What are the other Names for this Condition? (Also known as/Synonyms)

• Papuan Blacksnake Bite
• Pseudechis Papuanus Snake Bite

What is Papuan Black Snake Bite? (Definition/Background Information)

• The Papuan black snake (Pseudechis papuanus) is described as a highly venomous and dangerous snake that mostly inhabits the grasslands/savannahs of Papua New Guinea, an island nation in the southwestern Pacific Ocean
• The Papuan black snake forms a part of the Pseudechis species of black snakes that are located all over Australia and adjoining geographical regions. It belongs to the family Elapidae, which generally includes slender and swift-moving snakes
• The reptile is active during the day (but avoids the hot sun) and is normally found around water bodies, swamps, and on forest edges, where it hunts for frogs, lizards, birds, and other small mammals
• The Papuan black snake is uniformly black and shiny (sometimes dull black or even dark brown), with a robust body that show no patterns, and a grayish underbelly. It can grow to nearly 8 feet in length (the average size is about 6 feet)
• Interactions of humans with the snake are generally common in the endemic regions. The Papuan black snakes are described as being uneasy and edgy by nature that prefers to flee if disturbed. However, when cornered or threatened, it can attack powerfully and aggressively
• Papuan Black Snake Bite can cause severe and life-threatening envenomation (venom injection), which can result in fatalities without prompt and adequate treatment. The effect of the venom can be severe on children below age 10
• The signs and symptoms of Papuan Black Snake Bite may include pain and swelling at the bite site. The snake venom is highly neurotoxic and slightly hemotoxic, which can cause systemic symptoms such as dizziness, bleeding, muscle weakness, and severe paralysis
• Early administration of suitable antivenom (or antivenin) is the mainstay of treatment. Apart from this, symptomatic treatment is necessary, which may include pain medication, respiratory support, and blood transfusions. The prognosis of Papuan Black Snake Bite with immediate and effective therapy is usually good

Who gets Papuan Black Snake Bite? (Age and Sex Distribution)

• Papuan Black Snake Bite may occur to any individual exposed to the snake, particularly in its natural habitat (swamps and savannahs)
• Individuals of any age and gender are prone to snake bites, although most snake bites are noted among young teens and adults
• Papuan black snakes are mostly found in the southern part of Papua New Guinea (PNG), an island nation in the Pacific Ocean, located north of the Australian continent. There are over hundreds of snakes in PNG, but only a small proportion of snake bites are attributed to the Papuan blacksnake
• The snake is also found in smaller islands around the region including the Frederik-Hendrik Island, Sabai Island (in Torres Strait), and Yule Island
• Some literature reports inform that the Papuan black snake is also found in certain regions of Indonesia (a country in Southeast Asia)

What are the Risk Factors for Papuan Black Snake Bite? (Predisposing Factors)

The risks for Papuan Black Snake Bite include the following factors:

• Living or residing in the tropical regions endemic to the snake; the local people are especially at risk due to the incidences of regular contact with the snake
• The Papuan black snake is at the heart of certain rituals and beliefs of the ethnic tribes, placing them at a higher risk for exposure, and consequently, bites
• Since there are a few other species of “black-colored” but non-venomous snakes in Papua New Guinea, accidental bites from the very venomous Papuan black snake are also known to occur as a result of mistaken identity
• Occupational hazard: The snake may pose a threat to those working in fields, plantations, and herding cattle
• Having dwellings close to water sources (such as ponds) that attract frogs
• Walking unprotected through tall grasses, bushes, around especially during daytime; accidentally stepping on the snake. Most cases of snake bites are reported from people walking in the grasslands, bushes, or gardens
• Venturing outdoors and to the edge of forests, particularly during the night without adequate protection
• Hiking and trekking in the endemic regions
• Sleeping on the ground during nighttimes, at home or even just outside one’s dwellings
• Wildlife enthusiasts and scientific study groups, who explore the region
• Keeping them as pets
• Handling dead or live snakes; intentionally or accidentally picking up the snake

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Papuan Black Snake Bite? (Etiology)

Papuan Black Snake Bite can take place when one comes into contact with the venomous snake, usually unintentionally or inadvertently.

