Presentation Abstract

Session: Clinical Tropical Medicine I
Abstract Number: 692
Title: Use of clinical predictors and molecular diagnosis to identify the species responsible for snakebite in rural Nepal
Presentation Start: 11/4/2014 8:00:00 AM
Presentation End: 11/4/2014 8:15:00 AM
Authors: Sanjib K. Sharma1, Ulrich Kuch2, Patrick Höde2, Laura Bruhse2, Deb Pandey2, François Chappuis3, Emilie Alirol3
1B.P. Koirala Institute of Health Sciences, Dharan, Nepal, 2Forschungszentrum Biodiversität und Klima (Bio+C), Frankfurt am Main, Germany, 3Geneva University Hospital, Geneva, Switzerland
Abstract: Snakebite is an important medical emergency in rural Nepal. Correct identification of the biting species is crucial for clinicians to choose appropriate treatment and anticipate complications. This is particularly important for neurotoxic envenomation which, depending on the responsible species, may not respond to antivenoms. Adequate species identification tools are lacking. This study used a combination of morphological and molecular approaches (PCR-aided DNA sequencing from swabs of bite sites) to determine the relative contribution of venomous and non-venomous species to the snakebite burden in southern Nepal. The study also investigated the performance of baseline patient history and clinical characteristics to distinguish between cobra (Naja spp.) and krait (Bungarus spp.) bites. Out of 749 patients admitted to one of the 3 study centres with a history of snakebite, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous species, most commonly Naja naja (n=42) and Bungarus caeruleus (n= 22). When both morphological identification and PCR/sequencing results were available, a 100% agreement was noted. Among patients bitten by venomous snakes, 71 (81.6%) presented with signs of envenomation including neurotoxic signs in 55 (77.4%). Being bitten at night (OR= ∞), while sleeping (OR= 56 [95%CI= 9.9-318.2]), indoors (OR= 9.4 [95% CI= 1.9-46.9]), and presenting with abdominal pain (OR= 23.4 [95% CI=3.8-142.5]) was associated with krait bite, and local signs of envenomation (e.g., edema) with bites by cobras and pit vipers. This study is the first to report the use of forensic genetics methods for snake species identification in a prospective clinical study, and to identify epidemiological and clinical features associated with krait and cobra envenomation in Nepal, thereby providing decisive guidance to improve patient care.




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