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SNAKE BITES
 Distribution & Classification of Venomous Snake
 Anatomy of Venomous Snake
 Epidemiology of Snakebite
 Clinical Manifestation of Snakebite
 Diagnosis
 Treatment
 Prevention
OBJECTIVES
DISTRIBUTION OF VENOMOUS SNAKE
Reprinted from Wikimedia Commons, 20091
 Viperidae
 Russell’s viper
 Saw-scaled viper (Echis
carinatus)
 Elapidae
 Naja Naja Cobra
 Common Krait
 Hydrophidae (Sea
snake)
 Colubridae
 Atractaspididae
CLASSIFICATION OF VENOMOUS SNAKE
Cobra
Russell's viper
Sea Snake
Reprinted from Wikimedia Commons2 Reprinted from Wikimedia Commons,
20083
Reprinted from Wikimedia Commons, 20134
ANATOMY OF VENOMOUS SNAKE
Proteroglypha
Solenoglypha
Reprinted from Wikimedia Commons, 20085
Opisthoglypha
Reprinted from Wikimedia Commons, 20086
Reprinted from Wikimedia Commons, 20087
Reprinted from Biology Forums, 20129
ANATOMY
Venom Composition
Venom Enzyme
Venom polypeptide
toxins (neurotoxins)
Zinc
metalloproteinase
haemorrhagins
Procoagula
nt enzyme
Phospholipas
e A2
(lecithinasae)
Acetylcholine
sterase
Hyaluronida
se
Non-toxic
protein
EPIDEMIOLOGY OF SNAKEBITE
Reprinted from Wikimedia Commons,
20099
RISK FACTORS
Characteristics Details
Age 10 – 40 years old
Gender 2:1 male to female ratio
Target Farmers, plantation
workers, herders, and
fishermen
Time of Bite Diurnal: Viper and Copra
Nocturnal: Krait
Site of Bite 60%-80% on foot, legs or
ankles. Head and trunk
(while sleeping)
Transmission Time
Reprinted from PMC, 201510
 Physical observation
(bite marks)
 Misidentify snake
species  Ineffective
antivenom
 Blood clotting test
 ELISA test
DIAGNOSIS
Puncture of snake bites
Reprinted from Wikimedia Commons,189512
CLINICAL MANIFESTATION OF
SNAKEBITE
Reprinted from Wikimedia Commons,
 Paralysis
 Necrosis
 Hemostatic Abnormalities
 Renal Failure
 Fatal
COMPLICATIONS
TREATMENT
First Aid
Traditional First Aid
• Keep the victim calm.
• Call for emergency
• Remove jewelry and tight
clothing
• Position the victim, so the bite
is at or below the victim’s
heart level
• Clean the bite, don’t flush it
with water
• Cover the bite with dry, clean
dressing
Reprinted from PMC, 201013
Antivenom
 Albert Calmette (1890s)
 Monovalent
 Polyvalent
 Adverse effects:
 Anaphylactoid (10-180 mins)
 Pyrogenic reactions (1-2
hours)
 Late serum sickness (4-24
days)
TREATMENT
Venom
Extraction
Venom
Injection in
Animal
Immunization
Blood
collection
Antivenom
Wear boots and long pants
Stay way from tall grass or brush
Avoid sleeping on the floor
Avoid climbing on rocks where snakes
may be hiding
Inform about venomous snake and health
risks
Using flashlight/ torch during night time
PREVENTION
1. Eightonine. World Distribution of Snakes. Wikimedia Commons.
https://en.wikipedia.org /wiki/File:World_distribution_of_snakes.svg . Published July 24 th, 2009.
Accessed August 10 th, 2016.
2. Kamalnv . Indian Cobra. Wikimedia Commons.
https://commons.wikimedia.org /wiki/File:Indiancobra.jpg . Accessed August 10 th, 2016.
3. Aloaiza. Pelamis Platurus Costa Rica. Wikimedia Commons.
https://commons.wikimedia.org /wiki/File:Pelamis_Platurus_Costa_Rica.JPG . Published February
17th, 2008. Accessed August 10 th, 2016.
4. Gupt.sumeet. Russell’s Viper in Pune Zoo. Wikimedia Commons.
https://commons.wikimedia.org /wiki/File:Russells_viper_in_pune_zoo.jpg . Published April, 2013.
Accessed August 10 th, 2016.
5. Mokele. Ophiophagus hannah skull. Wikimedia Commons.
https://en.wikipedia.org /wiki/File:Ophiophagus_hannah_skull.jpg . Published February 17 th, 2008.
Accessed August 10 th, 2016.
6. Mokele. Crotalus skull. Wikimedia Commons.
https://commons.wikimedia.org /wiki/File:Crotalus_skull.jpg . Published February 17 th, 2008.
