C PEH1,3, J WHITE,2,3, S ALFRED,1, D BATES,2, A MAHMOOD,3, D WARRELL,4, T THWIN5, M THEIN, 6, S SAN, 6, K SWE, 7, M KYAW, 7,L MYINT, 7, A AUNG, 7, M HAN, 7, C KHINE, S CHAW 71
Royal Adelaide Hospital, , Australia, 2Women’s and Children’s Hospital, Adelaide, Australia, 3University of Adelaide, , Australia, 4Oxford University, , UK, 5Yangon Specialty Hospital, Yangon, Myanmar, 6Myanmar Snakebite Project Office, Mandalay, Myanmar, 7Mandalay General Hospital, Mandalay, Myanmar
As part of the Myanmar Snakebite Project, a clinical case record database was established at the Mandalay General Hospital to capture clinical data of snakebite patients. The study period was 12 months in 2016. 965 patients were enrolled, of whom 948 were included for analysis. The male: female ratio was 1.58:1. The great majority of cases were due to bites from Russell’s vipers (Daboia siamensis). Cobras and green pit vipers make up the rest. 9.8% of cases were fatal, all following Russell’s viper bites, which caused all cases of acute kidney injury. Most cases involved bites to the lower limbs of adults involved in farm work. Most patients sought care from the healthcare system, not traditional healers as their first point of contact. The pressure pad method of first-aid for snakebite was seldom used, while most patients used some form of tourniquet (92.0%). For all cases, clinical features included local swelling (76.5%); local pain (62.6%); acute kidney injury (59.8%), of whom 40% required dialysis; coagulopathy (57.9%); regional lymphadenopathy (39.8%); nausea/vomiting (40.4%); thrombocytopenia (53.6%); abdominal pain (28.8%); shock (11.8%); secondary infection (8.6%) and pan-hypopituitarism (2.1%).
Dr Chen Au Peh is a renal physician at the Royal Adelaide Hospital. His clinical research interest include ANCA-associated vasculitis, lupus nephritis and membranous nephropathy. He is project leader of an Australian DFAT-funded project that aims to improve the health outcomes of snakebite patients in Myanmar.