• This shy creature is generally known to avoid humans and will bite only under provocation or threat. When threatened, the snake may flatten its throat as an indication of its agitation. The venom of the Papuan black snake contains hemotoxins, anticoagulants, and strong neurotoxins that can affect the entire body
• The severity of the signs and symptoms depend on factors such as the location of the bite, age and health condition of the individual, and their body weight. Even so, the bites from Papuan black snakes can result in severe envenomation

According to case study reports, between 40-60% of the Papuan Black Snake Bites are ‘dry bites’ and do not lead to any local or systemic envenomation (i.e., no signs and symptoms may be noted). However, it is equally important to note that the death rate for untreated bites can be as high as 50%.

What are the Signs and Symptoms of Papuan Black Snake Bite?

The signs and symptoms of snake bites depend on the age (whether child or adult), weight, and overall health status of the individual (whether having an underlying condition or illness). Also, the signs and symptoms vary according to the potency and amount of venom injected.

The signs and symptoms of Papuan Black Snake Bite can vary from one individual to another. It may develop within a few hours and may include:

• Pain at the bite site, which may be severe; presence of noticeable fang marks. Often, significant injury at the bite site is not noted
• In a majority of cases, snake bites occur on the feet and ankles followed by the hands
• Skin discoloration
• Bleeding from the wound
• Swelling at the bite site
• Lymph node pain
• Breakdown of muscle tissue may occur, but is rare
• Double vision
• Droopy eyelids and eye muscle paralysis is commonly noted
• Chills and sweating
• Breathing difficulties; labored breathing
• Bleeding problems that are not commonly noted, but may include:
  • Bleeding from nose and mouth
  • Mucosal bleeding (seen a few hours after the bite) from other locations
• Nausea and vomiting; vomiting blood, in some
• Abdominal pain
• Mildly low blood pressure
• Headaches
• Feeling faint or dizzy
• Weakness and malaise
• Partial consciousness or unconsciousness

Systemic signs and symptoms may include: (children, below 10 years of age, present more severe symptoms than adults)

• Muscle damage; progressive muscle weakness
• Difficulty speaking and swallowing
• Individuals may be unable to stand, sit, or even raise their arms and legs
• Neurological symptoms including moderate to severe paralysis
• Kidney injury causing acute kidney failure is reported

Note: 

• In some cases, the fang marks may not be pronounced or even visible. Sometimes only small scratch marks or lacerations may be observed. Thus, any contact with a Papuan black snake merits immediate medical attention
• Severe anxiety may also result in some misleading symptoms of snakebites, such as sweating, fatigue, and shock, even when no bite has taken place (the individual may be imagining), or when it is a dry bite. Nevertheless, even in suspect cases, the presence of any such symptoms requires the attention of a qualified medical professional
• Also, if the individual has been treated using alternative/native medicines, it may present additional confusing symptoms. Thus, it is important to always consult a qualified healthcare provider promptly

How is Papuan Black Snake Bite Diagnosed?

Papuan Black Snake Bite may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history; a physical examination of the affected site by the physician may be normally sufficient to diagnose a snake bite
• The individual may be asked to provide an account (history) of the events that occurred (what took place and how), if possible
• Assessment of the signs and symptoms exhibited by the individual may be carefully observed
• Blood tests that may include:
  • Complete blood count (CBC) with differential and platelet count
  • White blood cell count
  • Prothrombin time (PT) and partial thromboplastin time (PTT) tests
  • Fibrinogen blood test
  • Lactate dehydrogenase (LDH) test
  • Serum electrolytes including blood urea nitrogen (BUN) and creatinine levels
• Urine test or urinalysis to test for free protein, myoglobin, and hemoglobin levels
• Electrocardiogram (ECG)
• Nerve conduction studies and neurological evaluation

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Papuan Black Snake Bite?

