Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India

Abstract

Background: Envenoming by vipers Russell’s and Echis Carinatus are common accidents faced by farmers and labors. Both viper venom toxins alter coagulation mechanism in the victim. The dose of snake antivenin to neutralize the venom is empirical and varies. Though the clinical manifestations in both vipers bite envenoming are nearly similar but dose of antivenin required is more in Russell's viper . We studied in detail about the correlation of clinical manifestations and confirmed species of snake. Methods: Cases of vipers snake bites admitted for last two successive years were studied. Analysis by local manifestations, systemic involvement, 20 minute whole blood clotting test (20WBCT), identification of snake responsible for clinical effects are confirmed by the snake species brought by victims or bystanders, in case of where victim saw the snake bur failed to kill. The victims identified from pictures of big four poisonous snakes ( Russell's viper , Echis carinatus , Cobra, and krait). Further confirmation from the species responsible is done by showing the hospital preserved specimen to identify the culprits. Findings: About 77 cases of viper bite studied of these 57 has clinical syndrome suggestive of Russell's viper (RV) bite, one has dry bite, 23 victims brought the killed specimen confirmed RV, of these 18 identified the specimen picture and 5 wrongly locate the species in pictures, 20 victims correctly identified the hospital preserved specimen while 3 failed to recognize. There were 28 patients who saw the snake while bitten but failed to kill, of these 20 patients identify correctly the species on picture while 8 failed to identify. Only 22 correctly identified the culprit by looking at the hospital preserved specimen and 6 were confused. One dry bite victim correctly identified the bitten snake species in picture and hospital preserved specimen. Interpretation: In viper bite poisoning clinical pictures and hospital specimen help to confirm the species are highly supportive for clinical diagnosis.

Challenges and Opportunities in Clinical Diagnostic Routine of Envenomation Using Blood Plasma Proteomics

“…In addition, asymptomatic cases have been reported in epidemiological studies worldwide [ 31 , 32 , 33 , 34 , 35 , 36 ]. The absence of clinical manifestations in these cases could be associated with the lack of venom injection, but their diagnosis to decide on the need (or lack thereof) to apply antivenoms and the lack of methods to detect the presence of venom in the patient’s blood may lead to an erroneous interpretation of the case, leading to a misapplication of antivenom that can result in early or late adverse reactions to it [ 9 , 11 , 37 ].…”

Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite

“…The WBCT20 has been used as the sole assessment method of VICC in numerous clinical studies, including non-randomized controlled clinical trials [ 58 ], randomized comparative trials [ 59 , 60 , 61 , 62 , 63 , 64 ], non-randomized comparative trials [ 29 , 65 ], observational studies [ 27 , 31 , 32 , 35 , 37 , 41 , 43 , 47 , 50 , 52 , 53 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ] and case series [ 77 , 78 , 79 , 80 ].…”

Development of Wunderlich syndrome following a Russell’s viper bite

“…Russell's viper is one of the 'Big Four' venomous snakes in India and is responsible for the majority of SBE incidents and associated deaths, disabilities and socioeconomic ramifications in India [4][5][6]. The bites from Russell's viper are known to induce local inflammation, tissue damage, coagulopathies often resulting in haemorrhage, neurotoxicity and nephrotoxicity [7][8][9]. Notably, the development of acute kidney injury (AKI) following Russell's viper bites is common and it often necessitates expensive renal replacement therapy [10,11].…”