom utilization between the year 2000 and 2011 were assessed from the centre after obtaining permission. Results: One hundred and thirty-six vials of polyvalent antivenom were utilized in the management of 129 patients that reported with snake bite. The victims were 103 (79.9%) males and 26 (20.2%) females within range of 2 years to 68 years (median, 34 years). The incidence was significantly higher among young adult males aged between 29 and 36 years. Limbs were the most common sites of bite and farmers were the most vulnerable which constituted larger proportion of 75 (58.14%) of unskilled workers. On arrival at the hospital, 90 (69.8%) of the victims had local tourniquet applied above the bitten sites. Their only description of snake was in color and size. Thirty-four patients visited herbalist before reporting to hospital. Oral quinolone (ciprofloxacin) and diclofenac were the most frequently used antibacterial and anti-inflammatory agents. Maximum duration of hospitalization was (102 ± 0.61 h). No death was recorded following snake envenomation and no adverse drug reaction during therapy. Conclusion: Adequate stocking of antivenom is strongly recommended during drug procurement because snake bite complications can be fatal if not promptly treated.

Persistent anosmia and olfactory bulb atrophy after mulga (Pseudechis australis) snakebite

Loss of sense of smell is an intriguing yet under-recognised complication of snakebite. We report olfactory function testing and neuroimaging of the olfactory bulbs in a 30-year-old man with anosmia persisting for more than 1year after mulga (Pseudechis australis) snakebite. This problem was first noted by the patient 1week after being definitely bitten in Queensland, Australia. He had then presented to a regional hospital where his envenomation was considered mild enough to not warrant antivenom administration. A week later the patient noted a reduction of sense of smell, which progressed to complete inability to smell over the ensuing weeks. On clinical review the patient’s neurologic and rhinologic examination did not reveal any structural cause for anosmia. Formal olfactory testing was performed using ‘‘sniffin’ sticks” and the patient scored 17 on this test, indicating severe hyposmia (functional anosmia <16.5, normal score >30.3 for men aged 16–35years). MRI of the brain showed no abnormalities. The olfactory bulb volumes were then measured on a volumetric T2-weighted MRI that demonstrated significantly reduced volume of both bulbs, with the right 34.86mm3 and left 36.25mm3 (normal volume ⩾58mm3, 10th centile). The current patient represents a rare instance of a definite, untreated, elapid (mulga snake) envenomation with an intriguing disjunction between the mildness of the systemic features and the severity of the olfactory lesion. It is also unclear if early antivenom use attenuates this condition, and due to the delayed manifestation of the symptoms, awareness of this phenomenon may be lacking amongst physicians.

Development of osteomyelitis secondary to a snakebite: Case Report

The Viperidae family is responsible for most of the venomous snakebites in Anatolia. Toxicity symptoms may be local such as edema, hyperemia, blisters, necrosis, lymphadenopathy, and ecchymosis or hematological, including high white blood cell (WBC), neutrophilia, decrease in hemoglobin, thrombocytopenia, international normalized ratio (INR) elongation, and increase in creatine kinase (CK), tumor necrosis factor alpha (TNFα), and lactate dehydrogenase (LDH). Antivenom thera- py should be provided if hyperemia continues and/or edema does not regress. Complications are very low in envenomation cases related to Viperidae bites with proper treatment and follow-up. Otherwise, complications can progress to necrosis, acute renal failure, compartment syndrome, amputation, and death may be seen. However, no report in the literature has described osteomyelitis as a late complication of snakebite. In this study, we present an osteomyelitis case caused by snakebite culminating in amputation because of the inadequate treatment.

Acute Kidney Injury and Rhabdomyolysis After Protobothrops flavoviridis Bite: A Retrospective Survey of 86 Patients in a Tertiary Care Center.

Acute kidney injury (AKI) is the main cause of death for victims of hematoxic snakebites. A few studies have described improvement in AKI rates in snakebite cases, but the reasons for the improvement have not been investigated. Eighty-six patients with Protobothrops flavoviridis bites admitted to a single center from January 2003 through March 2014 were included in the study. Clinical variables, including age, sex, blood pressure (BP), and serum creatinine (S-Cre), on admission were compared between patients with and without AKI. One patient died of disseminated intravascular coagulation following AKI (mortality rate 1.1%). Six patients developed AKI with rhabdomyolysis. Systolic BP, S-Cre, serum creatine kinase, white blood cell count, and platelet count differed significantly between the AKI and non-AKI groups (P = 0.01). Three of the six patients were physically challenged to a degree that made it difficult for them to move or communicate, and these difficulties likely exacerbated the severity of snakebite complications. Our study demonstrated that the risk of snakebite-induced AKI for physically challenged patients was high. To further reduce mortality due to snakebite-induced AKI, we need to make it possible for physically challenged patients to receive first aid sooner.

