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The rare case of a young boy treated in Bahrain for life-threatening complications caused by a snakebite sustained overseas has prompted medical researchers to call for clearer, evidence-based treatment guidelines.
The six-year-old child was bitten on his left foot by a snake in August last year while visiting rural Pakistan.
After receiving treatment at a local hospital as well as a facility in Islamabad, the patient was cleared for travel to Bahrain, but after arrival, worsening pain, swelling and oozing at the site of the bite prompted his father to rush him to Salmaniya Medical Complex (SMC).
SMC researchers, including Zain Mohammed Al Muqbel, Ali Haider Ali, Naseem Fahad, Reema Ajjawi, Amal Al Dailami, Afshan Murtada, Manal Al Maskati, and Nasser Mohamed Mansoor have submitted preliminary data from the medical case and its treatment for peer review and publication in Wiley’s open-access Clinical Case Reports academic journal.
“This case illustrates the challenges of treating severe envenomation in resource-limited settings and represents the first such case reported in Bahrain,” researchers noted.
“Its rarity highlights the need for clinical awareness and preparedness for envenomation (the process of venom entering the body usually through a bite or sting), even in regions where cases are uncommon.”
Snake bites are a major public health concern in Southeast Asia and Africa and the World Health Organisation classifies them as a ‘neglected tropical disease’ with 5.4 million bites and 2.7m envenomations annually.
Children are particularly susceptible to fatal venom-related consequences because of their smaller size, which amplies the toxic effects of the venom.
Doctors said the boy arrived at Salmaniya Medical Complex with extensive swelling and discolouration of his left leg, alongside bleeding from minor wound sites, indicating that the snake venom had severely disrupted his blood’s ability to clot.
The patient was drowsy but showed stable vital signs except for the affected limb. Medical tests revealed that the ability of his blood to clot had dropped to dangerously low levels, his red blood cells were being destroyed, and his platelet count had fallen sharply.
The inability to form blood clots – called refractory coagulopathy – can be dangerous since clots are necessary for wounds to stop bleeding and heal.
The swelling in his leg became so severe that it raised concern for compartment syndrome, a condition in which pressure inside the muscles can cut off blood supply and permanently damage the limb.
Despite receiving additional antivenom and intensive supportive care, the child’s condition failed to stabilise.
Surgery to relieve the pressure in his leg was deemed too risky because of the ongoing bleeding disorder.
With standard treatment proving insufficient, the medical team escalated care to a specialised blood purification therapy, in which the child’s plasma was repeatedly replaced to remove venom-related toxins and restore clotting ability.
This proved successful and doctors observed gradual improvement in his blood tests, reduced swelling in his leg and hand, and stabilisation of his condition.
After 15 days, the boy was discharged in good health, with follow-up arranged to monitor his recovery.
According to researchers, the case is the first documented paediatric snakebite with refractory coagulopathy managed with plasma exchange in Bahrain, highlighting the importance of rapid diagnosis and multidisciplinary intervention.
“The case also emphasises the absence of standardised protocols for high-risk paediatric envenomation, emphasising the urgent need for the development and implementation of clear, evidence-based guidelines to optimise outcomes and improve patient safety,” they added.
The species of the snake was not revealed in the report.
Historically, snakebites and especially venomous ones are relatively rare in Bahrain, which has a few native snake species, including rat snakes, found in the desert and a number of species of sea snakes.
naman@gdnmedia.bh
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