Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature.

Tianyi, Frank, Ngari, Cecilia, Wilkinson, Mark C., Parkurito, Stanley, Chebet, Elizabeth, Mumo, Evans, Trelfa, Anna, Otundo, Dennis, Crittenden, Edouard, Kephah, Geoffrey Maranga, Harrison, Robert, Stienstra, Ymkje, Casewell, Nicholas R, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 and Oluoch, George (2025) 'Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature.'. PLoS Neglected Tropical Diseases, Vol 19, Issue 2, e0012845.

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Abstract

Introduction
The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.

Methods
We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features.

Results
Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient’s description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases—swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings.

Conclusion
We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Antigens and Antibodies. Toxins and Antitoxins > QW 630 Toxins. Antitoxins
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pntd.0012845
Depositing User:	Clare O'Neill
Date Deposited:	10 Mar 2025 11:54
Last Modified:	10 Mar 2025 11:56
URI:	https://archive.lstmed.ac.uk/id/eprint/26163

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