Use of Molecular Diagnostic Tools for the Identification of Species Responsible for Snakebite in Nepal: A Pilot Study.
Snakebite is an important medical emergency in rural Nepal. Correct identification of the biting species is crucial for clinicians to choose appropriate treatment and anticipate complications. This is particularly important for neurotoxic envenoming which, depending on the snake species involved, may not respond to available antivenoms. Adequate species identification tools are lacking. This study used a combination of morphological and molecular approaches (PCR-aided DNA sequencing from swabs of bite sites) to determine the contribution of venomous and non-venomous species to the snakebite burden in southern Nepal. Out of 749 patients admitted with a history of snakebite to one of three study centres, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous snake, most commonly the Indian spectacled cobra (Naja naja; n = 42) and the common krait (Bungarus caeruleus; n = 22). When both morphological identification and PCR/sequencing results were available, a 100% agreement was noted. The probability of a positive PCR result was significantly lower among patients who had used inadequate "first aid" measures (e.g. tourniquets or local application of remedies). This study is the first to report the use of forensic genetics methods for snake species identification in a prospective clinical study. If high diagnostic accuracy is confirmed in larger cohorts, this method will be a very useful reference diagnostic tool for epidemiological investigations and clinical studies.
B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Sanjib Kumar
SK
Sharma
Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
Ulrich
U
Kuch
Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
Patrick
P
Höde
Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
Laura
L
Bruhse
Senckenberg Biodiversity and Climate Research Centre (BiK-F), Frankfurt am Main, Germany.|Senckenberg Forschungsinstitut, Frankfurt am Main, Germany.
Deb P
DP
Pandey
B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Anup
A
Ghimire
Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.
François
F
Chappuis
Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.|Médecins Sans Frontières UK, London, United Kingdom.
Emilie
E
Alirol
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009390:Nepal; D057089:Pathology, Molecular / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012909:Snake Bites / Q000175:diagnosis* / Q000473:pathology*; D012911:Snakes / Q000145:classification*; D014947:Wounds and Injuries / Q000473:pathology*; D055815:Young Adult