TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE

Knowledge, perceptions and healthcare practices of communities for management of snakebites in Kamuli District, Eastern Uganda
Tusabe J, Muhoozi M, Kajungu D, Mukose A, Kasasa S and Sebina Kibira SP
Snakebite is one of the neglected tropical diseases in Uganda affecting rural areas, especially during the rainy season. Households mainly rely on traditional remedies for management, which are not always effective, leading to disability and sometimes death. We explored the knowledge, perceptions and healthcare practices related to snakebites in Kamuli District.
Snake envenomation in Florida: a 20-year analysis of epidemiology and clinical outcomes at a tertiary medical centre
Grace RC, Leonard W, Zawoy M and Beatty NL
Venomous snakes are among the most lethal animals worldwide and envenomation survivors face lifelong morbidities. Envenomation is colloquially considered highly prevalent in the US state of Florida, yet envenomation trends here are currently unassessed.
Determinants of seeking or foregoing allopathic treatment after snakebite: a population-based study from rural Sri Lanka
Jayawardana S, Chang T, Gnanathasan A and Arambepola C
Despite the availability of antivenom, not all snakebite victims choose to seek allopathic care. This choice of care is likely to be determined by unexplored personal and external factors. We studied the factors influencing the choice of treatment and first aid measures among snakebite victims.
Community-based snakebite risk mapping for resource prioritisation in Eastern Province, Rwanda
Ediriweera DS, Hakizimana D, Diggle PJ and Schurer JM
Snakebite envenoming is a medical emergency that requires rapid access to essential medicines and well-trained personnel. In resource-poor countries, mapping snakebite incidence can help policymakers to make evidence-based decisions for resource prioritisation. This study aimed to characterise the spatial variation in snakebite risk, and in particular to identify areas of relatively high and low risk, in Eastern Province, Rwanda.
National Action Plan for the prevention and control of snakebite envenoming in India: strategies and challenges
Munshi H and Gajbhiye RK
India accounts for one-half of global snakebite-related deaths. The recently launched National Action Plan for the Prevention and Control of Snakebite Envenoming in India is a comprehensive initiative designed to address this burden. It aims to ensure universal access to antivenom, strengthen healthcare systems, train healthcare professionals and engage traditional healers to enhance public awareness. The plan also promotes democratization and inter-sectoral collaboration, allowing states to customize their approaches, and advocates for a One Health strategy. While the plan reinforces India's commitment to sustainable development, continued political commitment, robust monitoring and evaluation, global collaborations and community ownership remain crucial for its effective implementation.
Micronutrient status and risk of Mycobacterium tuberculosis infection in Indonesian tuberculosis case contacts
Verrall AJ, Houghton L, Apriani L, Atmaja HE, van Laarhoven A, Ussher JE, Ruslami R, Sharples K, McAllister S, van Crevel R, Hill PC and Alisjahbana B
Certain micronutrient levels have been associated with the risk of developing TB disease. We explored the possible association of selected at-risk micronutrient levels with the development of Mycobacterium tuberculosis (M.tb) infection.
Role of IL-6, TNF-α and VCAM-1 as predictors of renal impairment in patients with spontaneous bacterial peritonitis
El Raziky M, Rashwan M, Tamim HH, Afify S and Lithy RM
Multiple mechanisms may contribute to the occurrence of renal impairment (RI) in patients with spontaneous bacterial peritonitis (SBP). One such mechanism is systemic inflammatory response syndrome, which involves the release of pro-inflammatory cytokines (tumour necrosis factor [TNF]-α, interleukin [IL]-6 and vascular cell adhesion molecule [VCAM]-1). The goal of this research was to evaluate the role of IL-6, TNF-α and VCAM-1 as potential predictors of RI and mortality in cirrhotic patients with SBP.
