Cortical blindness and paraplegia following hypoxic ischemic encephalopathy as a complication of common krait bite

Sk, Samanta; Mahapatra, N; Fariduddin, K; Mazumdar, DB; Mandal, Kalyanbrata

doi:10.3126/nepjoph.v3i2.5280

Cited by 5 publications

(6 citation statements)

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“…A 15-year-old male from India developed hypoxic encephalopathy following an Indian krait bite, and had paraplegia and persistent cortical blindness four years after the bite [61].…”

Section: Neurological Effectsmentioning

confidence: 99%

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Long-term Effects of Snake Envenoming

Waiddyanatha

Silva

Siribaddana

et al. 2019

Toxins

102

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Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell’s viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects. Endocrine anomalies such as delayed manifestation of hypopituitarism following Russell’s viper bites have been reported. Delayed psychological effects such as depressive symptoms, post-traumatic stress disorder and somatisation have been reported. Blindness due to primary and secondary effects of venom is a serious, debilitating effect. In general, the available studies have linked a clinical effect to a snakebite in retrospect, hence lacked accurate snake authentication, details of acute management and baseline data and are unable to provide a detailed picture of clinical epidemiology of the long-term effects of envenoming. In the future, it will be important to follow cohorts of snakebite patients for a longer period of time to understand the true prevalence, severity, clinical progression and risk factors of long-term effects of snake envenoming.

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“…A 15-year-old male from India developed hypoxic encephalopathy following an Indian krait bite, and had paraplegia and persistent cortical blindness four years after the bite [61].…”

Section: Neurological Effectsmentioning

confidence: 99%

“…envenoming [63] and in a patient who developed respiratory arrest following a krait ( Bungarus sp.) bite [61]. There are two reports of optic atrophy due to central retinal artery occlusion following suspected viper bites in India [64].…”

Section: Neurological Effectsmentioning

confidence: 99%

Long-term Effects of Snake Envenoming

Waiddyanatha

Silva

Siribaddana

et al. 2019

Toxins

102

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“…Out of 100 fully evaluated, 52 references were included in the analysis as per selection criteria. [ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 ] The flow diagram for the article selection is presented as Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The observed complications were cerebral hypoxic damage (5.55%), acute renal failure (5.55%) and fetal death (3.7%), septicemia (3.7%), acute respiratory distress syndrome (1.85%), abnormal coagulation profile (1.85%), pulmonary edema (1.85%) and abnormal liver function (1.85%). [ 18 19 33 37 48 50 59 ] The mortality for anaphylaxis was observed in 7 (12.96%) cases. [ 19 33 36 37 46 49 53 ] One case did not mention the outcome.…”

Section: Resultsmentioning

confidence: 99%

Drug-induced anaphylactic reactions in Indian population: A systematic review

Patel¹,

Patel²,

Barvaliya³

et al. 2014

Indian Journal of Critical Care Medicine

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Background:Epidemiological data on drug-induced anaphylactic reactions are limited in India and are largely depending on studies from developed countries.Aim:The aim was to analyze the published studies of drug-induced anaphylaxis reported from India in relation with causative drugs and other clinical characteristics.Materials and Methods:The electronic databases were searched for Indian publications from 1998 to 2013 describing anaphylactic reactions. The information was collected for demographics, set up in which anaphylaxis occurred, causative drugs, incubation period, clinical features, associated allergic conditions, past reactions, co-morbid conditions, skin testing, IgE assays, therapeutic intervention and mortality. Reactions were analyzed for severity, causality, and preventability. Data were extracted and summarized by absolute numbers, mean (95% confidence interval [CI]), percentages and odds ratio (OR) (95% CI).Results:From 3839 retrieved references, 52 references describing 54 reactions were included. The mean age was 35.31 (95% CI: 30.52–40.10) years. Total female patients were 61.11%. Majority reactions were developed in perioperative conditions (53.70%), ward (20.37%) and home (11.11%). The major incriminated groups were antimicrobials (18.52%), nonsteroidal antiinflammatory drugs-(NSAIDs) (12.96%) and neuromuscular blockers (12.96%). Common causative drugs were diclofenac (11.11%), atracurium (7.41%) and β-lactams (5.96%). Cardiovascular (98.15%) and respiratory (81.48%) symptoms dominated the presentation. Skin tests and IgE assays were performed in 37.03% and 18.52% cases, respectively. The fatal cases were associated with complications (OR =5.04; 95% CI: 1.41–17.92), cerebral hypoxic damage (OR =6.80; 95% CI: 2.14–21.58) and preventable reactions (OR =14.33; 95% CI: 2.33–87.97).Conclusion:Antimicrobials, NSAIDs, and neuromuscular blockers are common causative groups. The most fatal cases can be prevented by avoiding allergen drugs.

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“…In India, four patients were bitten by B. caeruleus (Indian Krait), one of the most common snakes in Bangladesh and India. A 15-year-old boy was bitten by B. caeruleus and immediately sent to the hospital to receive AV treatment [ 28 ]. After one vial of AV treatment, he had respiratory difficulty, perhaps due to a hypersensitivity reaction.…”

Section: Envenoming By Snakes That Mainly Have Neurotoxic Venomsmentioning

confidence: 99%

Cerebral Complications of Snakebite Envenoming: Case Studies

Lin

Chen

Liu

et al. 2022

Toxins

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There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.

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Cortical blindness and paraplegia following hypoxic ischemic encephalopathy as a complication of common krait bite

Abstract: Evaluation of victims of neurotoxic snake bite for early signs of respiratory depression and prompt respiratory assistance, even if anti-venom is not available, is most essential as a life saving measure.

Cited by 5 publications

References 1 publication

Long-term Effects of Snake Envenoming

Long-term Effects of Snake Envenoming

Drug-induced anaphylactic reactions in Indian population: A systematic review

Cerebral Complications of Snakebite Envenoming: Case Studies

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