ArticleLiterature Review

Snakebite envenomings in the Republic of Korea from the 1970s to the 2020s: A review

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Abstract

Snakebite envenomings remain a neglected disease across the globe causing severe injuries and death. An understanding of regional snakebite patterns is a necessary prerequisite for public health programs aimed at reducing snakebite risks. However, such regional knowledge is poorly documented or lacking in many countries where the risk of snakebite envenomings receive little medical attention, and the Republic of Korea is one of these countries. Here, we reviewed the literature on snakebites published between 1970 and 2020 as well as public healthcare data recorded between 2010 and 2019 to determine the patterns of snakebite envenomings in the Republic of Korea. Our results, based on literature data, show Gangwon province as a hotspot of snakebite occurrences and identify middle-aged males living in rural areas as the demographic group at highest risk of venomous snakebites. We further highlight major limitations for further understanding snakebite patterns in the country, most notably the lack of proper species identification for snakes and conflicting patterns of envenomings revealed by different sources of data. Our study provides baseline information on venomous snakebites occurring in the Republic of Korea, thereby filling a gap in the knowledge of snakebite trends in the country.

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... Every year, snakebite envenoming kills or maims approximately 100,000 and 400,000 people, respectively [1,2]. In South Korea, an average of 3020 snake envenomation victims are reported annually according to data from South Korea's Health Insurance Review & Assessment Service, and the World Health Organization (WHO) database describes 101 incidents of casualties from snakebite envenomation in South Korea over 20 years from 1995 to 2015 [3,4]. Despite such medical significance, information on snakebite envenomation in the field of veterinary medicine in South Korea is limited. ...
... Snake envenomation is a frequently confronted medical emergency in humans in South Korea [3,4,6,20]. In veterinary medicine, however, the clinical characteristics and treatment of venomous snakebites are insufficiently documented [23]. ...
... Many factors influenced this result, including the snakes and envenomated dogs; however, the number of snakebites peaking in the afternoon suggests that snakes in South Korea are most active during the hottest part of the day. Furthermore, the dogs were mostly bitten between May and October, the hottest months in South Korea [4,9]. ...
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Snake envenomation is a medical emergency capable of causing local and systemic complications. However, information on venomous snakebite in dogs in South Korea is scarce. In this study, fifty-nine dogs treated at a private veterinary clinic from 2004 to 2021 were retrospectively studied. The aim was to characterize the demographics, elapsed time between snakebite and veterinary clinic presentation, laboratory findings, clinical signs, treatments, adverse reactions to antivenom, and prognosis of venomous snakebite. Snakebite was mostly observed between 12 p.m. and 5 p.m. from April to October. On the days of envenomation, the weather conditions were mostly cloudy, followed by rain/precipitation, and least frequently fair weather. Grassland was the most common incident location, and leashed dog walking was the most frequent activity when snakebite occurred. The main local symptoms were edema, hemorrhagic discharge, cutaneous erythema, ulceration, and necrosis. Major systemic clinical signs were tachypnea, tachycardia, altered mentation, ptyalism, and hypotension. Based on the time interval between snakebite and presentation at the veterinary clinic, two groups were defined:
... Scientific name Common name tigrinus belonging to Colubridae, and five marine species belonging to Elapidae [13]. Red-tongue viper (G. ...
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Understanding the ecology of species at risk is extremely important for their conservation and management. Due to land clearing for urban expansion, agriculture , and the import of pets, several snake species including the red-tongue viper (Gloydius ussuriensis) on Jeju Island of South Korea, have become threatened. We studied morphology, distribution, habitat characteristics, diet, and reproduction of red-tongue viper to provide a higher understanding of species ecology. This species on average reach 242-580 mm snout-vent length and is found in a wide range of habitat from mountain forest to lowland areas. Adult snakes prey almost entirely on amphibians followed by mammals and centipedes. The mating usually takes place in spring and birth takes place in autumn. This study points out the major threats and ill-information if addressed will not only contribute to the conservation efforts but also improve the negative attitudes that people hold toward these fascinating animals. The ecological data of G. ussuriensis herein provides basic information which assists in designing the management technique for conservation. Similar applications may be generalized and used to other vulnerable species to detect and quantify population ecology and risks, bolstering conservation methods that can be used to optimize the efficacy of conservation measures.
