Study of Key Components of Deaths Due To Ophitoxaemia

Shibanand Nepal Karmakar

Published on: 2022-11-30

Abstract

Background: There are more than 3500 species of snakes, but only about 250 are venomous. In India about 216 species are found, of which 52 are poisonous. In India only five of them are dangerously poisonous to man, i.e. king cobra, common cobra, common krait, Russell's viper and saw-scaled viper. Ophitoxaemia is poisoning by snake venom [1]. As per world health organization, though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenomings. Around 81000 to 138000 people die each year because of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually [2]. The present study aims to study key components of deaths due to snake bites.

Conclusion: All cases were of accidental manner. Most of the cases were in rural area. Half of the cases occurred in rainy season. Majority of the cases were married females.

Keywords

Forensic Medicine; Forensic Pathology; Ophitoxaemia; Accident; Snakes

Introduction

Snake bite is a neglected public health issue in many tropical and subtropical countries. About 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of envenomings (poisoning from snake bites). There are between 81410 and 137880 deaths and around three times as many amputations and other permanent disabilities each year [2].

Most of these occur in Africa, Asia and Latin America. In Asia up to 2 million people are envenomed by snakes each year, while in Africa there are an estimated 435000 to 580000 snake bites annually that need treatment. Envenoming affects women, children and farmers in poor rural communities in low- and middle-income countries. The highest burden occurs in countries where health systems are weakest and medical resources sparse [2].

Material and Method

A prospective study was conducted in the department of forensic medicine at our tertiary care centre for a period of four years from September 2011 to August 2015. During this period more than ten thousand cases of autopsy examination were conducted in our tertiary medicolegal centre. During the same period the author had conducted about eight hundred autopsy examinations. Of these autopsy cases a total of 8 cases of death due to snake bites were conducted by the author in the mentioned period of four years.

Necessary permission for the present study was obtained from institutional ethical committee. Consent is not required for conducting medicolegal autopsies in our country. All the cases were studied prospectively during routine medicolegal autopsies conducted in the institute and hence consent to participate was not required.

Inclusion criteria for the present study were:-

  • All autopsy cases at our tertiary care centre conducted by the author where death was due to snake bites.

Exclusion criteria for the present study were:-

  • Autopsy cases where death was not due to snake bites.
  • Autopsy cases which were not conducted by the author.
  • Autopsy cases where the reason and cause for died person were not known.
  • Autopsy cases where findings were not confirmatory of death due to snake bites.
  • Ambiguous findings on autopsy.

History of the case, the details of the cases, circumstances of the death and other relevant information related to the study was obtained from the respective investigating agencies. The cases were studied in relation to the gender, age, manner of death, marital status, and month of incidence and area of incidence.

Results

Table 1: Descriptions of the cases of snake bite deaths

S No

Gen-der

Age

Marital Status

Month of Incidence

Area of Incidence

Manner [Suicide/

Homicide/Accident]

1

F

60

Married

August

Rural

Accident

2

F

27

Married

August

Rural

Accident

3

F

3

Unmarried

October

Rural

Accident

4

F

45

Married

November

Urban

Accident

5

F

23

Married

March

Rural

Accident

6

F

60

Widowed

January

Rural

Accident

7

M

60

Married

June

Rural

Accident

8

M

55

Married

July

Rural

Accident

First case of snake bite death was of a 60 years married female of rural area who died of accidental manner in the month of august.

Second case of snake bite death was of a 27 years married female of rural area who died of accidental manner in the month of august.

Third case of snake bite death was of a 3 years unmarried female child of rural area who died of accidental manner in the month of October.

Fourth case of snake bite death was of a 45 years married female of urban area who died of accidental manner in the month of November.

Fifth case of snake bite death was of a 23 years married female of rural area who died of accidental manner in the month of March.

Sixth case of snake bite death was of a 60 years widowed female of rural area who died of accidental manner in the month of January.

Seventh case of snake bite death was of a 60 years married male of rural area who died of accidental manner in the month of June.

Eighth case of snake bite death was of a 55 years married male of rural area who died of accidental manner in the month of July.

Table 2: Age-wise and Gender wise distribution of cases

Age in years

Males

Females

Total

0 to 9 yrs

0

1

1

10 to 19 yrs

0

0

0

20 to 29 yrs

0

2

2

30 to 39 yrs

0

0

0

40 to 49 yrs

0

1

1

50 to 59 yrs

1

0

1

60 to 69 yrs

1

2

3

>70 yrs

0

0

0

Total

02

06

8

Of the total 8 cases of snake bite death; 3 cases were in age group 60-69 years, 2 cases were in the age group 20-29 years, while one case were in the age group of 0-9 years, 40-49 years and 50-59 years age group each.

Of the 2 male cases of snake bite death there was one case in the age group 50-59 years and 60-69 years age group.

Of the 6 female cases of snake bite death; 2 cases were in the age group 20-29 years and 60-69 years each, while one case were in the age group of 0-9 years and 40-49 years age group each.

