DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20201646

Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

Shatabdi Giri, Swarup Kumar Bisoi, Dillip Kumar Dash, M. D. Mohanty, S. K. Parida

Abstract


Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.

Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.

Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.

Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.


Keywords


Anti- snake venom, Envenomation, Snake bite, Tertiary care

Full Text:

PDF

References


World Health Organization. Neglected Tropical Diseases. [Last cited on 2014 Aug07]. Available at: http://www.who.int/neglecteddiseases/diseases/snakebites/en/.

Crompton DW, Peters P, editors. World Health Organisaton. Working to overcome the global impact of neglected tropical diseases. Geneva: Department for the Control of Neglected Tropical Diseases, WHO; 2010:172.

Crompton DW, editors. World Health Organization. Sustaining the drive to overcome the Global impact of neglected tropical diseases; Second WHO report on neglected tropical diseases. Geneva: department for the control of Neglected Tropical Diseases, WHO; 2013:172.

Inamdar IF, Aswar NR, Ubaidulla M, Dalavi SD. Snake bite: Admissions at a tertiary health care centre in Maharashtra, India. S Afr Med J. 2010;100(7):456-8.

Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinicoepidemiological study of snake bite in Nepal. Trop Doct. 1998;28(4):223-6.

Warrell DA, Gutiérrez JM, Calvete JJ, Williams D. New approaches and technologies of venomics to meet thechallenge of human envenoming by snakebites in India. Indian J Med Res. 2013;138:38-59.

World Health Organization. Rabies and Envenoming’s: A Neglected Public Health Issue.2007. Available at: https://www.who.int/bloodproducts/animal_sera/Rabies.pdf. Accessed on 01 May 2008.

Kumaravel KS, Ganesh J. A study on the clinical profile of children with snake envenomation in a tertiary referral centre at Dharmapuri, Tamilnadu, India. Int J Res Med Sci. 2016;4(6):2142-5.

Chandrashekar C, Shariff MA, Gopal K, Ravichander B. Clinical profile of snakebite in children. J Evidence Based Medi Healthcare. 2015;2(29):4176-84.

Krishana VM, Sheikh NA, Soren C. Clinical profile and outcome of snake bite envenomation in children: a retrospective study in a tertiary care centre KIMS Narketpally. Int J Information Res Rev. 2014;1(11):155-8.

Sani UM, Jiya NM, Ibitoye PK, Ahmad MM. Presentation and outcome of snake bite among children in Sokoto. North-western Nigeria. Sahel Med J. 2013;16(4):148-53.

Reddy MP, Sudharshan RC. Clinical, epidemiological and hematological profile of snake bite in children in rural teaching hospital. Int J Health Sci Res. 2015;5(7):58-63.

Lingayat AM, Wankhade PR. Study of clinical profile complications and outcome in patients of snake bite Inpediatric age group. Int J Healthcare Biomed Res. 2015;3(3):203-8.

Digra S, Singh V. A clinical profile of neurotoxic snakebite in pediatric population of Jammu region. JK Sci. 2016;18(2):67-70.

Chew KS, Khor HW, Ahmad R, Rahman H. A five-year retrospective review of snakebite patients admitted to a tertiary university hospital in Malaysia. Int J Emerg Med. 2011;4:41.

Wang JD, Tsan YT, Chiao M, Wang LM. Venomous snakebites and antivenom treatment according to a protocol for pediatric patients in Taiwan. J Venom Anim Toxins Incl Trop Dis. 2009;15(4):667-79.

Paudel KM, Poudyl VP, Rayamajhi RB, Budhathoki SS. Clinico-epidemiological profile and outcome of poisonous snake bites in children using the WHO treatment protocol in western Nepal. J Nobel Medical College. 2016;4(7):21-5.

Adhashivam B, Mahadevan S. Snake bite Envenomation in India: A Rural Medical Emergency. Indian Pediatr. 2006;43(6):553-4.

Halesha BR, Harshavardhan L, Lokesh AJ, Channaveerappa PK, Venkatesh KB. Study on the Clinico- Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India. JCDR. 2013;7(1):122-6.