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Am. J. Trop. Med. Hyg., 79(3), 2008, pp. 458-462
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Right arrow Snake Bite

Distinctive Epidemiologic and Clinical Features of Common Krait (Bungarus caeruleus) Bites in Sri Lanka

Christeine A. Ariaratnam*, M. H. Rezvi Sheriff, R. David G. Theakston, AND David A. Warrell
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; University of Oxford, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom

A prospective study was designed to define epidemiologic and clinical features of krait bites to improve diagnosis, management, and prevention. Among 762 cases of venomous snake bites admitted to 10 Sri Lankan hospitals in which the snake responsible was brought and identified, 88 (11.5%) were caused by common kraits (Bungarus caeruleus). Bites were: most frequent in September through November. Distinctive features of B. caeruleus bites (compared with bites by other species in parentheses) were bitten while sleeping on the ground, 100% (1%); indoors, 100% (49%); between 2300 and 0500 hours, 100% (3%). Only 13% of krait victims were bitten on their lower limbs (82%), only 9% had local swelling (in all cases mild) at the site of the bite (93%), 64% developed respiratory paralysis (2%), and 91% experienced (often severe) abdominal pain (10%). Case fatality was 6% (3%). This distinctive pattern of epidemiology and symptoms will aid clinical recognition (syndromic diagnosis) and prevention of krait bite envenoming.

Received February 14, 2008. Accepted for publication May 5, 2008.

Acknowledgments: The authors thank all the medical and nursing staff especially the consultants in charge of the units and medical officers of the collaborating hospitals for their assistance during the study, especially with collection of data and help with the care of the study patients. We also thank Dr. Carukshi Arambepola for statistical help. We are grateful to the late Haisinth Molligoda, curator, zoological garden, Dehiwela, for help in identifying the dead snakes. We acknowledge Gamini Wasantha Perera and Sripala for help in transferring these specimens to the study center in Colombo. The American Society of Tropical Medicine and Hygiene (ASTMH) and the American Committee on Clinical Tropical Medicine and Travellers’ Health (ACCTMTH) assisted with publication expenses.

* Address correspondence to Christeine A. Ariaratnam, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. E-mail: Ariaranee2000{at}yahoo.com bites in Sri Lanka, based on results of a large prospective clinical study.

Authors’ addresses: Christeine A. Ariaratnam, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka, Tel: 94-112695300, Fax: 94-112689188, E-mail: Ariaranee2000{at}yahoo.com. M. H. Rezvi Sheriff, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka, Tel: 94-112685413, Fax: 94-112682372, E-mail: rsheriff{at}emed.lk. R. David G. Theakston, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK, Tel: 44-1704-514436, E-mail: r.d.g.theakston{at}liverpool.ac.uk. David A. Warrell, University of Oxford, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK, Tel: 44-1865-221332/220968, Fax: 44-1865-220984, E-mail: david.warrell{at}ndm.ox.ox.uk.




This article has been cited by other articles:


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C. A. Ariaratnam, M. H. R. Sheriff, C. Arambepola, R. D. G. Theakston, and D. A. Warrell
Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes
Am J Trop Med Hyg, October 1, 2009; 81(4): 725 - 731.
[Abstract] [Full Text] [PDF]


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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.