Mortality following snake bite envenomation by Bitis arietans in an HIV positive child: A case report

Area of Science:

• Pediatric Toxicology
• Infectious Diseases
• Dermatology

Background:

• Snake bites are a significant public health concern in rural South Africa.
• Hospitals must maintain preparedness for uncommon snake bite presentations.
• This study documents the first reported case of human immunodeficiency virus (HIV) interaction with snake bite in South African children.

Observation:

• A 1-year-old child presented with cytotoxic envenomation and compartment syndrome in the left upper limb following a snake bite.
• Delayed polyvalent antivenom administration (4 days) and a concurrent HIV diagnosis complicated the clinical course.
• The patient developed extensive skin necrosis, persistent thrombocytopenia, and ultimately succumbed to overwhelming sepsis.

Findings:

• The case highlights the complex interplay between snake venom toxicity and HIV infection in a pediatric patient.
• Persistent thrombocytopenia was observed, potentially attributed to both HIV and snake bite envenomation.
• Delayed treatment significantly worsened the patient's prognosis, leading to severe local and systemic complications.

Implications:

• Effective management protocols for snake bites are crucial in all healthcare settings, especially in regions with high incidence.
• This case emphasizes the heightened risk and challenges in treating snake bites in immunocompromised children, particularly those with HIV.
• Further research into the synergistic effects of envenomation and HIV on hematological parameters is warranted.