Discussion
Snake venom contains of various toxins that acting systemically and locally, including, cardiotoxins, myotoxins, hemostasis toxins, neurotoxins, and renal toxins, that can cause the following disorders containing rhabdomyolysis, acute kidney injury, paralysis of the extremities, compartment syndrome, wound necrosis, coagulation disorder, persistent mydriasis and respiratory distress, cardiac dysrhythmia [13].
Treatment by antivenom can reduces the envenomation effects on various systems (coagulation, central nervous system, the cardiovascular and gastrointestinal system; however, antivenom cannot reverse the effects of local tissue destruction or necrosis.13 Sever wound infections such as cellulitis and necroziting fasciitis following venomous snake bites, are not common; they have been reported in up to 30.8% of patients after a snake bite and require aggressive treatment [3, 4].
The common signs and symptoms of wound infections and cellulitis, such as erythema, inflammation, warmth and local pain may develop in the early hours to days of evolution. However, the risk factors developing from cellulitis to necrotizing fasciitis secondary to a snake bite provided have seldom been investigated [13].
One of the most important complications of snake bite with local envenoming are soft tissue infections. The snake venom with proteolytic properties causes extensive tissue destruction and devitalization, thus predisposing the wound to bacterial infection from the snake’s indigenous oral flora. Although in patients with snake bite, bacteria are a major cause of wound infection, the role of prophylactic antibiotics to prevent their formation is discussible. However, the spectrum of bacteria from the venom and oral cavities of snakes vary with geographic area as well as with the species and the oral health of the snake, and these factors cannot easily be extrapolated to snakes in rest of the world [14].
Our reported patient was a 65 years old man who admitted with chest pain, tachycardia, fever, cold sweat, chills, frequent nausea, vomiting, left upper limb edema and decreased level of consciousness. After assessments and excluding the possibility of heart disease, infectious diseases and compartment syndrome, due to the burning sensation in the tip of the third finger of left upper limb after lifting a heavy object and the occurrence of hemorrhagic and non-hemorrhagic blisters in this limb with suspected snakebites, standard treatment with Anti-venom started for the patient and due to the rapid response with this treatment and the endemicity of the area in terms of snake bites, the diagnosis was definitive.
Hemorrhagic blisters often form at the site of the bite digits but may occur at any bite location or even in dependent areas distant from the bite. These blisters usually do not appear until hours after the bite. The tissue beneath these blisters is usually healthy, although large blisters can cause necrosis in their underlying tissue [2].
Coagulopathy, thrombocytopenia, or a combination of the two, may be present despite a paucity of other local or systemic effect. A decrease in platelet count, as well as decrease in fibrinogen with elevation of prothrombin time (PT), may be mild or moderate initially and may either remain so or continue to worsen for several days following the envenomation [2]. The standard Anti-venom treatment can reduce these toxic hemorrhagic and neurotoxic effects [6-8].
However, early usage of antivenom following snake bite, showed a trend toward a better local outcome within 12 hours. Prophylactic use of antibiotics was still controversial [7].
Conclusion :
It should be noted that wound infections caused by snake bites if not treated in a timely manner, can lead to complications such as necrotizing fasciitis, compartment syndrome, or superimposed bacterial infection, which require hospitalization, the use of broad-spectrum antibiotics, and emergency surgical procedures; and since blisters usually do not appear until hours after the bite, so in cases of local edema and swelling with hemorrhagic or non-hemorrhagic blisters of unknown cause, it is recommended to consider snake bite as a differential diagnosis and consult a clinical toxicology specialists .