Snakebite Envenoming Diagnosis and Diagnostics

Abstract

Snakebite envenoming is predominantly an occupational disease of the rural tropics, causing death or permanent disability to hundreds of thousands of victims annually. The diagnosis of snakebite envenoming is commonly based on a combination of patient history and a syndromic approach. However, the availability of auxiliary diagnostic tests at the disposal of the clinicians vary from country to country, and the level of experience within snakebite diagnosis and intervention may be quite different for clinicians from different hospitals. As such, achieving timely diagnosis, and thus treatment, is a challenge faced by treating personnel around the globe. For years, much effort has gone into developing novel diagnostics to support diagnosis of snakebite victims, especially in rural areas of the tropics. Gaining access to affordable and rapid diagnostics could potentially facilitate more favorable patient outcomes due to early and appropriate treatment. This review aims to highlight regional differences in epidemiology and clinical snakebite management on a global scale, including an overview of the past and ongoing research efforts within snakebite diagnostics. Finally, the review is rounded off with a discussion on design considerations and potential benefits of novel snakebite diagnostics.

Keywords: clinical toxinology; diagnosis; diagnostics; envenoming; ophidism; snakebite management; syndromic approach.

Figure 1

Comparison of venomous snakes with similar names and/or appearance and/or clinical syndromes. Visual comparison of two Australian snakes with similar names and appearances: (A) A king brown snake (Pseudonaja textilis), which belongs to the black snake genus, and (B) an eastern brown snake (Pseudonaja textilis), which belongs to the brown snake genus. Visual comparison of two venomous snake species from Brazil: (C) Bothrops sp. and (D) Lachesis sp. Species from these genera can appear similar to those not trained in snake identification, can cause similar clinical manifestations, and are both locally known as ‘surucucu’ in certain parts of Brazil. Visual comparison of (E) a puff adder (Bitis arietans) and (F) a horned viper (Cerastes cerastes), the venoms of which can cause similar clinical manifestations. Figures 1A, C, D copyright ^© Prof. Julian White, Figure 1B copyright ^© of Prof. Sean Bush, 1E, 1F were found on WikiMedia Commons are are copyright ^© of the user 4028mdk09 and the user Broobas, respectively.

Figure 2

Diagnostic algorithm for snakebite envenoming in South Australia. Algorithm copyright ^© Prof. Julian White.