Life after Surviving a Snakebite in Rural Sri Lanka: Lessons Learnt and the Way Forward

Snakebite is a neglected tropical disease affecting underprivileged farming communities in rural tropics and subtropics, causing significant morbidity and mortality. While acute effects of envenoming are well-known, information on long-term consequences remains scarce, despite the public health importance of the issue. Therefore, we explored the existing knowledge about the long-term effects of snake envenoming in the global literature by conducting a scoping review, which revealed that existing literature on snakebite predominantly relies on retrospective associations between envenoming and clinical outcomes, often without precise offending snake species authentication, comprehensive documentation of acute management, or baseline clinical data. Consequently, they could not provide a detailed picture of the long-term clinical epidemiology of envenoming. To overcome these gaps, we prospectively followed up snakebite patients to determine the true prevalence, severity, clinical progression, and risk factors of long-term effects of snakebites using a cohort of snakebite patients admitted to the Teaching Hospital, Anuradhapura, Sri Lanka. Based on a prospective study conducted at one and four-years post-envenoming, long-term musculoskeletal impairments appear to be infrequent and less severe among snakebite survivors in rural Sri Lanka. In contrast, a substantial proportion of individuals report persistent, non-specific systemic and oral symptoms, with the prevalence increasing over time after the bite. In the same two groups of patients, renal functions showed no significant association between snakebite or snakebite-associated AKI, with the development of CKD, or CINAC on review, though microalbuminuria was common. Serum sickness was reported in only 4% of the patients after discharge, despite high rates of acute adverse reactions to antivenom. Meanwhile, a significant number of viper bite patients leave the hospital with mild persistent local effects, which commonly leads them to seek further treatment, emphasizing the need for post-discharge follow-up of snakebite survivors.