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Venomous Snakes of Nepal. A photographic guide
Abstract
Snakebite envenoming is one of the most neglected diseases of the 21st century and affects several million people every year. It is most common in tropical and subtropical regions where it is an occupational disease of the young rural poor population and a disaster-related health hazard (e.g., after extreme weather events like floods). Children are highly vulnerable and especially severely envenomed. The morbidity and mortality or long-term disability of young people that is caused by snakebite envenoming has profound socio-economic consequences for these developing nations. In many countries, snakebite envenoming is also a true disease of poverty in the sense that it mostly affects the poorest of the poor, and further perpetuates poverty by causing treatment costs, loss of income during illness or due to disability, or the death of a family's bread-earner.
One of the most fundamental impediments to improving the management of snakebite envenoming is ignorance of the species of snake that cause bites. This has, for example, resulted in the production of therapeutic immunoglobulin preparations (antivenoms) that cover an insufficient number of species, or regionally irrelevant species. Ignorance of the local venomous and non-venomous snake species is also at the root of the indiscriminate killing of any snake that is widespread in countries where snakebite is a problem. This in turn can lead to ecological problems such as growing populations of rodents that eat crops and transmit diseases but are normally controlled by predators like snakes. Finally, most people do not know what to do if they are bitten by a snake, or believe in ineffective and often harmful "first aid" measures.
As part of Swiss and German cooperation with Nepal, a team of biologists and physicians from the three countries has prepared a book on the venomous snakes of Nepal that is the first to help identify these dangerous reptiles based on photographs and text in separate Nepali and English editions. The book also contains information on snakebite first aid and treatment. This information is country-specific and reflects the present state of scientific evidence on this topic in the Nepali context. While part of the information and recommendations given have general validity, readers should bear in mind that others may apply to the situation in Nepal only, or may change over time as new evidence becomes available.
Free electronic copies of the book (4.1 MB) are available for download from:
www.tinyurl.com/nepalsnakes
... Around 17 snake species have been found to be venomous among Nepal's 89 snake species, mostly belonging to the Elapidae and Viperidae families. 4 Nearly 10 of the venomous snake species can be found in the hilly and mountainous regions. 4 The majority of snakebite deaths go unreported, and there is no precise data on the morbidity and mortality of snakebite patients in Nepal's hills and highlands; much has to be explored. ...
... 4 Nearly 10 of the venomous snake species can be found in the hilly and mountainous regions. 4 The majority of snakebite deaths go unreported, and there is no precise data on the morbidity and mortality of snakebite patients in Nepal's hills and highlands; much has to be explored. 5,6 ...
... The green pit vipers and mountain pit vipers are widely distributed and frequently encountered venomous snake species in the hills and mountains of Nepal. 4,10 The common symptoms reported due to snakebite in these regions include local site pain, swelling with local tissue damage, and haematological features like coagulopathy, hematuria and thrombocytopenia. [11][12][13] Attempts to manage these symptoms have been done with Government supplied polyvalent antisnake venom for venom neutralization, vitamin K and Fresh Frozen Plasma (FFP) injection for coagulopathy management, MgSO 4 dressing and antibiotics for local manifestations of the snakebite and solely conservative management has been done at the centres with no availability of anti-snake venom. ...
Unlabelled:
Snakebite is an important public health issue around the world. In Nepal, it affects a huge number of people mostly belonging to low-income households who are involved in agriculture. Although snakebite has a serious impact on the Terai population, a few studies suggest that snakebite also occurs frequently in hills and mountains. In the absence of sufficient studies related to snakebites in these geographical regions, it is tough to sketch a true picture and estimate the magnitude of snakebites in those areas. Because of this, the healthcare system is probably not prepared enough to handle the victims of snakebites. This demands a proper study of the burden of the issue in these regions and appropriate initiatives for addressing it.
Keywords:
antivenom; Nepal; snakebite.
... However, this arrangement was short-lived and adjusted when additional specimen work led the same author (Khan, 1985) to resurrect the nomen walli at the level of subspecies and apply it to a group of B. sindanus populations in central India, forming the new combination B. s. walli. This taxonomy was followed by other workers (e.g., Das and Chaturvedi, 1998;David and Ineich, 1999;Schleich and Kästle, 2002), but most recently, and without apparent formal reasoning, the nomen is now once again used as a full species (Sharma et shares a trait unusual for the genus: B. sindanus and B. walli both possess 17 midbody dorsal scale rows (Wall, 1907;Slowinski, 1994;Sharma et al., 2013). In Nepal, B. walli has been reported for the southeastern region (Sharma et al., 2013), and this has been confirmed by 13 records obtained via snakebite occurrences (Pandey, 2015). ...
