Article Category:
Research Article

Symptoms and Management of Painful Progressive Swelling in Eswatini Snakebite Patients: A Prospective Observational Study

Jonathan Steinhorst Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands;

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Thea Litschka-Koen Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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Bianca Ascenção Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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Lindelwa Mmema Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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Nondumiso Shongwe Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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James Murray Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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Harry VanderWal The Luke Commission, Sidvokodvo, Eswatini;

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Rafael Cuginotti de Oliveira Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands;

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Trevor Sithole Research Unit, Ministry of Health, Mbabane, Eswatini;

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Sara Padidar Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;
Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini;

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Nicholas R. Casewell Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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Jonathan Pons Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini;
Eswatini Antivenom Foundation, Simunye, Eswatini;

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Robert A. Harrison Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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David G. Lalloo Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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Ymkje Stienstra Department of Internal Medicine/Infectious Diseases, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands;
Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

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DOI:
https://doi.org/10.4269/ajtmh.24-0671
Volume/Issue:
Ahead of Print
Open access
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In Eswatini, bites from snakes with cytotoxic venoms inflict substantial morbidity on humans through blistering, swelling, and tissue necrosis. Despite its widespread use, there is little evidence regarding the efficacy of antivenom in preventing snakebite-induced tissue damage. We conducted a prospective observational study in nine hospitals in Eswatini to describe and quantify symptoms of local tissue toxicity. Our secondary aim was to examine the use of antivenom. Data from 125 snakebite patients with extensive or rapidly progressive swelling were analyzed. The median increase in circumference of envenomed limbs was 12%. Necrosis developed in 31 (25%) patients, primarily in distal extremities. Seventy patients (56%) received South African Institute for Medical Research (SAIMR) Polyvalent antivenom (South African Vaccine producers, Johannesburg South Africa), which was administered for indications related to local tissue damage. Upon hospital presentation, patients treated with antivenom exhibited slightly more severe swelling. Ten out of 11 patients with necrosis upon admission received antivenom. At least seven patients developed necrosis after admission despite previous antivenom therapy. In this nonrandomized observational study, no relationship was observed between the rate at which swelling receded and antivenom treatment. Adverse reactions to antivenom occurred in 49% of patients. Although our analysis has its limitations, it emphasizes the compelling need for research into the indications for and outcomes of antivenom treatment for local tissue damage.

Author Notes

Financial support: This research was funded in part by the Wellcome Trust (grant 217264/Z/19/Z), awarded to T. Litschka-Koen, D. G. Lalloo, J. Pons, R. A. Harrison, and J. Steinhorst received funding from The Royal Society of Tropical Medicine and Hygiene (RSTMH Small Career Grants Programme) and project funding for his MD PhD from the University Medical Centre Groningen. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosures: This research was funded in whole or in part by the Wellcome Trust (grant number 217264/Z/19/Z). For the purpose of open access, the author has applied a CC BY public copyright license to any author-accepted manuscript version arising from this submission. Ethical approval was obtained from The Eswatini Health and Human Research Review Board, Eswatini (SHR204/2019), and the Research Ethics Committee of The Liverpool School of Tropical Medicine, United Kingdom (Reference LSTM REF 19-106). Informed consent from the participants was obtained before study enrollment. Permission for the participation of patients under the age of 5 years was obtained from their legal guardian. For patients aged 5–18 years, consent was sought from both the child and his or her legal guardian. In cases of emergency, or when the patient was too impaired to consent (e.g., unconsciousness, sedation, etc.), consent was deferred until the patient had sufficiently recovered. If participation was declined, all previously obtained data for research purposes were destroyed. Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.

Current contact information: Jonathan Steinhorst and Rafael Cuginotti de Oliveira, Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands, E-mails: j.e.steinhorst@umcg.nl and rafael_cuginotti@hotmail.com. Thea Litschka-Koen, Bianca Ascenção, Lindelwa Mmema, Nondumiso Shongwe, James Murray, and Jonathan Pons, Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini, and Eswatini Antivenom Foundation, Simunye, Eswatini, E-mails: thea.koen@res.co.sz, biancafilipebranco@gmail.com, mmemal@yahoo.com, nondusho@yahoo.com, murray.jld@gmail.com, and jono@mabuda.com. Harry VanderWal, The Luke Commission, Sidvokodvo, Eswatini, E-mail: harry.vanderwal@lukecommission.org.. Trevor Sithole, Research Unit, Ministry of Health, Mbabane, Eswatini, E-mail: sibonangay@gmail.com. Sara Padidar, Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini, and Eswatini Antivenom Foundation, Simunye, Eswatini, and Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini, E-mail: sarapadidar@gmail.com. Nicholas R. Casewell, Robert A. Harrison, and David G. Lalloo, Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mails: nicholas.casewell@lstmed.ac.uk, robert.harrison@lstmed.ac.uk and david.lalloo@lstmed.ac.uk. Ymkje Stienstra, Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands, and Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mail: ymkje.stienstra@lstmed.ac.uk.

Address correspondence to Ymkje Stienstra, Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, Liverpool, United Kingdom. E-mail: ymkje.stienstra@lstmed.ac.uk
Copyright:
© The author(s) 2025
Received:
04 Oct 2024
|
Accepted:
22 Dec 2024
|
Published Online:
15 Apr 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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