Management of Snakebite and Research Management of Snakebite ...

Management of Snakebite and Research
34
Clinical Features of Russell’s Viper (Daboia
russelii siamensis) Bite Cases Admitted to Six
Township Hospitals of Snakebite Endemic
Divisions of Myanmar
Tun-Pe 1 , Aye-Aye-Myint 1 , Sann-Mya 2 , Khin-Aye-Kyu 3 , Kyaw-Than 4 , Aung-Myint 5 ,
Tint-Lwin 6 , Myint-Soe 7 , and Min-Than 8
1 Venom Research Laboratory, Department of Medical Research(Lower Myanmar), Yangon
2 Department of Medicine, Institute of Medicine (1), Yangon
Senior Medical Officers from 3 Taungdwingyi, 4 Danuphyu, 5 Kyauksae, 6 Yaekyi, 7 Myinmu,
and 8 Nyaunglaybin hospitals, Department of Health
Abstract
Clinical features, antivenom response and outcome of Russell’s viper (Daboia russelii
siamensis) bite cases admitted to six township hospitals namely Danuphyu, Yaekyi
(Ayerawaddy division), Nyaunglaybin (Bago), Myinmu (Saging), Kyauksae (Mandalay)
and Taungdwingyi (Magwe) in one calendar year were studied. Majority of the victims
are young males bitten on the lower limb while at work in fields. It takes 3.44hrs
(5 minites-46 hrs) to get to the hospitals and have to travel 6.45 miles (0.25-41
miles). Forty-four percent brought dead snakes for identification. Eighteen percent
received pre hospital antivenom. The length of the snake responsible for the bites
ranges from 10-110cm. Twenty-eight percent of the bites are not envenomed, 29%
local and 43% systemic envenoming. Forty-two percent of the systemic cases
developed complications. Venom antigen levels of local envenoming cases range from
10-50ng/ml and that of systemic 20-100ng/ml. In general, common local and systemic
features of Russell’s viper bites are observed in all cases, however, bruising is more
common in (Yaekyi, Danuphyu and Taungdwingyi), necrosis in (Taungdwingyi, Kyauksae
and Danuphyu), blackening in (Danuphyu and Myinmu), gum bleeding, epistaxis and
haemoptysis in (Danuphyu), haemetemesis, malena and albuminuria (Danupgyu and
Yaekyi), malena (Kyauksae and Taungdwingyi), hypotension and conjunctival oedema
(Nyaunglaybin), conjunctival haemorrhage (Kyauksae and Danuphyu), renal failure
(Danupgyu and Nyaunglaybin) and high mortality (12.5-19.3%) in (Kyauksae,
Danuphyu and Nyaunglaybin). Traditional first aids are still practised in all cases except
Taungdwingyi and Myinmu. In 54% of the antivenom treated systemic cases, clot
restoration time takes 12hrs-48hrs. Pyrogen reaction is observed in 50% of antivenom
treated cases. Variation in clinical features of the cases, variable antivenom response
and clot restoration time highlighted that venom used for raising antivenom for
common use should be widely pooled.