The complications of Papuan Black Snake Bite may include:

• Multiple bites, causing injection of a larger quantity of venom
• Blood clotting defects may result in internal bleeding
• Rarely, tissue and muscle damage, which can result in superimposed infections
• The snake toxin can damage the muscle resulting in muscle breakdown known as rhabdomyolysis. Extensive muscle breakdown can lead to a variety of complications including kidney failure
• Flaccid paralysis that is severe; the onset of paralysis may occur within a few hours to even 20 hours following snake bite
• Loss of respiratory function due to neurological symptoms, which can be fatal
• Coma

Presence of misleading symptoms due to fear and anxiety, which may be also aggravated by those around the individual, such as one’s family members, can sometimes result in inappropriate or over-treatment.

Antivenom reactions:

• Some individuals may develop an allergic reaction, such as anaphylaxis, to the antivenom that may be serious. This may develop within 10 minutes or even after 6 hours, typically starting with itchiness over the scalp and other skin areas
• Life-threatening anaphylactic reactions that require immediate medical treatment may include:
  • Low blood pressure or hypotension
  • Bronchospasm causing narrowing of the airways (bronchi) resulting in breathing difficulties
  • Angioedema: Swelling of skin tissue layers at various locations including the throat, causing speaking and breathing difficulties
• Serum sickness may develop as a complication of antivenom therapy causing fever, nausea, itchy skin, muscle and joint pain, etc. It may develop after 4 days or even 2 weeks (average 7 days) following the administration of antivenom serum

How is Papuan Black Snake Bite Treated?

All snake bites should be considered as medical emergencies and evaluated by trained medical professionals, as soon as possible; the first 6-8 hours are particularly vital for preventing life-threatening symptoms. Failure to obtain early assessment and management from the highest level of care (available within the community) may potentially result in severe complications and death.

The following measures may be considered in the treatment of Papuan Black Snake Bite, based on the medical evaluation of a trained healthcare professional. Over 50% of the snake bites can cause severe envenomation and hospitalization is generally necessary.

• Administration of intravenous fluids to keep the patient well-hydrated
• Administration of anti-snake venom (ASV) to neutralize the venom through slow intravenous injection or infusion method; the ASV type administered is polyvalent antivenom
• Address any signs or early allergic reaction: A close observation of the patient is necessary for a minimum of 60 minutes immediately following antivenom administration, to detect early allergic reactions, if any
• Administration of pain medication
• Periodic blood and urine tests are undertaken for 12-24 hours or more
• Tetanus vaccination is usually required, if it is not up to date
• The patient is admitted and placed in an ICU setting and monitored for at least a day following the abatement of symptoms; the patient has to be rested and kept warm
• If necessary, blood and plasma transfusions for severe cases
• Peritoneal dialysis for acute kidney failure
• Intubation and respiratory support is usually necessary
• Providing life support, such as ventilation assistance and treatment for shock, for those with severe symptoms leading to potential organ failure
• Medications to control blood pressure
• Rehabilitation of the affected limb through physical therapy, if required
• Unless infection or tissue necrosis is observed, the administration of prophylactic antibiotics is generally not recommended in snake bites. However, the healthcare provider will determine whether antibiotics administration is necessary or not, based on one’s individual circumstances

Note:

• Consultation with a medical toxicologist is recommended for all cases requiring the administration of anti-snake venom
• Even though antivenom therapy is the key treatment for systemic envenomation; on its own, it may never be adequate enough to completely resolve the condition. Other supportive and symptomatic measures are always necessary to save the patient
• The dose of antivenom does not vary for a child, adult, or even for a pregnant woman, since the snake typically injects the same quantity of venom into an individual
• Gynecological evaluation may be necessary for pregnant women bitten by snakes to evaluate the health of the fetus
• In many instances, the type of venomous snake involved in the bite is unknown; hence, all vital organs and systems should be closely monitored and treated appropriately, as necessary

How can Papuan Black Snake Bite be Prevented?

