CLINICAL FEATURES AND ELECTROMYOGRAPHIC CHANGES OF NERVE DAMAGE IN PATIENTS ENVENOMED BY BUNGARUS MULTICINCTUS

Huy Tiến Nguyễn, Hữu Thông Trần , Trần Hưng Hà

Main Article Content

Abstract

Objective: To describe the clinical features and electromyographic changes of nerve damage in patients bitten by Bungarus multicinctus. Method: A descriptive study of 19 snakebite patients treated at Poison Control Center of Bach Mai Hospital. Results: Symptoms of cranial nerve and peripheral motor nerve paralysis included ptosis (100%), diplopia (89.5%), mydriasis (100%), extraocular muscle paralysis (89.5%), limited mouth opening (100%), neck muscle paralysis (100%), upper and lower limb muscle weakness (89.5%), and decreased deep tendon reflexes (89.5%). The duration of ptosis in the antivenom group was significantly shorter with a mean of 4.0 ± 1.83 days compared to the non-antivenom group with a mean of 7.86 ± 3.13 days, with a statistically significant difference of p = 0.013. Electromyography on the first day of hospital admission showed that the average latent period, conduction velocity of motor nerves were within normal limits, but the amplitude of motor nerve wave was reduced. The average latent period, conduction velocity of sensory nerves, and the amplitude of sensory nerve wave in the intermediate nerve were within normal limits. Among the patients who underwent repetitive stimulation tests on the first day, 10.0% had a positive result, and 30.0% had suspected positive results. Conclusion: Electromyography on the first day of patients bitten by Bungarus multicinctus initially indicates the detection of synaptic motor nerve damage, which is consistent with the mechanism of alpha-neurotoxin and beta-neurotoxin found in krait venom.

Article Details

References

1. Bộ Y tế (2015), Hướng dẫn chẩn đoán và xử trí ngộ độc, Ban hành kèm theo Quyết định số 3610/QĐ-BYT ngày 31/8/2015 của Bộ trưởng Bộ Y tế, Bộ Y tế, Hà Nội.
2. Nguyễn Ngọc Hiển (2017). Nghiên cứu đặc điểm lâm sàng và điện cơ ở bệnh nhân liệt cơ do rắn độc cắn, luân văn bác sĩ chuyên khoa cấp 2, Đại học Y Hà Nội.
3. Patikorn C, Blessmann J, Nwe MT, et al. (2022) Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model. PLoS Negl Trop Dis 16(9): e0010775. https://doi.org/ 10.1371/ journal. pntd. 0010775
4. Trevett A. J., Lalloo D. G., Nwokolo N. C., et al. (1995), Electrophysiological findings in patients envenomed following the bite of a Papuan taipan (Oxyuranus scutellatus canni). Trans R Soc Trop Med Hyg, 89(4), pp. 415-417.
5. Panduranga P., Sangle S.A., Mane A.A., et al. (2015), Comparative study of electrophysiological changes in snake bites. Neurol India, 63(3), pp. 378-381.
6. Warrel David A. (2010), Guidelines for the management of snake-bites, WHO Library cataloguing-in-publication data, India.
7. Hung H.T., Hojer J., and Du N.T. (2009), Clinical features of 60 consecutive ICU-treated patients envenomed by Bungarus multicinctus. Southeast Asian J Trop Med Public Health, 40(3), pp. 518-524.