Snakebite Cases Research Articles

An epidemiological profile of fatal snake bite cases in south-east region of Rajasthan

An epidemiological profile of fatal snake bite cases in south-east region of Rajasthan

Clinic-epidemiological profile and acute kidney injury among pediatric snake bite cases admitted in a tertiary care center of South India

Background: Snake bite is a neglected public health problem in the tropical countries, particularly in rural areas. Snake bite is more common in children and young adults. This study intends to bring out the burden of the issue in rural children of South India. Aims and Objectives: The objectives of the study are as follows: (1) To study the epidemiological profile, the clinical profile, complications, and outcome of pediatric snake bite cases and (2) to study the incidence, predictors, and outcome of acute kidney injury (AKI). Materials and Methods: A prospective and observational study carried out for 1½ years among 0–12-year-old snake bite children. The epidemiological details, details related to snake bite event, pre hospital events, clinical and laboratory parameters on admission, outcome, complications, incidence of AKI, and their possible predictive factors among the snake bite children are analyzed. Statistical analysis was done using SPSS software (IBM, USA) version 20. Results: Male children above 5 years of age in rural areas during outdoor activities are more commonly affected during the monsoon period and during night hours. Hemotoxic snake bites are more common. Incidence of AKI following snake bite is 10%. Possible predictive factors are long bite to admission interval, tender lymph nodes, anemia, increased total count, elevated serum bilirubin on admission, and increased requirement of Anti Snake Venom. Conclusion: This study proves the burden of snake bite among rural children and their morbidity and mortality following snake bite-induced AKI. A high index of suspicion should be kept in mind based on possible predictive factors for development of AKI in snake bite children.

Incidence of snakebites in rural communities living in the Paoua savannah and Mbaïki forest areas in Central African Republic

Snakebite is one of the most deadly neglected tropical diseases in Africa with more than 20,000 deaths reported each year. According to recent data from hospital in Central African Republic studies, the Paoua health district reports between 300 and 400 cases of ophidian envenomation each year. However, no epidemiological study on snakebites has been conducted at national level, nor a control strategy developed. The objective of this study is to describe the epidemiological aspects of snakebites in two rural communities, one located in savannah zone and the other in forest zone (both secondary and primary forest) in order to ensure adequate management of snakebites in these regions. Prospective community-based study in two health districts in the Central African Republic, the health district of Paoua in savannah area and the health district of Mbaïki in forest area, from December 2019 to January 2021. Snakebites were investigated in the community by selected trained people in charge of reporting data regarding all known cases of snakebites occurring during the study period. The data were actively notified either by health personal or community health workers in order to determine the circumstances and severity of the bite, its management and the clinical course in case of envenomation. A total of 412 snakebite cases were recorded during the study period, of which 198 cases occurred in the rural community of the forest zone and 214 in the community of the savannah zone. Case fatality rate was 5% in the forest zone and 1% in the savanna zone. The incidence rate of snakebite was significantly higher in savannah children compared to those in the forest (98/100,000 vs. 25.1/100,000; p<0.00001) while this incidence rate was significantly lower from age 45 onwards in the savannah area compared to the forest area (167/100,000 vs. 200/100,000; p=0.02). The case fatality rate of children and adults up to 44 years of age appeared to be significantly higher in the forest zone (7 deaths vs 1 death). Snakebites occurred significantly more frequently during field activities in the savannah zone than in the forest zone (51% vs 26%; p<0.0001). The symptomatology of bites was dominated by edema of the bitten limb and bleeding in the two study areas, compatible with cytotoxic and hemorrhagic syndromes due to viper bites. With an incidence rate of more than 160 cases per 100,000 inhabitants in the active population aged 15-44 years in rural communities of the forest and savannah zone, snakebites remain a public health problem in Central African Republic. A study on the toxicity of snakebites in Central African Republic is recommended. Besides, it is urgent to make anti-venomous serums available in health facilities in order to reduce the mortality related to the envenomation.

