Clinical profile &amp; complications of neurotoxic snake bite &amp; comparison of two regimens of polyvalent anti-snake venom in its treatment

Sarin, Krishna; Dutta, Tarun Kumar; Vinod, KV

doi:10.4103/ijmr.ijmr_1319_14

Cited by 10 publications

(5 citation statements)

References 6 publications

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“…A study from India reported no fatalities in 51 patients with neurotoxic snake envenomation after they were treated with a combination of antivenom therapy and mechanical ventilation. [28] In our study only a small number of patients (16.7%) with respiratory failure and who required mechanical ventilation received antivenom. The antivenom used during the study period is not among the products currently recommended by international specialists in this field.…”

Section: Discussionmentioning

confidence: 70%

Intensive-care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

Lang¹,

Amito²,

Duenser³

et al. 2020

S Afr J Crit Care

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Approximately 5.4 million people are bitten by snakes annually, with up to half of these victims experiencing signs of envenomation. This results in an estimated 138 000 deaths per year. [1] Only limited data exist on the long-term morbidity of snakebites, but one study suggested that between 5 900 and 14 600 amputations per year may be attributed to snakebites in sub-Saharan Africa (sSA) alone. [2] However, accuracy of epidemiological data is limited owing to under-reporting, patients' poor access to healthcare facilities and many victims attending traditional healers rather than health centres or hospitals. [1][2][3] The burden of snakebites is unevenly distributed across the globe, with 95% of cases encountered in low-and middle-income countries in Africa and Asia. [4,5] Even in those areas, the health effects of snakebites are disproportional, with the poorest of the poor generally experiencing poor outcomes. [6,7] Rural sSA is specifically vulnerable owing to limited availability of healthcare services. In 2017, the World Health Organization (WHO) recognised snakebite envenoming as a neglected tropical disease. [7] Accordingly, snakebite antivenoms are included in the WHO's list of essential medicines. [8] Common acute medical conditions arising from snakebites depend on the species, but include neurotoxicity, coagulation failure accompanied by shock or organ dysfunction, and local tissue destruction. [9] Multiple factors, including delayed presentation to healthcare facilities, adversely affect the management and outcome of snakebite victims. [2] Inadequate regulatory frameworks that result in ineffective or unsafe antivenom products being available, restricted access and high costs are crucial challenges limiting the use of antivenoms, particularly in sSA. [10,11] Supportive measures are often the only therapeutic options for patients presenting with snakebite envenoming in sSA.In this study, we report the intensive care unit (ICU) management and outcomes of 174 snakebite victims who were treated mainly with basic intensive-care interventions (e.g. mechanical ventilation) in a rural sSA hospital where adequate doses of antivenom were not available.

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Section: Discussionmentioning

confidence: 70%

Intensive-care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

Lang¹,

Amito²,

Duenser³

et al. 2020

S Afr J Crit Care

View full text Add to dashboard Cite

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“…The majority of primary outcome measures (82·1%) were unique to a single study. Amongst studies with shared primary outcome measures, three by Isbister et al adopted return of INR to less than two [ 23 , 24 , 31 ] and two studies measured duration of invasive ventilation [ 32 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…There have been just nine randomised controlled trials that have included participants with neurotoxicity, with a combined sample size of 492 [ 25 – 27 , 32 , 38 , 39 , 46 – 48 ]. All except one study [ 26 ] took place in Asia.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and outcome measurement tools reported in randomised controlled trials of treatment for snakebite envenoming: A systematic review