Necrotizing fasciitis complicating snakebite in Cambodia

A nine year old boy, living in rural Cambodia, presented to a hospital two days after being bitten on the forearm by a cobra. The patient was febrile, tachycardic and complained of increasing pain and swelling to his arm. The wound had developed an infection, resulting in necrotizing fasciitis (see Fig. 1), with erythema having spread to involve the whole arm, portions of his neck and chest wall. Surgeons carried out extensive debridement (see Fig. 2) and imipenem was prescribed intravenously to provide cover against a broad spectrum of bacteria. In this case, secondary infection was caused by Morganella morganii and Enterococcus faecalis, which were isolated from debrided tissue and were both sensitive to the empirical antimicrobial choice. Following 10 days of intravenous therapy, groin flap and skin graft surgery, the child was discharged home, having made a good recovery from this uncommon but severe complication of snakebite.

Pulmonary Effects and Complications of Snakebites

This review is on the pulmonary complications of snakebites, which can have fatal consequences. We identified three common themes as reported in the literature regarding envenomation: generalized neuromuscular paralysis affecting airway and respiratory muscles, pulmonary edema, and pulmonary hemorrhages or thrombosis due to coagulopathy. Respiratory paralysis and pulmonary edema can be due to either elapid or viper bites, whereas pulmonary complications of coagulopathy are exclusively reported with viper bites. The evidence for each complication, timeline of appearance, response to treatment, and details of pathophysiology are discussed.

An unusual complication of snake bite

Anterior pituitary hypofunction is a well-known complication following snake bite. However, central diabetes insipidus as a complication of snake bite is only rarely reported in the literature. We are reporting a case of central diabetes insipidus, which developed as sequelae to viper bite.

Acute hypopituitarism - a rare complication of vasculotoxic snake bite: A case report

Venomous snake bite is an important public health hazard in tropical countries including India. Vasculotoxic snake bites are well known to cause local cellulitis, local tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. We present the case of a 30-year-old female who was bitten by a Russell's viper snake and complicated by AKI, DIC, and acute hypopituitarism during her hospital course. Acute hypopituitarism as a complication of snake bite is a rare entity.

The ocular complications of an envenomous snakebite

AbstractAn envenomous snakebite is an important public health problem that can lead to irreversible loss of vision. Snake venom neurotoxins mainly act on the peripheral nervous system at the neuromuscular junction, and result in the implication of the cranial nerves. Consequently, mild neurological symptoms that relate to cephalic muscle paralysis, including exotropia, ptosis, diplopia and ophthalmoplegia, can occur. This happens because the extraocular muscles are especially susceptible to neurological muscular blockage. Other neurological complications of snake venom include accommodation paralysis, optic neuritis, globe necrosis, keratomalacia, uveitis, and loss of vision due to cortical infarction. Haemostatic complications may include subconjuctival haemorrhage, hyphema, and vitreous and retinal haemorrhages. Another rare complication of a snakebite is ocular injury. Snakebite injuries are often accompanied by facial swelling, periorbital ecchymosis, massive subconjuctival haemorrhage, severe corneal...

Vipera russelli venom‐induced oxidative stress and hematological alterations: Amelioration by crocin a dietary colorant

Snakebite is a serious medical and socio-economic problem affecting the healthy individuals and agricultural and farming populations worldwide. In India, Vipera russelli snakebite is common, ensuing high morbidity and mortality. The venom components persuade multifactorial stress phenomenon and alter the physiological setting by causing disruption of the blood cells and vital organs. The present study demonstrates the anti-ophidian property of Crocin (Crocus sativus), a potent antioxidant against viper venom-induced oxidative stress. The in vivo oxidative damage induced by venom was clearly evidenced by the increased oxidative stress markers and antioxidant enzymes/molecules along with the proinflammatory cytokines including IL-1β, TNF-α and IL-6. Furthermore, venom depleted the hemoglobin, hematocrit, mean corpuscular volume and platelet count in experimental animals. Crocin ameliorated the venom-induced oxidative stress, hematological alteration and proinflammatory cytokine levels. At present, administration of antivenom is an effective therapy against systemic toxicity, but it offers no protection against the rapidly spreading oxidative damage and infiltration of pro-inflammatory mediators. These pathologies will continue even after antivenom administration. Hence, a long-term auxiliary therapy is required to treat secondary as well as neglected complications of snakebite.

