Explore the vast range of titles available.

Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality. We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia. Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease. Bill & Melinda Gates Foundation.

Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon. We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated. Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5-156), p = 0.005) and complications (aOR: 17.3, 2.4-123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%). We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.

Rat bite fever (RBF) is a zoonotic disease caused primarily by Streptobacillus ( S .) moniliformis . Norway or brown rats ( Rattus [ R. ] norvegicus ) are the natural host for S. moniliformis and carry the bacterium in the nasopharynx without clinical disease. Transmission to humans often occurs through rat bites or scratches, but also through contact with the excreta of infected rats. Although human infections with S. moniliformis occur worldwide, they are rarely diagnosed. For decades, S. moniliformis was the only known member of the genus Streptobacillus . In recent years, however, four additional species were identified, two of which being zoonotic pathogens capable of causing symptoms identical to RBF in humans. The aim of this study was to develop a serological assay covering all known Streptobacillus species. A bead-based multiplex fluorescence immunoassay for S. moniliformis detection has been used for years in routine diagnostics of laboratory rodents. Here, this assay was adapted to enable the detection of antibodies against all currently known Streptobacillus species and tested with sera from experimentally inoculated mice and rats, and with negative sera from laboratory rodents. Using this assay, we broadly examined the prevalence of Streptobacillus spp. reactive antibodies in wild rodents. Transudates from a total of 107 Norway rats, 81 black or roof rats ( Rattus rattus ) and 110 house mice ( Mus musculus ) from different husbandries and wildlife populations within Germany were tested. Antibody prevalences of 41% in R. norvegicus and 83% in R. rattus suggest that Streptobacillus spp. are widespread in wild and captive rats in Germany, whereas wild mice seem to be free of infection. Due to its high throughput capacity and multiplex format, the Streptobacillus multiplex serology is well suited for large seroprevalence studies in rodents and has the potential, after adaptation, for use in humans, thereby allowing for the assessment of Streptobacillus infection risk and risk of RBF.

The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel–binding toxins and potassium channel–binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.

The phylum Arthropoda includes arachnids and insects. Although their bites typically cause only local reactions, some species are venomous or transmit disease. The two medically important spiders in the United States are widow spiders ( Latrodectus ), the bite of which causes intense muscle spasms, and the brown recluse ( Loxosceles ), which may cause skin necrosis. Widow bites usually respond to narcotics, benzodiazepines, or, when necessary, antivenom. Most recluse bites resolve uneventfully without aggressive therapy and require only wound care and minor debridement. Tick bites can transmit diseases only after prolonged attachment to the host. Treatment of clothing with permethrin and proper tick removal greatly reduce the risk of infection. Ticks of medical importance in the United States include the black-legged tick, the Lone Star tick, and the American dog tick. The prophylactic use of a single dose of doxycycline for Lyme disease may be justified in high-risk areas of the country when an attached, engorged black-legged tick is removed. Bites from fleas, bedbugs, biting flies, and mosquitoes present as nonspecific pruritic pink papules, but the history and location of the bite can assist with diagnosis. Flea bites are usually on ankles, whereas mosquito bites are on exposed skin, and chigger bites tend to be along the sock and belt lines. Antihistamines are usually the only treatment required for insect bites; however, severe mosquito reactions (skeeter syndrome) may require prednisone. Applying insect repellent containing diethyltoluamide (DEET) 10% to 35% or picaridin 20% is the best method for preventing bites.

We describe a case of alpha-gal syndrome (AGS) in a resident of Washington, USA, after local Ixodes pacificus tick bites, which were associated with IgE increases after diagnosis. AGS should be considered a potential cause of anaphylactic and allergic reactions in persons with tick exposures, regardless of geographic residence.

Animal-related injuries remain a neglected public health issue in rural Tanzania, exacerbated by limited access to care and varied occupational exposures. While some studies have examined bite management in tertiary hospitals, little is known about the situation at the primary healthcare (PHC) level. This study explored clinical presentations, management and outcomes of animal-related injuries in a rural Tanzanian setting, using Mkinga District as a case study. A mixed-methods study was conducted in February 2024 across 29 PHC facilities in Mkinga, Tanzania. The quantitative component involved a retrospective audit of animal-related injury records from 2019 to 2023. The qualitative component comprised 10 interviews with facility in-charges to explore clinical decision-making, treatment approaches, and outcomes. Quantitative data were analyzed using SPSS; thematic analysis was applied to the qualitative transcript. A total of 351 cases were documented. Symptom data were missing in over 70% of records, limiting clinical profiling. Among recorded cases, corticosteroids (55%) and antihistamines (53%) were commonly used, especially for insect and dog bites. Antibiotics were administered in insect stings (26%) and dog bites (23%), and analgesics were frequently used for insect bites. Antidotes were most common in dog (58%) and snake bites (26%). Of two cat bite cases, only one received antibiotics; neither received tetanus toxoid, despite the known infection risk. Qualitative findings highlighted three themes: clinical presentations, treatment modalities, and outcomes. Respondents described primary (e.g., bleeding, pain) and systemic (e.g., respiratory distress, neurological signs) symptoms. Treatment involved a mix of pharmacological, non-pharmacological, and traditional methods. While most patients recovered, some experienced complications or death. PHC facilities manage most animal-related injuries effectively, but gaps in documentation, guideline adherence, and referral systems remain. Strengthening provider training, improving resources, and engaging traditional healers may enhance timely care. Broader surveillance and community education are critical to reducing preventable harm.

Snake envenomation is a global health problem. The range of clinical sequelae includes thromboses and neuromuscular paralysis. Antivenoms made in horses and sheep are the treatments of choice but require accurate identification of the bite source and can cause anaphylaxis and serum sickness.

Snakebite envenoming is among the top five emergency health conditions in northern Ghana. Among the four genera of snake species classified to be of highest medical importance, species with haemotoxic venom are responsible for about 90% of all snakebite case presentations in the region. However, there is a dearth of clinical data on signs and symptoms of envenoming, treatment practices and health outcomes. We examined the signs and symptoms of envenoming and clinical management practices at referral hospitals in northern Ghana. Medical records of patients reporting on account of snakebite between 2016 and 2020 at the Wa Municipal Hospital in the Upper West region and the Baptist Medical Centre in the North East region of Ghana were reviewed. Demographic characteristics, patients' clinical data and management practices were analysed and evaluated taking into consideration the national standard treatment guideline. A total of 2,684 records of patients reporting on account of snakebite were accessed at both health facilities over the five-year period. 91% of the patients were admitted to the ward. Swelling, severe pain and bleeding were the most common clinical signs upon presentation. A total of 1,670 (64.7%) of all the patients tested had at least one abnormal blood clotting result suggesting haemotoxicity. Antivenom was administered to 84.3% of the patients. Antibiotics were administered to 70.5% with amoxicillin with clavulanic acid, flucloxacillin and metronidazole accounting for 59.2% of all antibiotics administered. The recorded case-fatality rate was 1.9%. The annual hospital attendance rate on account of snakebite to the Wa Municipal Hospital and the Baptist Medical Centre is estimated at 55 persons per 100,000 population per year. Mortality was low, with antivenom available to most of the patients. More evidence is needed on the indication and dosing of antivenom and to improve appropriate ancillary care.