History Of Snake Bite Research Articles

Successful management of viper envenomation in a Labrador dog

A nine months old male Labrador dog was presented to the Veterinary Clinical Complex, Gannavaram with a history of snake bite. Clinical signs exhibited include dullness, depression, frothy salivation, ataxia, edema and discoloration at paw region. Upon clinical examination fang marks were observed at left metatarsal region. Based on the history, identification of snake by the owner, clinical signs and whole blood clotting test it was diagnosed as viper snakebite. Neutrophilia, polycythemia and marginal lymphocytopenia were noticed. Treatment with poly valent anti snake venom, fluid therapy, tetanus toxoid, an antibiotic was carried out and the dog had uneventful recovery

Pemberian SABU (Serum Anti-Bisa Ular) untuk Kasus Gigitan Ular Awitan Lama dengan Komplikasi Disseminated Intravascular Coagulation (DIC)

Background: Snakebite is a neglected disease in subtropical and tropical countries in Asia, Africa, and Latin America. Snakebite is one of the most common venomous animal bites in the world. Case: A 34-year-old male presented with a history of snakebite two days before with a swollen left gluteus and spontaneous gum bleeding. At the emergency room, the patient was fully conscious with blood pressure of 120/80 mmHg, temperature of 36.8oC, pulse rate of 80 beats per minute, and respiration rate of 18 times per minute. Blood studies showed prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), leucocytosis, thrombocytopenia, low hemoglobin, and elevated renal function test. The patient's condition was improved after administration of anti-snake venom, vitamin K injection, transfusion of fresh frozen plasma and packed red cells. He was discharged after three days of hospital stays. Conclusion: Antivenom is the only specific antidote to snake venom; in Indonesia, there is only one local antivenom, commonly known as SABU (serum anti-bisa ular). Inappropriate use of antivenom should be strongly discouraged. Administration of the antivenom should be accompanied by preparedness for anaphylaxis risk.

The use of antivenom serum, fresh frozen plasma, and platelet concentrate for management strategy of snakebite related coagulopathy: a case series

Snakebite is a medical emergency. It can cause local and systemic effects in humans. Different venomous snakes produce different types of venom, which can cause a variety of symptoms and complications. The scarcity of anti-snake venom serum (SABU) in Indonesia encourages alternative administration strategies to patients, namely suboptimal doses or subdose.
 Three cases of adult patients with a history of snakebite and diagnosed with snakebite grade III were reported. The patient underwent initial antivenom therapy using suboptimal doses of anti-snake venom serum (SABU) due to the scarcity of SABU and fresh frozen plasma (FFP) and thrombocyte concentrate (TC) transfusions as well as initial emergency management and routine blood tests and coagulation function. Evaluation was done daily of clinical improvement and coagulation function.
 This case series proves that administration of suboptimal antivenom therapy, when combined with additional FFP and TC transfusions, coupled with appropriate supportive care and patient monitoring can result in good outcome in patients.
 Key words: Anti-snake Venom Serum; FFP; Snakebite; Thrombocyte Concentrate; Toxin
 Citation: Permana SA, Shalihin MM. The use of antivenom serum, fresh frozen plasma, and platelet concentrate for management strategy of snakebite related coagulopathy: a case series. Anaesth. pain intensive care 2023;27(6):750−756; DOI: 10.35975/apic.v27i6.2250
 Received: July 27, 2023; Revised: October 17, 2023; Accepted: October 17, 2023

Community members and healthcare workers' priorities for the control and prevention of snakebite envenoming in Ghana.

Snakebite is one of the most neglected tropical diseases. In Ghana, there has been a limited interest in snakebite envenoming research despite evidence of high human-snake conflicts. In an effort to meet the World Health Organisation's (WHO) 2030 snakebite targets, the need for research evidence to guide policy interventions is evident. However, in setting the research agenda, community and healthcare workers' priorities are rarely considered. Three categories of focus groups were formed in the Ashanti and Upper West regions of Ghana, comprising of community members with and without a history of snakebite and healthcare workers who manage snakebite patients. Two separate focus group discussions were conducted with each group in each region. Using the thematic content analysis approach, the framework method was adopted for the data analysis. A predefined 15-item list of potential snakebite-associated difficulties and the WHO's 2030 snakebite strategic key activities were ranked in order of priority based on the participants' individual assessment. Both acute and chronic effects of snakebite such as bite site management, rehabilitation and mental health were prioritised by the community members. Health system challenges including training, local standard treatment protocols and clinical investigations on the efficacy of available antivenoms were identified as priorities by the healthcare workers. Notably, all the participant groups highlighted the need for research into the efficacy of traditional medicines and how to promote collaborative strategies between traditional and allopathic treatment practices. The prioritisation of chronic snakebite envenoming challenges by community members and how to live and cope with such conditions accentuate the lack of post-hospital treatment follow-ups for both mental and physical rehabilitation. To improve the quality of life of patients, it is essential to involve grassroots stakeholders in the process of developing and prioritising future research agenda.