Overlooked Issues of Snakebite Management: Time for Strategic Approach

Snakebite is a medical emergency in many parts of the world, particularly in the temperate regions. According to 2007 World Health Organization (WHO) report, there are about 5 million snakebite incidences resulting in 2.5 million envenoming, and 125,000 deaths occur annually. Most affected are the healthy individuals like children and farming populations with resource poor settings and away from health care centers in low-income countries of Africa, Asia and Latin America. In view of this, the WHO has declared snakebite as an ignored health crisis and a tropical disease. Although the death rate has reduced markedly due to anti-venom regiment, several limitations of it offer scope for better understanding of various ignored issues. Currently, snakebite therapeutics facing plethora of scientific, technological and public health challenges, including secondary/long term complications that have not been given importance so far. Because of dearth of knowledge, venom researchers and medical practitioners from affected countries worldwide should join together to accomplish this scenario. In view of this, the present review provides a broader perspective on the possible production and application of highly effective therapeutic master anti-venom, designing master diagnostic kit and also to deal with the inefficacy of anti-venom therapy against local manifestations and secondary complications of snakebite. The review demands thorough understanding of venom pharmacology, inculcating new strategies to handle and to enhance the efficacy of snakebite management and urge the governing systems of affected countries to take steps to curtail accidental debilitation and death rate of healthy individuals due to snakebite.

Terrestrial Snakebites in the South East of the Arabian Peninsula: Patient Characteristics, Clinical Presentations, and Management

BackgroundTo describe the characteristics, clinical presentations, management and complications of snakebites in the border region between Al-Ain, United Arab Emirates (UAE) and Buraimi, Sultanate of Oman.Methodology/Principal FindingsWe carried out a retrospective review of medical records to study snakebite cases over four-year duration at three tertiary hospitals. Overall, 64 snakebite cases were studied with median hospitalization of 2 (interquartile range [IQR] 1–4) days. The majority of cases were male (87.5%), and most (61%) of the incidents occurred during summer months. The bite sites were predominantly (95%) to the feet and hands. Main clinical features included pain, local swelling, and coagulopathy, blistering and skin peeling. Overall, there were no deaths, but few major complications occurred; extensive skin peeling (n = 5, 8%), multi-organ failure (n = 1, 1.5%), and compartment syndrome (n = 1, 1.5%). Polyvalent anti snake venom (ASV), analgesia, tetanus toxoid, intravenous fluids, and antibiotics such as ampicillin, cloxacillin, and cephalosporins were commonly instituted as part of treatment protocols in the three hospitals.ConclusionThe overwhelming majority of bites occurred during summer months, and envenomations were more common in, relatively, young male farmers, but with no serious clinical complications. Prevention and treatment strategies should include increasing public awareness, developing management guidelines, and manufacturing specific ASV for a wide spectrum of the local venomous snakes.

Coagulopathy in patients who experience snakebite

Background/AimsCoagulopathy is a common complication of snakebite, but there is little information on the clinical importance of coagulopathy. We analyzed the characteristics of coagulopathy after envenomation.MethodsNinety-eight patients who experienced snakebite were enrolled in this study. We divided all the patients into three groups by the ISTH DIC scoring system: the normal, simple coagulopathy and DIC groups. The coagulopathy group included both the simple coagulopathy and DIC groups. We then conducted a case-control study.ResultsThere was a significant decrease in the Hct, protein, albumin, ALP and cholesterol levels in the coagulopathy group, and only the cholesterol level was deceased in the DIC group (p<0.05). Leukocytosis and rhabdomyolysis were significantly associated with coagulopathy, and hemolysis and rhabdomyolysis were associated with DIC (p<0.05). The presence of rhabdomyolysis was considered a risk factor for coagulopathy (p<0.05). These conditions continued for up to six to seven days after the snakebite.ConclusionsEvaluation of coagulopathy with using these characteristics is helpful to properly manage the patients who experience snakebite.

Snakebite-Induced Acute Kidney Injury: Data from Southeast Anatolia

Renal failure is an important complication of snakebite and a major cause of mortality. We aimed to study the clinical profile of snake envenomation in Southeast Anatolia, Turkey, in an adult population. We retrospectively analyzed the records of 200 snakebite victims from 1998 to 2006 at the Dicle University School of Medicine, Diyarbakir, Turkey. Sixteen patients (8%) developed AKI (acute kidney injury). Of those, 25% required dialysis and 18% died. There was no difference between groups in age, arrival time to hospital, and hospital stay time. Both groups received similar hydration and therapy at admission. Disseminated intravascular coagulation (DIC) was observed in 25% of the AKI group and was significantly higher than the non-AKI group (7.1%; p = 0.014). There was no significant difference regarding hemoglobin, platelet levels, and prothrombin time at admission. The prevalence of thrombocytopenia (<150,000 K/UL ) was 60% in the AKI group and 40% in the non-AKI group (p > 0.05). WBC count was significantly higher in the AKI group than in those without AKI (p = 0.001); serum albumin was significantly lower in the AKI group than in those without AKI (p = 0.013). AKI is an important complication of snakebite that may lead to mortality. Despite some troublesome aspects due to its retrospective design, this is a large series from Southeast Anatolia of Turkey in an adult population. Subjects with high WBC, low albumin, and DIC should be closely followed up for the development of AKI.