Papuan Black Snake Bite may be avoided by:

• If you spot a black snake in the endemic regions, step back slowly and keep a safe distance of 10-12 feet or more, between yourself and the snake
• Be alert, if you are in snake-infested regions, particularly containing dangerous species of snakes
• Be on the lookout for snakes and other animals while outdoors (in the grasslands, forests, around swamps and water bodies); also, if you are with a pet, do not allow the pet to wander away
• Avoid tall grassy areas or thick bushes; if you plan to explore the area, use heavy boots and thick pants
• Always stay on established paths and clearings, while walking in the woods, grasslands, or through thick undergrowths
• Always allow snakes crossing your path the right of way
• Avoid picking up firewood sticks, stones, or rocks without checking the area for any concealed creatures
• Always step on top of large rocks and fallen trunks; never place one’s foot by the side of big rocks and rotting tree stumps. Some snake species are known to take shelter or warm themselves on the sides, during the day
• Always check before sitting on dead tree logs, stumps, or a pile of rocks; use a stick to stir or probe around the area
• Do not reach out to move or hold bushes or tree branches without properly examining them for any camouflaged creatures such as snakes
• While walking through areas with thick undergrowth, pay attention to the sound of birds or monkeys that may warn of potential dangers such as snakes
• While walking outdoors at night, use a flashlight or lamp and make constant noise (singing or talking to others) or large stomping sounds that may alert the snake to move away from the region
• Natural disasters, such as floods and forest fires, are known to drive out snakes and other creatures into homes seeking shelter. Hence, always remain vigilant when returning home following such situations
• Never intentionally run over snakes on the road while on a vehicle (cycle, other 2-wheeler, or 4-wheeler); the injured snake lying on the road may strike other pedestrians, or get entangled in the vehicle and be carried to the parking lot or even inside one’s garage
• Carry a snake bite kit, if possible, when traveling through areas containing highly venomous snake species
• Avoiding being outdoors at night in forested areas; be careful while camping outdoors
• Avoid playing with or teasing snakes such as by touching their tails
• Do not pick up dead snakes - they may be poisonous and still bite through a reflex action
• Do not reach into dark nooks/corners/recesses with your bare hands/foot
• Teach and educate children about the dangers and importance of snakes
• Take steps to educate the members of a community to identify venomous snakes, recognize bite symptoms, and how to avoid encounter with snakes

Both large and small snakes have the potential for severe envenomation; hence, all snake bites should be treated promptly and appropriately.

Also, in case of a snake bite, do visit a registered medical practitioner immediately (and not any native or traditional medicine experts).

What is the Prognosis of Papuan Black Snake Bite? (Outcomes/Resolutions)

• The prognosis of Papuan Black Snake Bite is dependent on the site of bite, age and overall health of the individual, and promptness of medical response. However, the overall prognosis is primarily based on the quickness with which suitable antivenom is administered
• Without treatment or access to proper healthcare, deaths from severe complications, such as respiratory distress, severe paralysis, and kidney failure have been reported. The death rate from severe envenomation without suitable treatment is about 40-50%; children who are bitten, do much worse than adults

Additional and Relevant Useful Information for Papuan Black Snake Bite:

• The diffident and elegant Papuan black snake was on the brink of extinction, due to habitat loss and following the introduction of the cane toad (that is poisonous to the snakes) into the snake’s habitat. However, due to the concerted efforts of conservation experts and local governments, the snake numbers are on the increase from 2005-06 onwards
• In some cases, the snake bite may be a ‘dry bite’, meaning that even though there is a bite mark, no venom injection occurs. However, even for dry bites, the patient must be placed under observation and monitored closely for a period ranging anywhere from 12-24 hours, prior to discharge

Depending on the geographical region, either monovalent antivenom or polyvalent antivenom may be administered for systemic envenomation. Monovalent antivenom neutralizes venom of a single snake species only, whereas polyvalent antivenom can neutralize the venom of several snake species.

The snake venom is a highly complex mix of several proteins, enzymes, amino acids, peptide chains, fats, and even certain metals. The bite causing venom injection into the body may be categorized as:

• Intramuscular injection: Long-fanged snakes have a potential for injecting venom directly into the muscles (this is highly infrequent though)
• Intraperitoneal injection: When the snake bite involves the stomach or abdomen region
• Intravenous injection: In very rare cases, the snake fangs may inject venom directly into a blood vessel, releasing venom directly into blood (posing an even greater danger than normal snake bites)
• Subcutaneous injection: A majority of snake bites involve the subcutaneous skin layers (venom is injected just below the skin surface)