Epidemiological and Clinical Investigation of Snake Bite Cases Admitted to the Emergency Department of a Tertiary Hospital in Izmir

Objective: There are more than 3000 snake species in the world, about 30% of which are known to be venomous. Snake poisoning can cause serious mortality and morbidity. In this study, it was aimed to investigate epidemiologically and clinically the snake bite cases admitted to the emergency department of a tertiary hospital in Izmir.&#x0D; Material and Methods: Patients who applied to our emergency department with the complaint of snake bite between 2012 and 2022 were included in the retrospective observational study. The data of the patients were obtained by scanning the hospital electronic database. Vital signs, laboratory values, physical examination findings and outcomes of the patients were evaluated.&#x0D; Results: Of the 52 patients, 22 (42.3%) were female, 30 (57.7%) were male, and the mean age was 48±16. It was seen that the most cases occurred in the summer season and only 1 patient died in total. Snake bite was seen on extremity in 41 (78.8%) patients while 11 (21.2%) had non-extremity bites. There was a statistically significant difference in CK value, potassium value, local edema and diffuse edema incidence between the two groups according to the bite site.&#x0D; Conclusion: Higher CK, lower potassium level and more local and diffuse edema are seen in extremity bites compared to non-extremity bites.

Assessment of snakebite management practices at Meserani Juu in Monduli District, Northern Tanzania.

Snakebite envenoming represents a tragically neglected tropical disease mostly affecting poor people living in remote areas of developing countries, primarily in sub-Saharan Africa. Anti-snake venom (ASV) is the only approved specific treatment for systemic envenoming from snakebite, but it remains largely unavailable in many parts of developing countries. There is paucity of data on snakebite management practice in Tanzania. This study aimed at assessing the community management practices of snakebite and availability of anti-snake venom in the public health facilities in Monduli District, Northern Tanzania. A cross sectional study was carried out between May and June, 2018 involving 67 victims, 147 other household members, and 35 public health facilities. A structured questionnaire, respondent interview, and health facility report/document review were considered during data collection. Clean data were analyzed using SPSS version 20. Sixty-seven snakebite victims and 147 other household members were interviewed during a household survey. All snakebite cases reported to having visited a health facility after snakebite with the majority 55/67 (82.1%) reporting the use, prior attendance to medical care, of some form of local treatment such as tourniquets 13 (19.4%), local incision 11 (16.4%), and snakestone 7 (10.4%). None of the public health facilities in Monduli District attended a snakebite case and had never stocked anti-snake venom products. In this area, 45 snakebite cases were reported to be managed at Meserani snake park clinic where anti-snake venom products were available and provided for free in the period between January 2017 and December 2017. Majority of the snakebite cases at Meserani Juu relied on local methods for the management of snake bites of which most are of unknown efficacy and safety. Furthermore, none of the primary public health facilities in Monduli District stocked antivenom despite being a habitat for different kinds of venomous snakes. The government and local non-government organizations should collaborate so as to improve the anti-snake venom availability and the provision of snakebite preventive and management awareness programs, especially to the rural communities.

Snakebite knowledge assessment and training of healthcare professionals in Asia, Africa, and the Middle East: A review.

Snakebite envenoming (SBE) is a common neglected tropical disease in rural communities of Asia, Africa and Latin America. Among the several challenges besetting the control of SBE is inadequate access to high-quality care by snakebite victims, partly contributed by inadequate knowledge of SBE among healthcare professionals (HCPs). This narrative review examined the existing literature on the knowledge of snakebites among HCPs, the factors associated with their knowledge of snakebites and their training needs. Data on the knowledge of healthcare professionals regarding snakebites appeared scanty and were predominantly from studies done in Asia, Africa, and the Middle East. We found that the proportion of health workers with adequate knowledge of local medically important snakes could be as low as 20.2% in some settings in India, while as much as three-quarters of health workers still recommend tourniquets and Blackstone as first aid in some settings in India and Rwanda, respectively. In addition, the mean knowledge score of local snake-induced clinical syndromes could be as low as 46.2% in some settings in Ghana, while 52.7% of tertiary hospital doctors in northern Nigeria recommend antivenom in all snakebite cases. Similarly, 23% of Bhutan health workers have adequate overall knowledge of snakebite management. Furthermore, several sociodemographic characteristics of the HCPs (such as increasing age, years of experience, work setting, medical specialty, health profession and previous involvement in snakebite management) are associated with adequate snakebite knowledge. Moreover, most studies have consistently reported a lack of training on snakebites as a challenge. Therefore, the knowledge gaps identified could be incorporated into training programs and regional policies on SBE treatment protocols.

