Bites by snakes of lesser medical importance in a cohort of snakebite patients from rural Sri Lanka. (November 2020)

• Record Type: Journal Article
• Authors: Thalgaspitiya, Sujeewa; Isbister, Geoffrey; Ukuwela, Kanishka; Sarathchandra, Chamara; Senanayake, Hemal; Lokunarangoda, Niroshan; Siribaddana, Sisira; Silva, Anjana
• Is Part Of: Toxicon. Volume 187(2020)
• Page Start: 105
• Page End: 110
• Publication Date: 2020-11
• Subjects: Snakebite -- Rear-fanged -- Non-venomous -- Colubrid; Toxins -- Periodicals; Venom -- Periodicals; 615.9
• DOI: 10.1016/j.toxicon.2020.08.025
• Languages: English
• ISSNs: 0041-0101

Abstract

Abstract: Reporting of snakebite is poor in areas where they are most common. Comparatively, bites by snakes of high medical importance are likely to be documented than snakes of lesser medical importance. This study aims to describe the demographic, epidemiological and, clinical data of patients who were presented during a 49-month study period to a tertiary care center in rural Sri Lanka following authenticated bites by snakes of lesser medical importance. Of the total of 2362 confirmed snakebite patients during the study period, 517 (22%) presented with the offending snake specimen. Of them, 76 (15%) were identified as snakes of lesser medical importance and were included in this study. There were 41 (54%) females. The median ages of females and males were 35 and 43 years respectively. Most patients (86%) were bitten indoors or at home gardens. More than half of them were bitten between 1800 and 0000 h. Most bites (54%) had occurred to the ankle or below. The patients were bitten by 12 species of colubrids, one pythonid ( Python molurus ), and one viperid ( Trimeresurus trigonocephalus ). The snake species that caused the most-number of bites was the Trinket snake ( Coelognathus helena ) (n = 15). Three species of wolf-snakes, Lycodon aulicus, L. anamallensis, and L. striatus were responsible for 12, 11, and 5 bites respectively. Most of the patients (55%) presented to the local hospital and subsequently transferred to the study hospital for further management. None of the patients developed systemic envenoming and five developed mild local pain and swelling. Fifty-six (74%) patients were discharged on the following day, while 18 (24%) were discharged on the third day. There is a need to educate medical personnel working the peripheral hospital on how to identify medically lesser important snakes to avoid unnecessary transfers. Highlights: We describe 76 patients bitten by medically less-important snakes admitted to a Sri Lankan hospital over 49 months. Most bites had occurred at evenings, indoor, to lower limbs below the ankle. Over half of the patients were transferred from local hospital to the study hospital for further management unnecessarily. None of the patients developed systemic envenoming and five developed mild local pain and swelling. A need to educate staff in peripheral hospitals on the identification of medically lesser important snakes is emphasized.