Use of molecular diagnostic tools for the identification of species responsible for snakebite in Nepal: a pilot study

  • Abstract: 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. Author Summary: Snakebite is an important medical problem in sub-tropical and tropical regions, including Nepal where tens of thousands of people are bitten every year. Snakebite can result in life-threatening envenoming, and correct identification of the biting species is crucial for care providers to choose appropriate treatment and anticipate complications. This paper explores a number of methods, including molecular techniques, to assist care providers in identifying the species responsible for bites in rural Nepal. Out of 749 patients with a history of snakebite, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous snake, most commonly cobras (n = 42) and kraits (n = 22). This study is the first to report the use of molecular techniques for snake species identification. The diagnostic accuracy of this method appears high but needs to be confirmed in larger studies.

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Author:Sanjib Kumar Sharma, Ulrich KuchORCiDGND, Patrick Höde, Laura Bruhse, Deb P. Pandey, Anup Ghimire, François Chappuis, Emilie Alirol
URN:urn:nbn:de:hebis:30:3-398426
DOI:https://doi.org/10.1371/journal.pntd.0004620
ISSN:1935-2735
ISSN:1935-2727
Parent Title (English):PLoS neglected tropical diseases
Publisher:PLoS
Place of publication:Lawrence, Kan.
Document Type:Article
Language:English
Date of Publication (online):2016/04/22
Date of first Publication:2016/04/22
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2016/05/04
Volume:10
Issue:10(4): e0004620
Note:
Copyright: © 2016 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
HeBIS-PPN:421458674
Institutes:Medizin / Medizin
Angeschlossene und kooperierende Institutionen / Senckenbergische Naturforschende Gesellschaft
Fachübergreifende Einrichtungen / Biodiversität und Klima Forschungszentrum (BiK-F)
Dewey Decimal Classification:5 Naturwissenschaften und Mathematik / 59 Tiere (Zoologie) / 590 Tiere (Zoologie)
6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0