Snakebite in north-eastern South Africa: clinical characteristics and risks for severity

Abstract

Objectives:To identify the toxicity profile of snakebites and to assess clinical severity. Methods: An analysis of all patients admitted to Ngwelezane Hospital's Emergency Department with a diagnosis of snakebite over five years was done. All patients were admitted, assessed and standard haematological and biochemical tests were done. Patients were observed for a minimum of 12 hours' observation. Results: In total, 879 cases were analysed. Envenomation was identified in over two-thirds of admissions. Cytotoxic snakebites accounted for 98% of envenomations. Only four cases of haemotoxic bleeding and five cases of neurotoxicity were admitted. Abnormal laboratory indices correlated with severity: INR > 1.5 (odds ratio 2.25, CI 1.12-4.53; p = 0.023), platelets < 100x109/L (OR 2.35, CI 1.01-5.49; p = 0.048), haemoglobin concentration < 8.0 g/dL (OR 5.68, CI 2.15-15.00; p < 0.001) and leucocyte count > 10x109 (OR 3.15, CI 1.89-5.26, p < 0.001). Children and delays to admission correlated to and were predictors of severity. Conclusion: Two-thirds of patients who present to hospital with snakebite will have symptoms of envenomation, with the overwhelming majority having been bitten by cytotoxic species. Some factors correlate to severity and may be useful for anticipating the patient's clinical course.

The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers’ Perspectives and Knowledge, and Health Facilities’ Treatment Capacity

“…27 Similar findings were also observed in Ghana and South Africa. 34,36 In our study, people aged 21-30 years were believed to be most prone to snakebites. This again resonates with previous research, which often finds highest incidence in relatively young age-groups.…”

Fatal Boomslang bite in the Northern Cape

“…Boomslang bites are much less common than other snakes [1] . Traditionally, it has been taught that there is a window period of 24–48 h after a Boomslang bite to administer antivenom.…”

“…Only eight deaths due to Boomslang envenomation have been recorded since 1957 [3] . Furthermore, in a five year retrospective review done in Kwazulu-Natal [1] , there were only four hemotoxic envenomations attributed to the Boomslang requiring monovalent antivenom (4/879). Even so, tertiary and referral centres have a responsibility to effectively treat all patients within reason, and victims of a Boomslang bite should be no exception.…”

Classifying snakebite in South Africa: Validating a scoring system

“…However, its use is associated with a high rate of anaphylaxis and it is essential that its use is restricted to patients who really require it. [15] We therefore undertook a study to identify the factors most strongly predictive of an adverse outcome in our population, arising from which we propose a scoring system called the Zululand Snakebite Score (ZSS) that is validated in our setting. We suggest that its greatest value is in identifying those patients who do not appear overtly seriously affected at first presentation, but are at high risk of progression to severity over the ensuing hours.…”

“…This region has a very high incidence of snakebite. [15][16][17][18][19] The Emergency Department sees approximately 60 000 new patients annually. In the summer months, up to 10% of admissions are due to snakebite.…”