Retrospective Prevalence of Snakebites from Hospital

A hospital based retrospective study of the prevalence of snakebite cases at Hospital Kuala Lumpur was carried out over a five-year period from 1999 to 2003. A total of 126 snakebite cases were recorded. The highest admission for snakebites was recorded in 2001 (29 cases). The majority of cases were admitted for three days or less (79%). Most of the snakebite cases were reported in the 11-30 years age group (52%). The male:female ratio was 3:1. The majority of cases were Malaysians (80%, 101 cases). Of the non-Malaysians, Indonesians constituted the most (56%, 14 cases). Bites occurred most commonly on the lower limbs (49%), followed by upper limbs (45%) and on other parts of the body (6%). No fatal cases were detected and complications were scarce. In 60% (70 cases) the snake could not be identified. Of the four species of snakes that were identified, cobra (both suspected and confirmed) constituted the largest group (25%), followed by viper (10%), python (4%) and sea snake (1%). The most common clinical presentations were pain and swelling, 92% (116 cases). All patients were put on snakebite charts and their vital signs were monitored. Of the snakebite cases, 48% (61 cases) were treated with cloxacillin and 25% (32 cases) were given polyvalent snake antivenom. pit viper). All twenty-two species of sea snakes in Malaysia are venomous (Lim, 1990). Several studies of snakebites had been carried out in Peninsular Malaysia (Reid et al, 1963; Ambu and Liat, 1980; Lim, 1980; Muthusamy, 1988; Tan et al, 1990; Zulkifli et al, 1995; Jamaiah et al, 2004). In the majority of cases of snakebites admitted to hospitals in Malaysia, most of the snakes were not identified (Zulkifli et al, 1995; Jamaiah et al, 2004). Most cases of snakebites identified in Malaysia were due to the Malayan pit viper (Agkistrodon rhodostoma/Calloselasma rhodostoma/ular kapak bodoh) (Reid, 1963; Lim and Abu Bakar, 1970; Muthusamy, 1988; Lim, 1990). But Jamaiah et al (2004) and Tan et al (1990) reported that most of the cases of snakebites were due to the common cobras. The Malayan pit viper is confined to the Kedah and Perlis States which are situated in the northern part of west Malaysia extending to southern Thailand (Reid, 1963; Lim and Abu Bakar, 1970; Lim, 1990; Tweedie, 1990). It feeds mainly on small mammals and lives on the ground, where it is very well concealed by a background of dead leaves. It is also very slugRETROSPECTIVE PREVALENCE OF SNAKEBITES, MALAYSIA Vol 37 No. 1 January 2006 201 gish and has effective camouflage. These factors combine to increase the hazard of stepping on a snake, but death from the bite is unusual (Tweedie, 1990). Chen et al (2000) reported that most venomous snakebites admitted to a general hospital in northern Taiwan were attributed to the green habu and Taiwan habu. Fayomi et al (2002) did a retrospective study of snakebites reported by the Ministry of Public Health from 1994-2000 in Benin and found that a total of 30,273 cases were reported during 7 years and the lethality was high (15%). Hon et al (2004) reviewed the pattern and characteristics of snakebites in children in rural Hong Kong. He reported seven snakebite cases in children; 86% of the victims were male and the majority of bites (86%) occurred on the extremities. Pierini et al (1996) reported that snakebite was an important cause of morbidity and death among forest-dwelling Amazonian Indians and rubber tappers in northwestern Brazil. Overall, 13% of a surveyed population had been bitten during their l ifetime. 21 28 29