Epidemiological analysis of 952 venomous snake bite in Wuzhou City of Guangxi Zhuang Autonomous Region / 中华危重病急救医学

Objective:To improve the prevention and treatment of venomous snake bites by analyzing the epidemiological characteristics of venomous snake bite in Wuzhou City, Guangxi Zhuang Autonomous Region.Methods:A retrospective analysis was conducted. The medical records of 1 091 patients with venomous snake bites admitted to the department of snake wound of Wuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2020 were collected, including snake species, gender and age of patients, bite time, bite site and local symptom.Results:The medical records of 952 patients with a definite clinical diagnosis of snake bite were enrolled. Among the 952 patients with venomous snake bites, the main bites were from Ovophis (32.98%), Trimeresurus (27.84%) and Naja (26.26%), followed by Bungarus multicinctus (6.51%), Ophiophagus Hannah (3.15%) and Agkistrodonhalys (1.58%), and few bites were from Rhabdophis subminiatus (0.73%), Bungarus fasciatus (0.42%), viper (0.32%) and Agkistrodon (0.21%). Of the 952 patients with venomous snake bites, there were almost twice as many males as females [647 cases (67.96%) vs. 305 cases (32.04%), with male to female ratio of 2.12∶1]. The age of patients ranged from 0.8 to 87.0 years old, with 40-59 years old as the majority (42.44%), followed by ≥ 60 years old (27.31%). Snake bites mainly occurred from April to November (93.59%), with a peak in October (16.39%). The incidence time was mainly afternoon (12:00-17:59, 30.88%) and evening (18:00-23:59, 33.30%), followed by morning (06:00-11:59, 24.69%), and early in the morning (00:00-05:59, 11.13%). The incidence time of Ovophis and Bungarus multicinctus mainly concentrated in 18:00-23:59, the time of Trimeresurus was in 06:00-11:59, and that of Naja and Ophiophagus hannah was in 12:00-17:59. Most cases of snake bite were on limbs (98.53%), and mainly on the right limbs (53.57%). The lower limbs mainly were bitten by Ovophis, while the upper limbs mainly were bitten by Naja and by Ophiophagus hannah. The local symptoms of the bite of Ovophis and Trimeresurus were similar, mainly including pain, swelling, tenderness, high temperature of skin around the wound, bleeding and exudation, etc. And the local symptoms of the bite of Naja were pain, swelling, bruising, tenderness, bleeding and exudation, red skin, etc. Numbness and mild pain were the main symptoms of the bite of Bungarus multicinctus and Bungarus fasciatus, but other local characteristics were not obvious.Conclusions:The majority of venomous snake bite patients in Wuzhou City of Guangxi were middle-aged and elderly males, and the majority of venomous snakes were Ovophis, Trimeresurus, and Naja. Most venomous snake bite occurs from April to November, and the incidence time was concentrated between 12:00 and 23:59. The majority of venomous snake bite was limb bites. The local symptoms were pain, swelling, tenderness, high temperature of skin around the wound, bruising, etc. To reduce the incidence rate, disability rate and mortality of snake bite disease, a snake bite prevention system should be established, the education and publicity of snake bite prevention knowledge should be strengthened, the awareness of snake bite prevention should be improved, and clinical diagnosis and treatment should be assisted, based on the epidemiological characteristics of snake bite in Wuzhou area.

Clinicoepidemiology, clinical profile and outcome of venomous snake bite in children in Konaseema region of Andhra Pradesh, India

Background: Venomous snake bite is an acute medical emergency, and children are more quickly and severely affected than adult. Venomous snake bite is responsible for 28.5 deaths per 1000 snake bite death among 5-15years old children. Most of them used to be from rural India and is more common in school going children. But there is no study regarding clinic epidemiology and treatment outcome among pediatric age group in this part of Andhra Pradesh. This retrospective descriptive has been conducted to evaluate the clinic epidemiology, clinical presentation, complication and treatment outcome in snake bite in pediatric patients in our set up.Methods: Present study is a retrospective, descriptive study conducted in the department of paediatrics Konaseema institute of medical science Amalapuram Andhra Pradesh, between 2006 to September 2018. This study protocol is approved by the institutional ethics committee. All the clinical parameters like, age, sex, season of bite, time of bite, socio economic statue, region, site, common clinical presentation, complications, reaction to ASV outcome of treatment were obtained from patient's case record and was analysed.Results: In present study total 166 snake bite patient case records were evaluated, out of this 166 snake bite cases, 28 bites were by unknown snakes. Demographic profile of patient shows that out of 70 cases, 49 cases were in male child and 21 cases were in female child. Regarding clinical profile of the children with snake bite as mentioned in Table 3, local pain was present in (n=70) 100 % patients. Local blending was presenting symptom in 64.28 %(n=45) patients.Conclusions: From present study authors conclude that snake bite in children is more common among school going children, during monsoon and post monsoon, and in rural area. In our region vasculotoxic snake envanomation is more common and presented with cellulitis which required surgical intervention in most of circumstances. In neurotoxic envenomation some patient developed respiratory paralysis which required ventilatory support.

