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An Epidemiological Study of Venomous Snake Bites: a Hospital Based Analysis

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ORIGINAL RESEARCH ARTICLE pISSN 0976 3325│eISSN 2229 6816 Open Access Article www.njcmindia.org An Epidemiological Study of Venomous Snake Bites: A Hospital Based Analysis Dipak H. Vora1, Jyoti H. Vora2 Financial Support: None declared ABSTRACT Conflict of Interest: None declared Copy Right: The Journal retains the Background & Objectives: This study was carried out to describe copyrights of this article. However, re- epidemiology of snake bite cases which were seen in a tertiary care production is permissible with due ac- hospital of Ahmedabad region so that the data provided will help knowledgement of the source. in estimating the envenoming in this region of India. How to cite this article: Methods: Total 50 cases of venomous snake bites were studied ret- Vora DH, Vora JH. An Epidemiological rospectively. These patients were admitted in the Medicine De- Study of Venomous Snake Bites: A partment of V.S. Hospital, Ahmedabad during the period from Hospital Based Analysis. Natl J Com- April 2008 to October 2009. munity Med 2019;10(8):474-478 Results: Maximum number of cases (66 %) was belonging to the Author’s Affiliation: age group 15-34 years. Male are having twice the incidence com- 1 Assistant Professor, Department of pare to the female (M: F ratio 2.12:1). Maximum cases were from Forensic Medicine, B. J. Medical Col- rural areas i.e. 72 %. In 66 % cases, snake bites occurred during lege; 2Associate Professor, Department of Medicine, SMT NHL Municipal night time. Most of the cases i.e. 82 % occurred during rainy sea- Medical College, Ahmedabad son. Elapid snake bites leading to neurotoxicity is common fol- lowed by viperidae induced vasculotoxicity and acute renal fail- Correspondence ure. Dr. Jyoti H. Vora [email protected] Conclusions: Snakebite is an important medical emergency and causing significant morbidity and mortality of many young and Date of Submission: Aug 07, 2019 active people, especially those involved in farming and plantation Date of Acceptance: Sep 09, 2019 work. Public awareness regarding the simple preventive measures Date of Publication: Aug 31, 2019 and pre-hospital management i.e. first aid and early hospitaliza- tion should be emphasized. Key Words: Snake bite, Epidemiology, Venomous, Hospital based, Analysis INTRODUCTION Most snake bites are inflicted on the lower limbs of farmers, plantation workers, herdsmen and hunt- In India 330 snake species exist. Of these 70 are ers. Seasonal peaks in the incidence of snake bite venomous (40 land snakes, 30 sea snakes). Saw are associated with agriculture activities, such as scaled viper, Russell’s viper, Common cobra, and ploughing, or to fluctuations in the activity or common krait are traditionally referred to as the population of venomous snakes. Severe flooding “Big Four”, because they are responsible for virtu- by concentrating the human and snake popula- ally all snake bites in India.1 tions, has given rise to epidemics of snake bite in Envenoming and deaths resulting from snake Colombia, Pakistan, India, Bangladesh and Viet- bites, however, are a particularly important public nam.3 health problem in the rural tropics. Populations in Snake bite is an important cause of morbidity and these regions experience high morbidity and mor- mortality in India and it is estimated that about tality because of poor access to health services, 35000-50000 snake bites are found to be fatal in a which are suboptimal, and, in some instances scar- year. Death occurs from anywhere between 20 city of anti-venom, which is the only specific minutes to 6 hours after a bite from a colubrine treatment.2 snake (cobra, krait and sea snakes), and in 2-4 days National Journal of Community Medicine│Volume 10│Issue 8│August 2019 Page 474 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 after a bite from a viperine snake. Cobra or krait Cases having clear history of snake bite and clinical may kill within hours if respiration is not sup- manifestations of envenomation are included in ported / assisted.4 this study. Only those patients admitted in the medicine department above the age of 15 years are The poison secreted by the venomous snakes is of included. Patient admitted in pediatric wards are three types. First, the neurotoxic- acts primarily on excluded. Cases having history of something bite motor nerve cells, second vasculotoxic- acts mainly (no confirmative history of snake bite) were ex- on blood and blood vessels and third, myotoxic- cluded. acts mainly on muscles. Depending on the type of venom secreted, the poisonous snakes have been In each case details regarding the age, sex, residen- placed in three groups: 1. Elapids which secrete tial area, time of bite, site of bite, place of snake neurotoxic venom. The members of this group are bite, time of hospitalization were noted. Findings cobra, king cobra, common krait and banded krait of general, local and systemic examinations, and and the coral snakes. 