Toxicology International (Formerly Indian Journal of Toxicology)

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Clinico-Epidemiological Study of Snake Bite Presenting to the Emergency Department of a Tertiary Care Hospital


Affiliations
1 Department of Emergency Medicine, Dr DY Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune - 411018, Maharashtra, India
2 Department of Accident and Emergency, Norfolk and Norwich University Hospital, Norwich - NR47UY, India
     

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Snakebite is an acute, life-threatening condition which is most commonly faced by the rural population of tropical countries. About 1.2 million deaths related to snake bites are reported from the Indian subcontinent adding a major part to the global burden towards snake bite mortality. Maharashtra reported the highest number of snake bite cases in the year 2019. A retrospective study was carried out at the emergency department from April 1st, 2020 to June 30th, 2021. Data regarding demographic factors, clinical features, complications, details of treatment received and outcomes of the snake bite victims were recorded. A total of 103 patients with snake bites were admitted, 71.84% were males, and the mean age group was 31.68 years. 26% of the cases were reported during the month of June, and 68% of the bites were reported between 12:00 pm to 12:00 am. 62.14% had bites over their lower limbs, and 31.07% of them were farmers. 47.57% had local pain. 59.22% were dry bites out of which 17.47% received an incomplete dose of Antisnakevenom (ASV) from referring hospitals. 17.47% manifested with neurological symptoms. Our study suggested that farmers, children, women and labourers are the most vulnerable groups affected. There is still a lack of knowledge among healthcare workers regarding the use of ASV.

Keywords

ASV, Dry Bite, Neurotoxicity, Vasculotoxic.
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  • Chippaux JP. Snakebite envenomation turns again into a neglected tropical disease! J Venom Anim Toxins Incl Trop Dis. 2017; 23:38. https://doi.org/10.1186/s40409-017- 0127-6 PMID: 28804495 PMCID: PMC5549382

  • Minghui R, Malecela MN, Cooke E, Abela-Ridder B. WHO’s Snakebite Envenoming Strategy for prevention and control. Lancet Glob Health. 2019; 7(7):e837-e838. Epub 2019 May 22. https://doi.org/10.1016/S2214-109X(19)30225-6 PMID: 31129124

  • Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, Begum R, Sati P, Piyasena K, Bhatia M, Brown P, Jha P. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. Elife. 2020; 9:e54076. https://doi.org/10.7554/eLife.54076 PMID: 32633232 PMCID: PMC7340498

  • Salve PS, Vatavati S, Hallad J. Clustering the envenoming of snakebite in India: The district level analysis using Health Management Information System data. Clinical epidemiology and global health. 2020; 8(3):733-8. https://doi. org/10.1016/j.cegh.2020.01.011

  • Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: A review. PLoS Negl Trop Dis. 2010; 4(1):e603. https://doi.org/10.1371/journal. pntd.0000603 PMID: 20126271 PMCID: PMC2811174

  • Bawaskar HS, Bawaskar PH. Snakebite envenoming. Lancet. 2019; 393(10167):131. https://doi.org/10.1016/ S0140-6736(18)32745-4 PMID: 30638580

  • Bawaskar HS, Bawaskar PH. Call for global snakebite control and procurement funding. Lancet. 2001; 357(9262):1132-3. https://doi.org/10.1016/S0140- 6736(00)04286-0 PMID: 11303612

  • Warrell DA, Gutierrez JM, Calvete JJ, Williams D. New approaches and technologies of venomics to meet the challenge of human envenoming by snakebites in India. Indian J Med Res. 2013; 138(1):38-59. PMID: 24056555 PMCID: PMC3767246

  • Ralph R, Sharma SK, Faiz MA, Ribeiro I, Rijal S, Chappuis F, Kuch U. The timing is right to end snakebite deaths in South Asia. BMJ. 2019; 364:k5317. Erratum in: BMJ. 2019 Jan 24; 364:l397. https://doi.org/10.1136/bmj.k5317 PMID: 30670457 PMCID: PMC6340368