Surgical implications of snakebites.

Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment. A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results. 44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin. Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.

Central retinal artery occlusion: an unusual complication of snakebite

Snakebites are endemic in some parts of India, being associated with a number of complications. Ocular disturbances are rare, except for injury to the cornea or conjunctiva when the eye is directly exposed to the venom. In this work, we present a case of central retinal artery occlusion caused by snakebite.

Tetanus complicating snakebite in northern Nigeria:: clinical presentation and public health implications

Background: There is inequality in vaccination coverage, and adult farmers in tropical rural communities could have missed tetanus toxoid as campaigns target children. Snakebite is not uncommon and partly because of lack of effective antivenom, management in inaccessible areas could be complicated with tetanus in unimmunized victims. Patients and results: Four snakebite victims who developed tetanus were seen in northern Nigeria. Three were bitten while farming and patients took 10–25 days before presenting to hospital. All patients had incised bite sites and applied local medicinal herbs and in one case, a black ‘snake’ stone. Bites were by the cobra ( Naja nigricollis) and carpet viper ( Echis ocellatus) in the extremities and victims had swollen limbs and bleeding with incoagulable blood. Three of the patients were given anti-tetanus serum (ATS) after development of tetanus symptoms in a primary facility and only one recalled receipt of one dose of tetanus toxoid prior to bite. Patients had trismus, rigidity, backache, spasms and one had autonomic dysfunction and was managed with antispasmodics, ATS, wound care, antibiotics and supportive measures. Two patients with envenoming and severe tetanus received antivenom, but died. One of the two surviving patients developed osteomyelitis with prolonged hospital stay, while the other recovered with residual disability. Conclusion: Tetanus could follow snakebite in inaccessible rural agricultural communities with inadequate health care provision. Clinical presentation is typical but late and is confounded by snakebite complications leading to considerable morbidity and mortality. The cases highlight the triple problems of inadequacy, inaccessibility and inequality in health care and calls for measures aimed at improvement.

Epidemiological and clinical differences of snake bites among children and adults in south western Saudi Arabia.

OBJECTIVES: To compare the clinical course and complications of snake bite in children and adults. METHODS: A retrospective review of 66 patients (28 children and 38 adults) admitted after snake...

Aeromonas hydrophilasoft-tissue infection as a complication of snake bite: report of three cases

<i>Aeromonas hydrophila</i>soft-tissue infection as a complication of snake bite: report of three cases

Accidente ofi ́dico en niños en Costa Rica: epidemiologi ́a y deteccio ́n de factores de riesgo en el desarrollo de absceso y necrosis

P. Saborio, M. González and M. Cambronero. Snakebites in children in Costa Rica: epidemiology and risk factors related to the occurrence of abscess and necrosis in 80 cases. Toxicon 36, 359–366, 1998.—A retrospective epidemiological analysis is presented of 80 snakebites in children admitted to the Pediatrics Service of Tony Facio Hospital in Limón, Costa Rica, between 1985 and 1995. An overall incidence rate of 20 snakebite accidents per 100,000 inhabitants per year was calculated for the region in that period. However, a higher incidence was described in some counties (36 and 30 cases per 100,000 inhabitants in Talamanca and Siquirres, respectively). Most of the cases occurred in February and November, between 16:00 and 19:00 hr. The mean age of the affected children was 8.67±2.66 years. No significant difference was found between genders. Thirty-three children affected (41.2%) were members of the local indigenous groups and 31 (38.8%) were residents of Talamanca County. The species of snake responsible were identified in 58.4% of cases, with Bothrops asper being the most important. The lower extremities were the most important primary site affected (86.3%). The most common clinical complications described in the study group were abscess formation (11.25%), necrosis (10%), renal failure (3.75%), compartmental syndrome (2.5%) and anaphylactic shock (1.25%). The overall mortality was 2.5%. Statistical analysis of the risk factors relating to the two most common complications showed that the condition of coming from Talamanca County ( P=0.02), damage in the proximal extremities ( P=0.02), a prothrombin time <2% ( P=0.01) and serum fibrinogen levels <100 g/dl ( P=0.01) were risk factors for the development of abscesses. The grade of severity of the snakebite ( P=0.018) and serum fibrinogen levels <100 g/dl were associated with development of necrosis. All of the patients with necrosis and abscesses also experienced two or more of the risk factors that correlated with a sensitivity of 100% and a specificity of 67% for the development of abscess, and 87% sensitivity and 88% specificity for necrotic complications. According to these data, snakebite complications are a relevant health problem in Costa Rica.