Abstract

Introduction: Snake envenoming is a significant and neglected global public health issue causing multiple potentially life-threatening toxin mediated clinical syndrome. Snakebite is now recognized as a Neglected Tropical Disease by the World Health Organization.^[1]

WHO estimates about 5 million people are bitten each year by poisonous snakes which results in 2.5 million envenomations, at least 100000 deaths, and 300000 amputations and other permanent disabilities. Majority of snakebite induced deaths occur in Asia and Sub-Saharan Africa. The mortality due to venomous snakebite in India is estimated between 35000-50000 per annum, which is the highest in the world^[1].

Bihar, Jharkhand, Madhya Pradesh, Odisha Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan and Gujarat are eight states defined as high burden states for snake bite.^[2]

The study has been done in MGM Medical college and LSK Hospital at Kishanganj district under Purnia  divison having predominant rural population engaged in farming practices.]

The primary objective being  to study the demographics,  analyse  the clinical and epidemiological profile and outcome of snake bite cases by retrospective evaluation of hospital records from May 2019 to May 2020.

Snake venom may contain twenty or more toxins. Most of them are enzymes, non-enzyme peptide toxins and non-toxic proteins.^[1]The potency and composition of toxin depends on diet, geographical location and climatic condition of the snakes habitat. Cobras, Kraits, Russell’s viper and Saw Scale vipers are the commonly found venomous species of snakes responsible for maximum morbidity and mortality in India.

Bihar witnesses deaths of around 4,500 people every year due to snake bites, majority of them are from extremely poor backgrounds and stands as the third in the country with the largest number of deaths caused by snakebites in India^.[3]

Methods: Data extracted from medical records of snakebite victims admitted in the Medicine ward and Intensive care at Mata Gujri Memorial Medical College and LSK Hospital during the period extending from May 2019 to May 2020 was subjected to retrospective analysis to describe Clinico–epidemiological profile and management of snake bite cases. Age /gender distribution, site of envenomation, Time lag of presentation seasonal trends of snake bite cases, duration of hospital stay and complications have been described in the study. Proportion of envenomation and dry bite was assessed as well as case fatality rate computed from data collected.

Statistical Analysis: Statistical analysis was done using SPSS software.

Results: Out of 440 cases analysed from hospital records from May 2019 to May 2020. 61% were male predominantly engaged in farming and agricultural activities. Foot and ankle followed by area below knee joint was most common site of bite both in male and female patients. Maximum number of cases occurred in August which also has highest rainfall followed by October which corresponds to harvesting season of paddy crop in Bihar.

Most cases presented within mean time of   two hours of snake bite whereas six cases presented after 7 to 10 days with psychiatric symptoms. The proportion of dry bite and bite with nonpoisonous snakes was higher as compared to envenomation being    (58%) and (42%) respectively.

Among the envenomation cases majority were neurotoxic(44%), hematotoxic (37%),and (19%) cases of local envenomation.

Mean duration of hospital stay was five days. Long term complications like necrosis, amputation, renal failure  was identified in 42 patients most of whom presented beyond six hours of snake bite.

Case fatality rate was 3.6% (16\440).

Conclusion: Snake bite is a preventable public health problem and the morbidity and mortality associated can be minimized by increasing public awareness and timely intervention. As maximum number of bite cases are accidental or provoked and during outdoor farming activities use of rubber boots and protective clothing helps to reduce the incident. 

Antisnake venom should be developed using venom from the same region, adequate infrastructure in terms of dedicated centres in each district and decentralization of ASV production is need of the hour.

Keywords: Snake bite,   Envenomation, Poisonous snakes, Anti snake venom.