2. Vipers which secrete vas- results of investigations were studied to categorize culotoxic venom. They are Saw scaled viper, Rus- the envenomation in to neurotoxic or vasculotoxic. sell’s viper, Pit viper etc. 3. Sea snakes secrete Observed data are tabulated and plotted on the myotoxic venom and are seen around sea coasts.5 charts. These data are compared with the other re- Local reactions are extensive in viperine bite while search works having similar objectives. minimal in elapid bite. Neurotoxic symptoms like staggering gait, loss of speech and deglutition, pa- ralysis of tongue and larynx, hyper-salivation, RESULTS ptosis, diplopia, blurring of vision followed by pa- Maximum number of cases (66%) was belonging to ralysis of respiratory muscles occurs in elapid bites the age group 15-34 years. Male are having twice like cobra and krait. In viperine bite, severe local the incidence of venomous snake bites compare to reaction in the form of swelling, bruising, blisters, the female (M: F ratio 2.12:1). Maximum cases were persistent bleeding occurs which spread around to from rural areas i.e. 72 %. In 66 % cases, snake bites involve the entire limb. In viperine bite, coaguabil- occurred during night time. Most of the cases i.e. ity of blood is greatly decreased and hemorrhagic 82 % occurred during rainy season. Maximum manifestations are prominent features. In sea snake number of patients (68 %) had the site of bite in bite, generalized rhabdomyolysis and renal failure lower limb while 30 % were bitten over the upper 1 are the main features. limb. In only one case bite was present over left In all cases of snake bite or something bite, police ear. Elapid snake bites leading to neurotoxicity is shall be informed (medico-legal case). If death oc- common followed by viperidae induced vascu- curs, dead body shall be sent to the mortuary for lotoxicity and acute renal failure. In the present medico-legal post-mortem examination. study, 49 patients (98 %) were cured with treat- ment and discharged while 1 patient was died. Table-1 shows that- Majority of the cases (66 %) are AIMS & OBJECTIVES young adults between 15 and 34 years. Half cases The present study was carried out to study the (50 %) are involving young males of 15-34 years. epidemiological profile of hospitalized cases of Table-2 shows that- Venomous snake bite is more venomous snakebites and also to study the clinical common in rural areas. Majority of snake bites oc- manifestations, complications and outcome of the curred at night hours. In more than half cases (52 patients of snake bite. %), fang marks are not visible. Majority (84 %) of the cases have reached the hospital within 12 hours of the snake bite. Neurotoxic envenomation (52 %) MATERIAL & METHODS is most common followed by Vasculotoxicity Total 50 cases of venomous snake bites were stud- (32%). In the present study, 49 patients (98 %) were ied retrospectively. These patients were admitted cured with treatment and discharged while 1 pa- in the medicine department of V.S. Hospital, Ah- tient was died. medabad during the period from April 2008 to Oc- Table-3 shows that- Venomous snake bites become tober 2009. Epidemiological profile of these cases major problem during rainy season between June and circumstances surrounding the snake bite and October (82 % cases). were studied. Data were collected from their medi- cal records including history and clinical examina- Table-4 shows that- Lower limbs are involved in tions, investigations performed, treatment admin- majority of the cases of venomous snake bites fol- istered, and outcome. lowed by upper limbs. National Journal of Community Medicine│Volume 10│Issue 8│August 2019 Page 475 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 Table-1: Age group & Sex wise distribution of DISCUSSION cases: Despite the scale of its effects on populations, Age Group Male Female Total Cases (%) snake bite has not received the attention it deserves 15-24 13 4 17 (34) from national and international health authorities, 25-34 12 4 16 (32) and may therefore be appropriately categorized as 35-44 3 0 03 (6) a neglected tropical disease which makes it harder 45-54 6 4 10 (20) for public health officials to optimize the preven- 55-64 1 1 02 (4) >65 1 1 02 (4) tion and treatment of snake bites in their respective Total 36 14 50 (100) countries. India is recognized as having the highest snake bite mortality in the world, with WHO esti- mates placing the numbers at 50,000 per annum.2 Table-2: Selected variables of the cases A total 3254 cases of venomous snake bite cases Variables Cases (n=50) (%) admitted in Victoria Hospital of Bangalore (Jan Residential Area 2002 to December 2011) were studied by Rural 36 (72) Dayananda K.S.
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