Revisiting saw-scaled viper (Echis carinatus) bites in the Jaffna Peninsula of Sri Lanka: distribution, epidemiology and clinical manifestations.

In Sri Lanka, the saw-scaled viper (Echis carinatus) is distributed in the arid, dry and sandy coastal plains and in a prospective study we describe its bites in the Jaffna peninsula. Of the 304 snake bite admissions to the Jaffna Hospital in 2009, 217 (71.4%) were bitten by either venomous species or envenomed by unidentified snakes. There were 99 (45.6%) reported saw-scaled viper bites, of which 26 were confirmed cases. The length of the offending snakes ranged from 228-310mm and bites mainly occurred in the nearby islands. The median age of the confirmed cases was 34 years (range 1.5-72 years); occupations included housewives (8, 31%), school children (4, 15%) and farmers (2, 8%). In 18 patients (69%), bites occurred in daylight and in 8 (31%) within or near the compounds. The fingers were bitten in 8 (31%) and toes/foot in 11 (42%) cases. There were 2 (8%) dry bites and 19 patients (73%) developed local swelling; one patient developed haemorrhagic blisters. In 24 patients (92%), blood incoagulability manifested between 40 and 1095min after the bite, and three patients (12%) developed spontaneous bleeding. One patient (4%) developed mild acute renal dysfunction. The median time for correction of coagulopathy was 802min (range 180-1669min) with Indian polyvalent antivenom. All recovered. The saw scaled viper is responsible for most venomous bites in the Jaffna peninsula.