Mohanty Vivek, Dhar Minakshi, Panda Prasan Kumar, Walia Rohit
Department of Medicine and Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Int J Crit Illn Inj Sci. 2019 Apr-Jun;9(2):96-100. doi: 10.4103/IJCIIS.IJCIIS_6_19.
In the Himalayan region, there is a prevalence of unknown bites (not much data except media) including snakes with high range of mortality among victims because hilly terrain leads to delay in transportation and delayed initiation of proper treatment due to lack of developed tertiary care centers. These bites can present from local hypersensitivity reactions to neurological, cardiological, respiratory, hematological, musculoskeletal, and renal manifestations. We highlight two cases that presented with delayed and varied manifestations, recovered but delayed with dedicated supportive care. A 25-year-old female presented 3 days after bite from an unknown snake, possibly krait, developed cardiotoxicity, neuroxotoxicity, rhabdomyolysis, and hemolytic features and was managed with antivenom and anticholinesterase therapy along with medroxyprogesterone to facilitate recovery from bite-associated neurotoxicity. A 75-year-old male subjected to an unknown bite possibly a scorpion developed shock which was most likely cardiogenic in nature secondary to toxin and was managed initially using inotropic support. Prazosin was started, and he recovered completely though at a later time. Hence, apart from krait bite presenting as multisystem involvement, anticholinesterase and medroxyprogesterone acetate are vital for survival. Similarly, prazosin has a vital role in the recovery of scorpion bite-induced cardiotoxicity. Many such unknown venomous bites go unreported. Further case studies and case reports are necessary to help redefine the epidemiology of such bites in the Himalayan region that poses a diagnostic and therapeutic challenge.
在喜马拉雅地区，存在不明叮咬情况（除媒体报道外缺乏太多数据），包括蛇类叮咬，受害者死亡率很高，因为山区地形导致交通延误，且由于缺乏发达的三级护理中心，适当治疗的启动也被延迟。这些叮咬可能表现为从局部过敏反应到神经、心脏、呼吸、血液、肌肉骨骼和肾脏方面的症状。我们重点介绍两例出现延迟且多样症状的病例，患者经专门的支持治疗后康复，但过程较为缓慢。一名25岁女性在被不明蛇类（可能是金环蛇）咬伤3天后出现心脏毒性、神经毒性、横纹肌溶解和溶血症状，接受了抗蛇毒血清和抗胆碱酯酶治疗，并使用甲羟孕酮以促进从咬伤相关的神经毒性中恢复。一名75岁男性遭受不明叮咬（可能是蝎子）后出现休克，很可能是毒素继发的心源性休克，最初接受了强心支持治疗。开始使用哌唑嗪后，他最终完全康复。因此，除了金环蛇咬伤表现为多系统受累外，抗胆碱酯酶和醋酸甲羟孕酮对生存至关重要。同样，哌唑嗪在蝎子咬伤所致心脏毒性的恢复中也起着关键作用。许多此类不明有毒叮咬未被报告。需要进一步的病例研究和病例报告来帮助重新界定喜马拉雅地区此类叮咬的流行病学情况，该地区构成了诊断和治疗方面的挑战。
