Fatal neurotoxic envenomation following the bite of a greater black krait (Bungarus niger) in Nepal: a case report

 

Deb Prasad Pandey¹, Sanjib Kumar Sharma², Emilie Alirol^3 4, François Chappuis³, Ulrich Kuch⁵

 

1 Kaligandaki Health Foundation, Kawasoti, Nawalparasi, Nepal.

2 Departmentof Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

3 Clinical Trial Unit, Clinical Research Centre and Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.

4 Médecins Sans Frontières UK, London, UK.

5 Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany

 

ABSTRACT

 

Background

Neurotoxic envenomation following bites by kraits (Bungarus species) is a leading cause of snakebite mortality in South Asia. Over a long time, this had been attributed only to one species, the common krait (Bungarus caeruleus). However, recent research has provided increasing evidence of the involvement of several krait species. Here, we report a fatal case of neurotoxic envenomation following the bite of a greater black krait (Bungarus niger) in Nepal.

 

Case presentation

A 33-year-old man was bitten in the outdoor corridor of his home in the eastern hills of Ilam district while handling a snake he thought to be non-venomous. He subsequently developed severe abdominal pain, frequent vomiting, and signs of neurotoxic envenomation leading to respiratory paralysis. The patient did not respond to Indian polyvalent antivenom given 4 h after the bite and died under treatment 8 h after the bite. This is the second time that a B. nigerwas observed in Nepal, the first documented case of envenomation by this species in the country and the sixth reported case worldwide.

 

Conclusions

Previous distribution records – from eastern India and western Nepal, from western hills in Nepal, and from lowland localities in India and Bangladesh – indicate risk of envenomation by B. niger throughout the low and intermediate elevations of Nepal up to at least 1,500 m above sea level. As very few people in Nepal bring killed snakes to healthcare centers and because there is a general belief among local people that there are no kraits in the hills, bites by B. niger are likely to be misdiagnosed and underreported.

 

Key words: Bungarus niger; Neurotoxicity; Krait; Envenomation; Antivenom; Snakebite

 

Funding

This study was funded by the Swiss National Science Foundation (Project number IZ70Z0-131223). The foundation did not have any role in the design, collection, analysis, and interpretation of data, nor in the writing or the decision of submitting the manuscript for publication.

 

Received: December 19, 2015.

Revised: May 24, 2016.

Accepted: June 3, 2016.

 

Correspondence: debpandey@gmail.com

 

Authors’ contributions

DPP identified the snake, conducted interviews and collected primary data. DPP and UK drafted the manuscript. EA, FC, SKS, and UK conceived the study during which the case was recorded. SKS observed the reported case. EA, FC, and SKS contributed to manuscript writing. All authors read and approved the final manuscript.

 

Competing interests

The authors declare that there are no competing interests.

 

Consent for publication and ethics approval

Written informed consent was obtained from the deceased patient’s wife for the publication of this case report. The study was approved by the the Ethics Committee of Geneva University Hospitals, Ethical Review Board of the B.P. Koirala Institute of Health Sciences, and by the Nepal Health Research Council.

 

doi: 10.1186/s40409-016-0073-8