Essentials Of Bites And Stings

Nik Zainal Abidin Nik Ismail


History of bitten by animals and stung by insects is common occurrence and the effects are variedly noted. The focus for present discussion is concerning snake bites and stung by hornet.

Are these issues existed as a serious public health problem in Malaysia. 55,000 snakebites cases were admitted to the hospitals in Malaysia during the period of 1958-1980. Mortality rate of snake bite in Malaysia was reported as low i.e. 0.3 per 100,000 population (Lin & Ibrahim 1970,1982). The symptomatology and treatment of snakebites in Malaysia had been well documented. (Reid, 1979; Warrell, 1986). Prof. Tan Nget Hong had given beautiful picture and illustration of medically important poisonous snakes in Malaysia in the web (

WHO (David A Warrell, 2010), regional for South-East Asia had released excellent and complete guideline for management of snake bite and our Paediatric protocols for Malaysian hospital have also clearly define the approach in the management of snakebite in children. Has this pattern of snake bites changed with the advent of rapid development of country in Malaysia. Our observation in USM, Kangar Hospital and Sultanah Aminah Hospital illustrated the recent declining incidence and better outcome from snake bite.

With respect to hornet sting, it had been observed to be a non serious problem in other countries as compared to Kelantan. Hornet stings in particular occurred as frequent as 1-2 cases per month in USM alone and with deleterious effect. Complication of anaphylactic shock, renal impairment and death had been observed following multiple and single bite. Children had died following a single bite at foot.

The first case report of fatal hornet sting in the country was reported by Lee et al (2005) and last report of death following hornet in Singapore was way back in 1966.

The emphasis of longer observation in hospital for at least 48 hour is recommended as report of late anaphylaxis effect after 24 hour had been observed. Further epidemiology studies, antigenic response analysis and understanding of hornet need to be carried out. Promoting education on danger of hornet sting, quick recognition of type of hornet and effective preventive measures need to be undertaken.

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