The management of snakebites in South Africa

Snake bites are common in southern Africa especially in the rural and remote areas. Although all snake bites are not venomous, people bitten by venomous snakes require urgent medical attention and many will require antivenom. In the healthcare facility,the type of toxin may be identified by the wound and presenting clinical features which then should be managed appropriately

Snakebites in a Nigerian children population: A 5-year review

Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes.Objectives: This study was carried out to review the demographics, risk factors, interventions,outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database.Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5­year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi­square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952).Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health­seeking behavior and emergency interventions for snakebite victims

New approach in the improvement of antiscorpionic immunotherapy: Input of TMG use as adjuvant for irradiated venom

Background: Severe envenomation is a major public health problem in certain parts of the world such as North Africa, Central and South America, the Middle East, and South Asia. The toxic effects of scorpion envenomation are due to massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. Due to this severity, intra-venous immunotherapy should be given to patients stung by scorpions as soon as possible. The production of specific antibodies of immunotherapy requires the use of highly immunogenic preparation to immunize sera producing animals, thus this preparation has to meet strict bioethics rules. The aim of this study was to determine the immunostimulating effect of TiterMax Gold adjuvant (TMG) associated to irradiated Androctonus australis hector venom in comparison to commonly used Freund's complete adjuvant preparation. Methods: Two groups of mice were immunized twice at one month intervals with TMG of FCA adjuvants associated to irradiated venom. The induced inflammatory and adaptive immune responses were evaluated. One month after the last booster, animals were challenged to ascending doses of native venom to evaluate their immunoprotectivness.Results: TMG preparation use induced inflammation characterized by low activation of polynuclear cell levels and MPO and EPO seric activities compared to FCA group.Evaluation of the titers of specific antibodies showed that TMG preparation was more effective in inducing higher titers of neutralizing antibodies. Results also showed that animals immunized with TMG preparation were highly protected up to 6 LD50 of native venom.Conclusion: These results allow to suggest the irradiated venom-TMG preparation as a more effective and secure preparation that could replace the FCA preparation in immunizing animal producers of antiscorpionic immune sera

The Ocular Complications of an Envenomous Snakebite

An envenomous snakebite is an important public health problem that can lead to irreversible loss of vision. Snake venom neurotoxins mainly act on the peripheral nervous system at the neuromuscular junction; and result in the implication of the cranial nerves. Consequently; mild neurological symptoms that relate to cephalic muscle paralysis; including exotropia; ptosis; diplopia and ophthalmoplegia; can occur. This happens because the extraocular muscles are especially susceptible to neurological muscular blockage. Other neurological complications of snake venom include accommodation paralysis; optic neuritis; globe necrosis; keratomalacia; uveitis; and loss of vision due to cortical infarction. Haemostatic complications may include subconjuctival haemorrhage; hyphema; and vitreous and retinal haemorrhages. Another rare complication of a snakebite is ocular injury. Snakebite injuries are often accompanied by facial swelling; periorbital ecchymosis; massive subconjuctival haemorrhage; severe corneal oedema and exophthalmos in the affected eye. Unfortunately; such injuries result in permanent loss of vision; as early evisceration is deemed necessary to reduce the amount and effect of the venom in the affected eye. With such a variety of ocular complications as a result of a venomous snakebite; it is important for primary care physicians to have some basic knowledge of the management of these complications; as they may prove to be vital where patients present with a snakebite and possible venom injection in the eye

Management of Snakebites at a Rural South African Hospital

Background: Snakebites remain a source of considerable morbidity and mortality in many countries with an estimated global true incidence of envenomation exceeding five million per year; with about 100 000 of these cases developing severe sequelae. Despite the availability of polyvalent snake antivenom; inappropriate first aid; the regional effects of envenomation; and inappropriate use of antivenom result in significant and at times potentially avoidable; morbidity and mortality - particularly in children. The study was undertaken in Ellisras (now Lephalale) hospital; Limpopo province due to the frequency of snake bites managed at the hospital. Methods: This was a record-based retrospective study in which patient files with the diagnosis of snake bite were reviewed. The objective of this study was to document the management of snakebites at Ellisras (now Lephalale) hospital; Limpopo; a rural hospital in South Africa. The hospital files of all patients managed at the hospital for snakebites from 1 January 1998 to 31 December 2001 were reviewed. Results: Seventy patients were treated for snakebites during the study period. The results showed a male preponderance (60) and a mean age of 27.3 years among the reported cases managed for snakebites. Twenty-nine patients (41.1) were bitten between dusk and dawn (18h00 and 06h00); 43 (61.4) were bitten on the lower limb and the mean duration of admission in the wards was 4.2 days. Twenty-one bites (30) were attributed to known poisonous snakes; 22 (31.4) received polyvalent antivenom; 42 (60) received promethazine which has not been shown to prevent anaphylactic reactions; 12 (17.1) developed complications; and 2 died (case fatality rate of 2.9). Conclusion: The findings of this study highlight gaps in the management of snake bites at this rural hospital where they occur frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. The importance of administering prophylactic antibiotic; tetanus toxoid in all confirmed snakebites; and close monitoring of all patients during and after antivenom administration form the basis of most clinical protocols on the management of snakebites

Etude epidemiologique des serpents venimeux et prise en charge des envenimations a Kindia (Guinee)