  • Inamdar IF, Aswar NR, Ubaidulla M, Dalvi SD. Snakebite: Admissions at a tertiary health care centre in Maharashtra, India. S Afr Med J. 2010; 100(7):456-8. https://doi. org/10.7196/SAMJ.3865 PMID: 20822595

  • Gajbhiye R, Khan S, Kokate P, Mashal I, Kharat S, Bodade S, Yadav A, Mahale S. Incidence and management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India. Indian J Med Res. 2019; 150(4):412-416. https://doi.org/10.4103/ijmr. IJMR_1148_18 PMID: 31823924 PMCID: PMC6902356

  • Whitehall JS, Yarlini, Arunthathy, Varan, Kaanthan, Isaivanan, Vanprasath. Snake bites in north east Sri Lanka. Rural Remote Health. 2007; 7(4):751. Epub 2007 Dec 12. https://doi.org/10.22605/RRH751 PMID: 18081448

  • Thapar R, Darshan BB, Unnikrishnan B, Mithra P, Kumar N, Kulkarni V, Holla R, Kumar A, Kanchan T. Clinico- Epidemiological Profile of Snakebite Cases Admitted in a Tertiary Care Centre in South India: A 5 Years Study. Toxicol Int. 2015; 22(1):66-70. https://doi.org/10.4103/0971- 6580.172260 PMID: 26862263 PMCID: PMC4721179

  • Ghosh R, Mana K, Gantait K, Sarkhel S. A retrospective study of clinico-epidemiological profile of snakebite related deaths at a Tertiary care hospital in Midnapore, West Bengal, India. Toxicol Rep. 2017; 5:1-5. https:// doi.org/10.1016/j.toxrep.2017.11.008 PMID: 29234603 PMCID: PMC5723283

  • Halesha BR, Harshavardhan L, Lokesh AJ, Channaveerappa PK, Venkatesh KB. A study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in southern India. J Clin Diagn Res. 2013; 7(1):122-6. Epub 2012 Sep 14. https://doi.org/10.7860/ JCDR/2012/4842.2685 PMID: 23450135 PMCID: PMC3576766

  • Pandey PC, Bajaj S, Srivastava A. A Clinico-Epidemiological Profile of Neuroparalytic Snake Bite: Using Low Dose ASV in a Tertiary Care Centre from North India. J Assoc Physicians India. 2016; 64(8):16-20. PMID: 27762104.

  • Padhiyar R, Chavan S, Dhampalwar S, Trivedi T, Moulick N. Snake Bite Envenomation in a Tertiary Care Centre. The Journal of the Association of Physicians of India. 2018; 66(3):55-59. PMID: 30341870

  • Raina S, Raina S, Kaul R, Chander V, Jaryal A. Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India. Indian J Crit Care Med. 2014; 18(3):134-8. https://doi.org/10.4103/0972-5229.128702 PMID: 24701062 PMCID: PMC3963195

  • Bhalla G, Mhaskar D, Agarwal A. A study of clinical profile of snake bite at a tertiary care centre. Toxicol Int. 2014; 21(2):203-8. https://doi.org/10.4103/0971-6580.139811 PMID: 25253932 PMCID: PMC4170564

  • Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases, presented to Emergency Medicine department, Ahmedabad, Gujarat. J Emerg Trauma Shock. 2013; 6(3):199-202. https://doi. org/10.4103/0974-2700.115343 PMID: 23960378; PMCID: PMC3746443

  • Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinico-epidemiological study of snake bite in Nepal. Trop Doct. 1998; 28(4):223-6. https://doi. org/10.1177/004947559802800412 PMID: 9803844

  • Wanje SD, Rambhau DG. Clinical profile of snake bite cases in Marathwada, India. Indian J Fundam Applied Life Sci. 2011; 1:93.

  • Punde DP. Management of snake-bite in rural Maharashtra: a 10-year experience. Natl Med J India. 2005; 18(2):71-5. PMID: 15981441

  • Bhardwaj A, Sokhey J. Snake bites in the hills of north India. Natl Med J India. 1998; 11(6):264-5. PMID: 10083792.

