Frequency, clinical characteristics and outcomes of Tropidolaemus species bite envenomations in Malaysia.

Pit vipers from the genus Tropidolaemus are identified as one of the common causes of snake bite from venomous species in Malaysia. All Tropidolaemus species bite cases referred to the Remote Envenomation Consultation Services (RECS) between 2015–2021 were included. A total of 4,718 snake-related injuries cases consulted to RECS with 310 (6.6%) involved Tropidolaemus species; of these 190 (61.3%) were T. subannulatus and 120 (38.7%) T. wagleri. All the T. subannulatus cases occurred in Sabah and Sarawak while all cases of T. wagleri occurred in Peninsular Malaysia. The majority of patients were male (74.8%) and adults between 18–59 years old (61.2%). The upper limb (56.6%) was the most frequent anatomical region involved. Most cases were non-occupationally related (75.4%). Bites from both species caused local pain (77.1%) and swelling (27.2%). Most patients complained of mild pain (48.0%). Paracetamol (40.0%) was the most common analgesic prescribed. Antivenom was not indicated in all cases. Two patients were given antivenom inappropriately before RECS consultation. Most patients (54.7%) needed hospital observation for less than 24 hours. No deaths occurred in the group studied. Author summary: There is poor documentation and awareness of the clinical characteristics and significance of Tropidolaemus species bite in Malaysia. This study analysed RECS consultation data from 2015–2021 regarding Tropidolaemus species bite cases in Malaysia. By analysing the RECS consultation log, the frequency, geographical distribution, clinical features, clinical management and outcomes of verified Tropidolaemus species bite were documented. The significance of this study is to provide verified and reliable information regarding the clinical characteristics, significance and clinical burden of Tropidolaemus species bite cases. We provide the evidence for the revision and exclusion of T. subannulatus from the WHO category 2 list of medically important venomous snakes in Malaysia. By identifying and understanding the characteristics and significance of Tropidolaemus species bite envenomation, optimal management can be provided for a favourable outcome. [ABSTRACT FROM AUTHOR]

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