De juin a decembre 2004 une collecte de serpents a ete organisee dans huit localites des environs de Kindia; une region de Guinee Conakry ou l'incidence des morsures de serpents et des deces qu'elles occasionnent sont parmi les plus elevees signalees dans le monde. Un total de 916 specimens a ete recolte; dont 90 Elapides (9;8) et 174Viperides (19;0). Le Mamba noir Dendroaspis polylepis etait represente par huit specimens; soit pres de 1de l'ensemble des serpents collectes. Cette espece consideree comme tres rare en Afrique de l'Ouest apparait comme frequente dans cette region de Guinee. Les difficultes actuelles de prise en charge des victimes de morsure de serpents provoquees par la forte augmentation du cout du traitement antivenimeux sont discutees

Pattern of First-Aid Measures Used by Snake-bite Patients and Clinical Outcome at Zamko Comprehensive Health Centre; Langtang; Plateau State

The use of first aid measures in the management of snake bite by patients in rural communities in Africa is a popular practice. Records of 103 snake bite patients admitted at Zamko Comprehensive Health Centre; were retrieved and reviewed. 84 (81.6) of the 103 cases with snake bite used first aid measures. Common first aid measures employed include tourniquet (ropes; pieces of cloth); use of the black stone; application of traditional medicine and incision of site of bites. The use of first aid measure did not prevent spread of the venom. There was no significant increase in the proportion of patients with tissue necrosis between patient that used tourniquet and those that did not (7.9 vs 5.3). Patients that did not employ first aid measures required significantly higher doses (mls) of antivenom compared to those who used tourniquet (39.33 Vs 24.52 P 0.01); those who use traditional medicine (39.33 Vs 27.5 P 0.01); and those who used black stone (39.33 Vs 28.75 P 0.01). Also those who used the black stone required significantly higher quantity of antivenom as compared to those that used the tourniquet (28.75 vs 24.52 P 0.05). The use of the tourniquet; traditional herbs and the black stone appears to have beneficial effects by reducing the average antivenom requirement of patients and more studies are needed to identify the most appropriate approaches to their use

Morsure par vipere bitis arietans au Senegal; interet de la mesure de pression intracompartimentale

The purpose of this report is to describe a case of seve re snake bite with enve n o m ation by an A f rican puff adder(Bitis arietans). Presenting symptoms warranted administration of antivenon upon admission. The patient's ge n e ral condition improved. However bite-related trauma caused extensive phlyctenuar edema of the lower extremity with a high risk of compartimental syndrome due to hardening and compression. Due to the high risk for postoperative infection at our facility; apon ev ro t o my to relief pressure was not undert a ken immediately. Instead management consisted in close surveillance with rep e ated measurement of peripheral pulses by Doppler ultrasound and of intracompartimental pressure. The outcome was favo rabl e without need for aponevro t o my. This case demonstrates the value of intra c o m p a rtimental pressure measurement in cases invo lving this type of envenomation in function of available technical facilities

Les envenimation en reanimation : l'experience clinique des services de reanimation des CHU de Treichville et de Cocody a propos des 51 cas de morsure de serpent

Notre travail a eu pour objectif principal d'etudier l'experience clinique des envenimations par morsures de serpents dans nos services de reanimation. En effet; cette etude retrospective descriptive qui a portee sur 51 cas de morsures de serpent nous a permis de relever les faits suivants: au plan epidemiologique; de survenue nocturne; les morsures de serpents concernent surtout la population active masculine moins nantis vivant dans les quartiers precaires d'Abidjan. Au plan clinique; le tableau clinique est domine par un syndrome Inflammatoire local et une necrose cutanee qui repondent bien au traitement symptomatique; la prise en charge des necroses etant relayee par la chirurgie. En cas d'envenimation systemique; avec une mise en jeu du pronostic vital; la serotherapie anti-venimeuse devrait etre associee au traitement classique

Snakebites

Although a newspaper article pointed out that more people in East Africa die from snakebites than from attacks from any other animal;even road traffic accidents; most snakes are non-poisonous. About half the bites are not life threatening; so; only a few will need snake serum. Around 90of snake bites are on the feet and ankles; the best prophylaxis; therefore; is to wear shoes and to carry a torch at night so that if there are snakes; one would see them. The article outlines other prophylaxis measures; types of snake and management of snake bites; e.g. diagnosis; first aid; hospital care including antivene and how to get it in case the hospital did not have it

Morsures de serpents : aspects epidemiologiques et protocole therapeutique

En 12 mois; 53 cas de morsures de serpents ont ete colliges. Le sexe masculin est le plus touche. Le tableau clinique est celui d'un syndrome inflammatoire localise au niveau des membres inferieurs; il est plus sensible a l'heparinate de sodium intraveineux qu'aux anti-flammatoires non steroidiens. La duree moyenne d'hospitalisation a ete de 2;87 jours. Le traitement a ete uniquement symptomatique et l'evolution favorable dans 100 pour cent des cas

Les morsures de serpents en Afrique francophone

Les morsures de serpents constituent par leur frequence l'une des principales urgences observees dans les dispensaires de brousse et l'une des grandes causes d'evacuation vers les centres de soins intensifs. Les soins sur place doivent se limiter au strict necessaire. L'important est d'assurer; dans les meilleures conditions; le transfert de la victime sur un centre correctement equipe. Sans minimiser la valeur du traitement symptomatique; il parait essentiel de rappeler que la serotherapie reste le traitement specifique de choix; dont l'efficacite est indiscutable tant au plan du pronostic vital que fonctionnel