Snakebites in Lebanon: A descriptive study of snakebite victims treated at a tertiary care center in Beirut, Lebanon

• Type of Material: Article
• Authors: Tharwat El Zahran, Emory University; Ziad N. Kazzi, Emory University; Ahel Al-Hajj Chehadeh, American University of Beirut Medical Center; Riyad Sadek, American University of Beirut; Mazen J. El Sayed, American University of Beirut Medical Center
• Language: English
• Date: 2018-04-01
• Publisher: Medknow Publications
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Journal of Emergencies.
• License: Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4103/JETS.JETS-141-16
• Title of Journal or Parent Work: Journal of Emergencies, Trauma, and Shock
• ISSN: 0974-2700
• Volume: 11
• Issue: 2
• Start Page: 119
• End Page: 124
• Grant/Funding Information: Financial support and sponsorship: Nil.
• Keywords: Daboia palaestinae; Montivipera bornmuelleri; Macrovipera lebetina; Lebanon; snakebites; Antivenin
• Research Categories: Biology, General; Health Sciences, Medicine and Surgery

Abstract

Background: Snakebites lead to at least 421,000 envenomations and result in more than 20,000 deaths per year worldwide. Few reports exist in the Mediterranean region. This study describes demographic and clinical characteristics, treatment modalities, and outcomes of snakebites in Lebanon. Materials and Methods: This was a retrospective chart review of patients who presented with snakebite complaint to the emergency department between January 2000 and September 2014. Results: A total of 24 patients were included in this study. The mean age was 34.6 (±16.4) years and 58.3% were males. Local manifestations were documented in 15 (62.5%) patients, systemic effects in 10 (41.7%), hematologic abnormalities in 10 (41.7%), and neurologic effects in 4 (16.7%) patients. Nine patients (37.5%) received antivenom. The median amount of antivenom administered was 40 ml or 4 vials (range: 1-8 vials). About 50% of patients were admitted to the hospital with 75% to an Intensive Care Unit and 25% to a regular bed. All were discharged home with a median hospital length of stay of 4 (interquartile range 11) days. Among those admitted, seven patients (58.3%) had at least one documented complication (compartment syndrome, fasciotomy, intubation, deep vein thrombosis, coagulopathy, acute respiratory distress syndrome, sepsis, congestive heart failure, cellulitis, upper gastrointestinal bleeding, and vaginal bleeding). Conclusion: Victims of snakebites in Lebanon developed local, systemic, hematologic, or neurologic manifestations. Complications from snakebites were frequent despite antivenom administration. Larger studies are needed to assess the efficacy of available antivenom and to possibly create a local antivenom for the treatment of snakebites in Lebanon.