Retrospective Evaluation of Snake Bites in Eastern Black Sea Region

Year 2020, Volume: 2 Issue: 2, 40 - 43, 11.11.2020

Özlem Bilir , Alpaslan Ünlü , Gökhan Ersunan , Teslime Ayaz

Abstract

ABSTRACT:
Aim;The aim of this study is to review snake bites, which are rarely encountered and thus regionally neglected in Eastern Black Sea Region but which cause potentially serious clinical pictures, in order to provide a better patient management.
Material and Method:In this study, 27 cases who referred to tertiary emergency service due to snake bite were analysed retrospectively.
Results: Of the 27 cases, 70.4%(n=19) were female and average age was found as 46.77±16.11. Referrals were in the month of July when tea and hazelnut farming was frequently done regionally. However, two patients developed syncope and hypotension after admission. The most common complaints of referral were pain (96.3%,n=26), ecchymosis and swelling (88.9%,n=24) due to bite in the lower extremity dorsum of the foot (96.3%,n=26). While 18.5% were referred to our hospital after they were applied antivenom therapy in another health institution, antivenom therapy was applied to 2 patients(7.4%) due to their clinical picture at admission. 29.6% of the patients who referred to the emergency service were followed and treated by being hospitalized. None of the patients admitted with snake bite died. Elevated INR was the most common serious complication with 11.1%(n=3).
Conclusion: Snake bite is a rare situation in Eastern Black Sea region. In cases in the region which is the natural habitat of Vipera kaznakovi, depending on the feature of the venom, hematotoxic complications can occur, local lesions caused by other Viperia species being at the forefront. Appropriate follow-up and treatment should be based on the existing clinical picture.

Keywords

snake bite, eastern black sea region, emergency service visit

References

• 1- Harrison RA, Hargreaves A, Wagstaff SC, Fragher B, Lalloo DG. Snake envenoming: a disease of poverty. PLoS Negl Trop Dis. 2009; 3: e569.
• 2- Warrell DA. Snake bite. Lancet 2010; 375: 77-88.
• 3- White J. Overview of venomous snakes of the world. In: Medical Toxicology, 3rd edition, Dart RC (Ed), Lippincott, Williams, & Wilkins, Philadelphia 2004. p.1543.
• 4- Kumlutaş Y, Ilgaz Ç, Yakar O. Herpetofauna of Karabük Province. Acta Biologica Turcica 2017; 30: 102-107.
• 5- Nalik BS. “Dry bite” in venomous snakes: A review. Toxicon 2017; 133: 63-67.
• 6- Downey DJ, Omer GE, Moneim MS. New Mexico rattlesnake bites: demographic review and guidelines for treatment. J Trauma 1991; 31: 1380-1386.
• 7- Tchoffo D, Kamgno J, Kekeunou S, YAdufashije C, Nana Djeunga HC, Nkwescheu AS. High snakebite underreporting rate in the Centre Region of Cameroon: an observational study. BMC Public Health 2019; 19 (1): 1040.
• 8- Al B, Orak M, Aldemir M, Güloğlu C. Snakebites in the adults from the Diyarbakır region in southeast Turkey. Turkısh Journal of Trauma Emergency Medicine 2010; 16(3): 210-214.
• 9- Narvencar K, Favas TT, Dias A. Epidemiology and Clinical Profile of Snakebites in Goa and Surrounding Areas. J Assoc Physicians India. 2020; 68(3): 28-32.
• 10- Waheed H, Moin SF, Choudhary MI. Snake Venom: From Deadly Toxins to Life-saving Therapeutics. Curr Med Chem 2017; 24(17): 1874-1891.
• 11- Petras D, Hempel BF, Göçmen B, Karis M, Whiteley G, et al. Intact protein mass spectrometry reveals intraspecies variations in venom composition of a local population of Vipera kaznakovi in Northeastern Turkey. J Proteomics. 2019; 199: 31-50.
• 12- Karakus A, Zeren C, Celik MM, Arica S, Ozden R, et al. A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey. Toxicol Ind Health. 2015; 31: 188-192.
• 13- Ertem M, Esenkaya I, Kaygusuz MA, Turan C. Clinical experience in the treatment of snake envenomation (our clinical experience in the treatment of snakebites). Acta Orthopaedica et Traumatologica Turcica Journal 2005; 39: 54-58.
• 14- Najman L, Seshadri R. Rattlesnake envenomation. Compend Contin Educ Vet 2007; 29: 166-176.
• 15- Clark RF, O’Connell CW, Villano JH, ve ark. Severe recurrent coagulopathy following crotaline envenomation refractory to maintenance dosing of antivenom. Am J Emerg Med 2015; 33: 856. e3-5.
• 16- Lavonas EJ, Ruha AM, Banner W, ve ark. Unified treatment algorithim for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med 2011;11: 2.
• 17- Karakus A, Zeren C, Celik MM, Arica S, Ozden R, Duru M, Tasın V. A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey. Toxicol Ind Health. 2015; 31(2): 188-192.
• 18- Brys AK, Gandolfi BM, Levinson H, Gerardo CJ. Copperhead envenomation resulting in a rare case of hand Compartment Syndrome and sunsequent Fasciotomy. Plast Reconstr Surg Glob Open 2015; 3: e396.
• 19- Toschlog EA, Bauer CR, Hall EL, ve ark. Surgical considerations in the management of pit viper snake envenomation. J Am Coll Surg 2013; 217: 726-735.
• 20- Söker M, Haspolat K. Turkey’s southeastern Anatolia region of snake bite in children: 52 cases due. Gulhane Medical Journal 1999; 41(3): 331-337.