Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

Abstract

Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.

Splenic rupture and subsequent splenectomy in a young healthy victim following Russell's viper bite

“…However, the adverse effects of SBE on spleen are rarely encountered. Prior to this study, a cobra bite-induced splenic congestion was observed in a victim in 19 th century (as reviewed in (Feola et al, 2020)). Similarly, a total of four cases of splenic rupture following bites from unidentified snake species one to five days after receiving antivenom were reported from South Korea (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013).…”

“…Multiple systematic analyses were performed on the causes of atraumatic splenic rupture, however, SBE (specifically Russell's viper bite) has not been previously reported as a causative reason (Lieberman and Levitt, 1989;Renzulli et al, 2009) although few cases of splenic rupture following SBE have been reported (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013). A single case reported in the 19 th century demonstrates a cobra bite leading to congestion in all organs including spleen (reviewed in (Feola et al, 2020)). Similarly, few case studies have reported splenic rupture following SBE from unidentified snake species in South Korea (Kang et al, 2014;Kim et al, 2021;Lee and Sung, 2019;Yhi et al, 2013).…”

De Novo Venom-Gland Transcriptomics of Spine-Bellied Sea Snake (Hydrophis curtus) from Penang, Malaysia—Next-Generation Sequencing, Functional Annotation and Toxinological Correlation

“…Snakebite envenomation is a World Health Organisation (WHO)-classified neglected tropical disease that heavily affects many impoverished populations in the tropics and subtropics [ 1 ]. Each year, it causes 81,000 to 138,000 deaths across the world and approximately three times as many permanent disabilities and psychological trauma in those who survive [ 2 , 3 ]. Snakebite cases are mostly reported from inland areas where agricultural activities are predominant, whereas sea snake bite remains an under-estimated, fatal occupational hazard to fishermen and coastal communities [ 4 , 5 ].…”

Australian Sea Snake Envenoming Causes Myotoxicity and Non-Specific Systemic Symptoms - Australian Snakebite Project (ASP-24)

“…There were no cases of sea snake envenoming identified post-mortem in a previous series including coronial cases of snake envenoming ( Johnston et al, 2017 ). This may be due to the relative rarity of sea snake envenoming in Australia and the quality of care, as well as the difficulty conclusively diagnosing sea snake envenoming post-mortem ( Feola et al, 2020 ).…”