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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 100-101

Neglected snakebite injury and harmful practices in rural settings: A report of an 8-year-old child from Nigeria


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Federal Medical Centre, Birnin Kudu, Nigeria
4 Department of Paediatrics, University of Maiduguri; Federal Medical Centre, Makurdi, Nigeria

Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_67_18

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  Abstract 


Snakebite is prevalent in some communities in Nigeria. Unfortunately, some patients still find it difficult to readily assess health care, resulting in late presentation, whereas others will prefer to use traditional remedies, only seeking orthodox care late after experiencing failure of traditional remedies; this accounts for significant increase in cases of complications and mortalities witnessed. Therefore, the case of an 8-year-old boy who had carpet viper bite on the right hand that developed gangrene due to late presentation is highlighted.

Keywords: Carpet viper, gangrene, hand, snakebite


How to cite this article:
Aliyu I, Michael GC, Ibrahim HU, Idris U, Akuhwa RT. Neglected snakebite injury and harmful practices in rural settings: A report of an 8-year-old child from Nigeria. Libyan J Med Sci 2019;3:100-1

How to cite this URL:
Aliyu I, Michael GC, Ibrahim HU, Idris U, Akuhwa RT. Neglected snakebite injury and harmful practices in rural settings: A report of an 8-year-old child from Nigeria. Libyan J Med Sci [serial online] 2019 [cited 2019 Nov 13];3:100-1. Available from: http://www.ljmsonline.com/text.asp?2019/3/3/100/269230




  Introduction Top


Snakebites occur worldwide, especially in rural agrarian communities where farming activity bring humans and snakes closer to each other. A study by Pugh and Theakston [1] in the Savannah region of Northern Nigeria reported the annual incidence of snakebites of 497/100,000 with a mortality of 12.2%. Four main venomous families are found in Nigeria such as Elapidae, Viperidae, Colubridae, and Actraspididae; however, the carpet viper belonging to the Viperidae accounts for most bites (accounting for 66% of cases, especially in the northern part of Nigeria).[2],[3],[4] Prehospital practices are common in most settings such as the use of tourniquet and black stone, herbal remedies applied topically and/or ingested, and incisions,[5],[6] but these measures may result in late hospital presentation resulting in complications or death. Here, the case of an 8-year-old boy who had carpet viper bite on the right hand presenting late with extensive tissue necrosis and gangrene has been reported.


  Case Report Top


An 8-year-old Fulani boy was bitten by a snake on the right hand while gathering shrubs; this he reported to his elder brother who was close by. The snake was looked for and killed, and traditional remedies such as herbs with tourniquet were applied at the bite site. Few hours afterward, the hand became painful and had gotten swollen which progressively extended to the right forearm with bleeding from the bite site. The patient presented to the hospital 48 h later when they noticed progression of the swelling, more bleeding, and weakness. He did not receive antivenom at the referring health facility. On examination, there was edema and gangrene of the right hand and forearm [Figure 1], possibly due to compartment syndrome in addition to tissue necrosis from the venom. There was significant bleeding from the bite and puncture sites, and he was pale and hypotensive. He was resuscitated with intravenous fluid (normal saline) and had two 20 ml/kg units of fresh whole blood on two occasions; the pretransfusion packed cell volume was 18%, whereas posttransfusion packed cell volume was 24%. He had prolonged bleeding time which normalized by the 2nd day of admission. The bleeding stopped afterward. The parents came with the killed snake which was a carpet viper Echis ocellatus. He received antitetanus serum, antibiotics, and antivenom and was scheduled for amputation at our center, which they declined and left against medical advice.
Figure 1: Gangrenous right hand following snakebite