... Most of the experimental studies were done by in-vitro or pre-incubation assay method. Neutralizing actions of extractives of plants, upon shake venom are more notable in vitro but not confirmed in vivo study [8]. Poisonous snakes are classified into neurotoxic, vasculotoxic and myotoxic. ...
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On June 9th, 2017 WHO categorized snakebite envenomation into the Category A of the Neglected Tropical Diseases. This new situation will allow access to new funding, paving the way for wider and deeper researches. It should also expand the accessibility of antivenoms. Let us hope that it also leads to cooperation among stakeholders, aiming at improving the management of snakebites in developing countries.
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Marine reptiles are declining globally, and recent climate change may be a contributing factor. The study of sea snakes collected beyond their typical distribution range provides valuable insight on how climate change affects marine reptile populations. Recently, we collected 12 Laticauda semifasciata (11 females, 1 male) from the waters around southern South Korea - an area located outside its typical distribution range (Japan, China including Taiwan, Philippines and Indonesia). We investigated the genetic origin of Korean specimens by analyzing mitochondrial cytochrome b gene (Cytb) sequences. Six individuals shared haplotypes with a group found in Taiwan-southern Ryukyu Islands, while the remaining six individuals shared haplotypes with a group encompassing the entire Ryukyu Archipelago. These results suggest L. semifasciata moved into Korean waters from the Taiwan-Ryukyu region via the Taiwan Warm Current and/or the Kuroshio Current, with extended survival facilitated by ocean warming. We highlight several contributing factors that increase the chances that L. semifasciata establishes new northern populations beyond the original distribution range. © 2017 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Snakebite is a global public health crisis, but there are no nationwide data on snakebite in South Korea. The aim of this study was to describe the epidemiological profile and outcomes of snakebite cases in South Korea seasonally. Methods: The selected subjects were patients of all ages with a chief complaint of snakebite who presented to participating emergency departments (EDs) between 1 January 2011 and 31 December 2016. Results: A total of 1335 patients were eligible for the study. There were an average of 223 snakebite cases reported each year. Most snakebites occurred during the summer months (55.9%) in patients aged 40-59 y (36.3%) and males (61.5%). Snakebites occurred most frequently on Mondays (22.9%) between 12:00 and 17:59 h (42.0%) outdoors (57.9%) and in farm areas (20.7%). Over 82% of the bites were by venomous snakes across all seasons, and 66% of the patients visited EDs without using emergency medical services. Based on the excess mortality ratio-adjusted injury severity score, 88, 9.2 and 2.8% had mild, moderate and severe injuries, respectively. There were 10 fatalities during the study period. Conclusion: This study provides essential information to understand and assess the burden and distribution of snakebites in South Korea and provides valuable information for developing appropriate prevention and control interventions to address it.
Article
The scourge of snakebite has been well documented but largely ignored by the global health community for several decades, especially the role that economics has played in causing and exacerbating this crisis. Every year millions of people in low and middle-income countries face death, disability and disadvantage from snakebite envenoming (SBE) without access to appropriate treatment. Health-economic factors pervade every aspect of this neglected problem. A multitude of financial and commercial factors helped to cause, and now perpetuate, shortages of high quality, affordable and region-appropriate antivenom in areas where they are most needed. Alongside the death, physical disability and psychological anguish from SBE is a debilitating financial toll, which includes both direct costs of treatment and indirect costs from lost income. SBE is a problem that disproportionately affects poor, rural and agrarian communities, with most victims being young and industrious subsistence workers. The burden of envenoming is often felt by families and communities that can least afford it, and negatively impacts local and national productivity. The lack of long-term investment in health systems to properly manage SBE has led to insufficient funding for antivenom development, procurement, quality control and distribution, despite highly favourable cost effectiveness of some antivenoms. This has contributed to market failures that have seen antivenom output fall and become inaccessible to most victims. Solutions to these problems exist and are achievable, however the challenge for advocates is to appreciate the importance of health-economics and ensure that strategies to redress the economic causes and consequences of SBE are themselves cost-effective and financially sustainable.
