Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka; Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka.
Medical Unit, Teaching Hospital, Ratnapura, Sri Lanka.
Toxicon. 2023 Aug 1;231:107194. doi: 10.1016/j.toxicon.2023.107194. Epub 2023 Jun 14.
Sri Lanka homes 3 species of hump-nosed pit vipers including Hypnale Hypnale, H. zara and H. nepa from which, latter 2 are endemic to the country. Even though former 2 are the subject of several publications, no major clinical studies have been done regarding H. nepa bites. As these snakes confine only to central hills of the country, their bites are very rare. The objectives of this study were to describe epidemiological and clinical features of H. nepa bites. A prospective observational study was conducted for patients admitted with H. nepa bites to Teaching Hospital, Ratnapura, Sri Lanka for 5 years commencing from June 2015. Species identification was done using a standard key. There were 14 (3.6%) patients with H. nepa bites of which 9 (64%) were males and 5 (36%) were females. Their age ranged from 20 to 73 years (median 37.5). Seven bites (50%) occurred on lower limbs. Majority of bites (10; 71%) happened at daytime [0600-1759 h] in tea estates (8; 57%). Most patients (8; 57%) were admitted within 1-3 h from bite. Hospital stay was 2.5 days (IQR 2-3). Local envenoming was observed in all patients including local pain and swelling [mild (7; 50%), moderate (5; 36%), severe (2; 14%)], local bleeding (1; 7%) and lymphadenopathy (1; 7%). Nonspecific features were observed in 3 (21%). Systemic manifestations were found in 2 (14%) including microangiopathic haemolytic anaemia and sinus bradycardia. Two (14%) had myalgia. H. nepa bites frequently cause local envenoming. But, rarely systemic manifestations may occur.
斯里兰卡有 3 种驼峰鼻蝰，包括 Hypnale Hypnale、H. zara 和 H. nepa，其中后两种是该国特有的。尽管前两种已经有多项出版物，但对 H. nepa 咬伤还没有进行过重大的临床研究。由于这些蛇只限于该国的中央丘陵地区，因此它们的咬伤非常罕见。本研究的目的是描述 H. nepa 咬伤的流行病学和临床特征。从 2015 年 6 月开始，对在斯里兰卡拉特纳普勒教学医院因 H. nepa 咬伤住院的患者进行了为期 5 年的前瞻性观察研究。使用标准钥匙进行物种鉴定。共有 14 例（3.6%）H. nepa 咬伤患者，其中 9 例（64%）为男性，5 例（36%）为女性。年龄从 20 岁到 73 岁不等（中位数为 37.5 岁）。7 例咬伤（50%）发生在下肢。大多数咬伤（10 例；71%）发生在白天[0600-1759 小时]在茶园（8 例；57%）。大多数患者（8 例；57%）在咬伤后 1-3 小时内入院。住院时间为 2.5 天（IQR 2-3）。所有患者均观察到局部中毒，包括局部疼痛和肿胀[轻度（7 例；50%）、中度（5 例；36%）、重度（2 例；14%）]、局部出血（1 例；7%）和淋巴结病（1 例；7%）。观察到 3 例（21%）存在非特异性表现。2 例（14%）出现全身表现，包括微血管病性溶血性贫血和窦性心动过缓。2 例（14%）有肌痛。H. nepa 咬伤常引起局部中毒。但很少发生全身表现。