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  Discussion Top


Snakebites are more common in males than females; this occurs mostly at farms and bushes, as was noted in the index case. The limbs are the most common bite site, whereas the feet are more commonly affected than the hands.[7] The spitting cobra bite presents with local tissue reaction, with occasional bleeding from the site of bite, and neurotoxicity which is witnessed especially among Egyptian cobras,[8] whereas carpet viper venom causes mainly bleeding, hypotension/shock, and extensive local tissue necrosis; however, cardiotoxicity and renal failure may occur.[9] Our patient presented mainly with local tissue reaction with bleeding from the local site and hemorrhagic shock. Snakebite envenomation should be considered as an emergency in children because of their relatively small size; therefore, the fatality may be more, hence the need for early presentation and management in the hospital. However, the practice of prehospital care such as the use of traditional remedies often results in delayed presentation as was witnessed in the index case and heightens the risk of complications, disability, prolonged hospital stay, and death.[10],[11] Despite efforts at ensuring that antivenom is readily available, most patients still travel long distance to seek medical care, as was experienced in the index case. This is a common experience in rural settings where most bites occur. Therefore, health-care providers have an important role to play in curtailing this menace, by educating the populace on the importance of snakebite, preventive measures, early hospital presentation following bite, and avoidance of harmful treatment practices while ensuring that antivenom is readily available at the most required places at affordable or possibly at no cost to the populace.[12] Antivenom is the key to successful management of snakebite; it works best when given early in the course of illness because it binds to free toxins and neutralizes them; however, the common scenario that plays out in most rural settings is late presentation because patients often seek medical care late and often travel a long distance to reach the required medical facility. Therefore, at this point, severe complications would have set in; however, some researchers have reported clinical improvement of compartment syndrome [13],[14] in cases of late administration of antivenom, which this index case could had benefitted from.


  Conclusion Top


Snakebite is still a huge health burden in some rural Nigerian settings; while efforts should be made at decreasing this menace, antivenom should be readily available to those localities with high disease burden and late patient presentation should not preclude its use. Traditional harmful practices should be actively discouraged through community enlightenment programs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pugh RN, Theakston RD. Incidence and mortality on snake bite in Savanna Nigeria. Lancet 1980;2:1181-3.  Back to cited text no. 1
    
2.
Pugh RN, Theakston RD, Reid HA. Malumfashi endemic diseases research project, XIII. Epidemiology of human encounters with the spitting cobra, Naja nigricollis, in the Malumfashi area of Northern Nigeria. Ann Trop Med Parasitol 1980;74:523-30.  Back to cited text no. 2
    
3.
Habib AG, Gebi UI, Onyemelukwe GC. Snake bite in Nigeria. Afr J Med Med Sci 2001;30:171-8.  Back to cited text no. 3
    
4.
Habib AG. Tropical snake bite in Northern Nigeria: A clinical review. Niger Med Pract 1992;23:3-8.  Back to cited text no. 4
    
5.
Fadare JO, Afolabi OA. Management of snake bite in resource-challenged setting: A review of 18 months experience in a Nigerian hospital. J Clin Med Res 2012;4:39-43.  Back to cited text no. 5
    
6.
Michael GC, Thacher TD, Shehu MI. The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans R Soc Trop Med Hyg 2011;105:95-101.  Back to cited text no. 6
    
7.
7. Omogbai EK, Nworgu ZA, Imhafidon MA, Ikpeme AA, Ojo DO, Nwako CN. Snake bites in Nigeria: A study of the prevalence and treatment in Benin city. Trop J Pharm Res 2002;1:39-44.  Back to cited text no. 7
    
8.
Al Harbi N. Epidemiological and clinical differences of snake bites among children and adults in South Western Saudi Arabia. J Accid Emerg Med 1999;16:428-30.  Back to cited text no. 8
    
9.
Potet J, Smith J, McIver L. Reviewing evidence of the clinical effectiveness of commercially available antivenoms in Sub-Saharan Africa identifies the need for a multi-centre, multi-antivenom clinical trial. PLoS Negl Trop Dis 2019;13:e0007551.  Back to cited text no. 9
    
10.
Ademola-Majekodunmi FO, Oyediran FO, Abubakar SB. Incidence of snakebites in Kaltungo, Gombe state and the efficacy of a new highly purified monovalent antivenom in treating snakebite patients from January 2009 to December 2010. Bull Soc Pathol Exot 2012;105:175-8.  Back to cited text no. 10
    
11.
Njoku CH, Isezuo SA, Makusidi MA. An audit of snake bite injuries seen at the Usmanu Danfodiyo university teaching hospital Sokoto, Nigeria. Niger Postgrad Med J 2008;15:112-5.  Back to cited text no. 11
    
12.
Hamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, Warrell DA, et al. Cost-effectiveness of antivenoms for snakebite envenoming in 16 countries in West Africa. PLoS Negl Trop Dis 2016;10:e0004568.  Back to cited text no. 12
    
13.
Rosen PB, Leiva JI, Ross CP. Delayed antivenom treatment for a patient after envenomation by Crotalus atrox. Ann Emerg Med 2000;35:86-8.  Back to cited text no. 13
    
14.
Gold BS, Barish RA, Dart RC, Silverman RP, Bochicchio GV. Resolution of compartment syndrome after rattlesnake envenomation utilizing non-invasive measures. J Emerg Med 2003;24:285-8.  Back to cited text no. 14
    


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