Clinical profile and outcome of snake bite in children admitted in a tertiary care institute in the metropolitan city of Karnataka, India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20204960Keywords:
Snake Bite, Snake envenomation, Vasculotoxic, NeuroparalyticAbstract
Background: Snake bite is a major medical and public health problem in tropical agricultural world. A high incidence of snake bite envenomation has been reported from rural India, many times the incidence is underestimated due to lack of epidemiological information. The present study analyses the age, mode of presentation, seasonal variation, clinical profile, management and outcome of patients with snake bite in below 18 years of age group of a metropolitan city, India.
Methods: This study is a retrospective single centre study conducted in government referral hospital in Bangalore from January 2016 to January 2020 including 53 patients, who presented with a history of snake bite. Clinical data about age, sex, clinical manifestations, complications, management and outcome were analysed.
Results: In our study including of 53 patients, maximum snake bites incidents were noted in age group of 6-10 years (47.16%) of the rural population with male predominance (83.01%). Most of the bites occurred during monsoon season (54.71%) in evening time. Bite marks were observed mainly on lower limbs in 71.69% of patients. Tourniquet was the commonly used first aid care (67.92%). Most of the bites were vasculotoxic in (75.47%) followed by neuroparalytic in 15 patients (9.43%) and maximum cases responded to 20 vials of ante venom. Mortality was nil.
Conclusions: Snake bite is a life-threatening emergency. The key in minimizing mortality and severe morbidity is aggressive management of sick patient and timely as well as judicious administration of ante snake venom. There is a requirement to sensitize the general public and healthcare personnel on preventive measures, emergency care and treatment of snake bites. The serious clinical features of snake bite warrant early referral and management in tertiary care centers.
References
Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5(11):e218.
Emilie A. Snake bite in South Asia: a review. PLoS Negl Trop Dis. 2010;4(1):e603.
Snake bite-the neglected tropical disease. Lancet. 2015;386(9999):1110.
Kshirsagar VY, Ahmed M, Colaco SM. Clinical profile of snake bite in children in rural India. Iran J Pediatr. 2013;23(6):632-6.
Karunanayake RK, Dissanayake DMR, Karunanayake AL. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka. BMC Res Notes. 2014;7:482.
Jarwani AB, 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.
Halesha BR, Harshavardhan L, Lokesh AJ, Channaveerappa PK, Channaveerappa PK. 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.
Shrestha BM. Outcomes of Snakebite Envenomation in Children. J Nepal Paediatric Soc. 2017;31(3),192-7.
Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM et al. Million Death Study Collaborators. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5(4):e1018.
Chaudhari TS, Patil TB, Paithankar MM, Gulhane RV, Patil MB. Predictors of mortality in patients of poisonous snake bite: Experience from a tertiary care hospital in Central India. Int j critical illness injury sci. 12014;4(2):101-7.
Minghui R, Malecela MN, Cooke E, Abela-Ridder B. WHO Snakebite Envenoming Strategy for prevention and control. Lancet Glob Health. 2019;7:e837-8.
Rahman R, Faiz MA, Selim S, Rahman B, Basher A, Jones A et al. Annual incidence of snake bite in rural Bangladesh. PLoS neglected tropical diseases. 2010;4:10:e860.
Bawaskar HS, Bawaskar PB. Snake bite envenoming. Lancet. 2019;393:131.
Alirol E, Sharma SK, Bawaska HS, Kuch U, Chappius F. Snake bite in South Asia. PLoS Negl Trop Dis. 2010;4:e603-10.
Bhelkar SM, Chilkar SD, Morey SM. Study of snake bite cases admitted in tertiary care hospital in Nagpur. Int J Comm Med Pub Health. 2017;4(5):1597-1602.
Maduwage K, Isbister GK. Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite. PLoS Negl Trop Dis. 2014;8(10):e3220.
Ochola FO, Okumu MO, Muchemi GM, Mbaria JM, Gikunju JK. Epidemiology of snake bites in selected areas of Kenya. Pan Afr Med J. 2018;29:217.
Mehta SR, Sashindran VK. Clinical Features and Management of Snake Bite. Med J Armed Forces India. 2002;58(3):247-9.
Jayakrishnan MP, Geeta MG, Krishnakumar P, Rajesh TV, George B. Snake bite mortality in children: beyond bite to needle time. Arch Dis Child. 2017;102(5):445-9.
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.
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. 2017;4(6):2142.
Stone SF, Isbister GK, Shahmy S, Mohamed F, Abeysinghe C, Karunathilake H et al. Immune response to snake envenoming and treatment with antivenom; complement activation, cytokine production and mast cell degranulation. PLoS Negl Trop Dis. 2013;7(7):e2326.
Lahori UC, Sharma DB, Gupta KB, Gupta AK. Snake bite poisoning in children. Indian Pediatr. 1981;18:193-197.
Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Indian Pediatr. 1994;31(10):1239-43.
Omogbai EK, Zuleikha AM, Imhafidon MA, Ikpeme AA, Ojo D, Nwako CN et al. Snake bites in Nigeria: a study of the prevalence and treatment in Benin City. Trop J Pharm Res. 2002;1:39-44.