Edit concept Question Editor Create issue ticket

Black Mamba Snake Bite

Black mambas are among the commonly found snakes in Tanzania and are considered highly venomous. They cause local and systemic effects and result in high morbidity and mortality. The diagnosis of black mamba snake bite is confirmed by the identification of the reptile and assessment of the clinical manifestations.


Presentation

The black mamba (Dendroaspis polylepis), which is one of the most predominant species of snakes in Tanzania, is classified as category 1 for its "highly venomous" activity by the World Health Organization [1] [2]. Additionally, this animal is among other species that frequently attack humans [3]. The envenomings have a severe morbidity and high mortality rates [4] [5]. This neglected tropical disease poses a significant public health risk in rural regions due to the prevalent number of snakes, inadequate health care, and the lack of antivenoms in these areas [4] [5] [6]. All of these factors contribute to poor prognosis.

The clinical presentation may include local and systemic involvement. The site of the snakebite is typically characterized by pain, warmth, bruising, hemorrhagic swelling, and necrosis [7]. Moreover, the snake venom may lead to toxicity of the cardiovascular, nervous, renal, muscular, and hematologic systems [7]. Features include nausea, trouble swallowing, epistaxis, hemoptysis, paresthesia, and syncope. Additionally, patients develop seizures and mental status changes such as delirium and possibly coma [7].

Complications

Serious outcomes include disseminated intravascular coagulopathy (DIC), renal failure, intracranial hemorrhage [7] as well as respiratory distress and shock.

If tissue necrosis occurs, this may lead to compartment syndrome and subsequent digit amputation [8] [9]. Furthermore, victims are at risk for long-term disability and disfigurement secondary to tissue necrosis [6]. Overall, snakebites inflict significant impact on the patient's daily quality of life [3].

Physical exam

The vital signs in acute episodes are likely to show evidence indicative of shock. With regards to the snakebite site, it is marked by pitting edema, possibly fang marks, local hematoma, necrosis, and petechiae. Additionally, systemic findings will reflect the affected organ(s)/system(s).

