Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India
Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India
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DOI：
10.2147/ijgm.s136153
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发表时间：
2018-01-01
影响因子：
2.3
通讯作者：
Thulaseedharan, N. K.
中科院分区：
文献类型：
--
作者：
Kumar, K. G. Sajeeth;Narayanan, Santhosh;Thulaseedharan, N. K.
背景：蛇咬伤在所有热带国家都是一个被忽视的公共卫生问题，特别是在印度喀拉拉邦的马拉巴地区。人口学特征和临床参数在世界这一地区各不相同，基于这些特征和临床参数的研究很少。毛细血管渗漏综合征(CLS)在血液毒蛇咬伤中的发生率增加和驼峰毒蛇(HNPV)毒液中毒病例的出现是本研究的显著特征。目的：本研究旨在评估毒蛇咬伤患者的流行病学特征和临床特征，以确定影响其预后的因素。材料和方法：对2012年1月至2016年10月在喀拉拉邦科日科德政府医学院住院的毒蛇咬伤患者进行横断面观察性研究。结果：共有1500例中毒蛇咬伤病例，其中65%为男性。其中48%的人年龄在21岁到40岁之间。蛇咬伤以血毒性为主，占912例。毒蛇咬伤是最常见的蛇咬伤，其中70%是由罗素的毒蛇咬伤，25%是由HNPV引起的。在神经毒性咬伤中，常见的克莱特咬伤占主导地位。总死亡率为8.8%。CLS是主要死亡原因(80%)。抗蛇毒血清用于治疗神经麻痹蛇咬伤的平均剂量为10.25瓶，用于血液毒性咬伤的平均剂量为18.5瓶。蛋白尿、中性粒细胞增多症、血小板减少症、急性肾损伤(AKI)和早期出现症状与不良结局相关。结论：本研究强调了蛇咬伤对热带地区社区的重要威胁。血液毒蛇咬伤中的CLS是导致死亡的主要原因，而且通常对任何治疗措施都难以奏效。这项研究也揭示了HNPV毒液引起的并发症的严重性。需要生产具有抗HNPV毒液活性的抗蛇毒。缺乏意识、延迟到医院就诊以及非医务人员的治疗也增加了死亡的风险。
Background: Snake bites are a neglected public health problem in all tropical countries, and particularly in Malabar region of Kerala, India. Demographic characteristics and clinical parameters vary in this part of the world, and studies based on them are scarce. Increased incidence of capillary leak syndrome (CLS) in hemotoxic snake bites and emergence of cases of humpnosed pit viper (HNPV, Hypnale hypnale) envenomation are some notable features seen here.Objectives: The study was conducted to assess the epidemiological profile and clinical features to identify factors contributing to outcome in patients with venomous snakebites.Materials and methods: An observational cross-sectional study was done among patients with snakebite envenomation, admitted to Government Medical College, Kozhikode, Kerala, from January 2012 to October 2016.Results: There were 1,500 cases of toxic snake bites, of which 65% of these cases were males. Forty eight percent of them were aged between 21 and 40 years. Hemotoxic snake bites predominated, accounting for 912 cases. Viperine bite was the most commonly observed snakebite, and 70% of this was due to Russell's viper and 25% due to HNPV. Among the neurotoxic bites, common krait bites predominated. Overall mortality was 8.8%. CLS was the major cause of death (80%). The mean dose of antivenom given for neuroparalytic snakebite was 10.25 vials, and 18.5 vials for hemotoxic bites. Albuminuria, neutrophilic leucocytosis, thrombocytopenia, acute kidney injury (AKI), and early onset of symptoms were associated with poor outcome.Conclusion: This study emphasizes the importance of snakebite as a significant threat to the community in the tropics. CLS in hemotoxic snake bites is the leading cause of mortality and is often refractory to any treatment measures. This study also brings to light the graveness of complications caused by HNPV envenomation. Anti-snake venom with activity against HNPV venom needs to be manufactured. Lack of awareness, delayed presentation to the hospital, and treatment by nonmedical personnel also add to the risk of mortality.