Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

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dc.contributor.authorGiri, Shatabdien_US
dc.contributor.authorBisoi, Swarup Kumaren_US
dc.contributor.authorDash, Dillip Kumaren_US
dc.contributor.authorMohanty, M. D.en_US
dc.contributor.authorParida, S. K.en_US
dc.date.accessioned2020-09-24T07:48:04Z
dc.date.available2020-09-24T07:48:04Z
dc.date.issued2020-05
dc.description.abstractBackground: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.en_US
dc.identifier.affiliationsDepartment of Paediatrics, IMS SUM Hospital, Bhubaneswar, Odisha, Indiaen_US
dc.identifier.citationGiri Shatabdi, Bisoi Swarup Kumar, Dash Dillip Kumar, Mohanty M. D., Parida S. K.. Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit. International Journal of Contemporary Pediatrics. 2020 May; 7(5): 1096-1100en_US
dc.identifier.issn2349-3283
dc.identifier.issn2349-3291
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/204586
dc.languageenen_US
dc.publisherMedip Academyen_US
dc.relation.issuenumber5en_US
dc.relation.volume7en_US
dc.source.urihttps://dx.doi.org/10.18203/2349-3291.ijcp20201646en_US
dc.subjectAnti- snake venomen_US
dc.subjectEnvenomationen_US
dc.subjectSnake biteen_US
dc.subjectTertiary careen_US
dc.titleSnake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care uniten_US
dc.typeJournal Articleen_US
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