... This taxonomy was followed by other workers (e.g., Das and Chaturvedi, 1998;David and Ineich, 1999;Schleich and Kästle, 2002), but most recently, and without apparent formal reasoning, the nomen is now once again used as a full species (Sharma et shares a trait unusual for the genus: B. sindanus and B. walli both possess 17 midbody dorsal scale rows (Wall, 1907;Slowinski, 1994;Sharma et al., 2013). In Nepal, B. walli has been reported for the southeastern region (Sharma et al., 2013), and this has been confirmed by 13 records obtained via snakebite occurrences (Pandey, 2015). All records are from the southern part of the country's easternmost province, currently known by the placeholder name Province No. 1. ...
... The geographical distribution of the nominate species, as restricted here, extends from extreme eastern Pakistan, across the sub-Himalayan region of Kashmir, northern India, Nepal, Bhutan, Tibet, and south to the Godavari-Mahanadi-Ganges deltas of the Circar Coast in eastern India, east to the eastern coast of China, including Hong Kong, the range extending south to Indo-China, including Myanmar, Laos, Vietnam, Cambodia and parts of Thailand, presumably north of the Isthmus of Kra (Pope 1935;Das 1999;Leviton et al. 2003;Whitaker & Captain 2004 [in part]; Ahmed et al. 2009;Nguyen et al. 2009;Sharma et al. 2013;Chandra et al. 2014;Ahsan et al. 2015;Faiz et al. 2017;Dolia 2018;Tshewang & Letro 2018;Francis 2021;Koirala et al. 2021). The records from the extreme west of the distributional range (including Lahore and Palanpur, in Pakistan) were considered by Wall (1928) to be introductions by snake charmers or the result of transport along rivers. ...
The taxonomy of king cobras (Ophiophagus) was reevaluated using qualitative, mensural and meristic characters, based on 148 entire and five skeletal specimens, and supported by a recent molecular phylogenetic analysis. We provide nomenclatural synopses of both the genus and species-series nomina. We restrict the concept of Ophiophagus hannah s. str. to populations from eastern Pakistan, northern and eastern India, the Andaman Islands, Indo-Burma and Indo-China, south to central Thailand. The nomen Ophiophagus bungarus (Schlegel, 1837) comb. nov. is revived for the populations inhabiting the Sunda Shelf area, including the Malay Peninsula, the Greater Sunda Islands and parts of the southern Philippines. We describe two new species, Ophiophagus kaalinga Gowri Shankar, Das & Ganesh sp. nov. endemic to the Western Ghats of south-western India and Ophiophagus salvatana Gowri Shankar, Das & Wüster sp. nov., inhabiting the island of Luzon in northern Philippines. For the purpose of nomenclatural stability, we designate a neotype for Hamadryas hannah Cantor, 1836. A dichotomous identification key to the four species recognized here is provided.
... The source of the basemap shapefile onto which data has been plotted was used from an openly available source (https://gadm.org/data.html)]. In Nepal, at least 18 species of medically relevant venomous snakes are distributed [22,23] within a small area (147,181 km 2 representing about 0.1% of the global landmass) extending east to west by 885-900 km and north to the Himalaya and to its Terai in the south by 130-260 km, respectively [20,24]. Elapid snakes, particularly the Spectacled Cobra (Naja naja) and the Common Krait (Bungarus caeruleus), cause most of the mortality in Terai of Nepal [25]. ...
Background
Snakebite envenoming is a well-known medical emergency in the Terai of Nepal in particular. However, there is an epidemiological knowledge gap. The news media data available online provide substantial information on envenomings. Assessing this information can be a pristine approach for understanding snakebite epidemiology and conducting knowledge-based interventions. We firstly analyzed news media-reported quantitative information on conditions under which bites occur, treatment-seeking behavior of victims, and outcomes of snakebite envenomings in Nepal.
Methodology/Principal findings
We analyzed 308 Nepalese snakebite envenomed cases reported in 199 news media articles published between 2010 and 2022 using descriptive statistics, Wilcoxon, and Chi-square tests to know why and how victims were bitten, their treatment-seeking behavior, and the outcomes. These envenomated cases known with substantial information represented 48 districts (mostly located in the Terai region) of Nepal. These envenomings mostly occurred in residential areas affecting children. Generally, envenomings among males and females were not significantly different. But, in residential areas, females were more envenomed than males. Further, victims’ extremities were often exposed to venomous snakebites while their active status and these episodes often occurred at night while victims were passive during snakebites indoors and immediate surroundings of houses. Snakebite deaths were less among referred than non-referred cases, males than females, and while active than passive conditions of victims.
