Systematic review and meta-analysis of global prevalence of neurotoxic and hemotoxic snakebite envenomation

Abstract

Background: The World Health Organization estimates that there are approximately 5.4 million snakebites and 1.8–2.7 million cases of envenomation, with 81 410–137 880 deaths each year worldwide. Aims: To estimate the prevalence of neurotoxic and haemotoxic snakebite envenomation through a comprehensive systematic review and meta-analysis. Methods: We searched Medline/PubMed, Scopus and Cochrane Library up to January 2021 using keywords such as snakebite and snake envenomation. Bibliographic and random searches were also performed. Prospective or retrospective observational studies and randomized controlled trials were included for the review. Results: We included 271 of 9711 studies published between 1963 and 2020. The pooled prevalence of snakebite from 188 studies with a total of 207 235 participants showed the highest prevalence in North America (69.20%; 95% confidence interval, CI: 57.06–81.34%) and lowest in Africa (28.10%; 95% CI: 22.22–33.98%). There was a pooled prevalence of 24.94% (95% CI: 22.84–27.03%) for haemotoxicity, with a highest prevalence of coagulopathy (43.76%; 95% CI: 33.15–54.37%). The overall prevalence of neurotoxicity was 38.20% (95% CI: 31.88–44.53%), with a highest prevalence of ptosis (53.57%; 95% CI: 38.51–68.62%). Conclusion: There was a higher prevalence of snakebites in North America. The most prevalent haemotoxicity and neurotoxicity were coagulopathy and ptosis, respectively. The overall quality of evidence was good with a non-significant publication bias.

Disseminated intravascular coagulation like syndrome and cerebral hemorrhage caused by snake venom: a case report

“…Snake venom can cause neurotoxicity and hematological toxicity. Viperidae mainly exhibit hematological toxicity, whereas elapidae is neurotoxic [1]. The hematological toxicity of snake venom can result in coagulopathy, systemic bleeding, hemorrhage, thrombocytopenia, hematuria, and hematemesis [1].…”

“…Viperidae mainly exhibit hematological toxicity, whereas elapidae is neurotoxic [1]. The hematological toxicity of snake venom can result in coagulopathy, systemic bleeding, hemorrhage, thrombocytopenia, hematuria, and hematemesis [1]. Bleeding from snake venom occurs when snake venom metalloproteinase (SVMP) increases vascular permeability and causes DIC-like syndrome, making clotting difficult [2].…”

“…Snake bites can cause symptoms due to local tissue damage at the site; neurological abnormalities such as ptosis, ophthalmoplegia, blurred vision, and diplopia, and hematological abnormalities such as coagulopathy [1]. The hematological toxicity of snake venom is caused by snake venom metalloproteinase (SVMP) and snake venom serine protease (SVSP).…”

Data Descriptor of Snakebites in Brazil from 2007 to 2020

“…Snakebites are responsible for significant social and economic impacts associated with sequelae and deaths (18,19). In Brazil, between 2007 and 2020, 400,848 cases of snakebites were reported to SINAN across the country, a number considered relatively high when compared to other Latin American countries (20).…”

Hemostasis Testing in the Emergency Department: A Narrative Review

“…The prevalence of reported hemotoxic presentations is as follows: coagulopathy (43.8%), systemic bleeding and hemorrhage (23.8%), thrombocytopenia (18.7%), hematuria (14.1%), and hematemesis (4.1%). 133 While VICC shares similarities with DIC, including elevated D-dimer levels, prolonged PT, and low fibrinogen levels, it notably differs by lacking systemic microthrombi, end-organ failure, rapid onset and resolution, and exhibiting lower mortality rates. 134 The venom's toxins swiftly deplete clotting factors, inducing coagulopathy, and inflict damage upon blood vessel walls, heightening the risk of bleeding.…”