Document Type : Original Article
Authors
- AKM Ferdous Rahman 1
- Mohammad Salim 1
- Saifullah Al Kafi 2
- Abu Saleh 2
- MD Mamunur Rashid 2
- Tania Tanzil Eva 2
- Imrana Ali 2
- Mohammad Omar Faruq 3
1 Department of Critical Care Medicine, Dhaka Medical College Hospital, Bangladesh
2 Critical Care Medicine MD Resident (Phase B), Department of Anesthesia, Pain, Palliative & Intensive Care, Dhaka Medical College Hospital. Bangladesh
3 Professor and Chief consultant CCM & EM, United Hospital, Dhaka, Bangladesh
Abstract
Background: Effective management strategies for snake envenomation are critical for reducing the morbidity and mortality as treatment gaps, delays, and reliance on traditional healers frequently exacerbate outcomes. This study provides insights into the clinical presentation, management, and outcomes of snakebite envenomation in Bangladesh admitted at an ICU, highlighting key risk factors for mortality and potential interventions.
Methods: This retrospective observational study reviewed data from 14 patients admitted to the intensive care unit (ICU) at Dhaka Medical College Hospital, Bangladesh between January 2023 and July 2024. Variables including demographic details, snakebite characteristics, baseline clinical parameters and patient outcomes were assessed.
Results: The study found snakebite envenomation predominantly affecting males (92.8%) and urban residents (78.5%). Russell’s viper was responsible for 57.15% of bites followed by cobras and kraits. 42.85% victims consulted traditional healers initially. Cellulitis and gangrene were noted in 57.14% and 7.14% respectively. Neurotoxic effects (50%) included ptosis and respiratory paralysis. Acute kidney injury and ventilator associated pneumonia occurred in 57.14% and 42.85% of cases respectively. Treatment involved polyvalent antivenom, blood transfusions (78.5%), mechanical ventilation (64.29%), and hemodialysis (50%). In-hospital mortality was 35.71%, with an average ICU stay of 4.72 days. Hemodialysis significantly reduced the odds of mortality.
Conclusion: Acute kidney injury and ventilator-associated pneumonia are critical complications driving mortality risk. Timely hemodialysis is a vital life-saving intervention in severe envenomation cases. Enhanced public awareness, rapid referral systems and accessible critical care facilities are very much important to reduce snakebite-associated mortality in Bangladesh.
Keywords
Main Subjects
- World Health Organization Snakebite envenoming. Available from: https://www.who.int/en/news-room/fact-sheets/detail/snakebite-envenoming.
- Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008 Nov 4; 5(11):e218.
- Rahman R, Faiz MA, Selim S, Rahman B, Bashar A, Jones A, et al. Annual incidence of snake bite in rural Plos Negl Trop D. 2010 Oct26; 4(10) e 860.
- Martın G, Ya ́ñez-Arenas C, Rangel-Camacho R, Murray KA, Goldstein E, Iwamura T, et al. Implications of global environmental change for the burden of snakebite. Toxicon X. 2021 Jun 18;9–10:100069
- World Health Organization. Support for health system to fight snakebites. Available from:
https://www.who.int/bangladesh/news/detail/20-12-2018-support-for-health-system-to-fight-snakebites
- Bakar A, Ahsan N, Ahsan M. Snake Bite in Bangladesh. Pak Armed Forces Med J. 2006; 56(1):68-72.
- Alam MT, Wadud MA, Islam MMSU. A Study of Snake Bite Cases in Faridpur Medical College Hospital. Faridpur Med Coll J. 2014; 9(1):32-34
- Chowdhury S, Rahman I. Clinical Profile of Snakebite: A Cross-sectional Study In a Upazila (Subdistrict) Health Complex, Bangladesh. Journal of Bangladesh College of Physicians and Surgeons, 2024; 42(4):305–11. https://doi.org/10.3329/jbcps.v42i4.76303
- Mondal RN, Chowdhury FR, Rani M, Mohammad N, Islam MM, Haque MA, et al. Pre-Hospital and Hospital Management Practices and Circumstances behind Venomous Snakebite in Northwestern Part of Bangladesh. Asia Pac J Med Toxicol. 2012 December; 1(1):18-21.
- Hasan SMK, Basher A, Molla A, Kakoly NS, Faiz A. The impact of snake bite on household economy in Bangladesh. Tropical Doctor. 2012 Jan 5; 42(1):41-43. doi:10.1258/td.2011.110137
- Hossain J, Biswas A, Rahman F,Mashreky SR, Dalal K, Rahman A. Snakebite Epidemiology in Bangladesh—A National Community Based Health and Injury Survey. Health. 2016 March 18; 8:479-86. DOI:10.4236/health.2016.85051
- Mallik PK, Amin MR, Faiz MA. Clinical and Demographic Profile of Neurotoxic Snake Bite Patients in a Tertiary Care Hospital in Bangladesh. Asia Pac J Med Toxicol. 2021 March; 10(1):18-24.
- Harris JB, Faiz MA, Rahman MR, Jalil MA, Ahsan MF, Theakston RDG, et al. Snake bite in Chittagong Division, Bangladesh: a study of bitten patients who developed no signs of systemic envenoming. Trans R Soc Trop Med Hyg. 2010 May 1; 104(5):320-27. DOI:10.1016/j.trstmh.2009.12.006
- Faiz MA, Chowdhury SK, Hussain A. Snakebite in Chittagong and Cox’s bazaar: a hospital-based study. Bangladesh J Medicine. 1997; 8:52-57.
- Miah MT, Hoque AA, Tarafder BK, Patwary MKH, Khan RR, Kabir SMEJ. Epidemiology, Clinical Profile and Outcome of Patients of Snake Bite in Mymensingh Medical College Hospital. J Bangladesh Coll Phys Surg. 2009 May; 27(2): 70-75.
- Bangladesh reels from surge in snake bites, 22 June 2024, Anbarasan Ethirajan, BBC World Service.
- Sharif M, Amin MR, Barshan AD,Hasn MJ, Faiz MA. Optimizing survival in Russell’s viper bite cases in low-resource setting: two case reports. J Med Case Reports 2024; 18:
- Amin MR, Rahman ASMM, Haque MA, Haque MZ, Rahman FMA, Chowdhury FR, et First Two Cases of Russell’s Viper (Daboia russelii) bite, a Re-emerged Cause of Envenomation in Bangladesh. Bangladesh Journal of Medicine. 2024; 35(3): 204-10. 10.3329/bjm.v53i3.75304.
)