Snakebite is a neglected tropical disease (NTD) that is responsible for immense suffering, disability and premature death throughout the world.1 Majority of these snake bites occur in Latin America, Asia, and Africa. Snake bites can be due to venomous snakes or non-venomous snakes. Acute medical emergencies can result from venomous snake bites. Every year, an estimated 5.4 million individuals worldwide are bitten by snakes, with 1.8 to 2.7 million envenoming. These snake bites result in 81,410 to 137,880 deaths, as well as around three times as many amputations and other permanent disabilities.2 In June 2017, the World Health Organization included snakebite envenomation to its list of neglected tropical diseases (NTDs). According to the Million Death study, a nationally representative study conducted in India, around 45,900 snakebite deaths occur each year. The saw-scaled viper, Indian cobra, common krait, and Russell's viper are responsible for about 90% of snakebite incidents in India.3

In 2020 with 19,012 snakebite cases in rural areas and 5,425 in urban areas, Maharashtra ranked first in India for snakebite envenomation. The highest number of snakebite cases occurred in Nashik (2,696), followed by Palghar (2,343), Thane (1,332), Raigad (1,216), Jalgaon (1,180), and Pune (1,081).4 The treatment for snake bites is Anti-snake venom (ASV), which is provided free of cost at Maharashtra's public hospitals. People still prefer to seek traditional healers over medical facilities due to ignorance and financial concerns. Majority of people in nations like India, where most of the population lives in rural areas, 77% of snake bite victims die outside of medical facilities.5

This study was conducted to determine the epidemiological profile, clinical features, complications, management, and outcomes of snakebite cases presented to a Tertiary Care Teaching Hospital in Maharashtra.

A record based retrospective study was carried out at Teritary care teaching hospital in western Maharashtra. All the snakebite cases admitted to the hospitals from 1st January 2023 to 31st December 2023 were included in the study. Records of all snake bite cases in year 2023 were collected and analyzed after taking the necessary permission from the tertiary care teaching hospital. Data were collected using a pretested questionnaire which collected information on the demographic factors (age, gender, place of residence), history of snake bite (season, site, time), clinical features and complications, details of the treatment which was received and the outcome of the snake bite victims were recorded. Data collected was analyzed using Statistical Package for Social Sciences (SPSS version 27). Frequency analysis was done and results are expressed as percentages and graphs. The study is carried out as per standard ethical guidelines.

Total of 201 snake bite cases were reported in the year 2023. The most snake bite were noted in males (76.1%). The mean age of the study population was 33.2 years with the highest proportion in the age group of 21-30 (26.9%) years followed by 11-20 (22.9%) years and 31-40 years (22.4%). Religion distribution of the cases shows most were Hindu (98%) by religion and few were Muslims (2%). Most of the snake bite were from Rural area (72.2%) and rest were from Urban areas (27.8%). Most snake bites were reported in the month of June (20.4%) followed by August (13.9%) and October (11.9%). Most of the snake bites happened during the night time (47.8%), followed by evening (28.4%), morning (14.9%) and afternoon (9%). Of the 201 cases, more than half (52.7%) has seen the snake.  All the patients presented to the hospital within 6 hours of snake bite. Non-venomous snake bites were seen in 59.2% cases and venomous bites were seen in 40.8% cases. All the patients presented with local inflammatory signs; 38.3% presented tenderness, 34.3% presented with localized swelling and 27.4% presented with erythema. In the clinical manifestations; 10% presented with vasculo-toxic manifestation such as increased 20-minute Whole Blood Clotting Time (WBCT) and bleeding from bite site and swelling, 17.9% presented with neuro-paralytic manifestation such as ptosis, respiratory distress, and loss of motor functions and 38.8% presented with non-specific symptoms such as vomiting, hyperventilation, dizziness, and headaches and 33.3% had no symptoms other than local

Table 1: clinical manifestations and complications due to snake bite

inflammation. Anti-snake venom (ASV) was given to all cases of venomous snake bites and 34.4% of non-venomous bites based on clinical manifestations and judegement.

Few patients (9.5%) developed complications post snake bite and treatment. Cellulitis was noted in 5.5% cases; gangrene and compartment syndrome were noted in 1.5% cases and 2.5% developed acute kidney injury. Of the 201 cases of snake bite; 91.5% had complete recovery at discharge, 6% were discharged against medical advice with complications like gangrene and cellulitis. 2.5% cases succumbed to death during hospitalization of which 3 were due to kidney failure and 2 were due to respiratory failure.