Disability
  • Furthermore, victims are at risk for long-term disability and disfigurement secondary to tissue necrosis. Overall, snakebites inflict significant impact on the patient's daily quality of life.[symptoma.com]
  • In addition to the 100,00 deaths every year, 400,000 surviving victims are left with permanent disabilities. But regarding Mr Friede's amateur work, she said: "Self-immunisation with snake venom is incredibly dangerous.[independent.co.uk]
  • An estimated one million snakebites occur every year worldwide, causing 100,000 deaths, three times as many amputations and permanent disabilities, according to the World Health organization (WHO).[newvision.co.ug]
  • Global snakebite deaths Lorenzo Savioli, a former director of the World Health Organisation’s department for the control of neglected tropical diseases, said: “Snakebites cause severe disability, bring misery to families and kill thousands of people.[theguardian.com]
  • But for Winnie Bore, a pharmacist at KNH, watching victims succumb to snakebites led her to become an activist and found Snakebite-Kenya a year ago to provide antivenom in rural areas, help rehabilitate victims disabled or visually impaired by such bites[nation.co.ke]
Shivering
  • Within a minute my body started shivering,” Hebbard continues. He did not really feel any pain, just an indescribable, unbelievable and uncontrollable shivering.[namibtimes.net]
  • These survival stories are shocking enough send a shiver down even the most seasoned herpetologist’s spine. 6. This terrifyingly relatable first-hand account of a rattlesnake bite Rattlesnake.[community.lovenature.com]
Anemia
  • Findings may include leukocytosis, thrombocytopenia, worsening anemia, azotemia, and hypoalbuminemia. Additionally, the test results may demonstrate low fibrinogen levels and other findings consistent with DIC. Proteinuria is also a feature.[symptoma.com]
Respiratory Distress
  • Complications Serious outcomes include disseminated intravascular coagulopathy (DIC), renal failure, intracranial hemorrhage as well as respiratory distress and shock.[symptoma.com]
  • In Sri Lanka and perhaps other areas, the venom of Russell’s viper has a strong neurotoxic component as well that causes the typical signs of facial muscle paralysis and respiratory distress.[reptilesmagazine.com]
Cough
  • Snake venom and blood pressure medicine October 13, 2012 A group of scientist has recently found that normal symptoms of Captopril (blood pressure medicine) such as coughing and swelling can be alleviated by small doses of snake venom.[blackmambas.net]
  • ., coughing, dyspnea, urticaria, itching, increased oral secretions, etc.) develop, immediately discontinue the administration of antivenom, and treat symptoms with Epinephrine, Steroids and Antihistamines.[toxicology.ucsd.edu]
Hemoptysis
  • Features include nausea, trouble swallowing, epistaxis, hemoptysis, paresthesia, and syncope. Additionally, patients develop seizures and mental status changes such as delirium and possibly coma.[symptoma.com]
Sighing
  • (sighs). It's time to do what I must do. Live stream [unintelligible]."[ibtimes.co.uk]
Dysphagia
  • At the time of arrival, he had no history of diplopia, dysphagia or bleeding. He was conscious, oriented and hemodynamically stable. There was swelling on his left shin.[apicareonline.com]
  • Respiratory paralysis or Dyspnea Excessive salivation (Oral secretions may become profuse and thick) Drowsiness Restlessness Sudden loss of consciousness Ptosis Ophthalmoplegia Paresthesias and Dysesthesias Palatal paralysis Glossopharyngeal paralysis or Dysphagia[toxicology.ucsd.edu]
  • Early neurological signs that indicate severe envenoming include metallic taste, drooping eyelids ( ptosis ) and gradual symptoms of bulbar palsy. [34] Other neurological symptoms include miosis, blurred or diminished vision, paresthesia, dysarthria, dysphagia[en.wikipedia.org]
Ptosis
  • The symptoms range from profuse sweating, salivation, ptosis, bulbar palsy to respiratory arrest and collapse. Early management of the victim can save his life. We present a case of black mamba bite who was brought to our hospital.[apicareonline.com]
  • Respiratory paralysis or Dyspnea Excessive salivation (Oral secretions may become profuse and thick) Drowsiness Restlessness Sudden loss of consciousness Ptosis Ophthalmoplegia Paresthesias and Dysesthesias Palatal paralysis Glossopharyngeal paralysis[toxicology.ucsd.edu]
  • The bite of both N. naja and N. kaouthia produces a mixture of neurotoxic and hemotoxic signs, starting as severe pain and rapidly spreading swelling and tissue damage, progressing within an hour or less to paralysis of the eyelids (ptosis), mouth area[reptilesmagazine.com]
  • […] often fatal before antivenom was widely available. [33] The venom is predominantly neurotoxic ; symptoms often become apparent within ten minutes. [19] Early neurological signs that indicate severe envenoming include metallic taste, drooping eyelids ( ptosis[en.wikipedia.org]
Red Eye
  • eyes. [33] The bite of a black mamba can cause collapse in humans within 45 minutes or less. [35] Without appropriate antivenom treatment, symptoms typically progress to respiratory failure, which leads to cardiovascular collapse and death. [19] This[en.wikipedia.org]
Diplopia
  • At the time of arrival, he had no history of diplopia, dysphagia or bleeding. He was conscious, oriented and hemodynamically stable. There was swelling on his left shin.[apicareonline.com]
Quickening
  • His breathing quickens, and his eyes started rolling, before his muscles appeared to become numb. east2west news A day before he live streamed his death, Valeev announced a special broadcast of his beloved snake, Mamba east2west news In the disturbing[thesun.co.uk]
  • His breath quickens as his eyes can be seen rolling and his muscles seem to go numb in the footage. ...[deccanchronicle.com]
  • His breath quickens and his bloodshot eyes start rolling as he shows his bleeding, almost paralysed hands. But he stands up and walks off the screen.[hindustantimes.com]
  • His breathing quickened and his eyes started rolling. He continued: "Pass on to Katya that I loved her very much," showing his bitten finger. He added: "Beautiful, isn't it? Oh, damn, how it... Bye to everyone...[ibtimes.co.uk]
  • Just in case – on my mobile there is a message for Katya…” His breathing quickens, and his eyes started rolling, before his muscles appeared to become numb.[nehandaradio.com]
Petechiae
  • With regards to the snakebite site, it is marked by pitting edema, possibly fang marks, local hematoma, necrosis, and petechiae. Additionally, systemic findings will reflect the affected organ(s)/system(s).[symptoma.com]
Epistaxis
  • Features include nausea, trouble swallowing, epistaxis, hemoptysis, paresthesia, and syncope. Additionally, patients develop seizures and mental status changes such as delirium and possibly coma.[symptoma.com]
  • Shock Hypotension Abdominal Pain (may be severe) Nausea and Vomiting Regional lymphadenopathy and Lymphadenalgia Fever Epistaxis Flushing of the face Warm skin Increased Sweating Pallor Nephrotoxicity: Acute Renal Failure has been reported in a few cases[toxicology.ucsd.edu]
Grieving
  • Home Videos News Grieving Man Lets Deadly Black Mamba Snake Bite Him So He Can Live Stream Suicide Recommended Videos 03:15 Solution for all your hair loss issues.[daily.bhaskar.com]
Paresthesia
  • Features include nausea, trouble swallowing, epistaxis, hemoptysis, paresthesia, and syncope. Additionally, patients develop seizures and mental status changes such as delirium and possibly coma.[symptoma.com]
  • Respiratory paralysis or Dyspnea Excessive salivation (Oral secretions may become profuse and thick) Drowsiness Restlessness Sudden loss of consciousness Ptosis Ophthalmoplegia Paresthesias and Dysesthesias Palatal paralysis Glossopharyngeal paralysis[toxicology.ucsd.edu]
  • […] within ten minutes. [19] Early neurological signs that indicate severe envenoming include metallic taste, drooping eyelids ( ptosis ) and gradual symptoms of bulbar palsy. [34] Other neurological symptoms include miosis, blurred or diminished vision, paresthesia[en.wikipedia.org]
Intracranial Hemorrhage
  • Complications Serious outcomes include disseminated intravascular coagulopathy (DIC), renal failure, intracranial hemorrhage as well as respiratory distress and shock.[symptoma.com]
Tremor
  • When bitten by this snake, know that they’re sixteen times more toxic than a cobra, and their bite can cause: Loss of nerve function Muscle paralysis (quick acting) Cramps, tremors and muscle spasms Paralysis Fatality rates without antivenin are 85%,[pestwiki.com]