Accessed August 10 th, 2016.
7. Mokele. Heterodon nasicus skull. Wikimedia Commons.
https://en.wikipedia.org /wiki/File:Heterodon_nasicus_skull.jpg . Published February 17 th, 2008.
Accessed August 10 th, 2016.
8. Biomajor. Snake fangs and venom. Biology -forums.com . http://biology -
forums.com /index.php?action =gallery;sa =view;id=5309. Published 2012. Accessed August 10 th,
2016.
9. Eightofnine. Number of snake envenoming. Wikimedia Commons.
https://commons.wikimedia.org /wiki/File:Number_of_snake_envenomings.svg . Published June
24th, 2009. Accessed August 10 th, 2016.
10.Toxicol Int. Body mapping pf the distribution of snake bite sites. PMC.
http://www.ncbi.nlm.nih.gov /pmc/articles/PMC4721181/figure/F3/. Published January 2015.
REFERENCES

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Snake bites - Neglected Disease

  • 2.  Distribution & Classification of Venomous Snake  Anatomy of Venomous Snake  Epidemiology of Snakebite  Clinical Manifestation of Snakebite  Diagnosis  Treatment  Prevention OBJECTIVES
  • 3. DISTRIBUTION OF VENOMOUS SNAKE Reprinted from Wikimedia Commons, 20091
  • 4.  Viperidae  Russell’s viper  Saw-scaled viper (Echis carinatus)  Elapidae  Naja Naja Cobra  Common Krait  Hydrophidae (Sea snake)  Colubridae  Atractaspididae CLASSIFICATION OF VENOMOUS SNAKE Cobra Russell's viper Sea Snake Reprinted from Wikimedia Commons2 Reprinted from Wikimedia Commons, 20083 Reprinted from Wikimedia Commons, 20134
  • 5. ANATOMY OF VENOMOUS SNAKE Proteroglypha Solenoglypha Reprinted from Wikimedia Commons, 20085 Opisthoglypha Reprinted from Wikimedia Commons, 20086 Reprinted from Wikimedia Commons, 20087 Reprinted from Biology Forums, 20129
  • 6. ANATOMY Venom Composition Venom Enzyme Venom polypeptide toxins (neurotoxins) Zinc metalloproteinase haemorrhagins Procoagula nt enzyme Phospholipas e A2 (lecithinasae) Acetylcholine sterase Hyaluronida se Non-toxic protein
  • 7. EPIDEMIOLOGY OF SNAKEBITE Reprinted from Wikimedia Commons, 20099
  • 8. RISK FACTORS Characteristics Details Age 10 – 40 years old Gender 2:1 male to female ratio Target Farmers, plantation workers, herders, and fishermen Time of Bite Diurnal: Viper and Copra Nocturnal: Krait Site of Bite 60%-80% on foot, legs or ankles. Head and trunk (while sleeping) Transmission Time Reprinted from PMC, 201510
  • 9.  Physical observation (bite marks)  Misidentify snake species  Ineffective antivenom  Blood clotting test  ELISA test DIAGNOSIS Puncture of snake bites Reprinted from Wikimedia Commons,189512
  • 11.  Paralysis  Necrosis  Hemostatic Abnormalities  Renal Failure  Fatal COMPLICATIONS
  • 12. TREATMENT First Aid Traditional First Aid • Keep the victim calm. • Call for emergency • Remove jewelry and tight clothing • Position the victim, so the bite is at or below the victim’s heart level • Clean the bite, don’t flush it with water • Cover the bite with dry, clean dressing Reprinted from PMC, 201013
  • 13. Antivenom  Albert Calmette (1890s)  Monovalent  Polyvalent  Adverse effects:  Anaphylactoid (10-180 mins)  Pyrogenic reactions (1-2 hours)  Late serum sickness (4-24 days) TREATMENT Venom Extraction Venom Injection in Animal Immunization Blood collection Antivenom
  • 14. Wear boots and long pants Stay way from tall grass or brush Avoid sleeping on the floor Avoid climbing on rocks where snakes may be hiding Inform about venomous snake and health risks Using flashlight/ torch during night time PREVENTION
  • 15. 1. Eightonine. World Distribution of Snakes. Wikimedia Commons. https://en.wikipedia.org /wiki/File:World_distribution_of_snakes.svg . Published July 24 th, 2009. Accessed August 10 th, 2016. 2. Kamalnv . Indian Cobra. Wikimedia Commons. https://commons.wikimedia.org /wiki/File:Indiancobra.jpg . Accessed August 10 th, 2016. 3. Aloaiza. Pelamis Platurus Costa Rica. Wikimedia Commons. https://commons.wikimedia.org /wiki/File:Pelamis_Platurus_Costa_Rica.JPG . Published February 17th, 2008. Accessed August 10 th, 2016. 4. Gupt.sumeet. Russell’s Viper in Pune Zoo. Wikimedia Commons. https://commons.wikimedia.org /wiki/File:Russells_viper_in_pune_zoo.jpg . Published April, 2013. Accessed August 10 th, 2016. 