Green Pit Viper Envenomations in Bangkok: A Comparison of Follow-Up Compliance and Clinical Outcomes in Older and Younger Adults.

We compared older and younger adults envenomated by the green pit viper (GPV) with regard to the following: follow-up compliance, elapsed time between envenomation and emergency department (ED) visit, and clinical/treatment outcomes. This was a two-site retrospective cohort study. We searched hospital electronic medical databases between January 2011 and December 2021. Patients aged 15 and above were eligible if they had a history of snakebite and had at least two VCT and/or platelet count results in their medical records. After the search, 1550 medical records were reviewed and 760 cases were found to be eligible for analysis. In total, 205 cases (27.0%) were ≥60 years old. The median ages in the younger and older groups were 40 (26-51) and 68 (64-75) years, respectively. The median elapsed times from bite to the ED were 47 (30-118) vs. 69 (35-150) min (p-value = 0.001). Overall, 91.3% of all cases were managed as out-patient cases and were eligible for follow-up appointments. The rate of out-patient follow-up at 72 ± 12 h in the older patients was significantly higher (43.2%) than in the younger adult patients (32.4%) (p-value = 0.01). Regarding the clinical/treatment outcomes, the rates of coagulopathy, antivenom administration, and hospital admission were not statistically different between both groups.

Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases.

Snakebites are a common cause of morbidity and mortality, especially in tropical countries. Snakebites in any community are managed based on the clinical features and intravenous administration of antisnake venom (ASV). The administration of ASV is either deficient or given in excess based on clinical decisions and whole blood clotting test results. The present study is designed to analyze the level of snake venom component in the blood of snakebite in association with the clinical features. Blood samples were collected from the patients admitted to Karnataka Institute of Medical (KIMS) hospital with a history of snakebite considering the inclusion criteria. Serum was collected from the blood of snakebite patients before and after ASV and used to assess the level of venom-specific phospholipase A2 (PLA2) enzyme using the enzyme-linked immunosorbent assay (ELISA) method. Quantitative ELISA results revealed that the snake venom-specific PLA2 in the victim's blood was in the range of 0.3-1.27 mg/mL before the administration of ASV. However, the concentration of PLA2 after 24 hours of ASV administration was decreased in most of the patients. Further, it was observed that envenomation complications were directly proportional to the amount of snake venom-specific PLA2 found in the blood of the snakebite patient. The study concludes that snake venom-specific PLA2 in the blood of snakebite patients could be used as a reliable venom marker, which helps in determination of appropriate ASV dosage in snakebite patients. Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022;26(12):1259-1266.

Study of clinical profile and outcome of patients with snake envenomation at Bheri Hospital Nepal

BACKGROUND Snake bite is a public health problem in terai and inner terai of Nepal. It is a medical emergency leading to significant morbidity and mortality every year. This study aims to find the clinical profile and outcome of snake bite envenomation patients in Bheri Hospital Nepalgunj.
 METHODS This was a cross sectional, observational study from April 2021 to November 2021. Patients with history of snake bite and clinical features suggesting envenomation were enrolled in this study, their clinical data and outcome were recorded in Excel sheet and analyzed by SPSS 20.
 RESULTS A total of 58 cases of snake envenomation was admitted and managed, out of which 3 cases expired with case fatality of 5.17%. Krait and cobra were the common snake bites in this region. 84.48% of the snake bites occur inside houses and more than half 53.44% of the patients were bitten between 12am to 6am. The most common features of envenomation were ptosis, blurring of vision, swallowing difficulty, dysphonia, neck muscle weakness, epigastric pain and salivation. Majority of cases 96.55% was given 10 vials of Anti snake venom (ASV). Only 4 patients 6.89% needed ventilator assistance.
 CONCLUSION Mortality with snake bites can be minimized by strengthening the treatment centers and readily availability of ASV at such centers. Public awareness about snake bite, first aid, rapid transport to health facilities would be the key to success in reducing morbidity and mortality.

