Chronic Musculoskeletal Disabilities following Snake Envenoming in Sri Lanka: A Population-Based Study

Jayawardana, Subashini; Gnanathasan, Ariaranee; Arambepola, Carukshi; Chang, Thashi

doi:10.1371/journal.pntd.0005103

Cited by 36 publications

(29 citation statements)

References 15 publications

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“…The detailed descriptions of these musculoskeletal complications of snakebite have been recently published. 13 A need for therapies to counteract local venom effects has been recognized and used against some species. 14 …”

Section: Discussionmentioning

confidence: 99%

Long-term health complications following snake envenoming

Jayawardana¹,

Arambepola²,

Chang³

et al. 2018

JMDH

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BackgroundSnakebite is an important public health problem in tropical regions of the world. Although devastating effects of envenoming such as kidney failure, tissue necrosis, bleeding diathesis, and neurotoxicity are well known in the acute stage following a snakebite, the long-term effects of snake envenoming have not been adequately studied.Materials and methodsA population-based study was conducted among 8707 residents in a rural district in Sri Lanka to assess the long-term sequelae following snakebite. Health-related complaints that snakebite victims had developed immediately or within 4 weeks of the bite and persisted for more than 3 months, were assessed by interviewer-administered questionnaire and in-depth interviews, and further evaluated by physical examination and relevant investigations.ResultsOf the 816 participants who were identified as ever snakebite victims, 112 (13.7%) presented with at least one snakebite-related long-term health complication. Among them, “migraine-like-syndrome” characterized by headache vertigo, and photosensitivity to sunlight was found in 46 (5.6%); musculoskeletal disorders such as pain, local swelling, muscle weakness, deformities, contractures, and amputations were found in 26 (3.2%); visual impairment in 21 (2.6%); acute kidney injury in 4 (0.5%); skin blisters at the bite site in 5 (0.6%); psychological distress in 2 (0.2%); hemiplegia in 1 (0.1%); right-side facial nerve palsy in 1 (0.1%); paresthesia over bite site in 1 (0.1%); generalized shivering in 1 (0.1%); and chronic nonhealing ulcer in 1 (0.1%). Interestingly, 31 (3.8%) reported nonspecific somatic symptoms such as abdominal colic, chest tightness, wheezing, receding gums, excessive hair loss, and lassitude with body aches following the bite. The average duration of symptoms since snakebite was 12.7 years (SD=11.7).ConclusionThis study highlights that a significant proportion of snakebite victims suffer disabling chronic health sequelae. There is a need to place systems to address these unmet health needs.

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Section: Discussionmentioning

confidence: 99%

Long-term health complications following snake envenoming

Jayawardana¹,

Arambepola²,

Chang³

et al. 2018

JMDH

Self Cite

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“…Although sufficient in most cases, snakebite treatments have been challenged by the continuous high numbers of clinical illness and mortality associated with snakebites worldwide (WHO, 2018). Furthermore, chronic morbidity following snakebites have been underestimated, with many victims reporting chronic symptoms in the bitten region, including complex regional pain syndrome (CRPA) (Seo et al, 2014;Kleggetveit et al, 2016) and musculoskeletal disabilities (Jayawardana et al, 2016). Available snakebite treatments face challenges associated with limited para-specificity, poor antibody specificity, high incidences of adverse reactions, low availability and poor affordability to those who need them, along with poor efficacy against local tissue effects (Williams et al, 2011;Gutierrez et al, 2017;Ainsworth et al, 2018;Harrison et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Multifunctional Toxins in Snake Venoms and Therapeutic Implications: From Pain to Hemorrhage and Necrosis

et al. 2019

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Animal venoms have evolved over millions of years for prey capture and defense from predators and rivals. Snake venoms, in particular, have evolved a wide diversity of peptides and proteins that induce harmful inflammatory and neurotoxic effects including severe pain and paralysis, hemotoxic effects, such as hemorrhage and coagulopathy, and cytotoxic/myotoxic effects, such as inflammation and necrosis. If untreated, many envenomings result in death or severe morbidity in humans and, despite advances in management, snakebite remains a major public health problem, particularly in developing countries. Consequently, the World Health Organization recently recognized snakebite as a neglected tropical disease that affects ∼2.7 million p.a. The major protein classes found in snake venoms are phospholipases, metalloproteases, serine proteases, and three-finger peptides. The mechanisms of action and pharmacological properties of many snake venom toxins have been elucidated, revealing a complex multifunctional cocktail that can act synergistically to rapidly immobilize prey and deter predators. However, despite these advances many snake toxins remain to be structurally and pharmacologically characterized. In this review, the multifunctional features of the peptides and proteins found in snake venoms, as well as their evolutionary histories, are discussed with the view to identifying novel modes of action and improving snakebite treatments.

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“…In most cases, acute symptoms induced by snakebite envenomation can be relieved within days after antivenom injection. However, sequelae or delayed pathological effects could last for months or years [11,[25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

Huang

Hsieh

2020

Toxins

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Herein, we review the characteristics of the six predominant venomous snakes in Taiwan and the effects of traditional Chinese medicine on the long-term outcomes of snakebite venom. We electronically searched databases, including PubMed, ClinicalKey, China National Knowledge Infrastructure, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library, from their inception to November 2019 by using the following Medical Subject Headings’ keywords: snakebite, long-term, chronic, Chinese medicine, CAM, herb, and Taiwan. The most common long-term effects of snakebite envenomation include “migraine-like syndrome”, brain injuries caused by hypoxia or intracranial hemorrhage, and chronic kidney disease. In addition, hypopituitarism is also worth mentioning. Traditional Chinese medicine can potentially be used in a complementary or alternative treatment for these effects, but additional studies are needed.

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Chronic Musculoskeletal Disabilities following Snake Envenoming in Sri Lanka: A Population-Based Study

Cited by 36 publications

References 15 publications

Long-term health complications following snake envenoming

Long-term health complications following snake envenoming

Multifunctional Toxins in Snake Venoms and Therapeutic Implications: From Pain to Hemorrhage and Necrosis

Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan

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