5. Mokele. Ophiophagus hannah skull. Wikimedia Commons. https://en.wikipedia.org /wiki/File:Ophiophagus_hannah_skull.jpg . Published February 17 th, 2008. Accessed August 10 th, 2016. 6. Mokele. Crotalus skull. Wikimedia Commons. https://commons.wikimedia.org /wiki/File:Crotalus_skull.jpg . Published February 17 th, 2008. Accessed August 10 th, 2016. 7. Mokele. Heterodon nasicus skull. Wikimedia Commons. https://en.wikipedia.org /wiki/File:Heterodon_nasicus_skull.jpg . Published February 17 th, 2008. Accessed August 10 th, 2016. 8. Biomajor. Snake fangs and venom. Biology -forums.com . http://biology - forums.com /index.php?action =gallery;sa =view;id=5309. Published 2012. Accessed August 10 th, 2016. 9. Eightofnine. Number of snake envenoming. Wikimedia Commons. https://commons.wikimedia.org /wiki/File:Number_of_snake_envenomings.svg . Published June 24th, 2009. Accessed August 10 th, 2016. 10.Toxicol Int. Body mapping pf the distribution of snake bite sites. PMC. http://www.ncbi.nlm.nih.gov /pmc/articles/PMC4721181/figure/F3/. Published January 2015. REFERENCES

Editor's Notes

  1. Welcome! In this module on snakebite, we will first learn about the distribution, classification and anatomy of venomous snake. We will then discuss about the epidemiology of snake bite and how this neglected disease present themselves clinically. Finally, looking at the diagnostic methods and treatments for snakebite will help us understand preventive measures.
  2. Snakebite has know as a neglected public health issue, especially in the rural areas of the developing countries. However, there is an estimate of 5.4 million snakebites and 2.5 million envenoming. Snakebite can cause severe injury and death without proper first aid procedures within few hours. According to WHO, there are more than 3000 species of snakes in the world. 600 species are venomous. This is the map of the distribution of venomous snake in the world. Most venomous snake
  3. Venomous snakes are divided into 5 main snake families, which are Viperidae, Elapidae, Hydrophidae, Colubridae, and Atractaspididae.
  4. References: Eightonine. World Distribution of Snakes. Wikimedia Commons. https://en.wikipedia.org/wiki/File:World_distribution_of_snakes.svg. Published July 24th, 2009. Accessed August 10th, 2016. Kamalnv. Indian Cobra. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Indiancobra.jpg. Accessed August 10th, 2016. Aloaiza. Pelamis Platurus Costa Rica. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Pelamis_Platurus_Costa_Rica.JPG. Published February 17th, 2008. Accessed August 10th, 2016. Gupt.sumeet. Russell’s Viper in Pune Zoo. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Russells_viper_in_pune_zoo.jpg. Published April, 2013. Accessed August 10th, 2016. Mokele. Ophiophagus hannah skull. Wikimedia Commons. https://en.wikipedia.org/wiki/File:Ophiophagus_hannah_skull.jpg. Published February 17th, 2008. Accessed August 10th, 2016. Mokele. Crotalus skull. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Crotalus_skull.jpg. Published February 17th, 2008. Accessed August 10th, 2016. Mokele. Heterodon nasicus skull. Wikimedia Commons. https://en.wikipedia.org/wiki/File:Heterodon_nasicus_skull.jpg. Published February 17th, 2008. Accessed August 10th, 2016. Biomajor. Snake fangs and venom. Biology-forums.com. http://biology-forums.com/index.php?action=gallery;sa=view;id=5309. Published 2012. Accessed August 10th, 2016. Eightofnine. Number of snake envenoming. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Number_of_snake_envenomings.svg. Published June 24th, 2009. Accessed August 10th, 2016. Toxicol Int. Body mapping pf the distribution of snake bite sites. PMC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721181/figure/F3/. Published January 2015. Accessed August 10th, 2016. Mikael Haggstrom. Snake bite symptoms. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Snake_bite_symptoms.png. Published March 25th, 2009. Published August 10th, 2016. Punctures or bites of snakes. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:PSM_V46_D085_Punctures_or_bites_of_snakes.jpg. Published 1895. Accessed August 10th, 2016. PLoS Neglect Tropical Díease. PMC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811174/figure/pntd-0000603-g003/. Published January 2010. Accessed August 10th, 2016.