STUDY OF HAEMATOLOGICALAND COAGULATION PROFILE IN SNAKE BITE AND ITS OUTCOME IN TERTIARY CARE HOSPITAL.

Introduction: Snake bite is an important health problem in the tropical world including India. Snake venom contains many toxins which interact with clotting mechanism and brinolytic system causing coagulopathy. Awareness and educating the farmers and laborers who walks in barefoot in elds while walking in night is needed to prevent the snake bites. Hence this study was conducted to evaluate the clinical and laboratory parameters of coagulopathy.Aim of the study: To study the coagulation prole and hematological parameters for detection of snake bite and aid in early treatment. Materials And Methods: Total of 50 Patients with history of snake bite were considered in this study from January 2021 – June 2022. Detailed history, physical examination and following investigations were performed. Complete haemogram,whole blood clotting time, prothrombin time and a partial thromboplastin time were done. Results: Out of 50 patients,30(58%) patients showed anemia with Hemoglobin <10 gm%, Leukocytosis (Total count >11,000) in 12 (18%) patients and thrombocytopenia (platelet count <1.5 lakh) in 26 (52%) patients.Also 70% of the patients had prolonged whole blood clotting time that is more than 20 minutes.PT-INR was prolonged (>1.2 seconds) in 45 (95%) patients and APTT was prolonged (>28 seconds) in 48 (96%) patients respectively. Conclusion: Snake bite is a major public health problem Combined clinical and laboratory parameters evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.

Unmasking the ties of snake bite poisoning and COVID-19

BackgroundSnake bite envenoming is a neglected tropical disease with variable clinical presentation, neurotoxic manifestations (respiratory paralysis), rhabdomyolysis, cardiotoxicity, autonomic hyperactivity, and/or coagulation abnormalities. There is limited data on the clinical course of the envenomation in an incidentally diagnosed COVID-19 patient.Case presentationA 17-year-old male with history of snake bite and neuroparalysis developed shortness of breath. He was treated with lyophilized polyvalent anti-snake venom (ASV) on admission in the emergency department and mechanical ventilation. Subsequently, he tested positive for COVID-19 infection. No immunomodulatory therapy was administered, and patient was extubated on the 5th day of ICU admission without any neurological deficit.ConclusionsCoinfections of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus with snake bite poisoning lead to diagnostic dilemmas and controversies in management practices. Abnormalities of coagulation need to be cautiously addressed, and cause of development of pneumonia needs to be identified. The rapid recovery of the patient in our case theoretically can be explained on the organ-protective potential of snake-derived peptides; a large case series is however needed to prove the same.

What the snake leaves in its wake: Functional limitations and disabilities among snakebite victims in Ghanaian communities.

BackgroundThe estimated five million snakebites per year are an important health problem that mainly affect rural poor populations. The global goal is to halve both mortality and morbidity from this neglected tropical disease by 2030. Data on snakebite morbidity are sparse and mainly obtained from hospital records.MethodsThis community-based study was conducted among 379 rural residents with or without a history of snakebite in the Ashanti and Upper West regions of Ghana. All participants in the snakebite group were bitten at least six months before the day of survey. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Buruli Ulcer Functional Limitation Score were used to obtain patient-reported measure of functioning and disability. Long-term consequences were evaluated based on the severity of the symptoms at the time of the snakebite.FindingsThe median (IQR) time since the snakebite was 8.0 (3.5–16.5) years. The relative risk of disability was 1.54 (95% CI, 1.17–2.03) in the snakebite group compared to the community controls. Among patients with clinical symptoms suggesting envenoming at the time of bite, 35% had mild/moderate disabilities compared to 20% in the control group. The disability domains mainly affected by snakebite envenoming were cognition level, mobility, life activities and participation in society. A combination of the severity of symptoms at the time of the bite, age, gender and region of residence most accurately predicted the odds of having functional limitations and disabilities.ConclusionThe burden of snakebite in the community includes long-term disabilities of mild to moderate severity, which need to be considered when designing appropriate public health interventions. Estimating the total burden of snakebite is complicated by geographic differences in types of snakes and their clinical manifestations.

