Unidentified Snakes Research Articles

Health issues and related health-seeking behaviours of snakebite patients after hospital discharge: A cohort study from rural Sri Lanka

We aimed to assess the unresolved health issues experienced by a cohort of snakebite survivors and their health-seeking behaviours during the first three months after the snakebite. Patients from the Anuradhapura snakebite cohort admitted to the Teaching Hospital Anuradhapura, Sri Lanka, from July 2021 to June 2022 were recruited. Patients were interviewed over the telephone three weeks and three months post-bite to collect data on unresolved health problems post-discharge, patient's adherence to the review plan, newly experienced health issues, health-seeking behaviours and the effect on daily routine. Only snakebite survivors who could be contacted at both three weeks and three months were included. Of 710 eligible patients, 384 (54%) were contactable at both reviews. On discharge from the hospital, 248/384 (65%) had unresolved effects of the snakebite, including 224/384 (58%) who had local effects. The unresolved health problems were reported by patients bitten by H. hypnale (54%), D. russelii (23%), and unidentified snakes (19%). At three weeks and three months, 98/384 (26%) and 52/384 (14%) still had unresolved local effects of envenoming, respectively. Of 144/384 (38%) who were advised to attend review visits post-discharge, mostly to assess renal function, 118 (82%) complied. 112/384 (29%) patients reported self-motivated treatment seeking for unresolved effects of snakebite over the three months. Of them, 87 (78%) visited Sri Lankan indigenous medical practitioners. Patients missed a median of two working days (IQR: 2–4 days) post-discharge. 26 (6.7%) were unable to return to work at 3 weeks, and five patients at 3 months. In rural Sri Lanka, a significant number of viper bite patients leave hospital with mild persistent local effects, which commonly leads to them seeking further treatment. Despite that, almost all snakebite survivors had returned to work at three months post-bite.

Clinical Profile and Pharmacological Management of Snakebites in Community Care Units: A Retrospective Study Using Two Military Hospital Databases in South Thailand.

Snakebite envenoming is an occupational hazard in remote rural areas of South Thailand, where the highest incidence of snakebites is reported. In this work, a hospital-based retrospective study of snakebite patients from 2012 to 2022 at Fort Wachirawut Hospital and Fort Thepsatrisrisunthon Hospital, located in Nakhon Si Thammarat province, Thailand was conducted. Data from the laboratory investigation, physical examinations of snakebite victims, and clinical management, including pharmacological and non-pharmacological treatments, were evaluated. A total of 54 snakebite victims were included. The median age of patients was 49 years (IQR, 28 to 63). Males accounted for 74.1% of all participants. The majority of patients were bitten by Malayan pit vipers (68.5%), followed by unidentified snakes (18.5%), other non-venomous snakes (7.4%), and cobras (5.6%). The most common clinical manifestations were swelling (90.2%) and local pain (73.2%). One patient experienced respiratory failure following an envenoming by an unidentified venomous snake. No deaths were observed in this study. In total, 24 patients received antivenom administration (44.4%), most of whom were from Fort Wachirawut Hospital. Patients who were administered antivenom showed a median admission duration of three days (IQR, 3 to 4), compared with two days (IQR, one to three) for those who did not receive antivenom treatment (p < 0.001). In addition, paracetamol and prophylactic antibiotics, namely, amoxicillin-clavulanate and dicloxacillin, were the most common pharmacotherapies following snakebites. Overall, it was observed that these two community hospitals undertook appropriate clinical management under the standard guidelines for snakebite patients. This might be due to the effective emergency management, facilities, and clinical consultations. Finally, the management process in the medical teams also plays a crucial role in minimizing the severity of snakebite outcomes.

Food Habits of the Mountain Hawk-Eagle (Nisaetus nipalensis orientalis) During the Nesting Period in Japan

ABSTRACT The Mountain Hawk Eagle (Nisaetus nipalensis orientalis) is classified as endangered in Japan and poorly studied throughout its range. We assessed prey fed to a nestling between hatching and fledging (16 April to 31 July) in central Japan. We used a time lapse camera to record prey deliveries and facilitate prey identification, and we estimated prey biomass and energy content across the nesting season. Of 140 prey items delivered to the single nestling, 65 (46.4%) were of five species of snake, 50 (35.7%) were of nine species of birds, 24 (17.1%) were of seven species of mammals, and one was unknown. The diurnal feeding rhythm showed a peak in prey deliveries at midday; all three classes of prey were delivered at various times of the day in a balanced manner. Snakes were especially prominent in the early stages of the brooding period, but diet shifted toward young birds and mammals in the latter half of the season when the prey species' young had become independent of their parents. Snakes made up the greatest percentage of biomass delivered, followed by mammals and then birds. However, mammals provided more energy per g of prey mass than birds and snakes. The adult eagles relied on large snakes awakened from hibernation in early spring, when prey was scarce, and then shifted to mammals with higher energy value during the peak growth period of the eaglet. An additional 233 prey remains collected from 31 other Mountain Hawk-Eagle nests comprised 20 species of birds and 10 species of mammals, and several unidentified snakes. Pooling results, we identified five species of snakes, 24 species of birds, and 14 species of mammals. These results add to the knowledge of the hawk-eagle's diet and will help to inform management of the species.