et al. 2021

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Background Snakebite is a priority neglected tropical disease and causes a range of complications that vary depending on the snake species. Randomised clinical trials have used varied outcome measures that do not allow results to be compared or combined. In accordance with the Core Outcomes Measurements in Effectiveness Trials (COMET) initiative, this systematic review aims to support the development of a globally relevant core outcome set for snakebite. Methods All randomised controlled trials, secondary analyses of randomised controlled trials and study protocols investigating the efficacy of therapeutics for human snakebite envenoming were eligible for inclusion. Study screening and data extraction were conducted in duplicate by two independent reviewers. All primary and secondary outcome measures were extracted and compiled, as were adverse event outcome measures. Similar outcome measures were grouped into domains. The study was prospectively registered with PROSPERO: CRD42020196160. Results This systematic review included 43 randomised controlled trials, two secondary analyses and 13 study protocols. A total of 382 outcome measures were extracted and, after duplicates were merged, there were 153 unique outcomes. The most frequently used outcome domain (‘venom antigenaemia’) was included in less than one third of the studies. The unique outcomes were classified into 60 outcome domains. Patient-centred outcomes were used in only three of the studies. Discussion Significant heterogeneity in outcome measures exists in snakebite clinical trials. Consensus is needed to select outcome measures that are valid, reliable, patient-centred and feasible. The results of this systematic review strongly support the development of a core outcome set for use in snakebite clinical trials.

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“…In severe cases of progressive painful swelling or bleeding, anti-venom administration and fasciotomy may be necessary 42 . Low dose anti-venom has been found to be as effective as high dose anti-venom for both neurotoxic and hematotoxic snake bites 43 . Early, empirical anti-venom is lifesaving, but good supportive care with mechanical ventilation is equally important and can lead to a good outcome 44 .…”

Section: Discussionmentioning

confidence: 99%

Neurological and neuro-ophthalmological manifestations of snake bite: a systematic review

Pandit,

Rawal,

Maskey

et al. 2023

Annals of Medicine &Amp; Surgery

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Objective: Snake bite is a major health concern, particularly in developing countries, affecting mainly rural farming communities. When venom primarily neurotoxin enters the body by a snake bite, it affects the nervous system, causing neurological symptoms like muscle weakness, paralysis, altered sensation, and coordination issues. This systematic review aims to study a detail evaluation of neurological and neuro-ophthalmological manifestations associated with snake bites. Methods: This review studied the type, severity, neurological and neuro-ophthalmological symptoms and signs, treatment, outcomes of treatment, and long-term complications of snake bites. Result: Snake venom, whether hematotoxic or neurotoxic, can cause neurological symptoms. Ptosis and limb weakness are frequently reported by patients in this review. Ophthalmoplegia, nystagmus, delayed neuropathy, and dysarthria are less commonly reported. Vision loss is moderately observed in snake bite cases. In neurotoxic snake bites, ptosis followed by neuroparalysis are the primary ocular symptoms, while hematotoxic snake bites can lead to various symptoms such as accommodation deficiency, ptosis, ophthalmoplegia, neck muscle weakness, and dysphagia. Most reviewed cases showed recovery without neurological deficits. Neurotoxic snake bites had higher mortality rates compared to hematotoxic bites. Factors linked to higher mortality in children with Early Morning Neuroparalytic Syndorme (EMNS) include younger age, ptosis, cardiac arrest, and limited availability of Pediatric Intensive Care Unit (PICU) beds. Prompt recognition, respiratory support, and PICU care can reduce mortality rates. Conclusions: Snake bite treatment involves administering antivenom (ASV) and providing supportive care, including mechanical ventilation if needed. Guidelines for handling snakes in locations such as zoos are crucial to prevent workplace snake bites. Establishing a snake bite registry in regions with high snake encounters is essential for proper case documentation and enables effective planning and strategy development for prevention and management of snake bites.

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Clinical profile & complications of neurotoxic snake bite & comparison of two regimens of polyvalent anti-snake venom in its treatment

Cited by 10 publications

References 6 publications

Intensive-care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

Intensive-care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

Clinical outcomes and outcome measurement tools reported in randomised controlled trials of treatment for snakebite envenoming: A systematic review

Neurological and neuro-ophthalmological manifestations of snake bite: a systematic review

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