Snakebites Envenomation

Snake envenomation is a neglected tropical disease of global interest, causing from 80,000 to 130,000 deaths a year, higher in regions with poor access to treatment. Morbidity of envenomation, variable according to herpetological features, includes coagulopathy, neurotoxicity, myotoxicity and nephrotoxicity.

Cardiovascular damage is reported as a complication of snakebites in case reports and small case series; damage includes peripheral and visceral arterial involvement, in the form of arterial rupture, pseudo-aneurysms and compartment syndrome.

Factors related to health management and research in endemic settings, including barriers to accessing medical care or to advanced diagnostic methods and treatment, and the lack of data collection for epidemiological and research purposes, suggest that an under-reported bias of this issue of public health interest is likely.

The review of published cases showed that the age of victims ranges from 22 to 82 years. The onset of clinical symptoms of vascular complications could be delayed from the attack (ranging from 0 to 5 days). Severe cardiovascular events can occur not only in untreated cases but also in patients who received an antivenom. Clinical presentation can range from local swelling and pain to neurological impairment and haemorrhagic signs. The involved vessels can be peripheral arteries or visceral arteries. Interventional management is described as an effective treatment, in the form of ultrasound-guided pseudo-aneurysm compression, aneurysmectomy and endovascular embolization in case of visceral artery damage. Snakebites can lead to permanent morbidity (as in the case of limb loss) and to mortality due to sequelae of arterial involvement.

This public health issue thus calls for urgent implementation of the World Health Organization (WHO) programmes that aim at the reduction of snakebite envenomation fatalities, through the systematic reports of cases and herpetological investigations.