Profile of snakebite envenoming in rural Maharashtra, India.

ABSTRACT

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.