Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature.
<h4>Introduction</h4>The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.<h4>Methods</h4>We conducted a case-seri...
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Public Library of Science (PLoS)
2025-02-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0012845 |
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| author | Frank-Leonel Tianyi Cecilia Ngari Mark Wilkinson Stanley Parkurito Elizabeth Chebet Evans Mumo Anna Trelfa Denis Otundo Edouard Crittenden Geoffrey Maranga Kephah Robert A Harrison Ymkje Stienstra Nicholas R Casewell David G Lalloo George O Oluoch |
| author_facet | Frank-Leonel Tianyi Cecilia Ngari Mark Wilkinson Stanley Parkurito Elizabeth Chebet Evans Mumo Anna Trelfa Denis Otundo Edouard Crittenden Geoffrey Maranga Kephah Robert A Harrison Ymkje Stienstra Nicholas R Casewell David G Lalloo George O Oluoch |
| author_sort | Frank-Leonel Tianyi |
| collection | DOAJ |
| description | <h4>Introduction</h4>The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.<h4>Methods</h4>We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features.<h4>Results</h4>Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient's description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases-swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings.<h4>Conclusion</h4>We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species. |
| format | Article |
| id | doaj-art-1fdc286022e24a7fad873ee8d7c62f91 |
| institution | DOAJ |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-1fdc286022e24a7fad873ee8d7c62f912025-08-20T03:09:17ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352025-02-01192e001284510.1371/journal.pntd.0012845Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature.Frank-Leonel TianyiCecilia NgariMark WilkinsonStanley ParkuritoElizabeth ChebetEvans MumoAnna TrelfaDenis OtundoEdouard CrittendenGeoffrey Maranga KephahRobert A HarrisonYmkje StienstraNicholas R CasewellDavid G LallooGeorge O Oluoch<h4>Introduction</h4>The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.<h4>Methods</h4>We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features.<h4>Results</h4>Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient's description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases-swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings.<h4>Conclusion</h4>We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species.https://doi.org/10.1371/journal.pntd.0012845 |
| spellingShingle | Frank-Leonel Tianyi Cecilia Ngari Mark Wilkinson Stanley Parkurito Elizabeth Chebet Evans Mumo Anna Trelfa Denis Otundo Edouard Crittenden Geoffrey Maranga Kephah Robert A Harrison Ymkje Stienstra Nicholas R Casewell David G Lalloo George O Oluoch Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. PLoS Neglected Tropical Diseases |
| title | Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. |
| title_full | Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. |
| title_fullStr | Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. |
| title_full_unstemmed | Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. |
| title_short | Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature. |
| title_sort | clinical features of puff adder envenoming case series of bitis arietans snakebites in kenya and a scoping review of the literature |
| url | https://doi.org/10.1371/journal.pntd.0012845 |
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