Mass awareness regarding snake bite induced early morning neuroparalysis can prevent many deaths in North India

Abstract

Introduction:In North India snake bite deaths are predominantly seen with neurotoxic envenomations (NEs) whereas in South India the hemotoxic envenomation (HE) is more common. Krait is responsible for most deaths in North India. It bites people sleeping on the floors, mostly at night. We describe the profile of venomous snake bites over 1 year in 2013.Materials and Methods:The study was conducted in a rural tertiary care hospital in North India. Demographics, circumstances of bite, envenomation, first aid, delay, consultation, treatment, anti-venom, and outcomes were recorded for all victims of snake bite. We included all consecutive adult (>18 years) venomous snake bite victims admitted from January to December 2013.Results:A total of 91 patients with venomous snake bites were included in the study. Pure NEs were 41 (45.1%), pure HE in 31 (34.1%), 7 (7.7%) had mixed NE + HE, and 12 (13.2%) had only local swelling. Forty patients (44%) were bitten during sleep presenting as NE (92.5%), NE + HE (5%), and HE (2.5%). Findings in the 51 patients (56%) bitten during activity were HE (58.8%), local swelling (23.5%), NE + HE (9.8%), and NE (7.8%) (P < 0.0001). First aid was sought by 24 NE patients out of which 23 (96%) went to alternate practitioners or religious healers.Conclusion:Almost all (97.5%) bites during sleep resulted in NE in our study. About 96% of NE sought first aid from alternate practitioners or religious healers in hope of some magical treatment. Thus, a deadly combination of krait bite during sleep and wrong health seeking behavior is responsible for high mortality krait bites in this region. Mass public awareness regarding krait bites can prevent mortality in many such cases.

Mortality due to snakebite and other venomous animals in the Indian state of Bihar: Findings from a representative mortality study

“…Attribution of deaths to snakebite in 3 cases based on history of animal bite coupled with frothing around the mouth and skin colour change of the deceased could also be considered as a limitation. However, given that these signs are quite distinctive for a snakebite,[ 7 , 43 , 44 , 56 ] and with a history of animal bite, we believe this attribution to be reasonable. Only in 1 case, this attribution was based on only signs.…”

“…A common snake in India, the common Krait, bites indoors during night mostly while the victim is asleep who does not wake up at the time of bite because the bite is painless. [ 43 , 44 ] Sleeping on a bed off the floor in addition to awareness with effective health education and clearing of vegetation have been reported effective in preventing Krait bites. [ 45 ] Interestingly, sleeping under a mosquito net, rather than off the floor on a bed, has previously been reported to be protective of snakebite in Nepal.…”

“…[ 7 ] On the other hand, it is likely that we may have underestimated snakebites in which snake was not seen, particularly when the bite occurred while sleeping at night. The bites by the common Krait, a common snake in India, which mostly bites at night while the victim is asleep,[ 43 , 44 ] could be missed until the victim reaches a competent doctor who has knowledge of the early morning neuroparalysis caused by common Krait bite. [ 9 , 49 ]…”

New insights into snakebite epidemiology in Costa Rica: A retrospective evaluation of medical records

“…Our assessment confirms that Bothrops asper is responsible for the vast majority of snakebites in the country, although we acknowledge that the identification of the offending snake based on the description a posteriori is not always accurate. In regions where monovalent or bivalent antivenoms are used, knowing the identity of the biting snake is essential to provide adequate treatment; and various methodologies for identifying the offending snake have been implemented ( Eng and Gopalakrishnakone, 2004 ; Hung et al, 2014 ; Dhananjaya et al, 2015 ; Sharma et al, 2016a , 2016b ). In contrast, in the case of Costa Rica, the identity of the offending species is not so relevant for the choice of antivenom, since a clear difference in signs and symptoms exist between viperid species (where polyvalent antivenom is indicated) and elapid species (where coral antivenom is used), thus allowing the selection of the type of antivenom(( Bolaños, 1982 ).…”

“…In fact, numerous cases of neurotoxic envenoming caused by kraits ( Bungarus spp.) in Southeastern Asia occur while the victims sleep on the floor in their homes ( Mondal et al, 2012 ; Sharma et al, 2016a , 2016b ), an example of the close relationship between some venomous snake species and anthropic environments. Not surprisingly , B. asper is one of the most frequent snake species encountered in environments close to human dwellings in Costa Rica ( Sasa et al, 2009 ).…”