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

Abstract

ObjectivesAlthough devastating acute effects associated with snake envenoming are well described, the long-term sequelae resulting from these envenomings have not been adequately addressed, especially in the paediatric population. The aim of our study is to describe the clinical characteristics among paediatric patients in Costa Rica who developed long-term sequelae secondary to snakebite envenoming.DesignRetrospective descriptive study of paediatric patients under 13 years who were admitted with a history of a recent snakebite at the National Children’s Hospital in Costa Rica from January 2001 to December 2014.ResultsWe enrolled 74 patients admitted to our centre due to envenoming, and separated those who did not develop sequelae (50 patients) from those who did (24 patients). Of those who presented acute complications during hospitalisation, local wound infection and clinically diagnosed compartmental syndrome were significantly higher in the group that developed sequelae thereafter. Hypertrophic scars (66.7%), functional limitation of affected limb (37.5%) and the need of skin graft (37.5%) were the most common sequelae. The median follow-up of patients with long-term sequelae after discharge was 25.4 months (5.6–59.4). No deaths were reported during this time period.ConclusionsGiven the high economic, personal and healthcare burden that entails follow-up of these patients, efforts should be carried out to prevent the factors associated with sequelae among the affected population.

Extracellular Vesicles from Bothrops jararaca Venom Are Diverse in Structure and Protein Composition and Interact with Mammalian Cells

“…Considering the aspect of vascular permeability, Bj-EVs carrying 5NTD could contribute to venom spreading, since soluble 5NTD from snake venom causes vascular leakage in vivo [128]. On the other hand, Ado is immunosuppressive when immune cells express P1 receptors [117][118][119][120]129], which may be related to the long-term effects of snakebites [24][25][26][27][28]. In accordance with this, a strong immune suppressive function is well characterized in EVs from wasp venoms [48,54,55].…”

“…They are quite variable and can occur days, months, or even years after the snakebite. Those effects include the reopening or persistence of wounds and random bleeding [24][25][26][27][28]. The mechanisms behind these phenomena may involve factors additional to the action of toxins.…”

Chronic health effects and cost of snakebite

“…Chronic or long-term health effects of snakebite has many definitions in the available literature. They include, any condition related to snakebite that required follow-up after discharge from hospital, conditions that last or appear more than six weeks following envenoming, or health problems that had occurred immediately or within 4 weeks of the bite and had persisted for more than 3 months ( Williams et al, 2011 ; Jayawardana et al, 2018 ; Waiddyanatha et al, 2019 ; Brenes-Chacon et al, 2020 ).…”

“…Chronic health effects of snakebite, though likely to be commoner than reports indicate, have received limited attention in the snakebite literature. The wide variation in the definition of “chronic health effects” in relation to their point of appearance and duration, indicates the lack of a systematic approach to defining and describing this very important aspect of snakebite ( Williams et al, 2011 ; Jayawardana et al, 2018 ; Waiddyanatha et al, 2019 ; Brenes-Chacon et al, 2020 ). Screening and detection of chronic disability related to snakebite would require at least one out-patient follow-up visit after victims are discharged from hospital.…”

Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care

“…In this vein, integrating THs into allopathic healthcare services offers opportunities for improving patient follow-up post-discharge in the outpatient setting. This is particularly relevant in the setting of snakebite envenoming, in which patients often struggle to afford prolonged hospital admissions ( Schioldann et al, 2018 ; Harrison et al, 2009 ; Steinhorst et al, 2021 ; Arias-Rodríguez and Gutiérrez, 2020 ; Brown, 2012 ) and in which long-term follow-up, especially with regard to disability and morbidity, is notoriously challenging ( Aglanu et al, 2022 ; Brenes-Chacon et al, 2020 ; Jayawardana et al, 2016 ; Kasturiratne et al, 2021 ). Many patients and THs see promise in therapies offered at the hospital, most notably antivenom ( Chuat et al, 2021 ; Vaiyapuri et al, 2013 ; Steinhorst et al, 2021 ; Schurer et al, 2022 ).…”