Snakebite envenoming is an occupational hazard in many countries throughout the world. The highest burden of snakebite is in tropical regions of Asia (i.e., South Asia and Southeast Asia), Papua New Guinea, almost all African countries, and Latin America. In Southeast Asia, snakebite envenoming becomes a significant health problem causing morbidity and mortality in Laos, Cambodia, Myanmar, Vietnam and some remote Indonesian Islands, where access to antivenom and health care are far more limited. Notably, Malaysia exhibited the lowest incidence of snakebites, while Thailand boasted the lowest estimated mortality rate.

            Envenoming by Asian snake can result in a range of clinical outcomes. Life-threatening symptoms may include progressive neuromuscular paralysis, sudden cardiovascular collapse, severe coagulopathy with fibrinogen depletion and bleeding in vital organs (i.e., intracranial hemorrhage). Systemic envenoming can be fatal if first aid treatment and, if indicated, antivenom is not administered early, especially in the presence of neurotoxicity. Neurotoxicity following envenoming by snakes of genus Bungarus (kraits) is often poorly reversed even by large doses of antivenom or neostigmine (anticholinesterase). This might be due to the fact that post-synaptic neurotoxins present in krait venom are “pseudo-irreversible”, and/or the venoms contain pre-synaptic neurotoxins which are resistant to antivenom. This has been reported in patients, with delayed-onset or gradually developing neurotoxicity. Moreover, deaths resulting from rapid coagulopathy after Russell’s viper envenoming have been reported in Myanmar. A recent report also described a similar case of Indian Russell viper-induced pericardial hemorrhage with cardiac tamponade. Many studies attempt to investigate the new sophisticated strategies to prevent these life-threatening outcomes and associated complications following envenoming e.g., the pan-specific polyvalent snake antivenom, snakebite medication pills, monoclonal antibodies and/or detection kits. These innovations will hopefully be of significant benefit to clinicians treating envenomed patients.