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

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.

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.

Background: Globally, diarrhoeagenic Escherichia coli (DEC) has been implicated in the spread of waterborne diseases and abattoir wastewater has played a role in its dissemination into watersheds. This study isolated and characterised DEC from the abattoir wastewater-impacted Iyi-Etu River and other water sources at the Amansea livestock market settlement.

Methods: A total of 96 water samples comprising river water (upstream, downstream 1, downstream 2), borehole, well, sachet and abattoir wastewater samples were tested for DEC. In the inoculation process, membrane filtration was used, and selective media such as Eosin Methylene Blue, Chromoselect agar and Sorbitol Maconkey agar were used to screen for E. coli and Shiga toxin-producing E. coli (STEC) O157. Escherichia coli pathotypes were characterised using molecular techniques.

Results: Overall, E. coli was presumptively detected in 28.1% (27/96) of all samples. Of the 27 isolates, three (11.1%) were non-sorbitol fermenters (typical of E. coli O157), while 20 (74.1%) were confirmed as E. coli based on uidA housekeeping gene positivity. The detected circulating pathotypes were enteropathogenic E. coli (EPEC) (35.0%; 7/20), enteroinvasive E. coli (EIEC) (40.0%; 8/20), enterotoxigenic E. coli (15.0%; 3/20), STEC (40.0%; 10/20) and enteroaggregative E. coli (5.0%; 1/20). Escherichia coli as well as EPEC, EIEC and STEC pathotypes were most prevalent at the downstream 1 sampling point compared with the upstream. EPEC, EIEC and STEC were also detected in borehole samples (5.0%, 1/20).

Conclusions: The Iyi-Etu River and borehole water sources used for domestic and drinking purposes, respectively, at Amansea livestock market settlement are contaminated with some pathotypes of E. coli and the level of pollution may pose a public health risk to humans and animals during contact. Thus, public health measures including proper treatment of wastewater before disposal and continuous monitoring may help to learn the associated effect of DEC pollution in the area.

Venomous snakes are a potential hazard even after their death. Dead snakes or their severed heads can inflict bites under various bizarre circumstances and may result in envenomation. In this review, an effort has been made to discuss the circumstances under which envenomation from dead snakes can occur, the incidence and pathomechanics of such envenomation, clinical manifestations and management and preventive measures, as well as a review of the literature on this unique mode of snake envenomation.

Background: Snakebite is a neglected tropical disease that causes significant morbidity and mortality in India. In this study, we describe the clinical characteristics and outcomes of Echis carinatus sochureki envenoming from Western Rajasthan. We document the clinical ineffectiveness of the currently available Indian polyvalent antivenom in managing E. c. sochureki envenoming.

Methods: In this ambispective study, conducted from 14 April 2019 to 15 April 2024, we enrolled all patients presenting to our emergency department at a tertiary care centre in Jodhpur, Rajasthan, with a history of snakebite. After they provided informed consent, the demographic details, bite geo-location, bite-to-antivenom time, antivenom dose, coagulation profile, mortality and duration of hospital stay of those patients with E. c. sochureki envenoming were recorded.

Results: Of 210 patients screened, 105 had E. c. sochureki envenoming, 103 venom-induced consumption coagulopathy, 36 (34.3%) local bleeding and 55 (52.3%) systemic bleeding. The median bite-to-antivenom time was 2 (IQR: 1.13-4.0) h. The median antivenom dose was 22 (IQR: 10-30) vials. Of 92 patients who received antivenom, 63 (68.4%) were unresponsive. Total antivenom dose and geographical location (West zone) were significant predictors of antivenom unresponsiveness. Fifty-three of 70 patients (75.7%) had delayed hypofibrinogenaemia. The mean hospital stay was 8.3±7.1 d with nine (8.6%) mortalities.

Conclusions: Our study highlights the alarming finding of poor antivenom response to E. c. sochureki envenoming, with significant clinical bleeding and delayed coagulopathy. There is an urgent need for region-specific antivenom in Western India.

Background: Nearly 60 000 Indians die of snakebite envenoming each year. Most deaths occur in rural communities and remote tribal settlements. We describe snakebite-related epidemiology and health-seeking behaviours in a rural (Timiri) and remote tribal block (Jawadhu Hills) in Tamil Nadu, India.

Methods: This cross-sectional survey used structured questionnaires for information pertaining to snakebites and their treatment in the preceding year. Treatment-seeking behaviour from the moment reported until recovery was mapped. Traditional healers residing in the two blocks were also surveyed.

Results: Snakebite incidence and mortality were 174/100 000 population and 2.7/100 000 population in Jawadhu Hills and 194/100 000 population and 2.6/100 000 population in Timiri, respectively. More snakebite victims applied tourniquets in Jawadhu Hills (90%) than in Timiri (69%). Traditional healers were the first contact for 64% in Jawadhu Hills. Ambulances and buses were reported as unavailable in Jawadhu Hills. Traditional healers in Jawadhu Hills did not refer snakebite victims to hospitals.

Conclusions: Three challenges to snakebite mitigation in Indian rural and tribal communities highlighted in this study are potentially harmful first aid, a disconnect between traditional healers and the public health system and a lack of emergency transport to health facilities. Addressing these challenges would necessitate community awareness, traditional healer engagement and improved means of public transportation.