Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

Abstract

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’

Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite.

Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite.

Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients  were in the age group of 20-39 years  ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia  (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications  observed  were  acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and  ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%)  patients  recovered  and 13 (7.65%) patients  died and out of 130 neurotoxic snake bites, 124 (95.39%) patients  recovered and 6 (4.61%)  patients   died, overall mortality was 6.3%. In our study, bite to needle time  was less than 1 hour in 47 patients (15.66%), less than  6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%).

Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.