Health economics of snakebite envenomation: A sub-Saharan African perspective
Ayesiga I, Gmanyami JM, Akaka A, Kubwimana O, Ternor JN, Hashim UM, Gyabaah GA, Turzin JK and Kahwa I
Sub-Saharan Africa (SSA) is affected by the high direct and indirect costs of snakebite envenomation. With >30% of global mortality, different economic barriers still exist, and effective strategies must be employed to avert the burden and promote quality of life. With the WHO target of reducing the number of snakebites by one-half by 2030, different aspects concerning snakebite envenomation economics must be evaluated, and potential strategies must be developed. Strategies such as exploring the different snakebite prevention interventions, and the costs associated with these interventions, must be prioritized through extensive research and targeted surveys. Information obtained from these surveys can be used to draft effective policies to minimize snakebite envenomation incidence, reduce the economic burden associated with envenomation and improve the quality of life of people at risk. In this narrative review, we evaluate the different aspects concerning the health economics of snakebite envenomation and explore the financial capacity of SSA countries to mitigate envenomation. Additionally, we propose multiple steps that could be undertaken to mitigate the financial burden of envenomation in SSA. Furthermore, we propose critical research strategies to minimize direct and indirect costs arising from snakebite envenomation in the region.
Redefining the severity of orofacial tissue damage caused by noma: a novel classification approach
Gebretsadik HG
Noma is a severe orofacial disease with high mortality and morbidity. Although severity scales exist, they fail to fully capture the extent of damage caused by the disease.
Prognostic value of Chagas heart disease on short- and long-term clinical outcomes in patients hospitalized for COVID-19
Magalhães BK, Silva VPS, Machado MN and Nakazone MA
Immunological similarities led us to explore potential interactions between Chagas heart disease (CHD) and coronavirus disease 2019 (COVID-19). We evaluated CHD's impact on the short- and long-term clinical courses of COVID-19 patients.
Anti-M2-pyruvate kinase autoantibodies are correlated with digestive damage in human Chagas disease
da Silva DD, Pereira NS, Nunes DF, Brito RMM, Pereira LC, da Silva ANB, Brito CRDN, Andrade CM, Galvão LMDC, da Câmara ACJ, Nascimento MSL and Guedes PMM
Determining esophageal and colon involvement in patients with Chagas disease occurs through invasive and uncomfortable examinations, which in most cases are not performed. The objective of this study was to assess the involvement of anti-M2-pyruvate kinase (M2-PK) autoantibodies in the development of digestive alterations and/or in the diagnosis of the digestive form of human Chagas disease.
What is new in the treatment of snakebite envenoming? Opportunities and challenges
Warrell DA
A systematic review of variables associated with snakebite risk in spatial and temporal analyses
Collinson S, Lamb T, Cardoso IA, Diggle PJ and Lalloo DG
Snakebite is a priority neglected tropical disease, but incidence data are lacking; current estimates rely upon incomplete health facility reports or ad hoc surveys. Spatial analysis methods harness statistical associations between case incidence and spatially varying factors to improve estimates. This systematic review aimed to identify variables associated with snakebite risk in spatial and temporal analyses for inclusion in geospatial studies to improve risk estimation accuracy.
Medically important snakes in Sudan: an overview of distribution, clinical features and present challenges
Baleela RMH, Elamin MEMO, Mohammad A and Saeed SAK
Snakebite envenomation (SBE) is a neglected tropical disease. It causes substantial morbidity and mortality in Sudan. Despite its endemicity, there is a substantial lack of up-to-date data on venomous snakes and their geographical distribution in Sudan, with most information dating back to the early twentieth century. To address this gap, we conducted a narrative review of the literature on snakes and SBE in Sudan. This review involved systematic searches of databases, historical publications and online resources from 1908 to 2024. Integrating literature findings with personal field experiences to provide a comprehensive overview of the SBE situation in Sudan, we identified 19 medically significant snake species in Sudan from four families. These species exhibit a range of venom types and clinical effects, including neurotoxic, hemotoxic and cytotoxic envenomation. The most dangerous and important species are the carpet viper (Echis pyramidum), the Nubian cobra (Naja nubiae) and the Sudan burrowing asp (Atractaspis phillipsi). Challenges in snakebite management include the non-availability of specific antivenoms, inadequate healthcare infrastructure and reliance on traditional medicine. We recommend establishing a national snakebite registry, improving healthcare infrastructure, developing training programs for healthcare professionals and increasing public awareness. Strengthening international collaborations for antivenom production and investing in molecular research are also crucial for reducing the severity and associated morbidity of SBE in Sudan.