Abstract 56: Clinical profile of adult onset hypopituitarism in patients presenting to a tertiary care center in South Tamil Nadu

Background: The data regarding clinical profile of adult onset hypopituitarism in India is limited. Previous studies have shown that pituitary and sellar tumors are the most common cause of hypopituitarism.Aims and Objectives: To study the clinical profile of patients with adult onset hypopituitarism presenting to the Endocrinology Department to our tertiary care centre.Results: A total of seventeen patients were included in the analyses. The mean age of the patients was 39.55 +/-14 years. There were 8 (47%) males and 9 (53%) females included in the study. The most common presenting complaints were amenorrhea (52%), headache (35%), visual complaints (29%). 29%(n=5) patients were admitted with acute adrenal crises requiring intravenous steroids at diagnosis. 11%(n=2) of patients had pituitary apoplexy. 47%(n=8) patients had pituitary or sellar tumors, 35%(n=6) patients had postpartum pituitary necrosis, one patient each had history of snake bite and head trauma. 94 %( n=16) patients had secondary adrenal insufficiency, 88 %( n=15) patients had secondary hypothyroidism, 70 %( n=12) patients had hypogonadotrophic hypogonadism, and only 11% (n=2) had growth hormone deficiency. 88 %( n=15) patients had panhypopituitarism.Conclusion: The most common causes of hypopituitarism in our study were pituitary and sellar tumors. 88% patients had panhypopituitarism, 35% patients had deficiency of two pituitary hormones.

Early morning neuroparalytic syndrome – A diagnostic dilemma: A case report

Snakebite is a commonly seen problem in tropical countries like India. Early morning neuroparalytic syndrome and cranial nerve palsies are the usual presentations. Locked-in syndrome (LIS) is a rare presentation. We present a 1-year and 6-month-old female toddler with acute onset of weakness in all four limbs, who developed LIS. The patient was given anti-snake venom on day 3 of admission and fully recovered after 3 weeks of ventilation. Snakebite should be suspected in any child presenting with early-onset neuroparalytic syndrome or LIS even if there is no history of snakebite or any bite mark.

Clinical and epidemiological profile of snakebite cases - A study from an industrial teaching hospital at Jamshedpur, Jharkhand, India.

India accounts for approximately half of the worldwide snakebite deaths. It is often a neglected public health problem and particularly in Jharkhand region where medical facilities are limited. Epidemiological and clinical profile-related studies are scarce. The present study aims to assess the epidemiological profile and clinical features of snakebites encountered in a tertiary-care teaching hospital at Jamshedpur, Jharkhand, India. The aim of this study was to assess the clinical profile, outcome and epidemiological factors of snakebite cases, admitted to a tertiary care hospital in Jamshedpur. This was a retrospective study from 2014 to 2021 wherein a total of 427 snakebite patients were admitted and had received treatment for snakebite at a tertiary-care teaching hospital at Jamshedpur, Jharkhand. All patients who reported with a history of snakebite were included in this study. The demographic and clinical details of each case were obtained and analysed. A total of 427 snakebite cases were admitted to the hospital during the study period. The victims were predominantly males. Majority of the bite cases encountered were from rural areas and were in the second quarter of the year. The site of the bite was largely on the lower limb and the upper limb had fewer bites. The Glasgow Coma Scale was normal in those who presented early. Acute kidney injury, neutrophilic leucocytosis and deranged liver enzymes were associated with bad prognosis. Timely intervention with anti-snake venom offered good result. We had more male patients (69.55%), belonging to rural areas (67.91%), more bites in lower limbs and more cases in the second quarter of the year. Mortality rate was 0.7%.

UTILITY OF SERUM CRP AND LDH AS MARKERS OF HEMOTOXICITY IN SNAKE BITE VICTIMS: HOSPITAL BASED STUDY

Background: Snakebite is a common medical emergency and an occupational hazard commonly seen in the rural as well as suburban population. In this study to determine the utility of Serum CRP and LDH as Markers of hemotoxicity in snake bite victims.
 Materials & Methods: This hospital based prospective study was conducted a total 60 admitted patients in the department of general medicine at Vedantaa Institute of Medical Sciences, Palghar during June 2020 to December 2020. The patients were included were with alleged history of snake bite & history of unknown bite but with symptoms and signs compatible with snake bite envenomation otherwise patients were excluded.
 Results: Most frequent site of snakebite was the lower limbs constituting 85.0% of bites. Majority (41.7%) of the patients presented with features compatible with moderate envenomation. Serum CRP showed a significant elevation in their levels in the severe as compared to the mild envenomed group.
 Conclusion: Snakebite commonly affects people in the younger age group & hemotoxic envenomation is most common manifestation of envenomation observed.
 Keywords: Snakebite, Envenomation, Serum CRP, LDH, Haematological Parameters.

