Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

Background: Bangladesh has a high rate of snakebite. In rural areas, there is a significant mortality and morbidity rate due to lack of awareness and inappropriate first aid practices. This study aims to determine the knowledge and practices of the rural population in two subdistricts of Bangladesh regarding snakebite prevention and first aid measures.

Methods: This cross-sectional survey is part of an intervention study that was carried out in 250 randomly selected primary sampling units of Shibganj in the Chapainawabganj district and Kalapara in the Patuakhali district of Bangladesh. We enrolled a total of 2954 participants. The practice and knowledge were regarded adequate when the score exceeded 50%. We conducted a binomial logistic regression to identify the factors associated with inadequate knowledge and practice.

Results: The community's knowledge (15.9%) and practice (14.5%) regarding snakebite prevention was insufficient. More than 77% and 45.4% of respondents believed that applying a tourniquet above the bite site and seeking a traditional healer after a snakebite were effective first aid measures. Poor knowledge was more likely to occur in farming, fishing, homemaker groups and those with lower incomes (11 000-24 000 Bangladeshi taka). Negative practices were associated with females and high family income.

Conclusions: This study highlights the necessity of community intervention, with a focus on appropriate first aid and prevention measures through widespread education.

Background: Snakebite envenoming is a critical medical emergency and significant global public health issue, with India experiencing the highest annual snakebite deaths. Sea snakes in the Indian Ocean pose a severe threat to rural fishermen due to their potent neurotoxins.

Methods: From December 2020 to December 2021, we conducted surveys at 15 fishing ports in East Medinipur, West Bengal, and Balasore, Odisha, India (between 21.805651 N 87.874188 E and 21.574851 N 87.374059 E). We interviewed 2301 fishermen in 421 group sessions to document sea snake bite incidents, outcomes and perceptions from 2012 onwards. Historical data were also retrieved from various databases and social media platforms.

Results: We recorded 166 sea snake bite cases, with 55.4% fatalities, 2.4% permanent disabilities and 41% survivors. Gill net fishermen were the most affected, with most bites occurring while handling snakes caught in nets, particularly at dawn and dusk. Fishermen reported a significant decline in sea snake populations over the past decade due to by-catch and killing practices.

Conclusions: Sea snake bites are a major occupational hazard for Indian fishermen, with high fatality rates due to limited medical access. Increased awareness, safer handling practices and improved medical infrastructure are essential to reduce mortality and conserve sea snake populations. This study highlights the need for targeted interventions in affected communities.

Background: Snakebite envenoming is a medical emergency that requires rapid access to essential medicines and well-trained personnel. In resource-poor countries, mapping snakebite incidence can help policymakers to make evidence-based decisions for resource prioritisation. This study aimed to characterise the spatial variation in snakebite risk, and in particular to identify areas of relatively high and low risk, in Eastern Province, Rwanda.

Methods: Snakebite surveillance of people bitten in 2020 was conducted in Eastern Province through household visits and case verification. Geostatistical modelling and predictive mapping were applied to data from 617 villages in six districts to develop sector-level and district-level risk maps.

Results: There were 1217 individuals bitten by snakes across six districts. The estimated population-weighted snakebite incidence in Eastern Province was 440 (95% predictive interval 421 to 460) cases per 100 000 people, corresponding to 13 500 (95% predictive interval 12 950 to 14 150) snakebite events per year. Two sectors in the southwest, Gashanda and Jarama, showed >1500 snakebite events per 100 000 annually. The lowest incidence was observed in the north.

Conclusions: Considerable differences exist in snakebite risk between sectors in Eastern Province, with the highest risk concentrated in the southwest. Policymakers should consider prioritising resources related to snakebite prevention, essential medicines and health worker training in this region.

The ambitious WHO goal of halving snakebite mortality by 2030 is challenged by a number of logistical hurdles, none more so than in India where snakebite envenomation presents a multifaceted challenge. We have collaborated with several organizations focused on snakebite in India over the last 11 years, with an emphasis on fieldwork to collect samples from venomous snakes in various regions, particularly understudied regions in the northeast and western Himalayas. This programme has encountered several significant obstacles, including securing permits from government organizations to collect snake samples in the field, obtaining long-term research funding, coordinating multidisciplinary collaboration on snakebite projects and engaging with grassroots stakeholders who are most affected by snakebite incidents. We emphasize the necessity of adopting a nationally coordinated yet regionally diversified approach that accounts for the biogeographical and cultural complexity of the country.

