Long-term health complications following snake envenoming

Abstract

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.

The timing is right to end snakebite deaths in South Asia

“… 7 8 Long term complications occur in around 15% of survivors and include musculoskeletal deformities, amputations, visual impairment, chronic kidney disease, and neurological deficits. 9 …”

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

“…Migraine-like syndrome following snakebite envenomation was reported in a study from Sri Lanka. It revealed that 112 of 816 snakebite victims presented with long-term complications, and 46 patients (5.6%) developed "migraine-like-syndrome", which presented as headaches, dizziness, and sensitivity to light [36]. Hypercoagulability is suspected to be related to migraine pathophysiology, particularly migraine aura [35].…”

“…A case report described a 49-year-old woman who developed acute cerebral infarction following a T. stejnegeri snakebite in Taiwan [45]. Both cerebral infarction and intracranial hemorrhage can result in brain injuries that cause long-term sequelae such as hemiplegia or cerebellar ataxia [36,49].…”

Long-term sequelae secondary to snakebite envenoming: a single centre retrospective study in a Costa Rican paediatric hospital

“…In addition, the costs for the following-up of the consequences of snakebite envenoming are high, both for the affected people and for the public health system. Management of this neglected tropical disease is very costly, 4 and the expenses increase considerably when long-term follow-up is needed. This is another aspect of this problem that requires further studies.…”

“…However, few have focused on the risk factors associated with morbidity and further complications. 4 The few studies carried out on sequelae following snakebites have identified several physical and psychological outcomes which exert a heavy impact in the quality of life of affected people. 5 …”