DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161775

A study on the clinical profile of children with snake envenomation in a tertiary referral centre at Dharmapuri, Tamilnadu, India

Kumaravel K. S., Ganesh J.

Abstract


Background: Snake envenomation is a well-known cause of morbidity and mortality in rural India. In the year 2009, WHO included snake bite in the list of neglected diseases.

Methods: This study was conducted in children admitted with snake bite in Pediatric Intensive Care Unit in the year 2015. Their demographic details, site of bite, arrival time, 20Minutes Whole Blood Cloting Time, Clinical signs and symptoms, complications and outcome were measured.

Results: The male: female ratio was 2.57:1. Peak age group affected was 6 to 12 years old children. Lower limbs were commonly bitten. 65% of children arrived in the hospital between 6 and 24 hours after the bite. Pain and swelling at the site of bite were the most common symptom of envenomation. 80% of envenomation was found to be hematotoxic, 11% of envenomation was neurotoxic and 68% of children were successfully treated with 10 vials of ASV. There was only one death during the study period.

Conclusion: This study reiterates the need for a more rapid transport and administration of ASV in the transit period. Other important observations in the study are that the number of neurotoxic snake bites is only 9% and the presence of allergic reactions to ASV in 6% of children. The development of monovalent ASV specific to the snake species may be considered, which will be associated with less anaphylaxis and more effective neutralisation of venom.


Keywords


Anti snake venom, Snake envenomation, Pediatric intensive care unit

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References


Warrell DA. Animal toxins. In: Cook G (ed). Manson’s Tropical Diseases. 20th edn, 1996. ELBS with WB Saunders, London. 468-515.

Pillay VV. Comprehensive medical toxicology. 1st Ed. Banglore: Paras publications; 2003;552.

McNamee D. Tackling venomous snake bites worldwide. The Lancet. 2001;3579(9269):1680.

Warrell DA. The clinical management of snake bites in the southeast. Asian J Trop Med Public Health. 1999;30:s1-s67.

State/UT wise Cases and Deaths Due to Snake Bite in India. Government of India, Central Bureau of Health Intelligence. Health Status Indicators, National Health Profile 2007, 2008 and 2012(Provisional).Pp:107-108.Available at: http://cbhidghs.nic.in/ writereaddata/ mainlinkFile/ File1133.pdf.

Warrell DA. Guidelines for the management of snake bites. In: World Health Organization, Regional Office for Southern East Asia 2010:1-162[serial online]. Available at: www.searo.who.int/ LinkFiles/ BCT_snake_bite_guidelines.

Lingayat AM, Wankhade PR. Study of clinical profile complications and outcome in patients of snake bite in pediatric age group. International J. of Healthcare and Biomedical Research. 2015;03(3):203-8.

Shrestha BM. Outcomes of Snakebite Envenomation in Children. J. Nepal Paediatr. Soc. 2011;31(3):192-7.

Sani UM, Jiya NM, Ibitoye PK, Ahmad MM. Presentation and outcome of snake bite among children in Sokoto, North-Western Nigeria. Sahel medical Journal. 2013;16(4):148-53.

Banerjee RN. Poisonous snakes of India, their venoms, symptomatology and treatment of envenomation.In: Ahuja MMS (ed). Progress in Clinical Medicine in India. New Delhi: Arnold- Heinemann. 1978;2:136-79.

Bawaskar HS, Bawaskar PH. Profile of snake bite envenoming in Western Maharashtra, India. Transaction of Royal Society of Tropical Medicine and Hygiene. 2002; 96(1):79-84.

Varhala AM, Dundigalla C, Subrahmanyam GVS, Amrutha PR. Clinical Profile of Envenomation in Children With Reference To Snake Bite. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2015,14(11):12-8. e-ISSN.

Gupta PD. Clinical Profiles, Treatment and Complications of Snake Bites A One-Year Retrospective Study. JIAFM. 2006;28(3). ISSN: 0971-0973.

Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J. 2005;22:118-20.

Hati AK, Mandal M, De MK, Mukherjee H, Hati RN. Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc. 1992;90:145-7.

Virmani SK, Dutt OP. A profile of snake bites poisoning in Jammu region. J Indian Med Assoc. 1987;85:132-4.