Presentation and management of snakebite envenomation at a District Hospital in the north-east of South Africa

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE
Matamba Jean Benoit Kabeya , Darryl Wood , Peter Hodkinson
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Abstract

Background

Snakebites have been recognised as a neglected tropical disease by the World Health Organization and remain a potentially preventable cause of morbidity around the world, particularly in Africa. South Africa (SA) has a well-documented prevalence of snakebites, and there has been a recent surge in attention on snakebite due to dwindling antivenom stocks. uMkhanyakude District in the far northeast of SA has one of the highest incidences of snakebite and uses more antivenom than elsewhere in SA, and the impact of antivenom shortages and the high prevalence of disease has not been assessed recently.

Methods

A descriptive, retrospective, observational study was undertaken to describe victims of snakebites presenting from 1 September 2019 to 31 August 2022 to a district hospital, Mosvold Hospital. Data were manually extracted from patients’ medical records. Information about demographics, clinical presentations, treatments and outcomes was collected and analysed.

Results

A total of 155 snakebite cases presented, with an incidence rate of 58 snakebite cases per 100 000 people per year. Most patients were young, with a median age of 19 years (range 0–94 years), and most bites occurred outdoors (75/155, 48.4 %). Patients were most often bitten on the lower limbs (107/155, 69.0 %), and most presented with minimal swelling (117/155, 75.5 %). Antivenom was administered to 33 patients (33/155, 21.3 %), and 24 (24/33, 72.7 %) of those who received antivenom experienced some form of post-antivenom reaction. Three patients died during their hospital stay, resulting in a mortality rate of 1.2 deaths per 100 000 people per year. Antivenom shortages contributed to the outcomes of several patients.

Conclusion

Cytotoxic snakebites are a not infrequent presentation, many requiring admission, antivenom and subsequent management. Emergency personnel need to be familiar with local protocols for snakebite management, and have the resources to manage severe envenomation, including access to antivenom. Expanding knowledge and education about snakebites provided to community members might also improve outcomes and prevent bites.
南非东北部地区医院毒蛇咬伤中毒的表现和处理
蛇咬伤已被世界卫生组织认定为一种被忽视的热带疾病,并且仍然是世界各地,特别是非洲的一种潜在可预防的发病原因。南非(SA)有充分的证据表明蛇咬伤的流行,由于抗蛇毒血清库存的减少,最近对蛇咬伤的关注激增。南非最东北部的uMkhanyakude地区是蛇咬伤发生率最高的地区之一,使用的抗蛇毒血清比南非其他地方更多,抗蛇毒血清短缺和疾病高流行率的影响最近尚未得到评估。方法对2019年9月1日至2022年8月31日在莫斯沃尔德医院某地区医院就诊的蛇咬伤患者进行描述性、回顾性、观察性研究。数据是手动从患者的医疗记录中提取的。收集和分析了有关人口统计学、临床表现、治疗和结果的信息。结果全年共报告蛇咬伤病例155例,每10万人年蛇咬伤发生率为58例。大多数患者为年轻人,中位年龄19岁(范围0-94岁),大多数咬伤发生在室外(75/155,48.4%)。患者最常被咬伤的部位为下肢(107/155,69.0%),最常出现轻微肿胀(117/155,75.5%)。33例患者(33/155,21.3%)接受抗蛇毒血清治疗,24例患者(24/33,72.7%)出现某种形式的抗蛇毒血清后反应。3名患者在住院期间死亡,导致每年每10万人中有1.2人死亡。抗蛇毒血清的短缺导致了一些患者的结果。结论细胞毒性蛇咬伤是一种常见的疾病,多数需要住院治疗、抗蛇毒血清和后续治疗。急救人员需要熟悉当地的蛇咬伤管理方案,并拥有管理严重中毒的资源,包括获得抗蛇毒血清。向社区成员提供有关蛇咬伤的知识和教育,也可能改善结果并预防咬伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
78
审稿时长
85 days
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