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.

Health care workers' knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study.

Snakebite envenoming remains a public health threat in many African countries, including Malawi. However, there is a shortage of literature on the knowledge of Health Care Workers (HCWs) and the prevalence of snakebite cases in Malawi. We interviewed HCWs in Neno District to assess their knowledge of snake identification and management of snakebites. We further reviewed patient registers from 2018 to 2021 in all 15 health facilities in the district. We used descriptive statistics to characterize the survey population, knowledge, snake antivenom (SAV) administration, and snake identification. Using "shapefiles" from Open Street Maps, we mapped villages with snakebite cases. Of the 105 HCWs interviewed, 58% were males, and 60% had worked for less than five years. The majority (n = 93, 89%) reported that snakebite envenoming was a problem in the district. Among the clinicians, 42% said they had prescribed SAV previously, while among nurses, only 26% had ever administered SAV. There were discrepancies among clinicians regarding the dosing of snake antivenom. Significant gaps in knowledge also existed regarding snake identification. While two-thirds of HCWs could correctly name and identify venomous snake species, most (> 90%) failed for non-venomous snakes. Most (n = 100, 95%) reported that snakebite victims visit traditional healers more than the hospital. Between 2018 and 2021, the Neno District registered 185 snakebites with a yearly average of 36 cases per 100,000 population. Fifty-two percent (n = 97) were treated as an inpatient; of these cases, 72% were discharged in less than three days, and two died. More snakebite cases were recorded in the eastern part of the district. Significant knowledge gaps exist among HCWs in Neno regarding prescription and administration of SAV and snake identification, which likely challenges the quality of services offered to snakebite victims.

A Viper bite in an urban area : A case report

Envenomous viper snakes are not natural inhabitants of Istanbul, Turkey. The city is crowded and lacks an appropriate area for wild life. Viper snakes are mostly found in southern and middle rural Anatolia in Turkey. To our knowledge, viper bites have not been reported in our urban area previously. Here, we report a envenomous snakebite case, treated with polyvalent antivenom successfully. The snake was identified as Vipera Pontica, by the National Poisons Center.

Taking care of 55 cases of snakebite committed by Trimeresurus stejnegeri

To summarize the nursing experience of 55 cases of Trimeresurus stejnegeri snakebites. A review of 55 cases of snake bites received by our hospital as a designated snake bite hospital, Give emergency treatment and wound care. Nursing critical points included: Partial wound closure treatment, Observation and management of wounds and injured limbs, the anti-venom medicine should be used as early as possible, mental health care, and health promotion; after a series of nursing care, the patients were all cured and released from the hospital.

Seasonal variation, treatment outcome, and its associated factors among the snakebite patients in Somali region, Ethiopia.

BackgroundSnakebite is a major cause of mortality and morbidity in many areas, particularly in the rural tropics, and is a major public health problem around the world. It also imposes significant economic burdens on snakebite victims due to treatment-related expenses and lost productivity.ObjectiveThe purpose of this study was to assess seasonal variation, treatment outcomes, and its associated factors among snakebite in Denan health center in the Somali region, Ethiopia.MethodA facility-based cross-sectional study was conducted from 10 to 30 September 2020 in Denan health center, Somali region, Ethiopia. All snakebite cases in Denan health center from 1 September 2015 to 31 August 2020 were included. Data were collected using a pre-tested structured checklist from the patient cards. Data were entered into EpiData version 3.1 and analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion with 95% confidence interval (CI) and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0. 05.ResultThe overall prevalence of poor outcome of venomous snakebites was 31.4% (95% CI 26.3% 35.4%). Study participants with an age of less than 10 years old (AOR = 2.01; 95% CI 1.39, 4.05), age between 10 and 30 years old (AOR = 2.06; 95% CI 1.39, 9.30), arrival times greater than or equal to 6 hours (AOR = 2.37; 95% CI 1.39, 4.05), and timing of snakebite (AOR = 0.49; 95% CI 0.31–0.87) were factors found to be significantly associated with poor treatment outcome.ConclusionAccording to this study, about one in every three snakebite patients have a poor outcome. Patients with poor outcomes were those who did not improve as a result of treatment or died as a result of it. Designing appropriate engagement of public health education about snakebite prevention techniques, particularly during entry and exit of rainy seasons and establishment of appropriate case management protocol is strongly recommended, as well as increasing the accessibility or availability of antivenoms will undoubtedly have a significant impact on the reduction of mortality and disability related to that of the snakebites.

