ABSTRACT
Hump-nosed viper bites are common in the Indian subcontinent. In the past, hump-nosed vipers (Hypnale species) were considered moderately venomous snakes whose bites result mainly in local envenoming. However, a variety of severe local effects, hemostatic dysfunction, microangiopathic hemolysis, kidney injury and death have been reported following envenoming byHypnale species. We systematically reviewed the medical literature on the epidemiology, toxin profile, diagnosis, and clinical, laboratory and postmortem features of hump-nosed viper envenoming, and highlight the need for development of an effective antivenom.
Subject(s)
Animals , Antivenins/analysis , Poisoning/complications , Medicine in Literature , Snake Bites , Viperidae/classificationABSTRACT
Hump-nosed viper bites are frequent in southern India and Sri Lanka. However, the published literature on this snakebite is limited and its venom composition is not well characterized. In this case, we report a patient with thrombotic thrombocytopenic purpura-like syndrome following envenoming which, to the best of our knowledge, has not been reported in the literature before. A 55-year-old woman from southern Sri Lanka presented to the local hospital 12 hours after a hump-nosed viper (Hypnale hypnale) bite. Five days later, she developed a syndrome that was characteristic of thrombotic thrombocytopenic purpura with fever, thrombocytopenia, microangiopathic hemolysis, renal impairment and neurological dysfunction in the form of confusion and coma. Her clinical syndrome and relevant laboratory parameters improved after she was treated with therapeutic plasma exchange. We compared our observations on this patient with the current literature and concluded that thrombotic thrombocytopenic purpura is a theoretically plausible yet unreported manifestation of hump-nosed viper bite up to this moment. This study also provides an important message for clinicians to look out for this complication in hump-nosed viper bites since timely treatment can be lifesaving.
Subject(s)
Animals , Snake Bites/complications , Purpura, Thrombotic Thrombocytopenic , Viper Venoms/analysis , Toxicophis pugnax/analysisABSTRACT
Hump-nosed viper bites are common in the Indian subcontinent. In the past, hump-nosed vipers (Hypnale species) were considered moderately venomous snakes whose bites result mainly in local envenoming. However, a variety of severe local effects, hemostatic dysfunction, microangiopathic hemolysis, kidney injury and death have been reported following envenoming byHypnale species. We systematically reviewed the medical literature on the epidemiology, toxin profile, diagnosis, and clinical, laboratory and postmortem features of hump-nosed viper envenoming, and highlight the need for development of an effective antivenom.
Subject(s)
Animals , Antivenins/analysis , Poisoning/complications , Medicine in Literature , Snake Bites , Viperidae/classificationABSTRACT
Hump-nosed viper bites are frequent in southern India and Sri Lanka. However, the published literature on this snakebite is limited and its venom composition is not well characterized. In this case, we report a patient with thrombotic thrombocytopenic purpura-like syndrome following envenoming which, to the best of our knowledge, has not been reported in the literature before. A 55-year-old woman from southern Sri Lanka presented to the local hospital 12 hours after a hump-nosed viper (Hypnale hypnale) bite. Five days later, she developed a syndrome that was characteristic of thrombotic thrombocytopenic purpura with fever, thrombocytopenia, microangiopathic hemolysis, renal impairment and neurological dysfunction in the form of confusion and coma. Her clinical syndrome and relevant laboratory parameters improved after she was treated with therapeutic plasma exchange. We compared our observations on this patient with the current literature and concluded that thrombotic thrombocytopenic purpura is a theoretically plausible yet unreported manifestation of hump-nosed viper bite up to this moment. This study also provides an important message for clinicians to look out for this complication in hump-nosed viper bites since timely treatment can be lifesaving.
Subject(s)
Animals , Snake Bites/complications , Purpura, Thrombotic Thrombocytopenic , Viper Venoms/analysis , Toxicophis pugnax/analysisABSTRACT
Aims: This study was to assess victim’s environmental and behavioural risk factors that promote bites from two viperid snakes. Study Design: A case control study. Place and Duration of Study: Medical wards, General Hospital, Kurunegala, Sri Lanka, between June to December 2010. Methodology: Cases were recruited prospectively from consecutive admissions to the General Hospital, Kurunegala, Sri Lanka with proven viperid bites. Age and gender matched control group was selected from relatives and neighbourhood of the cases in a ratio of 1 case: 2 controls. Results: There were 56 cases and 112 controls with mean age 44 years and 45 years respectively. Of the 13 risk factors assessed, 7 risk factors showed a significant association with viperid bites. Those were (1) being in an ill lit place (OR, 95% CI= 6.6 (3.25-13.4), (2) being in outdoor places (OR, 95% CI= 148.8 (43.7-506), (3) working in a field (OR, 95% CI= 175 (31.4 – 976), (4) occupation as a field worker (OR, 95% CI= 5.3 (2.3-12 ), (5) low level of financial status (OR, 95% CI=9.9(2.75- 35.5), (6) lack of attached toilet (OR, 95% CI= 7.38 (2.15- 25.3), (7) presence of small rodents in the compounds (OR, 95% CI= 11 (4.88-24.9). Conclusion: Identifying easily remediable risk factors would help in preventing viperid snake bites.