Incidence of snakebites in 3 different geographic regions in Thua Thien Hue province, central Vietnam: Green pit vipers and cobras cause the majority of bites

BackgroundThe annual incidence of snakebites in Vietnam is not known and only few publications about snakebite envenoming and medically relevant snakes can be found in English language literature. The present community-based surveys provide data on incidence of snakebites in three different geographic regions of Thua Thien Hue (TT Hue) province, central Vietnam and snake species responsible for bites in this region. Methodology/resultsThe cross-sectional community based surveys were conducted from March to July 2017. Multistage cluster sampling was applied and snakebite incidence was calculated at 58 snakebites per 100,000 person-years for the entire province, and 172, 69 and 10 snakebites per 100,000 person-years in the mountainous, coastal and urban region of TT Hue province, respectively. Thirty-one snakebite victims interviewed during the surveys reported 18 (58%) green pit viper bites (Trimeresurus species), 5 (16%) cobra bites (Naja kaouthia, Naja siamensis), 2 (7%) krait bites (Bungarus candidus, Bungarus fasciatus), 2 (7%) red-necked keelback bites (Rhabdophis subminiatus) and 4 bites from unidentified snakes (13%). The outcome was favourable for 28 snakebite victims (90%), two (6%) had minor sequelae and one (3%) victim died after a Malayan krait bite. Two hundred and twenty-one snakebite patients were treated in 9 district hospitals and one central hospital in TT Hue between 2014 and 2016. Eighty green pit vipers (84%), 12 cobras (13%) and 3 kraits (3%) were responsible for bites in 95 patients where snake identification was documented. ConclusionsIncidence of snakebites is surprisingly low in TT Hue province in central Vietnam in comparison to other regions in Asia, particularly to neighbouring Lao PDR. However, snakebites are still a significant health problem in the mountainous region and green pit vipers and cobras cause the vast majority of bites.

Lack of Coagulopathy After Copperhead Snakebites

We determine the frequency and severity of abnormal laboratory measures of coagulation after suspected or known copperhead (Agkistrodon contortrix) envenomation. We identified the charts of venomous snakebites in children presenting to St. Louis Children's Hospital over a period of time greater than 14 years and of all venomous snakebites in adults presenting to Barnes-Jewish Hospital over a period of time greater than 11 years. We identified all known or suspected copperhead snakebites. We excluded bites by rattlesnakes, cottonmouths, unidentified snakes, and captive or non-native snakes. We classified the confidence that the culprit was a copperhead snake as "positive" or "probable," according to the previously published criteria. We recorded the most extreme values for laboratory measures of coagulation for each patient. The final data set included 106 venomous snakebites, of which 45 were positively identified as attributable to copperheads and 61 probable copperheads. Results for international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, and fibrinogen concentration remained within normal limits for 79%, 93%, 95%, and 91% of patients, respectively. The highest INRs and PTTs were 1.35 and 41 seconds, respectively, in different patients. Three patients had platelet counts below 100,000/mm(3) (54,000, 75,000, and 76,000/mm(3), respectively). The lowest fibrinogen concentration was 117 mg/dL. Five patients had 2 laboratory values outside normal ranges, and 1 had 3 abnormal laboratory values. No patient developed bleeding complications. In identified copperhead snakebites, it may be safe to forgo serial coagulation testing in both adult and pediatric patients in the absence of clinical evidence of bleeding.

