Management of Snakebite and Research Management of Snakebite ...

INTRODUCTION
Snakebite is an occupational hazard of our farmers. People in six of 14 states and divisions
are engaged in rice farming. Bites occur during the ploughing and harvesting seasons;
however, with the introduction of multiple cropping, contacts between snakes and man is
increased. Mono-specific antivenom manufactured by Myanmar Pharmaceutical Factory
is recommended for treating Russell’s viper bite cases throughout the country. Common
clinical features include: systemic bleeding, hypotension and renal failure. Russell’s viper
bite has been studied in Tharawaddy, Taungdwingyi, Magwe, Myinmu, Danuphyu,
Nyaunglaybin and Kyauksae (Aung-Myint et al., 1998, Kyaw-Than et al., 1997, Min-Than
et al., 1998, Myint-Lwin et al., 1985, Myint-Soe et al., 1997, Sann-Mya et al., 1998, Saw-
Naing, 1983). Geographical variation of biological properties of Russell’s viper venom
(Aye-Aye-Myint et al., 1993, 1994, 1995, Sann-Mya et al., 1994, Tun-Pe et al., 2000) and
variable performance of mono specific Russell’s viper antivenom in neutralizing venoms
from different localities (Tun-Pe et al., 1999) have been reported. The objective of the
study is to determine the possibility of geographical variation of clinical features, antivenom
response and outcome of Russell’s viper bite cases admitted to six township hospitals from
snakebite endemic divisions.
MATERIALS AND METHODS
The study was conducted on snakebite cases admitted to six township hospitals, from five
snakebite endemic divisions namely, Danuphyu and Yaekyi (Ayerawaddy), Nyaunglaybin
(Bago), Myinmu (Sagaing), Kyauksae
(Mandalay) and Taungdwingyi (Magwe)
Study sites
(Figure) in one calender year (between
1995-98).
Clinical details of the cases were
recorded in standard proforma. Twentyminute
whole blood clotting test (Warrell
et al., 1977) was used to assess the degree
of envenoming. Guidelines for indication
of antivenom were explained to medical
officers before the trial. Clotting test was
done at 2h intervals for 24h in cases
presented with clottable blood on
admission and for those presented with
incoagulable blood, it was repeated at 6h
intervals after antivenom till normal clot
restoration was restored. Serum was
collected on to filter paper strips and
venom antigen levels were measured by
enzyme immunoassay technique at the
Venom Research Laboratory of the
Department of Medical Research (Tun-Pe
et al., 1991).
Clinical Features of Russell’s Viper Bite Cases Admitted to Six Township Hospitals ...
Myinmu
Kyauksae
Nyaunglaybin
Danuphyu
Yaekyi
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