Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Abstract

Abstract. Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russell's vipers ( Daboia russelii ) and hump-nosed pit vipers ( Hypnale hypnale ) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. Distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in Sri Lanka where the biting species is unknown. Diagnostic sensitivities and specificities of these syndromes for envenoming were 78% and 96% by Naja naja , 66% and 100% by Bungarus caeruleus , 14% and 100% by Daboia russelii , and 10% and 97% by Hypnale hypnale , respectively. Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by H. hypnale who will not benefit from existing antivenoms. The technique of hospital-based collection, labeling and preservation of dead snakes brought by bitten patients is recommended for rapid assessment of a country's medically-important herpetofauna.

A Study on the Clinico-Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India

“…In our study, we noticed that 12.7% of the patients had developed allergic reactions to ASV. The incorrect assessment of the risk versus benefit can lead to the unnecessary use of antivenom in patients with milder or even no envenoming, and in those who are bitten by snakes, whose venoms are not neutralized by the available antivenoms [24].…”

Snakebite Envenoming: A Public Health Perspective

“…However, this is not the case in the vast majority of regions in the rest of the world. A 'syndromic approach' has been promoted for the diagnosis of the type of envenoming in various parts of the world (Ariaratnam et al, 2009;WHO, 2010b). For instance, in Central America, there are two predominant syndromes in snakebite envenomings: one presenting local pathological effects (swelling, pain, local tissue damage), clotting disturbances and bleeding, and another characterized by descending neuromuscular paralysis.…”

Enzymatic and toxinological activities of Hypnale hypnale (hump-nosed pit viper) venom and its fractionation by ion exchange high performance liquid chromatography

“…Recent clinical studies indicated that envenomation by this snake resulted in local edema, necrosis, regional lymphadenopathy, as well as systemic effects characterized by hemostatic dysfunction (coagulopathy, fibrinolysis, thrombocytopenia, spontaneous systemic hemorrhage) and acute renal failure, with an overall fatality rate of 1.7% in authenticated cases (11,12,(19)(20)(21)(22). To date, apart from the Calloselasma rhodostoma antivenoms (produced by the Thai Red Cross Society) which were shown to confer paraspecific neutralization in rodent models, there is no specific antivenom that is clinically effective against the H. hypnale venom (11,12,23).…”