Workup

One of the main components of the workup is the history, which should consist of details about how the attack occurred, timing of the bite, onset of manifestations such as pain, and details about the symptoms. Also important are the type and description of the snake (if known). Stable patients warrant a complete physical exam and a thorough assessment for signs of systemic effects. Acutely ill cases must be stabilized first. Note that the diagnosis is confirmed by identifying the snake and evaluating the resultant envenomation symptoms [10].

Laboratory tests

If possible, the clinician should obtain the patient's complete blood count (CBC), electrolyte panel, renal function tests, and coagulation studies including the international normalized ratio (INR) [11]. Further tests consist of an arterial blood gas (ABG), peripheral smear, blood type and cross-match, and a urinalysis.

Findings may include leukocytosis, thrombocytopenia, worsening anemia, azotemia, and hypoalbuminemia [12]. Additionally, the test results may demonstrate low fibrinogen levels and other findings consistent with DIC [7] [12]. Proteinuria is also a feature [7].

Imaging

Individuals with respiratory distress should have a chest X-ray performed. Additionally, a radiograph of the affected body part is needed to assess the possible presence of a fang.

Other

Compartmental pressures should be measured as well.

Treatment

  • “If it wasn’t for the right treatment I don’t know what would have happened,” he said. Once the anti-venom is injected, the treatment works quickly and effectively. Hebbard was allowed to go home after spending one night in hospital for observation.[namibtimes.net]
  • INTRODUCTION Black mamba (Dendroaspis polylepis) is one of the fastest and deadliest snakes on land, having a maximum speed of 12 miles/hour and 100% mortality without treatment.[apicareonline.com]
  • He received immediate treatment and was rushed to a hospital in Nairobi for further treatment. Doctors ascribed his survival to his physical fitness. References 1. Richardson, A. Mambas (2004) 2. Chippaux.[blackmambas.net]
  • "She recalls nothing of what transpired during the first few hours of the treatment," said McEwan.[news24.com]
  • Some patients react against anti-venom and may go into anaphylactic shock, a serious condition that requires emergency medical treatment.[southerndrakensbergtourism.co.za]