Adjunctive nivolumab in combination with antibiotic therapy for the management of refractory melioidosis in a patient with metastatic breast cancer and chemotherapy-induced pancytopenia
Tirlangi PK, Kiran S, Ke V, Mukhopadhyay C, Kundu R, Pai A, Ps P and Saravu K
Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to multiple classes of antibiotics and primarily affects immunocompromised individuals, such as those with poorly controlled diabetes or malignancies. In this case, a 58-y-old female farmer with poorly controlled diabetes (HbA1c of 11.4%), metastatic breast cancer with chemotherapy-induced pancytopenia and disseminated melioidosis showed no improvement despite receiving antibiotics and supportive care. However, the introduction of adjunctive nivolumab, combined with an antibiotic regimen, resulted in significant therapeutic benefit, suggesting a promising new approach for managing severe and refractory melioidosis.
Overcoming the snakebite challenge in Sudan: a call to action
Badri R, Dawood I, Osman R, Ahmed N and Adam SIM
Snakebite envenomation is a neglected tropical disease that affects millions of people in sub-Saharan Africa, including Sudan. The severity of snakebite envenomation ranges from mild to severe, and can even lead to death. Sudan has a high burden of snakebite envenomation, with an estimated 12 632 cases and a mortality rate of 2.5% per year. The country faces several challenges in addressing snakebite envenomation, including a weak health system, limited access to healthcare facilities and a shortage of antivenom. This article highlights the challenges facing snakebite control in Sudan and provides recommendations for reducing the burden of this neglected tropical disease.
Detection of diarrhoeagenic Escherichia coli in the abattoir wastewater-impacted Iyi-Etu River and other water types at the Amansea livestock market settlement, Anambra State, Nigeria: a matter of public health concern
Nfor GK, Omatola CA, Emurotu OM and Mofolorunsho KC
Globally, diarrhoeagenic Escherichia coli (DEC) has been implicated in the spread of waterborne diseases and abattoir wastewater has played a role in its dissemination into watersheds. This study isolated and characterised DEC from the abattoir wastewater-impacted Iyi-Etu River and other water sources at the Amansea livestock market settlement.
Health literacy among the rural Bangladeshi population on first aid measures and prevention of snakebite
Farheen C, Rahman AKMF, Ghose A, Amin MR, Rahman ASMM, Sayeed AA, Rahaman FMA, Howlader C, Khan S, Rashid R, Chowdhury N, Debi GR, Rahman MS and Faiz MA
Bangladesh has a high rate of snakebite. In rural areas, there is a significant mortality and morbidity rate due to lack of awareness and inappropriate first aid practices. This study aims to determine the knowledge and practices of the rural population in two subdistricts of Bangladesh regarding snakebite prevention and first aid measures.
Evaluation of the immunogenicity of a DNA vaccine for Leishmania major based on the Leishmania-activated C kinase antigen using calcium phosphate and chitosan adjuvants
Gharaei A, Rahdar M, Jorjani O, Saberi S, Beiromvand M and Feiz-Haddad MH
Leishmaniasis represents a significant parasitic disease with global health implications, and the development of an affordable and effective vaccine could provide a valuable solution. This study aimed to evaluate the immunogenicity of a DNA vaccine targeting Leishmania major specifically based on the Leishmania-activated C kinase (LACK) antigen, utilizing calcium phosphate nanoparticles (CaPNs) and chitosan nanoparticles (ChitNs) as adjuvants.
Financial assistance for snakebite envenoming by OECD nations
Rae RJ
The World Health Organization re-established snakebite as a neglected tropical disease in 2017. An overview is provided on snakebite financial assistance in relation to the policy landscape change.
Spatiotemporal analysis of visceral leishmaniasis in Belo Horizonte, Brazil: a historical perspective (1994-2018)
Lopes CMD, Cardoso DT, Bezerra JMT, de Araújo GR, Carneiro M, Morais MHF and Barbosa DS
In the Americas, visceral leishmaniasis (VL) results from the zoonotic transmission of Leishmania infantum. VL has a high occurrence rate in the Metropolitan Region of Belo Horizonte (BH), Minas Gerais, Brazil, and has rapidly spread throughout the municipality since it was first recorded in 1994. This research analysed a historical perspective over 25 y of human VL occurrence in BH.