Profile of snakebite envenoming in rural Maharashtra, India.

One hundred and eighty two cases of snakebite were admitted during twelve months at five hospitals situated in five different districts of rural Maharashtra. Out of these 55 (30.2%), 38 (20.8%), 48 (26.3%), 41 (22.5%) cases were bitten by Echis carinatus (Eh), Russell's viper (Rv), krait (Kr) and Cobra (Cr) respectively. Clinical confirmation of snakebite with envenoming was by identification of the dead snake brought by victims and by clinical signs and symptoms such as absent or minimum local signs, pain in abdomen preceding to neuroparalysis in the victim slept on floor bed, suggestive of krait bite. Rapid development swelling at the site of fangs marks with ecchymosis with rapid development of neuro-paralysis, respiratory depression suggestive of cobra bite. Severe local edema with fangs marks, active bleeding from fangs marks with rapid development of systemic bleeding with positive 20minute whole blood clotting test (20WBCT) suggestive of Russells's viper bite. Slow development mild local oedema with fangs marks, delayed development of local ecchymosis and systemic bleeding (20WBCT) in a case of Eh bite. Irrespective of similar clinical effects of particular type of snake, the total dose of anti-snake venom (ASV) administered is differs. In these five centers physicians are practicing and treating the snake bite cases for more than five year and know how to suspect and diagnose clinically the envenoming by poisonous snake. Early detection of clinical signs and symptoms and rapid administration of adequate initial dose of ASV on arrival, endotracheal intubation and timely intervention with either manual ventilation by amboo bag or mechanical ventilation in nuroparalysis and early detection of renal failure and its rapid treatment helped to reduce the morbidity and mortality in a rural setting.

Management of snake-bite in rural Maharashtra: a 10-year experience.

BACKGROUND: A high incidence of snake-bite envenomation has been reported from Marathwada, Maharashtra. This study analysed the pattern of snake-bites and their management in a rural area of India over a 10-year period. METHODS: A total of 633 patients with snake-bite admitted to the Rural Community Centre and Punde Hospital in Mukhed taluka, Nanded district (Marathwada) of Maharashtra, between 1992 and 2001, were analysed retrospectively. The local and systemic manifestations of snake-bite, response to antisnake venom, atropine and neostigmine, the treatment of complications and the outcome were analysed. RESULTS: Of the 633 patients, 427 (67.5%) had been bitten by poisonous snakes and 206 (32.5%) by non-poisonous snakes. The majority of snake-bites (68.9%) occurred between May and November. Those affected were mainly farmers (228 [36%]), students (191 [30.2%]) and housewives (175 [27.6%]). Of the 427 envenomed by poisonous snakes, 274 (64.2%) were by Echis carinatus (saw-scaled viper), 71 (16.6%) by cobra, 42 (9.8%) by krait and 40 (9.4%) by Russell viper. The requirement of antisnake venom for treating neurotoxic envenomation was 40-320 ml and for Echiscarinatus and Russell viper bites it was 20-250 ml. Among those envenomed by poisonous snakes, the mortality was 4.7% (n=20). CONCLUSION: Snake-bite is a common life-threatening emergency in the study area. We observed an occupational risk and a seasonal incidence of snake-bite. Knowledge of the varied clinical manifestations of snake-bite are important for effective management. Ready availability and appropriate use of antisnake venom, close monitoring of patients, institution of ventilatory support and early referral to a larger hospital when required help in reducing the mortality. Most patients with snake-bites can be successfully managed even in small rural hospitals with limited facilities.