Clinico-Epidemiological Profile and Outcome of Poisonous Snake Bites in Children using the WHO Treatment Protocol in Western Nepal

Paudel, Kiran; Poudyal, V P; Rayamajhi, Rajan Bikram; Budhathoki, Shyam Sundar

doi:10.3126/jonmc.v4i1.12811

Cited by 5 publications

(14 citation statements)

References 10 publications

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“…In this study, 115 (57.5%) of cases were bitten on the lower limb, 85(42.5%) on upper limb. Similar observations are reported in India and world literature but unusual sites like head, trunk was not observed in present study [20]. In rural India, due to mentality of the people to seek treatment from quacks they present to the hospital late after the bite and because of lack of transport facility during night hours the primary center is not approachable.…”

Section: Discussionsupporting

confidence: 89%

Clinical profile and outcome of snake bite in children

et al. 2019

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Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem. This study was conducted to ascertain clinical profile, complication and outcome of snake bite in pediatric population. Methods: Retrospective observational study was done in Paediatrics wards and Paediatric Intensive care unit of tertiary care institute. A medical record files of 200 patients of snakebite, between the periods of January 2013 to August 2018 were recovered from Medical Record and Statistics Section of Institute. Files were analyzed for demographic data; variables included site of bite, time of bite, type of primary treatment and treatment provider, and type of snake poison, common symptoms suggestive of hematotoxicity, myotoxicity and neurotoxicity. Results: Out of total 200 patients, 59.0% were male and most of snake bites were seen in age group of 6-12 years. All bites were nonprovocative and in 57.5% lower limb was the commonest site of bite. A 81.5% patient were primarily treated by medical personnel, 56.5% patients were received treatment within 1 hour of bite and hospitalized within 6 hours of bite. Cellulitis was commonest complication (39.0%) followed by vasculotoxicity (30%) and neuroparalysis in (27.5%), followed by respiratory paralysis in (19.0%), coagulation (17.0%). Renal replacement therapy was required in 6.5%, blood/blood product transfusion in 11% patients and case fatality rate was 11.5%. Conclusions: The most vulnerable to snake bites are boys aged more than 5 years. There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

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Section: Discussionsupporting

confidence: 89%

Clinical profile and outcome of snake bite in children

et al. 2019

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“…11,12 However this finding was opposite to many other studies. 3,5,13 In this study, incidence of snake bite was found more in rural area (91%) and least from urban area (9%). This finding was similar to other study.…”

Section: Discussionmentioning

confidence: 49%

“…This finding was similar to other study. 3,7,9,14 Dwelling conditions in rural areas of Nepal is more favorable for habitation of snakes and most people are engaged in agriculture work, which leads to more snake bites. Most patients visited are from Terai regions (84%) compared to hilly regions (16%).…”

Section: Discussionmentioning

confidence: 99%

“…This finding is similar to other study of the 81 patients 67 patients applied tourniquet as the first aid. 3,5,15,16 The use of tourniquets was almost universal. 7 In this study 64% of patients have low economic status and 36% of patients have medium economic status.…”

Section: Discussionmentioning

confidence: 99%

“…Cobra venom blocks the post synaptic receptors and needs more ASV and neostigmine. 3 The oral flora of snake comprises a wide range of aerobic and anaerobic micro-organisms, especially the fecal Gram-negative rods, because their prey usually defecates while being ingested. Culture of Department of Pharmacy, Crimson College of Technology, Butwal-11, Rupandehi, Nepal fangs, fang sheaths, and venom of various snakes such as vipers, rattle snakes and Naja, have shown heavy colonization with many bacteria, including members of Enterobacteriaceae including Morganella spp.…”

Section: Introductionmentioning

confidence: 99%

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A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

Chaudhary¹,

Gupta²,

Chand³

et al. 2020

Int J Basic Clin Pharmacol

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Background: Snake bite is a major health problem in Nepal. According to WHO, annual morbidity due to snake bite is 162 out of 100,000 people in Nepal. Aim of the study is to observe epidemiology, clinical features, and analysis of possible relationship between time delay in administration of anti-snake venom (ASV) and mortality. Methods: This prospective observational study analyses the data of 81 patients admitted to the Lumbini zonal hospital, Butwal, Rupandehi, Nepal with history of snake bite between April to September, 2017.Results: In this study 56% patients were female. Patients of age group (15-30) years were maximum (38.27%). The study showed that 50.61% of snake bites were occurred outside home. Most of patients (84%) were from the Terai region. Average no. of vials used per case was (28±10) vials. Most of victims of snake bite were from rural areas. In most of cases we found that prothrombin time was prolonged. It was found that most of patients 57% reach hospital before 4 hours of snake bite. The mean days of hospital stay was 6±2.86. Most of case of snake bite was unknown (62%). The mortality rate in this study was 6.17%.Conclusions: There is a great need to improve in existing health care conditions for effective management of snake bite; it requires training of the personnel engaged in the emergency health care management, development of national guidelines based on the clinical trials, improving the distribution and easy availability of antivenom.

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

Giri

Bisoi

Dash

et al. 2020

Int J Contemp Pediatr

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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.

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Clinico-Epidemiological Profile and Outcome of Poisonous Snake Bites in Children using the WHO Treatment Protocol in Western Nepal

Cited by 5 publications

References 10 publications

Clinical profile and outcome of snake bite in children

Clinical profile and outcome of snake bite in children

A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

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

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