Of the 8 cases of snake bite death; 6 cases were female and 2 cases were males.

Table 3: Month of incidence of cases

 

Married

Unmarried

Widow

Males

02

0

0

Females

04

01

01

Total

06

01

01

Of the 8 cases of snake bite death; six cases was married while one case was unmarried and widowed each.

Of the 2 male cases of snake bite death both cases were married.

Of the 6 female cases of snake bite death; four cases was married while one case was unmarried and widowed each.

Table 4: Manner of deaths in drowning cases

Month

No of Cases

% of cases

January

01

12.5%

February

0

0

March

01

12.5%

April

0

0

May

0

0

June

01

12.5%

July

01

12.5%

August

02

25%

September

0

0

October

01

12.5%

November

01

12.5%

December

0

0

Total

08

100%

Of the 8 cases of snake bite death; 2 (25%) cases were in the month of august while one (12.5%) cases were in the month of January, March, may, June, July, October and November each.

Table 5: Area wise distribution of cases

Area

No of Cases

% of cases

Rural Area

07

87.5%

Urban Area

01

12.5%

Total

08

100%

Of the 8 cases of snake bite death; 7 (87.5%) cases were from rural area while one (12.5%) case was from urban area.

Table 6: Distribution of cases as per manner of death

Manner of death

No of Cases

% of cases

Accident

08

100%

Suicide

0

0

Homicide

0

0

Total

08

100%

Of the 8 cases of snake bite death; all 8 (100%) cases were of accidental manner. There were no cases of suicidal and homicidal manner.

Discussion

Snakes are cylindrical, long, limbless, cold-blooded reptiles. The body of snake is divided into: Head, Trunk and Tail. Poisonous snakes are divided into 5 families namely Colubridae: e.g. African boomslanag snake, twig snakes; Alractaspididae: e.g. mole vipers or adders; Elapidae: e.g. cobra, krait, coral snake; Viperidae: e.g. Russell’s viper, saw-scaled viper and Hydrophidae: e.g. Sea snakes [3].

Majority of bites and consequent mortality in India is attributable to only five species and they include King Cobra (Ophiophagus hannah), Common Cobra (Naja Naja), Russell’s Viper (Daboia rusellii), Krait (Bungarus caeruleus) and Saw-scaled Viper (Echis carinatae)[4].

Poison apparatus of a snake is a modified salivary (Parotid) gland consisting of gland, duct and fangs [4].Venom is the saliva of the snake. Cobra venom is faint transparent yellow and is slightly viscous. It is basically a mixture of toxalbumins and enzymes in varying proportions [1].

Descriptions of the cases of snake bite deaths

Descriptions of all the cases of snake bite deaths are described in first section of results.

Age-wise and Gender wise distribution of cases

In all the articles surveyed males where the majority of cases in all articles. Male: Female ratio 1.5:1 was found by [5] & [6]. Male: Female ratio 2:1 was found by [7] & [8]. Male: Female ratio 2.2:1 was found by [9]. Male: Female ratio 4.25:1was found by [10].

In our study majority of the cases were females. This could be due to the fact that most of the cases were from rural areas and females do farm works and household works. Snake bites to females may be due to these reasons.

In our study of the total 8 cases of snake bite death; 3 cases were in age group 60-69 years, 2 cases were in the age group 20-29 years, while one case were in the age group of 0-9 years, 40-49 years and 50-59 years age group each. Thus cases were distributed in all phases of age. [6] Found most cases in 13-40 years age group. [8] Found most cases in 16-45 years age group. [9] Found most cases in 21-40 years age group. [11] Found most cases in 11-30 years age group.

Marital status of cases

In our study six cases was married while one case was unmarried and widowed each. [11] Found (68.18%) cases married and (31.82%) cases were unmarried.

In our study both the male cases of snake bite deaths were married (100%) cases. [11] Found that of total male cases; (60.00%) were married and (40.00%) were unmarried.

In our study of the female cases of snake bite death; four cases (66.7 %) cases was married while one (16.7 %) case was unmarried and widowed each. [11] Found that of total female cases; (85.71%) were married and (14.29%) were unmarried.

Month of incidence of cases

In our study 50% cases occurred in rainy seasons months of June, July and august. Most of the articles surveyed showed cases in the rainy season’s months. [9], [11], [12] and [13] found most cases in the months of June-September. [14] & [15] found most cases in monsoon (rainy) season.

Area wise distribution of cases

In our study (87.5%) cases were from rural area while (12.5%) case was from urban area.

[6],[7], [8],[9],[10], [11], [14] and [15] found most cases in rural area. While [16] found most cases in urban area.

Distribution of cases as per manner of death

In our study all (100%) cases were of accidental manner. There were no cases of suicidal and homicidal manner. [11] Also found all (100%) cases of snake bite cases were of accidental manner.

Conclusion

In our study all cases were of accidental manner. Most of the cases were in rural area. Half of the cases occurred in rainy season. Majority of the cases were married females.

References

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