Documentation of a proven Mountain Pitviper ( Ovophis monticola ) envenomation in Kathmandu, Nepal, with its distribution ranges: implications for prevention and control of pitviper bites in Asia

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Abstract

We document inadequately diagnosed coagulopathy (potential to be life threatening) due to Ovophis monticola bite. Although its bites are common in the hills of Nepal, associated envenomations have not been documented elaborately. Herein, we present the clinical and treatment details of a proven O. monticola bite and areas where it may pose the risk of envenomations (suggesting huge populations in Asia to be vulnerable to its bites). Its envenomation was managed symptomatically with several non-evidence-based interventions. Since no specific pitviper antivenom is available in Nepal yet, managing coagulopathy associated to O. monticola envenomation is still challenging. This case emphasizes the need of developing the standard protocol for the diagnosis and management of pitviper bites and study of effectiveness of the available pitviper antivenoms until specific pitviper antivenom is available. Further, the demonstrated distribution localities of this species may have implications for snakebite prevention and designing and distribution of the effective antivenoms.

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Most cited references 42

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Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite

Kalana Maduwage, Geoffrey K. Isbister (2014)

Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients.

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Frequent and potentially fatal envenoming by hump-nosed pit vipers (Hypnale hypnale and H. nepa) in Sri Lanka: lack of effective antivenom.

D Warrell, R. Theakston, Senanayake Kularatne … (2008)

In a prospective study of snake bites involving 10 hospitals in Sri Lanka, 302 (35%) of 860 patients with bites by identified snakes proved to have been bitten by hump-nosed pit vipers (301 by Hypnale hypnale and 1 by H. nepa). Most victims were males aged between 11 years and 50 years who had been bitten on their feet or ankles while walking at night close to their homes. There was local swelling in 276 (91%) and local necrosis in 48 (16%). Eleven (4%) required amputation of fingers or toes and 12 (4%) received skin grafts. In 117 patients (39%) blood incoagulability was first detected between 15 min and 48 h after the bite, and in 116 of them this was present on admission to hospital. Spontaneous systemic bleeding was observed in 55 patients (18%). Acute renal failure developed in 10%, five of whom died to give an overall case fatality rate of 1.7%. Thus, bites by hump-nosed pit vipers can cause debilitating local and fatal systemic envenoming. In Sri Lanka and southwestern India where bites by these snakes are common, the only available antivenoms (raised against cobra, krait, Russell's viper and saw-scaled viper venoms) are ineffective and carry a high risk of reactions.

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Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

Deb Prasad Pandey, Gita Subedi Pandey, Kamal Devkota … (2016)

Background Venomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. Attempting to kill snakes increases the risk of snakebite, and actual killing of snakes contributes to loss of biodiversity. Currently, snake populations in southern Nepal are thought to be declining, but more research is needed to evaluate the conservation status of snakes. Therefore, we assessed attitudes, knowledge, and awareness of snakes and snakebite by Chitwan National Park’s (CNP) buffer zone (BZ) inhabitants in an effort to better understand challenges to snake conservation and snakebite management. The results of this study have the potential to promote biodiversity conservation and increase human health in southern Nepal and beyond. Methods We carried out face-to-face interviews of 150 randomly selected CNP BZ inhabitants, adopting a cross-sectional mixed research design and structured and semi-structured questionnaires from January–February 2013. Results Results indicated that 43 % of respondents disliked snakes, 49 % would exterminate all venomous snakes, and 86 % feared snakes. Farmers were the most negative and teachers were the most ambivalent towards snakes. Respondents were generally unable to identify different snake species, and were almost completely unaware of the need of conserve snakes and how to prevent snakebites. Belief in a snake god, and the ability of snakes to absorb poisonous gases from the atmosphere were among many superstitions that appeared to predispose negativity towards snakes of BZ residents. Conclusion People with predisposed negativity towards snakes were not proponents of snake conservation. Fear, negativity, ambivalence towards, and ignorance about, snakes and the need for snake conservation were strong indicators of the propensity to harm or kill snakes. It seems that if wanton killing of snakes continues, local snake populations will decline, and rare and endangered snake species may even become locally extirpated. Moreover, inappropriate perception and knowledge about snakes and snakebites may put BZ people at increased risk of venomous snakebite. Therefore, intensive, pragmatic educational efforts focused on natural history and ecology of snakes and prevention of snakebite should be undertaken in communities and at schools and universities.

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Author and article information

Journal

Journal ID (nlm-ta): J Venom Res

Journal ID (iso-abbrev): J Venom Res

Journal ID (publisher-id): jvr

Title: Journal of Venom Research

Publisher: Library Publishing Media

ISSN (Electronic): 2044-0324

Publication date Collection: 2021

Publication date (Electronic): 06 January 2021

Volume: 11

Pages: 1-6

Affiliations

[1] ¹School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia

[2] ²Department of Veterinary Microbiology and Parasitology, Agriculture and Forestry University, Rampur, Chitwan, Nepal

[3] ³Institute for Social and Environmental Research, Fulbari, Chitwan, Nepal

[4] ⁴Department of Zoology, Birendra Multiple Campus, Tribhuvan University, Bharatpur, Chitwan, Nepal

[5] ⁵National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal, (current address: Karnali Academy Of Health Sciences, Nepal)

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*Correspondence to: Deb Prasad Pandey, Email: debpandey@ 123456gmail.com , Tel: +977 984 5055137

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PMC ID: 7970453

PubMed ID: 33747433

SO-VID: 1540a974-2d62-433d-b785-f145a5d203cf

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This is an open access article, published under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0). This license permits non-commercial use, distribution and reproduction of this article, provided the original work is appropriately acknowledged, with correct citation details.

Documentation of a proven Mountain Pitviper ( Ovophis monticola) envenomation in Kathmandu, Nepal, with its distribution ranges: implications for prevention and control of pitviper bites in Asia

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Most cited references 42

Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite

Frequent and potentially fatal envenoming by hump-nosed pit vipers (Hypnale hypnale and H. nepa) in Sri Lanka: lack of effective antivenom.

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

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