Snake Bite

Discussion

Venomous Snakes are distributed throughout warm continents. Elapidae (krait, cobra) and Viperidae (saw scaled viper, echis craniates and russel viper) are common poisonous snakes found in this region. Snake bite is a neglected problem of rural tropics, its incidence is usually underestimated because of lack of epidemiological data. During last few years more than thousand people have died of snake bite each year in Maharashtra state only.

Victims of viper bite usually report in early hours of day because this accident usually occurs while farmers or farm laborers are busy in planting or harvesting paddy during early hours of day. Viper bites usually toes or fingers while krait is nocturnal in habit and usually found around houses and moves during night for prey (usually rodents). Thus kraits usually bite a person asleep on ground. Krait has a very sharp fine fangs and it injects lethal venom of small molecular size, can easily reach by lymphatic into circulation and neuromuscular junction than viper venom which is large molecular size. Krait bite does not cause any local pain or swelling. Thus number of time neuroparalysed victim do not give history of snake bite.

Present situation
Indian Krait bungarus ceruleus venom contains a neurotoxin. Neurotoxic venoms differ in their sites of action and the avidity with which they are found. Krait venom contains both post synaptic neurotoxins and toxic phospholipids A2 acting presynaptically. In the neuromuscular blocking activity of postsynaptic Krait neurotoxin is less reversible than that of cobra neurotoxin. The presynaptic blockage produced by krait B bungarotoxin is completely resistant to anticholinesterse. Neuroparalysis in four fatal victims irrespective of maximum neostigmine could not be reversed. Clinical impression of anticholinesterase therapy have been both favorable and unfavorable, while in situations like nonavailability of antivenin or ineffective in a particular patient. Another approach would be to attempt the protection of high risk group by immunization with venom toxoid.

Maximum victims in this region are of saw scaled viper. High mortality reported in early monsoon due to potent output of venom. Besides the phosphates and amino acids esterase, haemorrhagin a typical component of viper venom, it acts by directly disrupting the endothelial lining and by inhibition of platelet aggregation, also by release of certain auto pharmacological mediators such as histamine and 5 HT. Viper venom caused marked tissue changes and destruction hyaluronidase enzyme is obviously related to the edema, swelling and absorption of the toxin. Anuria could be due to nephrotoxic action of venom or blockage of tubules due to hemoglobin. Mouth of snake contains anaerobic bacteria which contaminates wound and is responsible for cellulitis.

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