In the study most of the snake bites occurred in the month of June. The monsoon season's intense rains and flooding have the potential to flood snake burrows and underground habitats, driving them to seek higher ground and possibly into houses, gardens, and agricultural fields. As a result, there are more snake-human interactions, increasing the possibility of bites. Similar results were seen in the studies conducted in Maharashtra and south India 6,7. Two third of the snake bites were in males and in young people. Males are more prone to snake bites primarily due to occupational factors and recreational activities that involve more time spent outdoors. Various studies done in India consistently show a higher proportion of male snake bite victims 8–15. Most of the snake bites were reported in the night and evening time. The main reason why more snake bites happen at night is because many snakes are nocturnal and hunt at night and more likely to be encountered by people who are also active outdoors at night, such as those walking, working, or simply being outside. Another study done in western Maharashtra support the findings of the study where majority of bites are in night and evening11.

All the patients presented to hospital within 6 hours of snake bite. A study done in Latur also supports the study were most patients presented to hospital within 6 hours. 15 The early arrival to hospital could be because Western Maharashtra is well equipped with good roads and transportation facilities which makes it easier for patients to access hospital faster and the fact that most bites were presented from areas in and around the facility. The most common site of the bite was the lower extremities followed by the upper extremities and only one case over the trunk. Similar results were seen in many studies on snake bite in and around India 7,10,12,16–18. Snakes often strike and bite when they feel threatened or accidentally encounter a person's leg while hidden in vegetation or climbing and our legs are often exposed to the environment, especially when walking, hiking, or working outdoors, making them more susceptible to accidental snake encounters and bites. Most cases presented with compliant of pain and tenderness at bite site followed by localized swelling. Similar results were seen in studies conducted in and south India and Nepal. 12,18  As a natural defense mechanism, the body starts an inflammatory response after any bite and this involves changes in blood flow, increased permeability of blood vessels, and movement of various inflammatory markers to the site of injury causes symptoms like redness, swelling, discomfort, and warmth at bite site. Majority of cases of snake bite presented with non-specific symptoms such as vomiting, breathlessness, dizziness and headaches In snake bites, anxiety can manifest as physical symptoms that mimic those of envenomation, even in cases of dry bites where no venom is injected.19 17% of cases presented with neuroparalytic manifestations and 10% presented with vasculo-toxic manifestations contrary to most studies in Maharashtra were vasculo-toxic manifestations were more common 11,20. Only few studies from North India showed similar occurrence of more neuro-paralytic symptoms21,22. 

ASV is the only specific treatment available for snake bite envenomation. ASV is administered for all snakebite patients with signs of envenomation based on clinical examination findings or raised 20‐minutes Whole Blood Clotting Time. 23 Anti-snake venom (ASV) was administered to all cases of venomous snake bites and 34.4% of the of non-venomous bites received ASV based on clinical symptoms and suspicion in cases where patients haven’t seen the snake and snake was not identified. Only few patients developed complications post snake bite and most common complication was cellulitis followed by compartment syndrome and gangrene and this results were consistent with other studies in India 13,24. Most of the cases were discharged with complete recovery post admission. Case fatality rate was 2.5% where 5 deaths were noted which is lower than the reported by most studies in India 25, 26. Low case fatality points to effective timely and appropriate medical intervention and management done in snakebite cases 27.Proper management of venomous snakebites and timely administration of ASV can drastically reduce both mortality and long-term complications in snake bite cases. A community-based study in Pune by Pandve et al 28 assessed the level of awareness about snakebites which showed that people had only moderate knowledge about snake bite and pointed out that people need to have through knowledge about snake bite and management with emphasis on implementation of community-based awareness programmes on snake bites.

This was a retrospective study conducted based on documentation review and some data may be insufficient or missing such as socio-demographic details, snake identification details, measures done to prevent the spread of envenomation etc.

The study revealed that most of the snake bites occurred in the monsoon and post monsoon months. Two third of the snakebite victims were males and seen in young people. Most of the snake bites were noted in the lower limbs and presented with complaints of pain and tenderness at bite site with non-specific symptoms. ASV was administered in the all-snake bite cases with signs of envenomation. Most patients had complete recovery at discharge and only few developed complications such as cellulitis, gangrene, compartment syndrome and acute kidney injury. Case fatality rate was noted to be 2.5% for snake bites in the period of 1 year

