Clinical profile and prognostic indicators of neurotoxic snake bite in rural India
DOI:
https://doi.org/10.18203/2349-3933.ijam20195244Keywords:
Anti-Snake venom, Neurotoxic snake bite, Outcome, Respiratory failure, Rural india, Traditional treatmentAbstract
Background: In rural India, snakebite is an occupational and environmental hazard. WHO listed snakebite as one of the neglected tropical diseases and in rural India it is underreported because of popular traditional methods of treatments and lack of healthcare facilities. This study is an attempt to look into the epidemiological, clinical and prognostic indicators of neurotoxic snake bite in rural India.
Methods: This study is a prospective, descriptive study of 25 neurotoxic snake bites admitted in our hospital from January to September 2019. Clinical factors like age, sex, clinical features, management and the outcome of patients are studied.
Results: Young males were common victims of snakebite in evening hours during monsoon season. All patients received traditional methods of treatment, and despite this 64% of our patients reported to the hospital within 6 hours after the bite. Overall, the mortality rate in this study was 12%. Poor outcome was also noted in cases who were having respiratory failure and needed artificial ventilation (30%). Mortality was 22.2% in patients where bite to admission time was greater than 6 hours as compared to 6.25% in patients where it was less than 6 hours.
Conclusions: Author concluded that a neurotoxic snake bite is a life-threatening emergency. In preventive measures, outdoor activities in dim lights during monsoon season should be restricted. Traditional treatments are still popular and trusted methods of treatment in rural India and these healers can be educated to recognize and refer immediately all neurotoxic bites to nearby medical facilities.
Metrics
References
Annan AKK. La morsure de serpent est une grande crise de santé publique ignore. [Electronic edition]. Paris, France 2018. 26 June 2018. Available at: https://www.lemonde.fr/idees/article/2018/06/26/kofi-annan-la-morsure-de-serpent-est-une-grande-crise-de-sante-publique-ignoree_5321260_3232.html. Accessed 30 Nov. 2019.
State/UT wise Cases and Deaths Due to Snake Bite in India. Government of India, Central Bureau of Health Intelligence. Health Status Indicators, National Health Profile;2007 and 2008:107-108. Available at: http://cbhidghs.nic.in/writereaddata/mainlinkFile/File1133.pdf. Accessed on 15 October 2019.
Vijaysree V. Snakebites under-reported in India: Nature India. Available at: http://www.nature.com/nindia/2012/120509/full /nindia.2012.69.html. Accessed on 13 October 2019.
Joseph JK, Simpson ID, Menon NC, Jose MP, Kulkarni KJ, Raghavendra GB, et al. First authenticated cases of life-threatening envenoming by the hump-nosed pit viper (Hypnale hypnale) in India. Trans Royal Socie Trop Med Hygien. 2007;101(1):85-90.
Kochar DK, Tanwar PD, Norris RL, Sabir M, Nayak KC, Agrawal TD, et al. Rediscovery of severe saw-scaled viper (Echis sochureki) envenoming in the Thar desert region of Rajasthan, India. Wilderness Environ Med. 2007;18(2):75-85.
Banerji RN, Sahni AL, Chacko KA. Neostigmine in the treatment of Elapidae bites. J Assoc Phys India. 1972;20:503-9.
Saeed A, Tussadiq K. Successful revival of neurotoxic snake bite by artificial ventilation and anticholinesterases. JCPSP, J Colleg Physic Surg Pak. 2000;10(7):267-9.
Suchithra N, Pappachan JM, Sujathan P. Snakebite envenoming in Kerala, South India: clinical profile and factors involved in adverse outcomes. Emerg Med J. 2008;25(4):200-4.
Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snake bite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5(4):e1018.
Kirte RC, Wahab SN, Bhathkule PR. Record based study of snake bite cases admitted at shri vasantrao naik government medical college and hospital, Yavatmal (Maharashtra). Indian J Public Health. 2006;50(1):35-7.
David S, Matathia S, Christopher S. Mortality predictors of snake bite envenomation in southern India a ten-year retrospective audit of 533 patients. J Med Toxicol. 2012;8(2):118-23.
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. Ind J Crit Care Med: Peer-reviewed, Official Pub Ind Soci Crit Care Med. 2014;18(3):134.
Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J. 2005;22(2):118-20.
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.
Reid HA, Theakston RD. The management of snake bite. Bull World Health Organ. 1983;61(6):885.
Virmani SK, Dutt OP. A profile of snake bite poisoning in Jammu region. J Ind Med Asso. 1987;85(5):132-4.
Banerjee RN. Poisonous snakes of India, progress in, clinical medicine’ in India. In: Ahuja MS, eds. 1st Ed. 1987;136-177.
Majumder D, Sinha A, Bhattacharya SK, Ram R, Dasgupta U, Ram A. Epidemiological profile of snake bite in south 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Ind J Pub Health. 2014;58(1):17.
Singh A, Goel S, Singh AA, Goel AK, Chhoker VK, Goel S, et al. An epidemiological study of snakebites from rural Haryana. Intern J Advan Med Health Res. 2015;2(1):39.
Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in‐hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Trop Med Int Health. 2006;11(1):22-30.
Narvencar K. Correlation between timing of ASV administration and complications in snake bites. JAPI. 2006;54:717-9.
Kularatne SA. Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: a prospective clinical study, 1996-98. Postgraduate med J. 2002;78(919):276-80.
Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snakebite-reappraisal of the situation in Eastern Nepal. Toxicon. 2003;41(3):285-9.
Naik RS, Tirpude BH, Khajuria BK. Mortality and morbidity pattern in snake bite at MGIMS Sevagram, Wardha: A rural area. Ind Pract. 1997;50:31-5.
Sarin K, Dutta TK, Vinod KV. Clinical profile and complications of neurotoxic snake bite and comparison of two regimens of polyvalent anti-snake venom in its treatment. Ind J Med Res. 2017;145(1):58.
Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in‐hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Trop Med Inern Health. 2006;11(1):22-30.
Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Ind Pediatr. 1994;31:1239.
Punde DP. Management of snakebite in rural Maharashtra: A 10-year experience. Nat Med J Ind. 2005;18(2):71.
Agrawal PN, Aggarwal AN, Gupta D, Behera D, Prabhakar S, Jindal SK. Management of respiratory failure in severe neuroparalytic snake envenomation. Neurol Ind. 2001;49(1):25-8.
Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J. 2005;22(2):118-20.