Nephrotoxicity in krait bite: a rare case series of three fatalities in consecutive bites by a single snake

Abstract

Background: Death due to poisonous snakebite is a formidable health hazard. It is a matter of concern especially in agrarian countries. Clinically snakebite envenomation are neurotoxic and vasculotoxic. Krait (Bungarus faciatus) Venom is essentially neurotoxic.Nephrotoxicity in krait bite is an important issue that has been less studied and reported. Case presentation: In the present series, we report three cases of deaths in consecutive bites by a single banded krait. Significant renal involvement was found at autopsy. The kidneys showed interstitial haemorrhage and inflammatory cell infiltration. The renal changes were similar in all the three cases bitten by the same snake. Conclusions: From the findings of autopsy and histology of the present case series we can conclude that nephrotoxicity is an important effect of krait bite. Though less reported and researched kidney changes in krait bite is a significant issue in treatment as well as autopsy diagnosis. . We can also infer that the immunogenicity of the snake venoms can be different from our expectation.

Cytotoxin antibody-based colourimetric sensor for field-level differential detection of elapid among big four snake venom

“…An adult cobra can release ~110 mg of venom (in dry weight) in a single yield [ 45 ] whereas up to 115 mg of dry weight krait venom has been listed for a single bite [ 46 ]. The LD 50 for cobra and krait venom in mouse has been estimated to be 1.91 mg.kg -1 and 0.1 mg.kg -1 body weight respectively [ 3 , 47 ].…”

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

“…Tubulointerstitial lesions represented, in particular, by ATN, were observed in 70% to 80% of patients with AKI [83]. However, kidney injuries have been also found in three cases of SBE by Bungarus Fasciatus, Elapidae family [3]. Among the intestinal injuries, bowel ischemia due to thrombosis of the mesenteric vessels has been reported in very few cases.…”

“…Instead, in most of the pit viper bites one or more fang marks are usually found [48] due to the stabbing motion of this snake specie's bite [29]. Although important for the identification of the offending snake, only in very few cases (n = 8) [3,12,20,22,24,37,44,45], the distance between the fang marks is reported. At the external examination, the area surrounding the bite mark shows dermal alterations represented mostly by signs of flogosis such as edema, cellulitis, and erythema.…”

“…Microthrombosis of the small inter-lobular vessels was found in a single case. Additional renal alterations are represented by acute interstitial nephritis (AIN) in three cases [3]. Intestinal injuries are reported in only three cases, but no better described [20,30,42].…”

“…The promptness of the therapy is a key element for a good outcome after SBE. However, given the socio-cultural and economic context of the territories, effective treatment is often delayed due to the lack of hospital infrastructure, the non-availability of a species-specific antivenom or delay in its injection caused by the not prompt identification of the offending snake, and the use of traditional healers or popular remedies [3,4]. Pathogenesis induced by snake venoms is complex and characterized by local and systemic alterations represented mostly by bleeding, dermo/myonecrosis, inflammation, and coagulation disorders.…”