Frequency, geographical distribution and outcomes of pit viper bites in Malaysia consulted to Remote Envenomation Consultancy Services (RECS) from 2017 to 2020.

Not all pit viper species are present in every state of Malaysia and their distribution varies according to altitude. There is limited information on pit viper bite incidence and its geographical distribution. This was a cross-sectional study of confirmed pit viper bite cases referred to Remote Envenomation Consultancy Services (RECS) from January 2017 to December 2020. Data was collected following the approval of institutional research ethics committee. Universal sampling methods were used. Confirmed pit viper bite cases in each state, geographical location and the antivenom used were reported. A total of 523 confirmed pit viper bite injuries occurred over the 4-year study period. The majority were Malaysians, male and young adults. Most were non-occupational related (83.9%) and involved the upper limbs (46.8%). The commonest pit viper species involved was Trimeresurus purpureomaculatus (23.7%). Green pit viper antivenom (GPAV) was the most frequent antivenom used (n = 51) with the majority of patients requiring only one dose (3 vials). This study provides a better appreciation of indigenous pit viper species distribution for each state and reflects the requirement of appropriate antivenom to be stocked in each state or district hospital

The clinical presentation, management and outcome of <i>Tropidolaemus spp</i>. bite consulted to RECS from 2015–2021.

The clinical presentation, management and outcome of Tropidolaemus spp. bite consulted to RECS from 2015–2021.</p

Demographic characteristics of the <i>Tropidolaemus</i> spp. snake bite patients.

Demographic characteristics of the Tropidolaemus spp. snake bite patients.</p

The frequency of anatomical region involved in bite injury from <i>Tropidolaemus</i> spp.

The frequency of anatomical region involved in bite injury from Tropidolaemus spp.</p

The number of <i>Tropidolaemus</i> spp. bite cases consulted to RECS from each district and state in Malaysia from 2015–2021.

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The morphological differences between male and female <i>Tropidolaemus wagleri</i> and <i>Tropidolaemus subannulatus</i>.

(A) Adult female Tropidolaemus wagleri. Image credit: M. K. Arif (B) Adult male Tropidolaemus wagleri. Image credit: M. K. Arif (C) Adult female Tropidolaemus subannulatus. Image credit: M. K. Arif (D) Adult male Tropidolaemus subannulatus. Image credit: E. W. Teo.</p

Number of <i>Tropidolaemus wagleri and Tropidolaemus subannulatus</i> cases consulted to RECS from each state’s district from 2015–2021.

(A) Geographical distribution of T. wagleri in Peninsular Malaysia. The highest consultations was recorded in the district of Larut Matang, Perak. (B) Geographical distribution of T. subannulatus in East Malaysia (Sabah and Sarawak). The highest consultations was recorded in the district of Serian, Sarawak. Base map and data from OpenStreetMap and OpenStreetMap Foundation.(© OpenStreetMap contributors, https://www.openstreetmap.org/#map=6/4.226/108.237).</p

Annual number of snake related injury consulted to RECS and the number of <i>Tropidolaemus subannulatus</i> and <i>Tropidolaemus wagleri</i> bite cases from 2015 to 2021.

Annual number of snake related injury consulted to RECS and the number of Tropidolaemus subannulatus and Tropidolaemus wagleri bite cases from 2015 to 2021.</p