Article
Among the many complications that may follow envenomation by some species of venomous snakes, coagulopathy is common and well known. However, hemoperitoneum induced by coagulopathy after a snakebite is rare. Atraumatic spontaneous splenic rupture is also an uncommon and life-threatening condition. Here, we report a case of presumptive envenomation by Gloydius spp. that resulted in atraumatic splenic rupture as a probable manifestation of coagulopathy, which has not been previously reported.
Article
In Korea, there are four types of snakes, Glyoidius brevicaudus, G. intermedius (formerly named, saxatilis), G. ussuriensis, Rhabdophis tigrinus. The case-fatality rate in snake bite envenomation is very low. Snake venom is a heterogeneous mixture of pharmacologically active enzymatic, non-enzymatic protein, peptide toxins, other organic and inorganic substances. The pathophysiology evokes a complex series of events that depend on the combined and synergistic action of toxic and non-toxic components. The manifestation includes local and systemic effects. Local tissue effects includes of tissue pain, redness, swelling, tenderness, bullae formation, and necrosis. The major systemic manifestations of snake bite include neurotoxicity, myotoxicity, cytotoxicity, hemolytic, procoagulant, hemorrhagic, and hypotensive effects and interfere in platelet function. General care includes parenteral analgesia, antivenom administration, and serial assessments of limb swelling and laboratory tests. Despite the presence of soft tissue inflammation, prophylactic antibiotics are rarely required, and most patients achieve good outcomes with supportive care and antivenom alone. In the case of mild poisoning do not need to be treated with antivenom. In moderate to severe envenomation, antivenom should be administered. When administered antivenom, adverse reactions are monitored closely and treated early with epinephrine and anti-histamine. In future, we should establish algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.
Article
• (1)A survey of north-west Malayan fishing villages suggests that sea-snake bite is much more common than has hitherto been realized. • (2)Biology of sea-snakes is described with a brief account of them in captivity. • (3)Venom yields of several sea-snake species are reported, and available information on toxicity quoted. • (4)The pathological changes in subjects of sea-snake bite are described, and other aspects of basic toxicology considered in the light of relevant work. • (5)The treatment of neurotoxic snake poisoning is critically reviewed. The prevention of sea-snake bite is briefly discussed. • (6)A new theory is postulated to account for the apparently large number of sea-snake bites which do not cause serious signs of poisoning. • (7)The need for further clinical and laboratory research is mentioned.
Article
This bibliography lists 71 publications dealing with human envenomation by colubrid snakes during the years 1873–1988. This information appears in a wide variety of publications in medicine, herpetology, and toxicology. Fifty snake species, many conventionally considered nonvenomous, are included. Reports are divided into those showing evidence of systemic poisoning, usually associated with coagulopathy, and those showing only local signs and symptoms.
Article
The viviparous sea snakes (Hydrophiini) are by far the most successful living marine reptiles, with ∼ 60 species that comprise a prominent component of shallow-water marine ecosystems throughout the Indo-West Pacific. Phylogenetically nested within the ∼ 100 species of terrestrial Australo-Melanesian elapids (Hydrophiinae), molecular timescales suggest that the Hydrophiini are also very young, perhaps only ∼ 8-13 Myr old. Here, we use likelihood-based analyses of combined phylogenetic and taxonomic data for Hydrophiinae to show that the initial invasion of marine habitats was not accompanied by elevated diversification rates. Rather, a dramatic three to six-fold increase in diversification rates occurred at least 3-5 Myr after this transition, in a single nested clade: the Hydrophis group accounts for ∼ 80% of species richness in Hydrophiini and ∼ 35% of species richness in (terrestrial and marine) Hydrophiinae. Furthermore, other co-distributed lineages of viviparous sea snakes (and marine Laticauda, Acrochordus and homalopsid snakes) are not especially species rich. Invasion of the oceans has not (by itself) accelerated diversification in Hydrophiini; novelties characterizing the Hydrophis group alone must have contributed to its evolutionary and ecological success.
Article
Pit viper snake venom exerts a mildly neurotoxic effect that may rarely lead to neurotoxic complications, such as paralytic strabismus. Extraocular muscles are known to be particularly susceptible to this complication. In previously reported cases, the medial rectus muscle has been the most frequently involved. We report the first case of a pit viper snakebite resulting in comitant exotropia without obvious paralytic features.{A figure is presented}. © 2009 American Association for Pediatric Ophthalmology and Strabismus.
