By
DR. E. Ndambiri.
Background
Information
The rhino had been treated on 13/10/2013
for what appeared to be swollen right fore carpal joint. The rhino died on the
morning of 16/10/2013 after deteriorating from lameness to recumbency. It was
found on left lateral recumbency. Both front and rear horns were intact. There
was no obvious external injury. The two horns were excised and wet weight taken
6.2kgs and 2kgs respectively. They were handed over to Warden Kisumu Station.
Important
Postmortem Findings
1. Signs of struggle before death were
evident as the tail wagged and limbs peddled pushing the mud to the sides.
2. There were traces of froth from the
nostril. Mucus membranes of the eye were congested
3. Right neck region was doughy on pressure
4. Anteriolateral of the right armpit
depicted points of blood ooze (possible fang marks)
5. After skinning the whole of the right
side of the animal capillaries at the right armpit area were heavily congested
and petechial/ecchymotic hemorrhage areas were obvious corresponding to points
where blood was oozing. The congestion was evident on deep cut into the
surrounding muscles. The rest of the skinned surface had no congestion or haemorrhage.
6. The whole of the skinned right side was
opened to expose the thoracic and stomach cavities. The whole of stomach organs
with exception of liver had little or no congestion/hemorrhage. Colons had
little fermentation gas. Liver was mottling on pressure and was completely dark
and enlarged. Lungs were not collapsed and the pleural surface had fibrin with some
areas raised above others. The anteriodistal edges of the anterior lobe of the
lungs were congested. The whole of bronchial tree was full of whitish froth. Thoracic
fluid was bloody i.e. Hemothorax. Heart was collapsed with no blood in any
chamber. Coronary vessels were heavily congested and surface of myocardium had
different forms of hemorrhages (superficial petechial and ecchymotic
hemorrhages). Blood from ascending and descending aorta was ‘boiling’ i.e.
flowing mixed with air bubbles.
Fig.
a) Rhino on left lateral recumbence
Fig.
b) Congested ocular vessels
Fig.
c) Frothy discharge from Nostrils
Fig.
d) Seemingly fang marks oozing blood
Fig. e) Skinning the dead Rhino
Fig. f) Congested capillaries at fang mark area
Fig.
g) Congestion inside fang mark area
Fig.
h) Fibrin (red dots) on the lung viscera surface
Fig. i) Congested anteriodistal parts of lungs
Fig. j) Heavily congested liver (Visceral surface)
Fig.
k) Congested liver (Pleural Surface)
Fig.
l) ‘Boiling’ blood and froth in the trachea
Figs.
m) & n) Heart showing coronary vessels congestion and different forms of superficial
hemorrhages
Conclusion
Tentatively this is a case of envenomation
more so by a viper or adder. Death of the victim was as a result of circulatory
failure due to disseminated intravascular coagulation (DIC) syndrome leading to
multiple organ failure.
Insight.
Poisonous
Snakes Found within Kisumu-two slides and
signs of envenomation below courtesy of National Museums of Kenya, Ministry of
Health, and Kenya Red Cross
Signs of Envenomation
Snake
|
½ hour
|
½ to hour
|
Plus hour
|
Vipers and adders
-have long hinged hollow movable front fangs. They
strike and inject venom (voluntary action) and withdraw
|
-Severe radiating pain
-Local oedema
|
-Persistent pain
-Spreading oedema
|
-Gastro-intestinal disorders
-Necrosis, infection gangrene
-Haemorrhage, DIC(Disseminated Intravascular
Coagulopathy)
|
Cobras and Mambas
-have fixed front short fangs and tend to hang on
and ‘chew’ venom into their victims
|
-Moderate diffuse pain
-Numbness
|
-Intense asthenia
-Palpebral ptosis
-Neuro-muscular disorders
|
-Paralysis
-Asphyxia
-Collapse
|
Diagnosis. Unless bite has been witnessed diagnosis is not easy and vice
versa. Typical pit viper bites are characterized by severe local tissue damage
that spread from bite site. Tissues become markedly discolored within few
minutes and dark bloody fluid may ooze from fang wounds if not prevented by
swelling. In elapine snakebites pain and swelling are minimal and systemic
neurologic signs predominate. Where possible the snake has been caught or
killed head should not be mutilated as it helps in identifying the snake type.
Treatment Intensive therapy should be instituted as soon as possible because irreversible
effects of venom begin immediately after venomation. Some points worthy noting;
- - Animals bitten by elapine
snake(cobra, mamba) may be treated with antivenin and supportive care including
anticonvulsants if necessary
- - A polyvalent antivenin (horse-serum
origin) against pit vipers can be used upon envenomation
- - Although not infallible it is
important to consider both the size of the snake as an indicator of quantity of
venom injected and size of snake relative to that of the victim.
- - Probably the site of the bite
matters in relation to mortality. It has been noted that mortalities are higher
from bites to thorax or abdomen than from bites to head or extremities in dogs
and cats. However this may relate to size and vulnerability of the victim
- - Reportedly degree of
sensitivity to venom varies among the animals. For example sensitivity to pit
vipers in domestic animals in decreasing order is horse, sheep, goat, rabbit,
pig and cat.
- - It has been reported that
previous exposure may result to some degree of active humoral immunity thus
less vulnerability
- - Treatment for pit viper
envenomation is directed to prevent or controlling shock, neutralizing venom,
preventing or controlling DIC, minimizing necrosis and preventing secondary
bacterial infection
- - Smaller animals probably
receive larger dose (per unit body weight) of venom than more massive animals
and require proportionally larger doses of antivenin.
- - Tetanus antitoxin is usually
administered in treatment regime
Note
Sanofi Pasteur P.O. BOX 30104-00100 NAIROBI,
TEL: 6939128/141 does business of selling Fav-Afrique Polyvalent Antisnake Serum
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