Snakebite case management: a cohort study in Northwest Ethiopia, 2012-2020.

Timely and appropriate management of snakebites in the tropics is a lifesaver. Many snakebite patients are being bitten in remote rural areas and do not manage to get in due time to healthcare facilities. This study assessed the clinical features and the risk factors associated with treatment outcomes of snakebite patients admitted at two hospitals in the Northwest of Ethiopia. In a retrospective cohort study, routinely collected data from 250 patients' medical charts at University of Gondar Hospital and Metema Hospital, between September 2012 and August 2020, were reviewed. The median age of the snakebite cases was 24 years (95% CI = 22-26), with 80.8% male patients. At admission 148/250 patients presented in Clinical stage 1 or 2 (local symptoms only) and 73.7% presented more than 12 hours after the bite, 80.2% received antibiotics and 79.0% antivenom. The median duration of hospitalization was 3 days (95% CI = 3-4); 72% of the patients recovered and were discharged, 10.8% died and 0.5% underwent an amputation. On logistic regression analysis, residence in rural areas (AOR = 2.52, 95 % CI = 1.2-5.3), sign of bacterial superinfection on the bite site (AOR = 4.69. 95% CI = 1.4-15.4), clinical stage 3 or 4 with systemic symptoms or toxic signs at admission (AOR = 4.84, 95% CI = 1.3-18.0) and no treatment with antivenoms (AOR = 6.65, 95% CI = 1.6-27.7) were associated with bad outcome (death, amputation and/or referred/ went against medical advice). Timely presentation at early clinical stage, appropriate clinical management and availability of antivenoms are cornerstones to reduce snakebite morbidity and mortality.

ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol

Snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases). Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. Incidence data on snakebite is available for 2 districts of the state of West Bengal only. Hospital-based data on snakebite admissions and use of ASV are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries. The proposed study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country. A community level surveillance for snakebite covering 31 districts in 13 states of India in order to obtain annual incidence of snakebites from the community. Frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1-year, from "wards "(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023. The study would be the first of its kind in India looking prospectively at the incidence of snakebite covering 13 states in 5 zones of India and a population of 84 million. Our study covers 6.12% of the total population of the country as compared to the incidence study conducted in Sri Lanka which covered 1% of the total population.

A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon.

Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.

Herbs as Antidote for Snake Bite Treatment- Traditional Practices and Its Future Prospects- A Review

Snake bite is a life-threatening neglected tropical infection reporting high mortality across the world including India. Out of the available yearly statistics of this occupational hazard caused 4.5-5.4 million people and nearly 1,38,000 fatalities were reported globally. Several factors such as the low availability of antivenom, inadequate health centres in rural areas, poor transportation facilities affected the higher number of morbidity and mortality cases of snake bite. The prognostic and diagnostic approach towards the snake bite infection is difficult due to its complexity in venom. The conventional therapy is polyvalent antivenom derived from horses or sheep, with its limitations. The traditional physicians use plants and other herbs as its sustainable remedy for snake bite treatment. Nearly, 523 plant species from 122 families reported their neutralizing property against toxic venom. The secondary metabolites extracted from plants, are capable of reducing the toxic effects of the venom. Many research works has been reported the inhibitory potential of the plant compounds against the snake venom enzymes. Therefore, there is a necessity for increasing therapeutic studies on plant metabolites and the development of an antidote for the better treatment of snakebite. This review article discusses various herbal plant used for snake bite in India.

Medicinal plants used in the treatment of snakebite and scorpion sting by the tribes of Shahapur and Jawhar forest division

Many tribal communities living in the forest area deals with emergency cases of snakebite, scorpion sting by using traditional knowledge of medicinal plants. They possess Traditional and authentic information gained from their elders about the antidote for poisonous bites. The present study was conducted in the tribal pockets of Shahapur and Jawhar forest division of Thane forest circle, Maharashtra. Data was collected by interviews with folk healers and informers by using specially design open and close-ended proforma. Collected data have been verified from the classical text of Ayurveda, books and available articles. This medico-ethno-botanical survey reveals the detail information on 27 plants belonging to 19 families. Total 17 and 10 claims have been reported for the treatment of snakebite and scorpion sting, respectively. Only 1 plant is claimed for veterinary use. Tribal has been using flower, fruit, pod, root, stem, stem bark, leaf, etc. as an antidote in the form of fresh juice, powder for internal use and paste for local application. They also are administering medicine via Nasya (nasal administration) and Dhumapan (smoke). The observation generated by this article create scientific curiosity regarding further studies to evaluate the efficacy and develop antidote from medicinal plants based on tribal knowledge

Retrospective review of case records of snakebite presenting to a single tertiary care centre over a 5-year period.

