Volume 100, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The local signs and symptoms following snakebites are similar to those of cellulitis caused by bacterial infections. This leads to empirical treatment with antibiotics, which however is not supported by evidence. Procalcitonin (PCT) is a biomarker with good diagnostic accuracy for bacterial infection. We studied serum PCT concentration in 100 patients aged 13 years or more, presenting to the hospital with significant local manifestations (crossing the joint proximal to the bitten wound) within 24 hours after snakebite. The extent and progression of local manifestations were monitored 12 hourly. Baseline PCT measurement was carried out for all patients and measurement was repeated 12 hourly only in those patients with progressive local manifestations. The median interqartile range PCT concentration did not differ significantly by the severity of local manifestation at presentation (Grade 2 = 0.28 [0.26–0.30]; Grade 3 = 0.28 [0.26–0.32]; Grade 4 = 0.27 [0.26–0.32] ng/mL; = 0.15). Furthermore, we did not observe an increase in PCT concentration on serial estimation in those with progressive local manifestation (0.28, 0.29, and 0.29 ng/mL) over 36 hours. These observations suggest that the local manifestations following snakebites were not caused by bacterial infection.


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  1. Kasturiratne A, Wickremasinghe AR, Silva ND, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ, , 2008. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 5: e218. [Google Scholar]
  2. Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, Rodriguez PS, Mishra K, Whitaker R, Jha P, Million Death Study Collaborators; , 2011. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis 5: e1018. [Google Scholar]
  3. WHO, 2016. Guidelines for the Management of Snake-Bites, 2nd edition. New Delhi, India: World Health Organization, Regional Office for South-East Asia. Available at: http://apps.searo.who.int/PDS_DOCS/B5255.pdf?ua=1. [Google Scholar]
  4. Goldstein EJC, Mandell GL, Bennett JE, Dolin R, , 2016. Bites. , eds. Mandell, Douglas, Bennett’s Principles and Practice of Infectious Diseases. Philadelphia, PA: Elsevier, 35103515. [Google Scholar]
  5. Clark RF, Selden BS, Furbee B, , 1993. The incidence of wound infection following crotalid envenomation. J Emerg Med 11: 583586. [Google Scholar]
  6. Kerrigan KR, Mertz BL, Nelson SJ, Dye JD, , 1997. Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial. World J Surg 21: 369373. [Google Scholar]
  7. Chen C-M, Wu K-G, Chen C-J, Wang C-M, , 2011. Bacterial infection in association with snakebite: a 10-year experience in a northern Taiwan medical center. J Microbiol Immunol Infect 44: 456460. [Google Scholar]
  8. Mao YC, Liu PY, Hung DZ, Lai WC, Huang ST, Hung YM, Yang CC, , 2016. Bacteriology of Naja atra snakebite wound and its implications for antibiotic therapy. Am J Trop Med Hyg 94: 11291135. [Google Scholar]
  9. Garg A, Sujatha S, Garg J, Acharya NS, Chandra Parija S, , 2009. Wound infections secondary to snakebite. J Infect Dev Ctries 3: 221223. [Google Scholar]
  10. Palappallil DS, , 2015. Pattern of use of antibiotics following snake bite in a tertiary care hospital. J Clin Diagn Res 9: OC05OC09. [Google Scholar]
  11. Jorge MT, 2004. Failure of chloramphenicol prophylaxis to reduce the frequency of abscess formation as a complication of envenoming by Bothrops snakes in Brazil: a double-blind randomized controlled trial. Trans R Soc Trop Med Hyg 98:529534. [Google Scholar]
  12. Kularatne SA, Kumarasiri PV, Pushpakumara SK, Dissanayaka WP, Ariyasena H, Gawarammana IB, Senanayake N, , 2005. Routine antibiotic therapy in the management of the local inflammatory swelling in venomous snakebites: results of a placebo-controlled study. Ceylon Med J 50: 151155. [Google Scholar]
  13. Sachett JAG, 2017. Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: a randomized controlled clinical trial. PLoS Negl Trop Dis 11: e0005745. [Google Scholar]
  14. Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, Nusbaumer C, Tamm M, Christ-Crain M, , 2007. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7: 10. [Google Scholar]
  15. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C, , 1993. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341: 515518. [Google Scholar]
  16. Jeandrot A, Richard JL, Combescure C, Jourdan N, Finge S, Rodier M, Corbeau P, Sotto A, Lavigne JP, , 2008. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 51: 347352. [Google Scholar]
  17. Eder J, Hlavin G, Haushofer A, Trubert-Exinger D, Trautinger F, , 2012. Correlation of serum procalcitonin with the severity of skin and skin structure infections–a pilot study. J Dtsch Dermatol Ges 10: 564571. [Google Scholar]
  18. Enguix A, Rey C, Concha A, Medina A, Coto D, Diéguez MA, , 2001. Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive Care Med 27: 211215. [Google Scholar]
  19. Aikawa N, 2005 Multicenter prospective study of procalcitonin as an indicator of sepsis. J Infect Chemother 11: 152159. [Google Scholar]

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  • Received : 17 Nov 2017
  • Accepted : 18 Oct 2018
  • Published online : 19 Nov 2018

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