Next-generation sequencing analysis reveals high bacterial diversity in wild venomous and non-venomous snakes from India

The oral cavities of snakes are replete with various types of bacterial flora. Culture-dependent studies suggest that some of the bacterial species are responsible for secondary bacterial infection associated with snakebite. A complete profile of the ophidian oral bacterial community has been unreported until now. Therefore, in the present study, we determined the complete bacterial compositions in the oral cavity of some snakes from India. Methods: Total DNA was isolated from oral swabs collected from three wild snake species (Indian Cobra, King Cobra and Indian Python). Next, the DNA was subjected to PCR amplification of microbial 16S rRNA gene using V3-region-specific primers. The amplicons were used for preparation of DNA libraries that were sequenced on an Illumina MiSeq platform. Results: The cluster-based taxonomy analysis revealed that Proteobacteria and Actinobacteria were the most predominant phyla present in the oral cavities of snakes. This result indicates that snakes show more similarities to birds than mammals as to their oral bacterial communities. Furthermore, our study reports all the unique and common bacterial species (total: 147) found among the oral microbes of snakes studied, while the majority of commonly abundant species were pathogens or opportunistic pathogens to humans. A wide difference in ophidian oral bacterial flora suggests variation by individual, species and geographical region. Conclusion: The present study would provide a foundation for further research on snakes to recognize the potential drugs/antibiotics for the different infectious diseases.(AU)

Clinical application of VSD negative pressure aspiration and detoxification in severe snake bite / 中华危重病急救医学

Objective To assess the clinical efficacy of vacuum sealing drainage (VSD) in the treatment of mixed poisonous snake bite. Methods A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group (n = 20) and VSD treatment group (n = 23) according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein (CRP), length of hospital stay and disability rate were compared between the two groups. Results Forty-three patients were followed up for 6-12 months with average of (10.3±1.4) months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% (2/23) vs. 40.0% (8/20)], local skin necrosis area was significantly reduced (cm2: 4.2±0.8 vs. 6.0±1.3), the maximum CRP was significantly lowered (mg/L: 50.0±12.1 vs. 68.0±13.4), the hospitalization time was significantly shortened (days: 11.7±2.9 vs. 17.7±4.9), and the difference above was statistically significant (all P < 0.05). The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% (3/23) vs. 13.0% (6/20)] without statistically significant difference. Conclusion Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.

Therapeutic Effect of External Application of Shuangbai Powder for Patients with Wounded Limb Injured by Venomous Snake and Nursing Experience / 广州中医药大学学报

Objective To compare the therapeutic effect of conventional treatment and conventional treatment plus external application of Shuangbai Powder for patients with wounded limb injured by venomous snake. Methods One hundred patients bitten by venomous snake were randomized into treatment group and control group, 50 cases in each group. The control group was given conventional treatment including repeatedly washing the wound with hydrogen peroxide, debriding the wound, letting blood and draining toxicity, local blocking with chymotrypsin, wet packing the wounded limb with magnesium sulfate, and injection with anti-venomous serum, tetanus antitoxin, antibiotics, furosemide and energy mixture. The treatment group was given external application of Shuangbai Powder on the basis of the treatment for the control group. Both groups were given the comprehensive nursing of psychological nursing, wound nursing, dietary nursing, defecation nursing and functional nursing. The swelling-subsiding time for the wounded limb and pain scores of visual analogue scale (VAS) in the two groups were compared. Results(1) After treatment, swelling-subsiding time for the wounded limb of the treatment group was shorter than that of the control group, the difference being statistically significant (P < 0.05). (2) After treatment for 4 days and at the end of the treatment, VAS scores of the two groups were decreased compared with those before treatment(P < 0.05), and the decrease of VAS scores in the treatment group after treatment for 4 days was superior to that in the control group (P < 0.05). Conclusion The conventional treatment plus external application of Shuangbai Powder is an effective therapy for patients with wounded limb injured by venomous snake by shortening swelling-subsiding time and relieving pain for the wounded limb .