Background Snakebite is a disease of the poor, and hospitals catering to these individuals are often resource-constrained. Lack of electronic medical records in these resource-limited settings makes the capture of data even harder. Methods Before establishing a snakebite registry in the region, we did a retrospective case record review of all snakebite victims (n=3229) over 5 years who presented to a single tertiary care centre, catering to one of the largest number of snakebite victims in the country. Results Of the 451 cases, 262 (58.1%) presented to the emergency department within 2 hours of the bite. In 170 instances, the snake was brought along and the species of the snake was recorded. Russell's viper was the most common (130; 76.5%). Blood products were used in 237 (52.5%) patients. Acute kidney injury occurred in 165 (36.6%) patients, of whom 37 (8.2%) required dialysis. The mean (SD) duration of hospital admission was 10.5 (7.4) days. There was a significant correlation between number of snakebites with rainfall and humidity. One hundred and seven cases (3.3%) of snakebite resulted in mortality. A majority of mortality records were not available (88%; 94/107), rendering us incapable of doing reliable mortality data correlations or interpretation. Conclusion Viperidae bites predominate in the region, with renal injury being the most common cause for morbidity. Region-specific, prospective snakebite mapping could be a cost-effective strategy that might help in vulnerability analysis of the region. A multi-centric region-specific snakebite registry encompassing not just the clinico-epidemiological characteristics of snakebite victims, but also the demographic data, the pre-hospital care and local remedial practices, geospatial distribution, anti-snake venom and blood product usage, will help in developing better healthcare strategies for snakebite victims in India.

EXAMINATION OF SNAKEBITE PREVALENCE AND FACTORS PREDISPOSE TO BITE IN LANGTANG NORTH, PLATEAU STATE, NIGERIA

Snakebite poisoning is a public health concern to persons in agrarian environments and Langtang North Local Government Area is not an exception. Agricultural and field workers have been reported to be at higher risk of snakebite in this area. The objective of this paper is to examine the prevalence rate and factors predisposed to snakebite. The primary data was gotten from information drive from questionnaire interview of the respondents (victims) while secondary data was obtained from hospital records at Zamko Comprehensive Health Centre (CHC) and National Population Commission and was analysed by using frequency table and trend line as well as the prevalence rate formula (equation). The results showed that the highest number of snakebites incidence was recorded in 2017 with 117 cases, followed by 2008 and 2018 with 109 cases each. The lowest was recorded in 2014 with 33 cases of snakebites. The result further depicts that the highest number of the snakebite cases was recorded at Zamko ward with 117 cases, followed by Nyer with 100 cases, Lipchok and Kuffen C ward had 78 cases each. The prevalence rate of snakebite cases in Langtang north LGA was found to be 424/100000. The findings of the study shows that majority of the snakebite victims were farmers with 36.23% and was observed from the findings that majority 37.68% of the bites occurred in the morning time as compared to the number in the night with 33.33%. Thus, the major factors found to be associated with snakebites included farming activities

Cerebral Complications of Snakebite Envenoming: Case Studies.

There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.

Poisonous snake bite cases in the sub-urban region of Chennai

In a developing country like India, the incidence of snake bites is very high. Some states like Uttar Pradesh, Bihar, Andhra Pradesh, etc. are the worst affected states. The rate of fatality is also comparatively higher in India as there is usually a delay in hospital admission. In the present study, we observed a higher incidence of snakebites amongst farmers and field workers in the age range of 21 to 40 years with a male preponderance. Most commonly bite marks were seen on legs and hands. Pain, local swelling, and neurotoxic features were dominant clinical features at the time of hospitalization. None of the victims were found using protective measures such as rubber gloves or long boots while working in the field.