Study of local manifestations of snake bite and its surgical implications, at a rural hospital in India

Background: Manifestations of snakebite have local and systemic implications. While systemic manifestations can be life-threatening, local complications like cellulitis, necrosis, and compartment syndrome secondary to snakebite can threaten limb survival. This study undertakes the recognition of local complications and its outcome.Methods: A retrospective observational study was conducted at our tertiary center in India. 219 snake bitten patients presenting in between January 2013 to December 2020, were studied. Surgical interventions whenever required for managing local surgical complications were recorded and analyzed.Results: Of the 219 patients, 118 (53.88%) of the patients were bitten by venomous snakes requiring systemic therapy and 101 (46.12%) were non-venomous. Of the 118 patients with venomous snakebite, 78 (35.62%) had signs and symptoms. 83.11% reported to the hospital within 6 hours of the bite, while 45.66% within 2 hours. There were 169 (77.17%) patients who had local signs of inflammation, ischemic changes in 28 (12.79%), compartment syndrome in 15 (6.88%). 167 (76.26%) patients were treated conservatively while 52 (23.74%) had to undergo surgical interventions. Those undergoing surgical interventions had longer hospital stays (mean=8.09615) as compared to those treated conservatively (mean=4.82635) (p value=< 0.001). In patients with no local inflammation, only 1 (0.46%) required surgical intervention as compared to 51 (23.29%) (p value=< 0.001) patients with local inflammation requiring surgical intervention.Conclusions: Along with systemic medical treatment, local manifestations of most snakebites can be well managed with suitable surgical intervention. Surgical complications of snakebite are not infrequent leading to interventions. Such patients usually have a longer hospital stay

Multiple hepatosplenic abscesses in an immunocompetent host

Sphingomonas paucimobilis, a gram-negative organism, mainly infects immunocompromised hosts due to its low virulence. Patients with such an infection usually have contact with healthcare. Meningitis, peritonitis, visceral abscess, septic arthritis, septicemia, post-traumatic endophthalmitis, and keratitis are among the documented complications of Sphingomonas paucimobilis infection. Such an infection is rarely seen in the literature as the one causing splenic and liver abscess and that too in an immunocompetent host. We present a case of a 23-year-old immunocompetent male, who presented with fever and other constitutional symptoms with recent onset of abdominal pain and fullness. Splenic and liver abscesses were detected on radiology with the growth of only Sphingomonas on blood culture and negative reports for other organisms excluding the differentials, proving S.mobilis being the cause of the abscesses. The patient was managed on broad-spectrum antibiotics and additional medications for symptomatic relief. The patient gradually improved over 7 days of hospitalization. This case report mainly focuses on Sphingomonas paucimobilis infection, which is rarely seen and documented, and surprisingly in an immunocompetent host causing life-threatening infections and abscesses. Even though it’s a rare and a low virulence organism, such a presentation must not be overlooked. A regular and focused laboratory workup for detection and management, with adequate antibiotic treatment, is a must to avoid a poor prognosis