Revisiting saw-scaled viper ( Echis carinatus) bites in the Jaffna Peninsula of Sri Lanka: distribution, epidemiology and clinical manifestations

In Sri Lanka, the saw-scaled viper ( Echis carinatus) is distributed in the arid, dry and sandy coastal plains and in a prospective study we describe its bites in the Jaffna peninsula. Of the 304 snake bite admissions to the Jaffna Hospital in 2009, 217 (71.4%) were bitten by either venomous species or envenomed by unidentified snakes. There were 99 (45.6%) reported saw-scaled viper bites, of which 26 were confirmed cases. The length of the offending snakes ranged from 228–310 mm and bites mainly occurred in the nearby islands. The median age of the confirmed cases was 34 years (range 1.5–72 years); occupations included housewives (8, 31%), school children (4, 15%) and farmers (2, 8%). In 18 patients (69%), bites occurred in daylight and in 8 (31%) within or near the compounds. The fingers were bitten in 8 (31%) and toes/foot in 11 (42%) cases. There were 2 (8%) dry bites and 19 patients (73%) developed local swelling; one patient developed haemorrhagic blisters. In 24 patients (92%), blood incoagulability manifested between 40 and 1095 min after the bite, and three patients (12%) developed spontaneous bleeding. One patient (4%) developed mild acute renal dysfunction. The median time for correction of coagulopathy was 802 min (range 180–1669 min) with Indian polyvalent antivenom. All recovered. The saw scaled viper is responsible for most venomous bites in the Jaffna peninsula.

Envenoming after carpet viper (Echis ocellatus) bite during pregnancy: timely use of effective antivenom improves maternal and foetal outcomes

The report describes successful management of 10 women in 2nd and 3rd pregnancy trimesters with EchiTab IgG antivenom after carpet viper (Echis ocellatus) envenoming. All women survived but foetal loss in a victim with delayed presentation and a case of mild hypersensitivity reaction were recorded. Excellent outcomes can be achieved in rural and semi-nomadic populations without specialized care and immediate access and provision of effective antivenoms is paramount in curtailing snakebite maternal morbidity, mortality and foetal loss.

Diet of the Eagle Owl, Bubo bubo, in Syria

Pellets regurgitated by the Eagle Owl, Bubo bubo, were collected from Al-Karyatien, Central Syria. The analysis yielded 206 food items representing seven mammalian species (five rodents, one insectivore and one lagomorph), unidentified snakes and lizards, three species of birds, five insects, three species of scorpions, and a solifugid. By frequency small mammals constituted 76.2% of the consumed prey items, of which the Long-eared Hedgehog, Hemiechinus auritus, constituted 25.3%. Additional distribution ranges for certain small mammals in Syria are discussed.

SNAKEBITE POISONING IN CHILDREN

Snakebite Poisoning is a common paediatric emergency especially during the monsoonseason in the terai and inner terai regions of Nepal. There is hardly any study conductedso far in Nepal to highlight different aspects of snakebite poisoning in children. Thisretrospective study was therefore conducted basically to find out the clinicoepidemiologicalfeatures, case fatality rate and risk factors for death in childrenadmitted in Lumbini Zonal Hospital (LZH) with features of snakebite poisoning.The study showed the highest incidence of snakebite poisoning among children agedabove 10 years. The peak incidence of poisoning was seen during July-August. Thesemonths correspond with the monsoon season in Nepal. Most of the victims had bitesby unidentified snakes (75%), mostly on the fingers &amp; hands (nearly 50%). Nearly47% of the children had respiratory distress, and a large majority of them requiredrespiratory support therapy. Case fatality rate (CFR) was nearly 29%. The relativerisk factors for death due to snakebite poisoning were: age above 5 years, male sex,bites on the finger &amp; hand and bites by Kraits. Mortality and morbidity due to snakebitecan be reduced by early &amp; judicious use of anti-snake venom (ASV).Key Words: Snakebite, Poisoning, Children, Case fatality rate, Nepal

Venomous snakebite: past, present, and future treatment options.

Venomous snakebites continue to cause great morbidity, and treatment options are confusing the attending physician. In the United States approximately 45,000 snakebites occur each year, of which some 8000 are by 20 species of venomous snakes. Information on venomous snakes and snakebite treatment was gathered from the libraries of the Wilderness Medical Society and the Rocky Mountain Center for Wilderness Medicine in Boise, Idaho (co-supported by the Boise State University and the Family Practice Residency of Idaho), as well as from current literature files of physicians practicing wilderness medicine. Three genera of venomous snakes account for the majority of poisonous snake envenomations in this country. Most hospitalized victims are bitten either by rattlesnakes or copperheads or by unidentified snakes. Most of these bites occur during the summer months and are found on the extremities. Field treatment focuses on the application of a vacuum extractor and transportation to the nearest medical facility. Although constriction band use can be helpful, tourniquets, incision and suction, and ice therapy are contraindicated. Electric shock therapy is of no use and could cause serious injury. Hospital management focuses on rapid clinical evaluation and laboratory tests to establish the degree of envenomation, looking for clotting abnormalities. If envenomation has occurred and is reactive, polyvalent antivenin should be administered according to the degree of envenomation. Errors in diagnosis and treatment result in increased morbidity and put attending physicians at risk for litigation. Prevention remains the most successful approach to snakebite management.