We describe a series of five patients with bilateral parotid enlargement as a sequalae to envenomation by the common krait (Bungarus caeruleus). Fine-needle aspiration cytology of the parotid gland was performed in four cases. The cytology revealed a mild lymphocytic inflammatory response in a red blood cell mixed proteinaceous background. The possible pathophysiology is either a direct injury due to the venom toxins or an inflammatory phenomenon due to an immune response. All the patients had classic early morning descending neuroparalysis and were managed by mechanical ventilation along with antivenom. A favourable outcome in the form of full recovery was observed in all the patients.

Background: Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality in rural sub-Saharan Africa. However, there is a notable lack of data concerning the management and treatment outcomes for those affected. This study addresses this gap by examining the management and treatment outcomes of snakebite victims in Uganda.

Methods: We reviewed retrospective data of 532 snakebite cases attending 16 Ugandan health facilities from January 2017 to December 2021. Demographic characteristics and clinical data were extracted from patient records and summarized using descriptive statistics.

Results: The snakebite victims had a median age of 26 y, most were male (55.3%) and had bites of unidentified snake species (92.3%). Among the 465 treated patients, 71.6% received antibiotics, 66.0% hydrocortisone, 36.3% analgesics and only 6.9% antivenom. No adverse antivenom reactions were documented. The majority (89.5%) were discharged; 1.3% died and 5.5% had unknown outcomes.

Conclusions: These results suggest that snakebite envenoming affects vulnerable Ugandans, particularly young males and children. Treatment is primarily supportive, with antibiotic overuse and infrequent antivenom administration. Health provider training on appropriate snakebite management is needed to optimize outcomes.

Background: Snakebite is a public health challenge that has a substantial impact on humans and snakes. Annually, millions of people are affected by snakebite globally but there is a paucity of detailed data on snakebite incidences. The aim of this study was to assess the patterns of snakebite incidences in South Africa.

Methods: We collected data from hospital records, information from the National Snakebite Database and records from the AfriTox Telelog database from 2011 to 2024.

Results: The combined dataset showed that 3496 snakebite incidences have been recorded over 12.5 years. The prevalence was calculated to be 5.63 per 100 000 individuals of the population for South Africa, with the highest prevalence in KwaZulu-Natal (8.89). Males made up 65.9% of snakebite incidences and most incidences were recorded between November and March. The snake species responsible for most snakebite incidences was Bitis arietans.

Conclusion: Snakebite is generally well managed in South Africa with few recorded deaths despite the relatively high number of bites. However, incidents are often not recorded or have missing information particularly regarding the circumstances of the bite. Our study provides insight on the snake species responsible for snakebite incidences in South Africa and can be used to create prevention measures.

Background: Although cnidarians are mostly marine organisms, the occurrence of freshwater jellyfish frequently arouses the interest of ecologists, due to their sudden and unusual appearances in natural and artificial water bodies around the world.

Methods: This study describes a series of cases compatible with cnidarian envenomation that occurred coincidentally in time and space with the presence of Craspedacusta sowerbii Lankester, 1880 jellyfish in the province of Misiones (El Saltito stream) in January 2022. A year later, its presence was confirmed in another watercourse of this province (Cazador stream). Based on these findings, its possible toxicological consequences in humans were evaluated by characterizing the jellyfish extract using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and enzymatic/toxic activities.

Results: We revealed the presence of proteolytic enzymes and cytolytic toxin(s), which-by means of activating the inflammatory cascade-could explain the stinging skin lesions observed in the suspected cases described.

Conclusions: In addition to recording for the first time the occurrence of this cnidarian in northeastern Argentina, this work provides, for the first time, a toxinological explanation for the clinical observations after contact with the most widespread freshwater jellyfish species in the world, giving support to health professionals in the diagnosis and management of such accidents/envenomation.

Viral exanthems can present with diverse morphologies of rash, including macular, maculopapular, papular, urticarial and vesicular, or sometimes a combination of these. There has been an increasing trend towards emerging and re-emerging viral exanthems in recent years, the cause of which is multifactorial, including changing environmental conditions and altered host-vector-agent interaction. The significant temperature variations brought on by climate change and ever-increasing international travel has modified the host-agent interactions, and many re-emerging viral illnesses are now presenting with atypical presentations, including an increased frequency of affliction across broader age groups and heightened manifestations often posing as 'great imitators' mimicking a myriad of other dermatoses. Although final diagnosis often relies on serological and molecular tests, certain cutaneous clues can help arrive at a probable clinical diagnosis and help the clinicians order specific and relevant investigations, especially in resource-poor settings where access to laboratory diagnostic tests is likely to be limited. In this review we explore the changing disease dynamics of common viral infections, especially in resource-poor settings, including coronavirus disease 2019, chikungunya, hand-foot-and-mouth disease and some newly emerging ones like mpox (previously referred to as monkeypox), and highlight recent developments in our understanding of the clinical variations seen in their presentations.