  • Bawaskar HS, Bawaskar PH. Profile of snakebite envenoming in western Maharashtra, India. Trans R Soc Trop Med Hyg. 2002; 96(1):79-84. https://doi.org/10.1016/S0035- 9203(02)90250-6 PMID: 11926002

  • Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med. 2018; 11:209-216. https://doi.org/10.2147/IJGM.S136153 PMID: 29892202 PMCID: PMC5993036

  • Jadon RS, Sood R, Bauddh NK, Ray A, Soneja M, Agarwal P, Wig N. Ambispective study of clinical picture, management practices and outcome of snake bite patients at tertiary care centre in Northern India. J Family Med Prim Care. 2021; 10(2):933-940. Epub 2021 Feb 27. https://doi.org/10.4103/jfmpc.jfmpc_1408_20 PMID: 34041101 PMCID: PMC8138377

  • Gautam P, Sharma N, Sharma M, Choudhary S. Clinical and demographic profile of snake envenomation in Himachal Pradesh, India. Indian Pediatr. 2014; 51(11):934-5. PMID: 25432234

  • Chauhan V, Thakur S. The North-South divide in snake bite envenomation in India. J Emerg Trauma Shock. 2016; 9(4):151-154. https://doi.org/10.4103/0974-2700.193350 PMID: 27904261 PMCID: PMC5113082

  • Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. 1994; 161(11-12):695-700. https://doi. org/10.5694/j.1326-5377.1994.tb126923.x PMID: 7830641

  • Kim YH, Choi JH, Kim J, Chung YK. Fasciotomy in compartment syndrome from snakebite. Arch Plast Surg. 2019; 46(1):69-74. Epub 2019 Jan 15. https://doi.org/10.5999/ aps.2018.00577 PMID: 30685944 PMCID: PMC6369054

  • Monteiro FN, Kanchan T, Bhagavath P, Kumar GP, Menezes RG, Yoganarasimha K. Clinico-epidemiological features of viper bite envenomation: a study from Manipal, South India. Singapore Med J. 2012; 53(3):203-7. PMID: 2243429


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  • Clinico-Epidemiological Study of Snake Bite Presenting to the Emergency Department of a Tertiary Care Hospital

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Authors

Arjun H M
Department of Emergency Medicine, Dr DY Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune - 411018, Maharashtra, India
Varsha Shinde
Department of Emergency Medicine, Dr DY Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune - 411018, Maharashtra, India
Suhrith Bhattaram
Department of Emergency Medicine, Dr DY Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune - 411018, Maharashtra, India
Zahid Shaikh
Department of Accident and Emergency, Norfolk and Norwich University Hospital, Norwich - NR47UY, India

Abstract


Snakebite is an acute, life-threatening condition which is most commonly faced by the rural population of tropical countries. About 1.2 million deaths related to snake bites are reported from the Indian subcontinent adding a major part to the global burden towards snake bite mortality. Maharashtra reported the highest number of snake bite cases in the year 2019. A retrospective study was carried out at the emergency department from April 1st, 2020 to June 30th, 2021. Data regarding demographic factors, clinical features, complications, details of treatment received and outcomes of the snake bite victims were recorded. A total of 103 patients with snake bites were admitted, 71.84% were males, and the mean age group was 31.68 years. 26% of the cases were reported during the month of June, and 68% of the bites were reported between 12:00 pm to 12:00 am. 62.14% had bites over their lower limbs, and 31.07% of them were farmers. 47.57% had local pain. 59.22% were dry bites out of which 17.47% received an incomplete dose of Antisnakevenom (ASV) from referring hospitals. 17.47% manifested with neurological symptoms. Our study suggested that farmers, children, women and labourers are the most vulnerable groups affected. There is still a lack of knowledge among healthcare workers regarding the use of ASV.

Keywords


ASV, Dry Bite, Neurotoxicity, Vasculotoxic.

References





DOI: https://doi.org/10.18311/ti%2F2023%2Fv30i2%2F32375