Article
Epidemiological features as reflected by 101 patients with unequivocal sea-snake bite received in north-west Malaya are reviewed. Enhydrina schistosa caused over half the bites, including seven of the eight fatal bites. It is the most dangerous sea-snake to man. Over 90 per cent of the victims were male and 80 of the 101 patients were fishermen bitten at their job. Most victims were bitten on the lower limb through treading on the snake, and this resulted in more cases of serious poisoning than upper limb bites (caused through handling nets, sorting fish and so on). Only 14 cathers were bitten (through treading on the sea-snake; no bathers were bitten while swimming). In patients coming to hospital more than six hours after the bite, there was a four-fold increase in serious poisoning compared with patients coming within six hours of the bite. Thus, as time elapses after the bite, the victim is less likely to seek medical help unless poisoning is severe. Despite the lethal toxicity of sea-snake venom, in patients seen during 1957-61 before sea-snake antivenom became available, the mortality was only 10 per cent. Trivial or no poisoning followed in 80 per cent of the bites. On the other hand, of 11 patients (20 per cent) with serious poisoning, over half (six patients) died despite supportive hospital treatment. These epidemiological features observed in Malaya probably apply to most fishing folk along Asian coastlines where sea-snakes abound. If this is so, sea-snake bite must be a common hazard feared by millions of fishing folk, and a common cause of illness and death. But it is unlikely that the extent of this problem will be revealed to orthodox medicine for many decades because most fishing villages are far from medical centres; and even if hospitals or medical centres are available, fishing folk are usually reluctant to attend them. Only one species of sea-snake, Pelamis platurus, extends to the east coasts of Africa and west coasts of the tropical Americas, but for various reasons this species does not appear to constitute much of a hazard to fishing folk in these areas. Although bathers are occasionally bitten along Asian coasts, when they inadvertently tread on a sea-snake, the risk of sea-snake bite in this area is extremely low. The prevention of sea-snake bite and poisoning is considered. Highly effective antivenom is now available for treating victims with serious poisoning; death should not occur provided adequate medical treatment is given within a few hours of the bite. The main problem is provision of adequate medical care at rural medical centres and overcoming the reluctance fishing folk often have in attending these centres.
Article
The causes and implications of venom variability are discussed with a review of the literature. Venom variability may have an impact on both primary venom research and management of snakebite, including selection of antivenoms and selection of specimens for antivenom production. Choice of venom is reviewed, including venom collection, maintenance, and pooled venom versus venom milked from individual specimens, the latter being more reliable in many applications. Intraspecific variability resulting in clinical variability of envenomation occurs and is reviewed. Venom variability is considered at several levels; interfamily, intergenus, interspecies, intersubspecies and intraspecies, geographical variation, between individual specimens, and in individual specimens, due to seasonal variation, diet, habitat, age-dependent change, and sexual dimorphism. It is concluded that venom researchers must be aware of venom variability both in selecting their sources of venom and in interpretation of results. Producers of antivenom must utilize an understanding of such variability in selecting sources of venom for antivenom production to ensure representation of all venom types required within each antivenom. Furthermore, clinicians treating snakebite should understand the influence of venom variability on both the presentation of envenomation and the treatment implications.
Article
Snake venom can cause myriad local and systemic signs and symptoms. Neurotoxic effects include difficulty seeing, diplopia, difficulty in opening the mouth, speaking, or swallowing, and difficulty getting out of bed the morning after the snakebite. Because of the unique structure of the extraocular muscles, they are particularly susceptible to the neurotoxin. Rarely, though, are symptoms of snakebite confined to the extraocular muscles. This case report describes a patient who experienced only extraocular manifestations of envenomation. It is important for clinicians to recognize this unique neurotoxic manifestation and to begin treatment of snakebites, because delay in treatment could cause permanent injury and even death.
Prognostic predictors of outcome in patients with snakebite, based on initial findings in the emergency department
  • I Y Baek
  • T K Kim
  • S C Jin
  • W I Cho
Baek, I.Y., Kim, T.K., Jin, S.C., Cho, W.I., 2017. Prognostic predictors of outcome in patients with snakebite, based on initial findings in the emergency department. J. Korean Soc. Clin. Toxicol. 15, 1-10.