Snakebites worldwide: Clinical manifestations and diagnosis
- Julian White, AM, MB, BS, MD, FACTM
Julian White, AM, MB, BS, MD, FACTM
- The University of Adelaide
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Snakebites account for significant morbidity and mortality worldwide, especially in South and Southeast Asia, sub-Saharan Africa, and Latin America . Venomous snakes are widely distributed around the world and clinical effects from envenomation can overlap to a great degree even among different classes of snakes. This topic will discuss the clinical manifestations and diagnosis of snakebite worldwide.
The principles of management of snakebites within the United States are discussed separately. (See "Evaluation and management of Crotalinae (rattlesnake, water moccasin [cottonmouth], or copperhead) bites in the United States" and "Evaluation and management of coral snakebites".)
Although common names are used to describe snakes throughout this topic, the genus and species that correlate with the common names can be found in the following tables for Africa (table 1), Asia (table 2), Central and South America (table 3), Australia and the Pacific Islands (table 4), Europe (table 5), and the Middle East (table 6) and at the following website: WHO snake and antivenom database.
Up to 5 million venomous snakebites occur worldwide each year and result in at least 100,000 to 125,000 annual deaths and 400,000 amputations [1-4]. Because most venomous snakebites occur in developing countries with poorly developed health reporting systems and because many deaths occur before medical care can be provided, these numbers likely reflect underestimates . Regions with the highest incidence of venomous snakebites and snakebite deaths include Southeast and South Asia (eg, India, Pakistan, Sri Lanka, and Bangladesh), sub-Saharan Africa, and Latin America (figure 1) [1,2,6,7]. In an effort to draw attention to the problem of venomous snakebites worldwide and to spur strategies that improve outcomes, the World Health Organization has designated snakebite as a neglected tropical disease [8,9]. The best strategy to increase the production of existing antivenoms is under debate .
Snakebites disproportionately affect poorer populations in rural areas. Two common patterns are described [1,7,10]:
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- GEOGRAPHIC DISTRIBUTION AND CHARACTERISTICS
- VENOM PROPERTIES
- Composition and sites of action
- CLINICAL MANIFESTATIONS
- Physical examination
- - Wound site
- - Systemic findings
- Tissue and muscle toxicity
- Ancillary studies
- - Coagulopathy
- - Rhabdomyolysis
- - Neurotoxicity
- Trial of anticholinesterase (neostigmine or edrophonium)
- - Shock
- - Venom identification
- DIFFERENTIAL DIAGNOSIS
- ADDITIONAL RESOURCES