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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).

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]
Respiratory Distress
  • Complications Serious outcomes include disseminated intravascular coagulopathy (DIC), renal failure, intracranial hemorrhage as well as respiratory distress and shock.[symptoma.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]
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]
Swelling
  • The site of the snakebite is typically characterized by pain, warmth, bruising, hemorrhagic swelling, and necrosis. Moreover, the snake venom may lead to toxicity of the cardiovascular, nervous, renal, muscular, and hematologic systems.[symptoma.com]
Nausea
  • 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]
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]
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]
Intracranial Hemorrhage
  • Complications Serious outcomes include disseminated intravascular coagulopathy (DIC), renal failure, intracranial hemorrhage as well as respiratory distress and shock.[symptoma.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]
Seizure
  • Additionally, patients develop seizures and mental status changes such as delirium and possibly coma.[symptoma.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.

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]

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.

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Last updated: 2018-06-22 00:35