6700 Evaluation of association between snake bite and myocarditis among children: a hospital based prospective observational study

Objectives Snakebite envenomation was declared as a potentially lethal neglected tropical illness by the world health organization (WHO) in 2009. Each year, 1.8 to 2.7 million snake bites occur worldwide, with fatalities ranging from 81,410 to 137,880. South Asia, South East Asia, and Sub-Saharan Africa have the biggest burdens.¹ We conducted an observational study at All India Institute of Medical Sciences, Patna, a tertiary healthcare center in eastern India, with the following objectives. To evaluate association between myocarditis and snake envenomation, in children. To estimate association between myocarditis and mortality in children with snake envenomation. Methods This was a prospective observational study, including 30 confirmed cases of snake envenomation in children, admitted under the department of pediatrics, in a tertiary care medical college hospital in eastern India, over a period of 24 months (Feb 2021 to Jan 2023). Eligible cases were evaluated for the signs and symptoms of myocardial dysfunction, the need for ionotropic support, cardiac biomarkers such as creatinine phosphokinase- Myocardial Band (CPK-MB), and screening 2D echocardiography for ejection fraction. Results The majority of snake envenomation cases (26/30, 86.7%) were neurotoxic. Biochemical evidence of myocardial injury in the form of high CPK levels (>25 IU/L) was seen in 21/30 (70%) of cases (figure 1). Echocardiographic abnormalities in the form of a low ejection fraction were seen in 9/30 (33.3%) cases. Ionotropic support was required only in 6/30 (20%) of the cases due to signs and symptoms of myocardial dysfunction (figure 2). The overall mortality was 5/30 (16.7%) and binomial logistic regression analysis revealed CPK level and mortality were significantly (p<0.001) associated with each other with coefficient of determinant (R²) = 83.4%. Conclusion In our study, Snake envenomation in children were associated with a considerably higher incidence of cardiac complications. A considerable number of these children had biochemical and echocardiographic abnormalities, indicating that a significant number of them develop subclinical myocardial dysfunction that often goes unrecognized. According to the systemic review by Liblik K et al., the incidence of clinically apparent cardiovascular complications ranges between 0.2% and 3.8%, based largely on studies on adult populations.² In contrast, in our study, 70% of children showed biochemical evidence of myocardial injury. Cardiovascular complications are associated with significant mortality also. Hence clinicians in endemic areas must be very cautious in detecting these complications specially among children References World Health Organization. Snakebite Envenoming. Fact Sheets 2019. Curr Probl Cardiol, Snakebite Envenomation and Heart: Systematic Review, 2022 Sep.