A Retrospective Observational Study of Mangrove Pit Viper Envenomation Presented to Selangor Middle Zone Cluster Hospitals in Malaysia

(256 words) OBJECTIVE: There is very limited published experience on mangrove pit viper envenomation in the medical literature. This study aims to analyze the clinical characteristics, treatment modalities and outcomes of patients presenting to Selangor middle zone cluster Hospitals in Malaysia with confirmed mangrove pit viper bites.

METHODS: We conducted a retrospective observational study, reviewing medical records of patients treated for mangrove pit viper bites between 1st July 2020 to 30th June 2023. Data on patient demographics, clinical characteristic, laboratory findings, treatment modalities and clinical outcomes were collected and analyzed.

RESULTS: A total of 25 patients were included in this study. The majority of the patients were male (n=23, 92%) with the mean age of 38.7±17.6 years. Most frequent anatomical region involved is foot (n=12, 48%). Common clinical presentation included localized pain (n=xx, 96%), swelling (n=22, 88%) and fang mark (n=22, 88%). Systemic symptoms were less common, with 1 patient exhibit coagulopathy with clinical bleeding at 28 hours post bite. Antivenom was administered to 68% (n=17) of the patients. The majority of the patients (n=23, 92%) recovered without significant morbidity while 8% (n=2) of the patients developed skin infection that required antibiotic therapy. No fatalities were reported.

CONCLUSION: Mangrove pit viper envenomation encounter in these regions predominantly causes local symptoms while systemic symptoms were less common. This study provides a glimpse to the clinical characteristics and management of mangrove pit viper envenomation, coagulopathy may be delayed due to characteristic of the snake venom and patient's preexisting illness. Further research is needed to enhance our understanding of this snakebite envenomation.