A Study of Pattern of Snake-Bite Cases Admitted to Hospitals in Bagalkot

Objectives: The present study was under taken to know the Sociodemographic profile of snake bite victims.Methods: This is a Hospital based case series study which included snake bite cases of both sex groups and all agegroups who presented with history of snake bite or history of unknown bite with clinical features suggestiveof snake bite admitted to HSK Hospital and all private Hospitals of Bagalkot city in one year duration from 15thApril 2010 to 14th April 2011. Results: Of the 75 cases, maximum victims were males 61.4%. Maximum 60%victims belonged to 20-49 yrs age group. There was a statistically significant difference in the occurrence of casesin the age group of 20-49yrs and also among males of the same age group. Majority of victim 93.3% belongedto rural region which was statistically significant and 60% of the victims were farmers by occupation. Most ofthe bites 60% occurred in fields. Bites were more 37.3% between 12.01PM to 6PM and during monsoon season60.1%. Most common site of bite was foot 45.3%. Krait was the most commonly identified snake and most of itsbites were between 12.01AM to 6AM.

Clinical profile and outcome of snakebite poisoning in sub-district hospital Akhnoor

Background: In a predominantly agricultural country like India, with rich in flora and fauna, long rainy season and rural background, the encounter between man and snake is a frequent occurrence. Viper-bites are more common than other poisonous snakebites. Only the cases of snakebite with severe envenomation reach the health care centers. This study was planned to analyze the presentation of complaints and symptoms in snake bite patients.Methods: This ‘record based descriptive observational study’ was carried out over a period of 6 months from May 2020 to November 2020 in Sub District hospital Akhnoor. A total of 96 patients with a history of snake bite and signs of envenomation were included in this study. Results: Incidence was higher among people from rural background (86.46%), more among males (67.71%) and highest among farmers (53.13%) and labourers (16.67%). Maximum no of snakebites took place during night and on the lower parts of body, mainly legs (54.17%); while the period of the study contained the peak rainy season of the region. As many as 39.58% of victims didn’t receive any kind of formal first aid at all and as many as 48.96% patients reported after a minimum delay of 6 hours, which could be considered as potentially fatal. Chief complaints among the reported patients of snake bite were found to be: Local edema, bleeding, vomiting, drowsiness, ptosis and Ophthalmoplegia.Conclusions: There is an urgent and dire need for awareness and education among rural population about the hazards involved and treatment of snakebite.

Early severity predictors of snakebite envenomation in the southern region of Tunisia

Objective: To identify the early predictors of severe envenomation in the southern region of Tunisia. Methods: It was a retrospective monocentric study including consecutive patients admitted to the emergency department for snakebite envenomation. Snakebite envenomation was defined by a history of snakebite. Predictors of severe envenomation were determined by univariate and multivariate analyses. Results: Our sample consisted of 109 patients aged 30 (20-44) years with a 1.1:1 sex-ratio (56 males and 53 females). During the 24-hour surveillance period, 25 patients developed severe envenomation (22.9%). The in-hospital mortality rate was 4.6% (n=5). The independent predictors of severe snakebite envenomation were leucocyte count over 11 550/mm3 (OR: 18.7, 95% CI: 3.3-107.8), creatine kinase over 155 IU/L (OR: 6.16, 95% CI: 1.1-35.6), and/or tourniquet before arrival to the ED (OR: 32.14, 95% CI: 3.5-295.9). Conclusions: This study emphasizes the importance of early evaluation of snakebite envenomation. Further studies are required to approve a severity scale proper to snakebite envenomation in Tunisia.

Point-of-care infrared thermal imaging for differentiating venomous snakebites from non-venomous and dry bites.

