Snake bite management in a toddler: a case report in Sumbawa Besar

  • Ferry Liwang Manambai Abdulkadir Hospital, Sumbawa Besar, West Nusa Tenggara
  • Fitria Nuraeni Manambai Abdulkadir Hospital, Sumbawa Besar, West Nusa Tenggara
  • Mulya R. Karyanti Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Keywords: snake bite, toddler, antivenom, Indonesia

Abstract

Snake bite is an often-neglected,1 life-threatening emergency prevalent in rural areas of tropical countries such as Indonesia.2 The WHO reported a worldwide incidence of 5 million snake bites per year, with 100,000–200,000 deaths.3 The incidence rate and likelihood of subsequent complications are higher in children than adults.4 According to the WHO, 35% of child deaths related to poisonous animal bites are attributable to snake bites and occur more frequently in boys than girls.5 In Indonesia, no national epidemiological data on snake bites in children is available, but the WHO estimated that 5–8 snake bite cases occur weekly in Lombok, West Nusa Tenggara.6

Lower limbs are the most common site for bites (72%), while facial bites are quite rare (10%).7 Bites involving children and/or the face are considered as severe envenomation and usually require antivenom at an appropriate dose and timing to be effective.8 Therefore, it is important that hospitals are equipped with life-saving intervention measures to optimize care and improve the chances of survival.9 Nevertheless, in developing countries, the use of antivenom is limited by the absence of standardized guidelines, scarcity/unavailability, and high cost.9 In Indonesia, the only antivenom, serum antibisa ular (SABU), is costly and difficult to obtain due to limited quantities, especially in rural areas. Furthermore, SABU is a polyvalent antivenom with low coverage, as it is only indicated for Naja sputatrix, Bungarus fasciatus, and Agkistrodon rhodostoma, despite the numerous other snake species endemic to Indonesia.2

References

1. Sminkey L. World report on child injury prevention. Inj Prev. 2008;14:69. DOI: 10.1136/ip.2007.018143.
2. Warrel DA. Snake bite. Lancet. 2010;375:77–88. DOI: 10.1016/S0140-6736(09)61754-2.
3. World Health Organization. World report on child injury prevention. 1st ed. Geneva: World Health Organization; 2008. p. 123–38.
4. Niasari N, Latief A. Gigitan ular berbisa. Sari Pediatri. 2003;5:92–8. DOI: 10.14238/sp5.3.2003.92-8
5. Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ. 1998;76:515–24. Available from: https://apps.who.int/iris/handle/10665/56029.
6. WHO Guidelines for the management of snakebites. 2nd ed. Geneva: World Health Organization; 2016. p. 75–104.
7. Cavazos MEDO, Garza CT, Guajardo-Rodríguez G, Hernández-Montelongo BA, Montes-Tapia FF. Snake bites in pediatric patients, a current view. In: Özdemir Ö, editor. Complementary pediatrics. 1st ed. Croatia: Intech; 2012. p. 123–36.
8. Habib AG. Public health aspects of snakebite care in West Africa: perspectives from Nigeria. J Venom Anim Toxins Incl Trop Dis. 2013;19:27. DOI: 10.1186/1678-9199-19-27
9. Ahmed SM, Ahmed M, Nadeem A, Mahajan J, Choudhary A, Pal J. Emergency treatment of a snake bite: pearls from literature. J Emerg Trauma Shock. 2008;1:97–105. DOI: 10.4103/0974-2700.43190
10. Silva A, Marikar F, Murugananthan A, Agampodi S. Awareness and perceptions on prevention, first aid and treatment of snakebites among Sri Lankan farmers: a knowledge practice mismatch? J Occup Med Toxicol. 2014;9:20. DOI: 10.1186/1745-6673-9-20
11. Adiwinata R, Nelwan EJ. Snakebite in Indonesia. Acta Med Indones. 2015;47(4):358–65. Available from: http://www.actamedindones.org/index.php/ijim/article/view/30/28
12. Chippaux JP, Rage-Andrieux V, Le Mener-Delore V, Charrondiere M, Sagot P, Lang J. Epidemiology of snake envenomations in northern Cameroon. Bull Soc Pathol Exot. 2002;95:184–7. PMID: 12404867
13. Kreisfeld R, Winkel KD, Harrison J. Hospitalisations due to animal and plant injury in Australia 2000/01–2001/2. 1st ed. Canberra: Research Centre for Injury Studies, Australian Institute of Health and Welfare; 2007. p. 123–42.
14. Micheal GC, Aliyu I, Grema BA. Viper bite on the neck following a fight. Sudan Med Monit. 2015;10:133–6. DOI: 10.4103/1858-5000.171865
15. Fatima LD, Fatah C. Pathophysiological and pharmacological effects of snake venom components: molecular targets. J Clin Toxicol. 2014;4:1–9. DOI: 10.4172/2161-0495.190
16. Juckett G, Hancox JG. Venomous snakebites in the United States: management review and update. Am Fam Physician. 2002;65:1367–74. PMID: 11996419
17. Ledsgaard L, Jenkins TP, Davidsen K, Krause KE, Martos-Esteban, Engmark M, et al. Antibody cross-reactivity in antivenom research. Toxins. 2018;10:393. DOI: 10.3390/toxins10100393.
18. World Health Organization. Snakebite envenoming. [Internet]. [cited 2019 December 07] Available from: https://www.who.int/snakebites/treatment/en/.
19. Wangoda R, Warmon B, Kisige M. Snakebite management: experiences from Gulu Regional Hospital Uganda. East Cent Afr J Surg. 2004;9:82–6. Available from: https://www.ajol.info/index.php/ecajs/article/view/137289.
Published
2021-07-29
How to Cite
1.
Liwang F, Nuraeni F, Karyanti M. Snake bite management in a toddler: a case report in Sumbawa Besar. PI [Internet]. 29Jul.2021 [cited 29Mar.2024];61(4):171-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2352
Section
Case Report
Received 2019-12-07
Accepted 2021-07-29
Published 2021-07-29