Conclusion/Significance
The most of reported envenomed patients were children, and most envenomings were due to cobra bites. Consultation with traditional healers complicated snakebite management. In most cases, deaths that occur without medical interventions are a severe snakebite consequence in Nepal. Further, several deaths in urban areas and mountains and higher hills of Nepal suggest immediate need of snakebite management interventions in the most affected districts. Therefore, there is an urgent need to immediately admit Nepalese snakebite victims to nearby snakebite treatment centers without adopting non-recommended prehospital interventions. The strategies for preventing snakebite and controlling venom effects should also include hilly and mountain districts where snakebite-associated deaths are reported.
... Among this great diversity of snakes, we know with certainty of 17 Nepal Mediciti Medical Journal species of snake that are found in Nepal and have the frontfanged type of venom apparatus and thus are considered to be highly venomous and dangerous. 5 The commonest poisonous snakes in the terai and inner terai regions of Nepal are Krait and Cobra. 6 In Nepal, incidence of snake bite shows a distinct seasonal pattern closely related to rainfall and temperature, and snake bite is observed in all age groups, the large majorities (90%) are in males aged 11-50 years. ...
BACKGROUND
Snake bite is a public health problem in terai and inner terai of Nepal. It is a medical emergency leading to significant
morbidity and mortality every year. This study aims to find the clinical profile and outcome of snake bite envenomation
patients in Bheri Hospital Nepalgunj.
METHODS
This was a cross sectional, observational study from april 2021 to november 2021. Patients with history of snake bite and
clinical features suggesting envenomation were enrolled in this study, their clinical data and outcome were recorded in Excel
sheet and analyzed by SPSS 20.
RESULTS
A total of 58 cases of snake envenomation was admitted and managed, out of which 3 cases expired with case fatality of
5.17%. Krait and cobra were the common snake bites in this region. 84.48% of the snake bites occur inside houses and more
than half 53.44% of the patients were bitten between 12am to 6am. The most common features of envenomation were
ptosis, blurring of vision, swallowing difficulty, dysphonia, neck muscle weakness, epigastric pain and salivation. Majority of
cases 96.55% was given 10 vials of Anti snake venom (ASV). Only 4 patients 6.89% needed ventilator assistance.
CONCLUSION
Mortality with snake bites can be minimized by strengthening the treatment centers and readily availability of ASV at such
centers. Public awareness about snake bite, first aid, rapid transport to out snake bite, first aid, rapid transport to health facilities would be the key to success in
reducing morbidity and mortality.
KEYWORDS: snake bite; envenomation; clinical profile; outcome
... The scales are larger than adjacent ones and of hexagonal shape, whereas that of B. lividus is significantly narrow [29]. Figure-7) is being considered rare according to the availability of this species [30]. It has brownish or light greyish-blue coloured belly. ...
A collective data on kraits (genus Bungarus) showed the presence of six different species of kraits in West Bengal, India. The recorded krait species are-Common Krait or Indian Krait (B. caeruleus), Banded Krait (B. fasciatus), Wall's Krait (B. walli), Greater Black Krait (B. niger), Lesser Black Krait (B. lividus) and Northeastern Hill Krait (B. bungaroides). There was a constant debate over the existence of some of those species, and some misconceptions too, but based on the recent data collected from various authentic sources as well as based on our field study, it is confirmed that six species of kraits are available, although their distribution differs significantly. The unique pattern of envenomation and subsequent symptoms of krait bite are the major reasons to understand the kraits in depth. This study is mainly aimed to prepare a comparative data on the general morphology with special reference to their identifying features and distribution in West Bengal.
... Nepal and Cameroon have a rich snake fauna with 14 medically important venomous snake species in Nepal and 17 in Cameroon (WHO, 2010). These species include both elapid and viperid snakes like cobras (Naja spp.) and kraits (Bungarus spp.) found throughout Nepal's Terai, and Russel's viper (Daboia russelii) occurring in southern Terai (Sharma et al., 2013). The forest cobras (Naja melanoleuca) and Gaboon vipers (Bitis gabonica) are particularly abundant in south-west Cameroon, and the northern region is dominated by the carpet viper (Echis ocellatus) (Gonwouo et al., 2005). ...
