Epidemiology and Clinical Outcome of Snakebite in Western Nepal: A Retrospective Study

Abstract

Introduction: Snakebite is an environmental hazard associated with significant morbidity and mortality. It is an important medical emergency and cause of significant numbers of hospital admissions in many parts of the Asian region. In this study, we assess the epidemiology and clinical outcome of snake bite.
 Methods: This was a retrospective study of all patients with snake bites admitted to the Department of Internal Medicine, Manipal Teaching Hospital, Pokhara, kaski, Nepal. A total numbers of 265 snake bite cases in the period of 2013 to 2016 were enrolled in this study. Snake bite cases by person, place and time along with month of snake bite and time of bite, were analyzed. We also identified the types of snake and site of the bite. Sign and symptoms were clinically observed and the management of the snake bite cases was clinically done. Prothrombin time (PT) test along with INR value was performed by Medical Technologist at the Department of Laboratory, Manipal Teaching Hospital. Data was entered in to the Microsoft excel and analyzed by SPPS version 21.0. Percentages were applied to find the results.
 Results: Total numbers of snake bite cases were 265. More than half, 60.4% of the snake bite cases were females. Regarding the age group, nearly half, 47.9% were in the age group of 20 - 40 years and 9.8% cases were in the age group of 60 years and above. In this study, 50.6% bite cases were held at the day time and most of the bites were reported/ observed in the limb, 53.6% in lower limb, and 43.4% in the upper limb. Very few bites were in the head, neck and trunk. Our result shows 49.1% were green snake and 30.9% snake were unidentified. When we observed the sign and symptoms, 153 (57.7%) cases showed local swelling, 83 (31.3%) showed fang mark. Hematological manifestation were 144 (54.3%) cases and complication observed in 145 (54.7%) cases. Snake bite cases were managed after PT/INR test, INR. Antibiotic were prescribed in 154 cases and in 135 (50.9%) cases blood was transfused. There were no fetal cases noticed among hospital admitted snake bite cases.
 Conclusion: There is gross disparity in the management and outcomes of snake bite in different hospitals. Snake bite cases should manage in tertiary care hospital as early as possible.

Study of clinical profile and outcome of patients with snake envenomation at Bheri Hospital Nepal

“…6,15,19 However other study from Western Nepal revealed green snake to be most prevalent. 9 Most of the people was bitten during sleep or early morning between 12am to 6am in this study which is similar to the study done in India. 6,20 Another study from western Nepal the maximum bites were between 5 to 7am which is also similar to our finding.…”

“…Snakes habitats, holes are flooded by water and they hide in the houses, bushes, fields where they encounter humans. 9,10,18 Krait was the most prevalent snake among the identified one, a larger number of snakes remain unidentified and unknown. This is due to the bite occuring during sleep or due to the lack of awareness among the general public about the type of snake.…”

“…This finding was similar with several studies from Nepal. [9][10][11][12] A study from Bangladesh reported 10 to 19 years to be at highest risk group for snake envenomation. 10 to 40 age group being active in outdoor activities, job, fields.…”

“…Since the maximum bite had occurred during sleep both upper and lower limbs are equally bitten by snakes however other studies report maximum bites in lower limb. 2,9,10,12 There are few studies where upper limb was found to be mostly bitten. 14,19 Upper limb are mainly bitten when snakes are suddenly mishandled by hands during cutting grass, working in fields, putting hands in holes for fishing, collecting fire woods.…”

Snakebite in the Hills and Mountains of Nepal

“…4,10 The common symptoms reported due to snakebite in these regions include local site pain, swelling with local tissue damage, and haematological features like coagulopathy, hematuria and thrombocytopenia. [11][12][13] Attempts to manage these symptoms have been done with Government supplied polyvalent antisnake venom for venom neutralization, vitamin K and Fresh Frozen Plasma (FFP) injection for coagulopathy management, MgSO 4 dressing and antibiotics for local manifestations of the snakebite and solely conservative management has been done at the centres with no availability of anti-snake venom. [11][12][13] Complications like severe coagulopathy, intrauterine foetal demise, and renal failure have been reported in studies from other countries.…”