Local envenomation following snakebites is accompanied by thermal changes, which could be visualized using infrared imaging. We explored whether infrared thermal imaging could be used to differentiate venomous snakebites from non-venomous and dry bites. We prospectively enrolled adult patients with a history of snakebite in the past 24 hours presenting to the emergency of a teaching hospital in southern India. A standardized clinical evaluation for symptoms and signs of envenomation including 20-minute whole-blood clotting test and prothrombin time was performed to assess envenomation status. Infrared thermal imaging was done at enrolment, 6 hours, and 24 hours later using a smartphone-based device under ambient conditions. Processed infrared thermal images were independently interpreted twice by a reference rater and once by three novice raters. We studied 89 patients; 60 (67%) of them were male. Median (IQR) time from bite to enrolment was 11 (6.5-15) hours; 21 (24%) patients were enrolled within 6 hours of snakebite. In all, 48 patients had local envenomation with/without systemic envenomation, and 35 patients were classified as non-venomous/dry bites. Envenomation status was unclear in six patients. At enrolment, area of increased temperature around the bite site (Hot spot) was evident on infrared thermal imaging in 45 of the 48 patients with envenomation, while hot spot was evident in only 6 of the 35 patients without envenomation. Presence of hot spot on baseline infrared thermal images had a sensitivity of 93.7% (95% CI 82.8% to 98.7%) and a specificity of 82.9% (66.3% to 93.4%) to differentiate envenomed patients from those without envenomation. Interrater agreement for identifying hot spots was more than substantial (Kappa statistic >0.85), and intrarater agreement was almost perfect (Kappa = 0.93). Paradoxical thermal changes were observed in 14 patients. Point-of-care infrared thermal imaging could be useful in the early identification of non-venomous and dry snakebites.

Pattern of snakebite cases evaluated at a tertiary care hospital

Introduction: Snakebite is a serious public health issue worldwide especially in Indian subcontinent. The high mortality in India is due to climatic factors, rural predominance of population and their agricultural dependence. It is a neglected disease that usually affects the rural inhabitants indulging in agricultural activities. All snakes are tabooed for being deadly poisonous but truth is miles away as majority of them belongs to non-poisonous category. Objective: To study the pattern of Snakebite cases evaluated at KLE Hospital of J.N. Medical College, Belagavi, Karnataka. Study Design: A retrospective hospital record based study. Materials and Methods: The study was done by analyzing the case records at Medical Record Department of J.N. Medical College, Belagavi, Karnataka for all patients admitted with Snakebite envenomation from January 2013 to December 2017. Relevant information was entered in a pre-structured proforma which include age, sex, site of bite, place of residence, occupation, season and time of bite and mortality. All the patients who came to hospital with the history of Snakebite were included in the study. Results: There was total 143 Snake bite cases among which 89 (62.2%) were males and 54 (37.8%) were females. The highest incidence of Snake bite was observed in age group of 20-29 years (29.4%). The majority of the victims belonged to rural areas 107 (74.8%) as compared to urban areas 36 (25.2%). The most vulnerable occupation group was the people involved in the agricultural activities 85 (59.4%). The maximum number of snake bite cases was reported during the rainy season (40.6%). 117 (81.8%) patients were bitten by venomous snakes as compared to 26 patients (18.2%) which were bitten by non-venomous snakes. Conclusion: Snakebite is a matter of great concern as it is one of the neglected health problems. It is a need of hour to educate the community about the prevention of snakebite, early hospitalization and first aid measures by which ther

Circulating Secretory Phospholipase A2 Activity following Snakebites and Its Relationship with Envenomation Status and Progression of Local Swelling.

We studied whether circulating secretory phospholipase A2 (sPLA2) activity reliably distinguished patients with snakebite envenomation from those with nonvenomous/dry snakebites, and whether patients with progressive local swelling had persistence of circulating sPLA2 activity despite antivenom treatment. We prospectively enrolled adults presenting to the emergency with a history of snakebite in the past 24 hours. We estimated circulating sPLA2 activity at baseline before antivenom administration and after 48 hours in those with envenomation. We enrolled 52 patients with snakebites (mean age 39.3 ± 12.6 years; 35 [67%] men), and 16 patients with infective cellulitis as controls. Thirty patients had local ± systemic envenomation; 15 were classified as dry/nonvenomous bites; and envenomation status was unclear in seven patients. Baseline sPLA2 activity was significantly higher in snakebite patients than that in those with infective cellulitis (4.64 [3.38-5.91] versus 3.38 [1.69-4.01] nmol/minute/mL; P = 0.005). Among patients with snakebites, sPLA2 activity in the highest quartile was significantly associated with envenomation (12 of 27 versus two of 22; P = 0.010). However, median sPLA2 activity did not differ significantly between patients with envenomation and the rest. Baseline sPLA2 activity was significantly associated with the maximum extent of limb swelling (P = 0.031 for trend). In envenomed patients, circulating sPLA2 activity significantly decreased after 48 hours compared with the baseline (5.49 [3.38-8.86] versus 3.38 [2.53-4.64]; P = 0.003) including those with progressive swelling. Although circulating sPLA2 activity was elevated following snakebites, its sensitivity to diagnose envenomation appears to be limited. Administration of more antivenom after systemic manifestations had reversed might not benefit patients with progressive local swelling.