Analysis of abnormal detectable rates for blood test indexes before and after treatment of snake bite / 国际检验医学杂志

Objective To analyze the abnormal detectable rates of different kinds of blood test indexes before and after treatment in the patients with snake bite and to probe into the change condition of these indexes after different snake bite .Methods The inpa‐tients with clearly diagnosed what kind of snake bite in the past two years were selected as the research subjects .The multiple blood test indexes were determined before and after treatment in these patients .The abnormal detectable rates of these indexes were ana‐lyzed and compared among various snake bite patients .Results The different kinds of snake bite all could cause the different de‐grees of changes in some detection indexes among partial patients .Specially ,the detectable rates of WBC ,PT ,APTT ,TT ,D‐D ,CK , CK‐MB ,LDH ,Urea ,Cr and Cys‐C increase and PLT and Fbg decrease caused by viper bite were apparently higher than those caused by other kinds of snake bites (P<0 .05) .The detectable rates of CO2 increase and K+ decrease in the coral snake bite were apparently higher than those in trimeresurus gramineus ,cobra and viper bite (P<0 .05) .Conclusion Because the snake species and toxicities are different in the various snake bites ,so the caused changes and the abnormal detectable rates of blood test indexes also are different .

Change regulation before and after treatment of snake bite for routine blood test and hypersensitive C-reactive protein / 国际检验医学杂志

Objective To probe into the change regulation before and after treatment every snake bite patients for the routine blood test and serum hs‐CRP .Methods The study objects were selected in the hospitalized patients for clear diagnosis belong to what kind of snakes in the past two years .The indexes of routine blood test and serum hs‐CRP were determined before and after treatment various periods in these patients .The test results were made to statistical analysis according to kind of snakes ,periods and disease condition .Results WBC was obvious .rise before treatment only the viper snake bite patients .WBC was all significant .rise after treatment first day and second day for 5 kinds snake bite patients (P<0 .01) .This index had all reduced trend after treatment fourth day but determined value was still high in contrast to the normal reference scope .RBC and HGB all were normal level and had not obvious change before and after treatment for 5 kinds snake bite patients .PLT was reduced before treatment for the trime‐resurus gramineus bite patients ,before and after treatment for the viper snake bite patients (P<0 .05) .The hs‐CRP content was higher before treatment for the viper snake bite patients and was highest after treatment for the cobra snake bite patients ,the inter‐comparison had significant difference (P<0 .05) .Conclusion 5 kinds snake bite patients before and after treatment not basely ane‐mia symptom .But most of the patients appear the inflammatory response .PLT decrease is more serious for the trimeresurus grami‐neus bite patients ,and for the viper snake bite patients especially .

Investigation on change regulation of blood coagulation function before and after treatment of snake bite patients / 国际检验医学杂志

Objective To explore the change regulation of blood coagulation function before and after treatment of snake bite pa‐tients .Methods A total of 226 hospitalized patients with clear diagnosis belong to what kind of snakes in the past two years were selected in this study ,39 cases were bit by coral ,76 cases were bit by trimeresurus stejnegeri ,47 cases were bit by cobra ,24 cases bit by king cobra ,40 cases were bit by adder .Five blood coagulation indexes were determined before and after treatment various pe‐riods for these patients .The tested results were made to statistical analysis according to kind of snakes ,periods and disease condi‐tion .Results D‐D level obvious .rise before treatment for the severe cases patients of coral snake bite (P0 .05) before and after treatment ,only D‐D level of the severe cases had statistical significance before treat‐ment in contrast to the mild cases of cobra bite (P< 0 .05) .The changes of 5 item blood coagulation indexes were all very large whether mild or severe for viper bite patients ,a number of comparisons had statistical significance difference (P<0 .05) whether before or after treatment and whether mild or severe for viper bite patients .Conclusion The bite of coral snake ,cobra and king co‐bra affect little for the blood coagulation function .The severe cases patients of trimeresurus stejnegeri bite might lead to more seri‐ous blood coagulation function abnormality but the recovery is faster after treatment .The viper bite might lead to maximum blood coagulation function abnormality and the recovery is slow after treatment .

Clinical Review of Venomous Snake Bite

PURPOSE: The aim of this study was to understand venomous snake bites and to predict the prognosis in the clinical course. METHODS: From April 1995 to October 1999, the case histories of 97 patients with venomous snake bites were reviewed retrospectively. RESULTS: The ages of the patients varied from 17 to 76 (mean age was 49.2 years), and the peak age was in the fourth decade. The sex ratio of males to females was 1.9:1. The accidents occurred mainly in summer (77.3%). According to the grade of envenomation, grade I and II were most common (77.3%). The duration of hospitalization was proportional to the grade of envenomation. The snake bites most commonly occurred in fields (56.7%). The finger was the most common site of the bite (51.5%). 96.9% of the patients arrived at the hospital within 4 hours. 97.9% of the patients were treated with antivenin. The most common local symptoms and signs were edema and pain. The most common general symptoms and signs were blurred vision, dizziness, and hematuria. The most common complication was celluitis. Severe complications such as UGI bleeding and DIC occurred in grade II and III. CONCLUSION: The most important factor for determining the prognosis of venomous snake bites is the grade of envenomation. In grade III or IV envenomation, antivenin should be included as part of intensive systemic treatment.