1. World Health Organization. Snakebite envenoming: a strategy for prevention and control [Internet]. Geneva: World Health Organization; 2019 [cited 2025 May 4]. 50 p. Available from: https://iris.who.int/handle/10665/324838
2. World Health Organization. Snakebite envenoming [Internet]. world health organization; Available from: https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming
3. World Health Organization. Snakebite in India. [Internet]. Geneva: World Health Organization; 2019 [cited 2025 May 4]. Available from: https://www.who.int/india/health-topics/snakebite
4. Rahul Gajbhiye. A model of addressing snake bites in rural india through capasity building [Internet]. Indian Council Of Medical Research; Available from: https://nirrch.res.in/wp-content/uploads/2023/10/Snakebite-Dr-R-Gajbhiye_compressedd.pdf
5. Bawaskar H, Bawaskar P. Call for global snake-bite control and procurement funding. The Lancet. 2001 Apr;357(9262):1132–3.
6. R. H. A Study on the Clinico-Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India. JCDR [Internet]. 2013 [cited 2025 May 3]; Available from: http://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=January&volume=7&issue=1&page=122-126&id=2685
7. Mhaskar D, Agarwal A, Bhalla G. A study of clinical profile of snake bite at a tertiary care centre. Toxicol Int. 2014;21(2):203.
8. Ghosh R, Mana K, Gantait K, Sarkhel S. A retrospective study of clinico-epidemiological profile of snakebite related deaths at a Tertiary care hospital in Midnapore, West Bengal, India. Toxicol Rep. 2018;5:1–5.
9. Inamdar IF, Aswar NR, Ubaidulla M, Dalvi SD. Snakebite: Admissions at a tertiary health care centre in Maharashtra, India. S Afr Med J. 2010 Jul 5;100(7):456.
10. Gajbhiye R, Khan S, Kokate P, Mashal I, Kharat S, Bodade S, et al. Incidence & management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India. Indian Journal of Medical Research. 2019 Oct;150(4):412–6.
11. Arjun HM, Shinde V, Bhattaram S, Shaikh Z. Clinico-Epidemiological Study of Snake Bite Presenting to the Emergency Department of a Tertiary Care Hospital. TI. 2023 May 11;187–92.
12. Thapar R, Darshan B, Unnikrishnan B, Mithra P, Kumar N, Kulkarni V, et al. Clinico-epidemiological profile of snakebite cases admitted in a tertiary care Centre in South India: A 5 years study. Toxicol Int. 2015;22(1):66.
13. R. H. A Study on the Clinico-Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India. JCDR [Internet]. 2013 [cited 2025 May 3]; Available from: http://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=January&volume=7&issue=1&page=122-126&id=2685
14. Padhiyar R, Chavan S, Dhampalwar S, Trivedi T, Moulick N. Snake Bite Envenomation in a Tertiary Care Centre. J Assoc Physicians India. 2018 Mar;66(3):55–9.
15. Gosavi P, Jaju J, Pawar G, Dharmadhikari S, Ubale V, Parekar S. A study on the clinico-epidemiological profile and the outcome of snake bite cases in the tertiary care hospital. Int J Basic Clin Pharmacol. 2014;3(2):298.
16. R. H. A Study on the Clinico-Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India. JCDR [Internet]. 2013 [cited 2025 May 3]; Available from: http://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=January&volume=7&issue=1&page=122-126&id=2685
17. Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases, presented to Emergency Medicine department, Ahmedabad, Gujarat. J Emerg Trauma Shock. 2013;6(3):199.
18. Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A Clinico-Epidemiological Study of Snake Bite in Nepal. Trop Doct. 1998 Oct;28(4):223–6.
19. Mehta S, Sashindran V. Clinical Features And Management Of Snake Bite. Medical Journal Armed Forces India. 2002 Jul;58(3):247–9.
20. Bawaskar HS, Bawaskar PH. Profile of snakebite envenoming in western Maharashtra, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2002 Jan;96(1):79–84.
21. Jadon RS, Sood R, Bauddh NK, Ray A, Soneja M, Agarwal P, et al. Ambispective study of clinical picture, management practices and outcome of snake bite patients at tertiary care centre in Northern India. Journal of Family Medicine and Primary Care. 2021 Feb;10(2):933–40.
22. Gautam P, Sharma N, Sharma M, Choudhary S. Clinical and demographic profile of snake envenomation in Himachal Pradesh, India. Indian Pediatr. 2014 Nov;51(11):934–5.
23. Dorji T. Is anti‐snake venom required for all snakebites: A case report. Clinical Case Reports. 2020 Jan;8(1):194–7.
24. Sasidharan P, Kaeley N, Mahala P, Jose JR, Shankar T, Santhalingan S, et al. Clinical and demographic profiling of snakebite envenomation in a tertiary care centre in northern India. Int J Emerg Med. 2025 Mar 10;18(1):50.
25. Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, et al. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife. 2020 Jul 7;9:e54076.
26. Menon JC, Bharti OK, Dhaliwal RS, John D, Menon GR, Grover A, et al. ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol. Soto-Blanco B, editor. PLoS ONE. 2022 Aug 22;17(8):e0270735.
27. Bhaumik S, Beri D, Tyagi J, Clarke M, Sharma SK, Williamson PR, et al. Outcomes in intervention research on snakebite envenomation: a systematic review. F1000Res. 2022 Jun 8;11:628.
28. Pandve HT, Makan A, Kulkarni TA. Assessment of awareness regarding snakebites and its related issues among rural communities. Scifed J Public Health. 2017;1:1.