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[Snake bites in children at the Fez University Hospital in Morocco]
M A Berdai1, S Labib1, M Harandou1
1CHU Hassan II, Service de Réanimation mère et enfant, 30000 Fès, Maroc.
Insights
Pediatric snake bites in northern Morocco are severe, causing widespread symptoms and hemostasis disorders. Prompt immunotherapy is crucial for improving outcomes in children with snake envenomation.
Area of Science:
- Pediatric critical care medicine
- Toxicology
- Epidemiology
Context:
- Snake bites in children present significant challenges in northern Morocco.
- Understanding the specific epidemiological and clinical profiles is essential for effective management.
Purpose:
- To describe the epidemiological, clinical, biological, and therapeutic aspects of snake bites in children treated at a pediatric intensive care unit in Fez, Morocco.
Summary:
- A retrospective study of 12 children revealed severe snake envenomation with predominant local signs, edema, and systemic manifestations in 83% of cases.
- Hemostasis disorders, including profound thrombocytopenia, were observed in 91% of patients. Treatments included analgesia, fasciotomy (25%), and blood product transfusion (66%).
- The study highlights a high incidence of severe envenomation (grade 2-3), with 25% requiring intubation and a mortality rate of 16%.
Impact:
- The findings underscore the severity of pediatric snake bites in the region, characterized by locoregional complications and hemostasis disorders.
- This study emphasizes the need for readily available, species-specific immunotherapy to improve the prognosis of snake envenomation in children.
Aims:
The objective of our study is to describe the epidemiological, clinical, biological, and therapeutic aspects of snake bites in children in northern Morocco.
Methods:
This retrospective study reviewed files of all children admitted to the pediatric intensive care unit of the Hasssan II University Hospital in Fez from April 2011 through April 2013. It includes all children reported by themselves or their family to have been bitten by a snake and all those with traces of snake fangs.
Results:
This study included 12 children, with a mean age of 9.6 ± 2.9 years. In each case, admission took place the day the envenomation occurred, a mean of 8.8 ± 5.6 hours after the bite. Locoregional signs and edema were seen in all cases, associated with bruising (58%) and blisters (25%). General events, including gastrointestinal, cardiovascular, neurologic, and hemorrhagic signs, affected 83% of the children. Hemostasis disorders occurred in 91% of patients, including profound thrombocytopenia (mean: 27.7 ± 30.7 G/L. All envenomations were grade 2 or grade 3. Analgesia was administered systematically; a fasciotomy was performed in 25% of cases and transfusion of blood products in 66%. Three children (25%) were intubated and two children died (16%).
Conclusion:
This series is characterized by the severity of the clinical presentations, with a predominance of locoregional complications and hemostasis disorders corresponding to snake-bite syndrome. We conclude that immunotherapy adapted to the local species must be made available to improve the prognosis of this envenomation.
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