Clinical approach to bites by unidentified snakes in Zululand, S.A.: Tilbury, C. R. and Coetzer, P. W. W. (Department of Medicine, Riyadh Armed Forces Hospital, Saudi Arabia)

Clinical approach to bites by unidentified snakes in Zululand, S.A.: Tilbury, C. R. and Coetzer, P. W. W. (Department of Medicine, Riyadh Armed Forces Hospital, Saudi Arabia)

HUMAN SNAKE BITE VICTIMS: THE SUCCESSFUL DETECTION OF CIRCULATING SNAKE VENOM BY RADIOIMMUNOASSAY

A new solid-phase radioimmunoassay has been developed which allows positive identification of the type of snake venom in human tissue and fluids and its accurate quantitation. Tiger snake venom at a level of 210 ng/ml was detected post mortem in the serum of a child, and brown snake venom was detected in two adults bitten by unidentified snakes. Apart from forensic applications, the assay will be useful in studying clinical aspects of envenomation and the use of antivenenes.

Outcomes of Snakebite Envenomation in Children

Introduction: Snakebite is a medical emergency, and is considered to be one of the major public health hazards in the Terai and inner-Terai regions of Nepal. Very few studies have been conducted so far in Nepal to highlight the epidemiology of snakebite in children. Aim: To review the pattern and characteristics of snakebites in children, focusing primarily on the outcomes, fatality and risk factors for death. Settings: An emergency department of a 136-bedded secondary care-referral hospital (Lumbini Zonal Hospital) situated at Butwal in the Western Nepal. Methodology: The study was carried out in 152 children aged &lt; 15 years old, who got anti-snake venom (ASV) over a period of 48 months. Diagnosis of snakebite envenomation was based on clinical ground. Results: Children over 5 years of age constituted the highest number (87%) of cases. Peak incidence of poisoning (71%) was observed during the months of Asadh- Bhadra (June-September). Most of the bites (61%) were by unidentified snakes, most commonly (91%) on the extremities. Snakebite envenomation occurred more frequently (52%) during night time. 85% of children had local or systemic complications, commonest being respiratory paralysis(92/152).Case fatality rate (CFR) was 28%. Risk factors for death were: age &lt; 5 years; bites by unidentified snakes and kraits and bites on ears &amp; unknown sites. Conclusion: Compared with adults, children with snake envenomation have higher morbidity and mortality, which can be minimized by early diagnosis, appropriate treatment and close monitoring of children on ventilation for the timely management of complications. Emphasis should be given on developing a standard management protocol in children. Keywords: Snakebite; Envenomation; Children; Outcomes; Nepal DOI: http://dx.doi.org/10.3126/jnps.v31i3.5358 J Nep Paedtr Soc 2011;31(3):192-197

Study of Clinico-Epidemiological Profile and Outcome of Poisonous Snake Bites in Children

Introduction: Snake bite poisoning in children is an emergency condition with significant mortality. It is more prevalent in Terai and Inner Terai regions of Nepal especially during monsoon season. There is no study on snake bite poisoning in this part of the country after the introduction of national snake bite management guideline in 2003. This retrospective study was conducted to evaluate the clinicoepidemiological profile, amount of anti-snake venom used and outcome of snake bites. Materials and Methods: Two hundred and forty six cases of snake bite poisoning admitted in emergency department of the hospital up to the age of 14 years, over a period of 6 years from 2004/2005 to 2009/2010 were evaluated retrospectively. Results: The study showed male predominance (57.3%) in snake bites with higher incidence of children above ten years of age (58%). The most of the poisonings (71.9%) was seen during June, July and August months which correspond to the monsoon season in Nepal. Majority of the victims had been bitten by unidentified snakes (52 %), mostly on the fingers &amp; hands (64.6 %). Ptosis was observed in all cases of snake bite poisoning. Slightly less than 1/3rd of the children had respiratory distress needing respiratory support. Average ASV used was 18.2 vials. Case fatality rate (CFR) was quite high (28.2%) with more fatality on those with respiratory distress. Conclusion: As mortality due to snakebite poisoning and consumption of antisnake venom is not reduced by the use of the national protocol 2003, further study to evaluate alternate protocol is recommended. Key words: Case fatality rate; Envenomation; Nepal; Poisoning; Snakebite. DOI: http://dx.doi.org/10.3126/jnps.v32i1.5948 J. Nepal Paediatr. Soc. Vol.32(1) 2012 47-52