Prognosis

  • All of these factors contribute to poor prognosis. The clinical presentation may include local and systemic involvement. The site of the snakebite is typically characterized by pain, warmth, bruising, hemorrhagic swelling, and necrosis.[symptoma.com]
  • Inaccessibility to the health centers and inadequate anti-venom specialists and drugs in health facilities also predispose victims to poor prognosis after the bite.[hivisasa.com]
  • Snakebite Prognosis and Outcomes Although the vast majority of victims bitten by venomous snakes in the United States do very well, predicting the prognosis in any individual case can be difficult.[emedicinehealth.com]
  • Outlook Although the vast majority of victims bitten by venomous snakes in the United States do very well, predicting the prognosis in any individual case can be difficult.[webmd.com]
  • Despite the hospital physicians having declared it a "moderate" envenomation, Pienaar lapsed into a coma at one point and his prognosis was declared "poor".[en.wikipedia.org]

Epidemiology

  • There are no clear facts and figures concerning the prevalence of snake bites in the country, probably because little efforts are being put on epidemiologic studies.[hivisasa.com]
Sex distribution
Age distribution

Prevention

  • By preventing the flow of charged atoms through these channels, the mambalgins stop pain signal This article is only available to Science News subscribers. Already a subscriber? Log in now. Or subscribe today for full access.[sciencenews.org]
  • Preventing Snakebites The snake is almost always more scared of the human, than the human is of the snake, it is assumed because giving the snake the opportunity to escape prevents most bites.[emedicinehealth.com]
  • Continued Prevention The snake is almost always more scared of you than you are of the snake. Giving the snake the opportunity to escape prevents most bites. Do not attempt to handle, capture, or tease venomous snakes or snakes of unknown identity.[webmd.com]
  • Crew aboard the West African vessel managed to put the snake in a box before contacting the Scottish Society for the Prevention of Cruelty to Animals to take it away.[express.co.uk]
  • On that occasion, Coffee had taken her to the local hospital to have her eyes flushed and treated to prevent blindness after the snake spat venom into her eyes. Hazell came face-to-face with a Black Mamba days later.[news24.com]

References

Article

  1. World Health Organization. Guidelines for the production, control and regulation of snake antivenom immunoglobulins. Geneva: World Health Organization. http://www.who.int/biologicals/expert_committee/Antivenom_WHO_Guidelines_DJW_DEB_mn_cp.pdf?ua=1. Published May 2010. Accessed June 13, 2017.
  2. World Health Organization. Guidelines for the prevention and clinical management of snakebite in Africa. http://www.afro.who.int/ http://www.afro.who.int/en/divisions-a-programmes/ dsd/essential-medicines/highlights.html. Published August 2010. Accessed June 13, 2017.
  3. Habib GA. Public health aspects of snakebite care in West Africa: perspectives from Nigeria. J Venom Anim Toxins Incl Trop Dis. 2013;19(1):27.
  4. Gutiérrez JM, Warrell DA, Williams DJ, Jensen S, Brown N, Calvete JJ, et al. The need for full integration of snakebite envenoming within a global strategy to combat the neglected tropical diseases: the way forward. PLoS Negl Trop Dis. 2013;7(6):e2162.
  5. World Health Organization. Rabies and envenomings: a neglected public health issue. http://apps.who.int/iris/bitstream/10665/43858/1/9789241563482_eng.pdf. Published January 2007. Accessed June 13, 2017.
  6. Kasturiratne A, Wickremasinghe AR, Silva DE, Gunawardena NK, Pathmeswaran A. Estimating the global burden of snakebite: a literature analysis. PLoS Med. 2008;5(11):e218.
  7. Elbey B, Baykal B, Yazgan ÜC, Zengin Y. The prognostic value of the neutrophil/lymphocyte ratio in patients with snake bites for clinical outcomes and complications. Saudi J Biol Sci.. 2017;24(2):362-366.
  8. Bentur Y, Cahana A. Unusual local complications of Vipera palaestinae bite. Toxicon. 2003;41(5):633-635.
  9. Michelarakis J, Varouhaki C. Osteomyelitis of the calcaneus due to atypical mycobacterium. Foot Ankle Surg. 2009;15(2):106–108.
  10. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med. 2002;347(5):347–56.
  11. Hifumi T, Sakai A, Kondo Y, et al. Venomous snake bites: clinical diagnosis and treatment. J Intensive Care. 2015;3(1):16.
  12. Spiller HA, Bosse G.M. Prospective study of morbidity associated with snakebite envenomation. J Toxicol Clin Toxicol. 2003;41(2):125-130.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 10:39