Indian network for


An Amrita Institute of Medical Sciences Initiative

Management protocol of venomous snakebite in India: a consensus statement -
J. C. Menon, J. K. Joseph, M. P. Jose, D. Punde, D. B. Mazumdar, H. S. Bawaskar, V. V. Pillay, B. N. Mohapatra, C. Rajendiran, P. D. Tanwar, S. Raut, S. Ragunanthatan & S. Tripathi

Venomous snakebite is a significant cause of mortality and morbidity in South East Asia. The WHO, in 2009 declared venomous snakebite as one of the ‘‘neglected diseases of the tropics’’. It is estimated that there are over 300 000 snakebites in India alone leading to between 45 000 and 50 000 deaths annually. The majority of venomous bites could be attributed to the big four – Daboia russellii (Russell’s viper), Bungarus caerulus (common krait), Naja naja (Indian cobra) and the Echis carinatus (saw scaled viper). Hemostatic abnormalities are prima facie evidence of hemotoxic snakebite. This could range from a mild cutaneous bleed to catastrophic intracerebral bleeds. Hemotoxic snakebite could also lead to Acute Kidney Injury (AKI) and Disseminated Intravascular Coagulation (DIC). A descending paralysis starting as a ptosis, which could progress on to life threatening respiratory paralysis is what is seen in neurotoxic snakebites. Anti-snake venom is started at 10 vials (100 ml) and most bites require up to 20 vials.

Filariasis: Epidemiological and Parasitological study of Onchocerciasis and Lymphatic Filriasis In Anfilo Woreda, Western Wellega, Ethiopia - Geme Urge Dori/ Prof. Asrat Hailu/ Prof. KN Panicker

The World Health Organization estimates that 123 million people live where river blindness is endemic and that 17.7 million people are infected with Onchocerca volvulus. Lymphatic filariasis is a painful and profoundly disfiguring disease which has major social and economic impacts. Currently World Health Organization and World Bank have an African Program for Onchocerciasis Control and a global program for elimination of lymphatic filariasis. Epidemiological and parasitological study was conducted in Anfilo Woreda to determine the prevalence and distribution of Onchocerciasis and Lymphatic filariasis.The study included 1114 inhabitants. Onchocerciasis was found in all study areas with an overall prevalence of 74.8%. The overall prevalence of Onchocercal Skin Disease was found to be 26.4%. The new prevalence of lymphatic filariasis was found to be 7.5%. Onchocercal skin disease was found to affect considerable number of population. Therefore, the currently commenced community directed treatment with ivermectin should be enhanced. Moreover, there should also be health education on transmission of the disease and control of vector.

Handbook of Medical Entomology - Prof. KN Panicker / Geme Urge Dori

I suppose you are an Entomologist ? Not quite so ambitious as that sir! I would like to put my eyes on the individual entitled that name! No man can truly be called an Entomologist, Sir. The subject is too vast for a single human intelligence to grasp! Oliver Wenedell Holmes Sr. Vector-borne diseases continue to dominate the public health scenario of all developing countries in the world. It is more so, in Africa and south East Asian countries, including India, as it interferes with the socio-economic development and takes away a huge chunk of money from the state exchequers.While malaria continues to be a major threat to human health all over, many other vector-borne diseases, such as Leishmaniasis, Dengue, Chikungunya,Japanese encephalitis, West Nile Fever etc, are keeping the health machinery on its toes. Yellow fever, yet another mosquito-borne disease, is a notorious killer, and endemic in the African continent. It can be sneaked in anytime into our fold with the boom in International travel and abundance of vectors around. India is also an important partner of the Global Elimination Programme of Lymphatic Filariasis, which is a disabling, as well as disfiguring disease, with severe socio-economic and emotional consequences. It is absolutely essential for the medicos and other healthcare professionals who are waging a war against these diseases to have adequate knowledge of this subject in order to tackle the situation. Prevention will be more appropriate and practical, rather than trying to contain the epidemic after it breaks out. Strategies have to be developed, suiting to local needs and environment. An in-depth knowledge on the dynamics of the vectors involved can provide proper insight in designing effective strategies. With this view in mind this book is written, Further it is also expected to serve as a comprehensive handbook for all the healthcare professionals,who are toiling in the field, fighting against vector-borne diseases.

Characteristics of fatality among severe dengue patients in a tertiary care setting in India- A retrospective case- control review
Dr. Vidya Menon, Amrita Institute of Medical Sciences, Kochi


Aim of study was to evaluate clinical and laboratory characteristics associated with dengue fatality.


Retrospective case control study included fatal and nonfatal "severe dengue" by WHO (2009) criteria admitted to AIMS between 2012-14. Clinical and laboratory features were compared between groups. Statistical significance was assessed using Fischer’s exact test for categorical variables and T test for continuous variables.