Snakebite envenoming is a life-threatening disease in humans and animals and a major public health issue in rural communities of South-East Asia and sub-Saharan Africa. Yet the impact of snakebite on domestic animals has been poorly studied. This study aimed to describe the context, clinical features, treatment, and outcomes of snakebite envenoming in domestic animals in Nepal and Cameroon. Primary data on snakebite in animals were recorded from a community-based nation-wide survey on human and animal snakebite in Nepal and Cameroon (Snake-byte project). Mobile teams collected data on snakebite in humans and animals in 13,879 and 10,798 households in Nepal and Cameroon respectively from December 2018 to June 2019. This study included 405 snakebite cases (73 in Nepal and 332 in Cameroon) in multiple types of animals. An interview with a structured questionnaire collected specific information about the animal victims.
Snake bites in animals took place predominantly inside and around the house or farm in Nepal (92%) and Cameroon (71%). Other frequent locations in Cameroon were field or pasture (12%). A large diversity of clinical features was reported in all types of envenomed animals. They showed either a few clinical signs (e.g., local swelling, bleeding) or a combination of multiple clinical signs. Only 9% of animal victims, mainly cattle and buffaloes and less frequently goats, sheep, and dogs, received treatment, predominantly with traditional medicine. The overall mortality of snakebite was 85% in Nepal and 87% in Cameroon.
Results from this nationwide study show an important impact of snakebite on animal health in Nepal and Cameroon. There is a need for cost-effective prevention control strategies and affordable snakebite therapies in the veterinary field to save animal lives and farmer livelihood in the poorest countries of the world. The WHO global strategy to prevent and control snakebite envenoming supports a One Health approach, which may help develop integrated solutions to the snakebite problem taking into account human and animal health.
... Therefore, in addition to their being collected to manufacture belts, purses, key chains, etc. [7], unnecessarily killing of snakes is likely to continue because people considered snakes to be harmful [3,4]. In Nepal, of the total of 90 snake species reported, two species of cobras (Naja), six species of kraits (Bungarus species), Russell's Viper (Daboia russelii), at least six species of pitvipers, and a colubrid snake species (Rhabdophis subminiatus) are venomous which may be responsible for the majority of snakebite envenomations and deaths [4,[20][21][22][23]. These snakes and other similar looking non-venomous snakes [23,24] are being killed by people on sight due to fear factor in Nepal [3,4]. ...
... Our records, both dead specimens of O. cyclurus show that the species has direct threats on its populations. Pandey (2015) mentioned the record of O. cyclurus from a snake bite treatment center by a snakebite victim and it is likely that people in the area are frequently bitten and kill the species whenever they encounter it believing it to be venomous; despite the fact that only 17 species of snakes in Nepal are venomous (Sharma et al., 2013). ...
The distribution of Cantor's Kukri Snake Oligodon cyclurus has been poorly documented in its geographic range from Bangladesh, and Vietnam. We provide confirmed locality records with notes on some aspects of natural history information for O. cyclurus. Although the species is designated as Least Concern according to IUCN Red list of Threatened Species, the species is facing multiple threats like roadkills and vindictive killing. We suggest a more detailed inventory to better understand its biology, distribution patterns, population status and molecular identity to aid in a more comprehensive global conservation action.
Introduction and Importance
Owing to the high number of envenomation and fatalities, the Russell’s viper holds greater medicinal significance than any other Asian serpent. South East Asia is one of the most snakebite-prone regions in the world. Dense population, extensive agricultural practices, abundance of venomous snake species, and overall lack of knowledge about primary treatment (first aid) are the major culprits associated with snake bite related morbidity and mortality . The venom of vipers is known to produce vasculotoxicity and contains hemotoxins.
Case presentation
We describe a patient who was bitten by a viperine snake and showed signs of both neurotoxicity and acute kidney injury (AKI). The 20 years male was treated in tertiary case center of Nepal. Patient developed respiratory failure and needed ventilator support. Further more Haemodialysis was also done to manage AKI. Later patient was discharged after smooth recovery.
Discussion
Numerous clinical manifestations, such as neurotoxicity and vasculotoxicity, can result from a viperine bite. The majority of viperine snake bites are hemotoxic. Dual neurotoxic symptoms are possible after a viperine bite, despite their rarity. The prevention of respiratory failure depends critically on the early detection of neurotoxicity.
Conclusion
Unusual neuromuscular paralysis is caused by Russell’s vipers (Daboia russelii) in South East Asia. Physicians should know the exceptional presentations of snake bites to diagnose and treat patients
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