Of 896 “probable dengue” adult cases admitted, 21 patients had fatal outcome.26 age and severity matched non-fatal cases were controls. 86% of the patients in fatal group compared to 38% from non-fatal group had > one co-morbidities. Significant association of fever, nausea/vomiting, abdominal pain, shortness of breath and altered mental status was seen in the fatal cases. Tachycardia hypotension, hypoxia correlated with fatality. Admission metabolic acidosis, oliguria and sepsis heralded death .Statistically significant upward trend in the WBC counts in fatal group compared to controls seen. Average neutrophil counts for the fatal group cases were higher (60-80% in fatal & 45-60% in non-fatal). Decline in monocyte counts in fatal group while elevated for nonfatal group significant thrombocytopenia in fatal group 20% fall in the HCT with drop in HGB among the fatal grp. Prolonged PT in fatal group. Serum total bilirubin in fatal cases elevated (7- 20 mgs/dl) compared to the < 5 mgs/dl in controls. 50% of controls required < 72 hours of ICU. The average length of stay for fatal subgroup was 5.8 days, & non-fatal was 8.5 days.

Complications of Hemotoxic Snakebite in India
Dr. Jaideep C. Menon and Joseph K. Joseph


Hemotoxic snakebite is the major cause of mortality and morbidity in India in victims of venomous snakebite. The hemotoxic species in India include the Russell’s viper, saw-scaled viper, and various pit viper species.

The major complications related to hemotoxic snakebite, other than bleeding manifestations,which could occur anywhere from the bite site, mucosal membranes, serous cavities, and organs, include life-threatening ones like acute kidney injury (AKI), acute respiratory distress syndrome (ARDS) or its lesser variant acute lung injury (ALI), disseminated intravascular coagulation (DIC), and capillary leak syndrome (CLS). Mortality secondary to hemotoxic snakebite is high with complications like ARDS and CLS.

The prolonged hospital stay and mortality in hemotoxic snakebites as compared to Elapidae bites are mostly related to the multiorgan involvement seen in hemotoxic snakebites which is not seen in Elapidae bites.

The long-term complications related to hemotoxic snakebite include amputations and limb deformities, hypopituitarism, osteomyelitis, squamous cell carcinoma at sites of nonhealing ulcers, sequelae of acute coronary syndromes like left ventricular dysfunction, and sequelae of stroke like limb weakness or cognitive impairment.

A Post-Epidemic Study on Awareness of Vector Habits of Chikungunya and Vector Indices in a Rural Area of Kerala
Aswathy S, Dinesh S, Kurien Beteena, Johnson AJ, Leelamoni K


Chikungunya struck Kerala in a devastating form in the years 2006 and 2007and it’s after effects continued to 2008. In May 2008, a post epidemic study of the awareness of vector habits and prevalence of the vectors was done. A cross sectional study was conducted in a randomly selected Panchayat affected by Chikungunya in a rural area of Kerala, India. 93.3% respondents were aware that mosquitoes spread Chikungunya though 31.3% knew the type of mosquito that spreads it. 69% knew that the vector breeds in artificial collections of water. Although three fourths (73.6%) had good knowledge, only 39% had actually took control measures. Four of the six wards were high risk areas as per House Index and Breteau Index. All the larval samples collected were identified as Aedes albopictus. About 94.3%of the respondents used one or the other measure of personal protection against mosquito. An analysis of the high risk areas showed a significant association with education (p< .001) and information on control measures (p < .01). It therefore appears that integrated vector control is the key though converting vector control knowledge into practice by influencing human behavior is the challenge.

Title: Mass drug administration against filariasis in India: Perceptions and practices in a rural community in Kerala
Aswathy S, K. Beena, Leelamoni K


In India, annual rounds of mass drug administration (MDA) based on diethylcarbamazine and albendazole are used to control filariasis, which is a major public-health problem. In December 2007/January 2008, a few weeks after one such MDA, a household survey was conducted in the Ernakulam district of Kerala to evaluate coverage and compliance. After one member aged .14 years from each of 599 households was interviewed, coverage of the last MDA was estimated to be 77.0% and compliance only 39.6%. Most (67.4%) of the interviewees were not aware of the term ‘mass drug administration’ but 20.9% of the others thought that MDA prevented the occurrence of filariasis. Most (62.3%) of those interviewed said that they obtained information about MDA from television or radio programmes and/or newspapers and most (66.3%) considered MDA to be useful (only 5.0% said that MDA were not useful, the other interviewees saying that they did not know whether MDA were useful or not). Those who had not ingested the tablets given to them in the last MDA said that they were fearful of the drugs (39.4% of the non-compliers), were too ill to take the drugs (22.5%) or had misconceptions about the aims of the MDA (12.5%). Only 2.7% of the interviewees who had ingested the distributed tablets reported adverse effects and these were mild (fever, drowsiness, swelling/oedema and/or vomiting) and only occurred within 24 h of tablet ingestion. In a univariate analysis, individual compliance in the last MDA was found to be positively associated with perceived benefits to the individual (P, 0.001), the perceived usefulness of MDA (P50.001) and certain study wards within the panchayat (P50.032). It therefore appears that communication exercises targeted at the areas with relatively low compliance and designed to improve perceptions of the benefits and usefulness of MDA against Filariasis could be the key to a successful control programme.