Common Krait is the Most Mysterious Snake

Introduction

Common Krait is the most mysterious snake .It is a Neurotoxic snake , commonly seen in the rural areas of India , particularly in West Bengal . This site is built particularly to give some idea about this mysterious snake . Some case history and photograph are given here

Common Krait (  Bungarus caeruleus) is commonly known as KALACH snake in West Bengal state of India. It is also known as " Seorchanda " or " Neorchanda" Snake; other local names are " Domna Chiti " and " Sankha Chiti. " In some area it is called as " KALA CHITI" snake. That means a black Chiti snake . One nonpoisonous snake called " CHITI" snake is confusing with this Kalach snake. Particularly baby Chiti snake may be mistaken as the dangerous Kalach Snake . See in the photogallery that the white bands are only differentiating point.

ABOUT The SNAKE

This snake ( Common Krait ) is found all over india .  This is a non hooded snake. Average length is 25 inches. Longer snake of about 40 inches is rarely seen . Very slender , black colour snake is identifiable by slim white bands on it's body. Bands of nonpoisonous Woulf snake ( CHITI or Ghar Chiti ) are wider . Colour of mature Ghar Chiti is grey to yellowish ; but baby Ghar chiti may be of darker colour . But the bands are always wide in nonpoisonous one. This snake is a domestic snake . Usually feed on small insects.

VENOM : Venom of Kalach ( Common Krait ) is a Neurotoxic one . But this venom is atypical because they do not respond to Injection Neostigmine ( as in Cobra venom ).This Kalach venom causes presynaptic blockage of nerve endings . Killar ( Fatal ) dose of Krait venom is only One milligram ; in comparison , Killar dose of Cobra venom is 15 mg and that of Russell's Viper ( Chandra Bora ) 42 mg. This Kalach venom gives no local pain or swelling.

 

MYSTERY

Mystery of the Common Krait bite is due to the property of it's venom , Painless bite in sleep may kill the victim in sleep.I have collected case history of such mysterious presentation of Krait bite patients. These cases would be detailed here.

OLD CASES

 1)Above two are the last slide of the scientific presentation of this author . After his very first presentation on 7th August 2007 at Habra State General Hospital , North 24-Paraganas district of West Bengal, the senior most physician of the hospital could retrospectively diagnose a case seen by him about 20yrs back at NRS Medical College , Kolkata. The physician confessed that , they could not diagnose that ill fated patient who ultimately died . The doctors of NRS MC suspected that to be a case of ceribrovascular accident and treated in that manner .

  After presentation of the same slide at a seminar at Mecheda of East Midnapur district of WB on 2nd October 2009 one senior practitioner confessed that they have given death certificate to many a patients of such mysterious presentation ; in every case cause of death was written as CVA!   

2) After knowing this reaction from the senior physician one staff nurse of Habra S G Hospital Gayatri told that , her elder brother in law was treated at the same NRS Medical college in the year 2004, in the department of ENT . After 3 days treatment for Tonsillitis the patient was diagnosed to be a victim of neurotoxic snake bite and was given Anti Snake Venom Serum ; the patient survived.

Presented with Difficulty in Swallowing only 40 hrs after 1st Symptom:

This 40 yrs lady came to the ER of Calcutta National Medical College & Hospital , Kolkata on 13.7.2016 ( at 1.45 PM ) from a remote village of Jibantala PS of South 24-Paraganas district of WB. . Main complaint was inability to take any solid food for last 40 hrs or more. Started complaining in the early morning on 12.4.7.2016. Gradually progressed to whole body weakness , Pain in Throat and inability to open the eyes for more than a few minutes. No History of any bite. Only positive history was a " Floor Bed". Admitted and Started 10 vials of ASV. Almost symptom free in the morning of 14th July 2016.

 

SOME Recent Cases:

http://www.50000snake.webs.com/

1) See the workshop photo in the web site www.50000snake.webs.com ; you would see Dr Rafiq of Debra Rural Hospital in the front row. Dr Rafiq was pleased to inform this          " snake bite fanatic" on 9th August 2009 that, he could save one female patient of Kalach Bite.

This middle aged female patient  came to Debra Rural Hospital of West Midnapur district of West Bengal in the morning of 9th August 2009. She had only complaint of " Pain Abdomen". Dr Rafiq did not find any abnormality in her abdomen . While interogating the patient doctor could notice some drooping of eye lids of the patient . Now the diagnosis was done to be a case of common krait ( Kalach) bite . 10 Vials of AVS was given rapidly IV . The patient survived. You can congratulate Dr Rafiq at 09434005487. He is doing extraordinary works on snake bite at that small hospital.

2) You can see the video of interview of this patient Tapan Bag and his mother with the treating team. Tapan Bag, 13 yrs male, presented only with pain in throat in the morning of 21st September 2009 . He was brought to the Popular Nursing Home of Mecheda , East Midnapur district of West Bengal at about 11.30 AM as he was gradually becoming unable to open his eyes. He was lucky to be diagnosed to be a case of Kalach bite as he developed total respiratory failure in a short time. He was intubated at that nursing home and was carried to Kolkata in an old ambulance with Ambo Bag ventilation. He survived after 5 days' artificial ventilation at the Calcutta Heart Research Clinic , Salt Lake , Kolkata -91. 

Tapan was treated by a team of doctors at Popular NH and at CHRC . Dr Asoke Samanta ( 9433006566) suspected the case to be a Krait bite victim first. To be certain the snake was recovered from the room where Tapan slept in the last night. 10 vials of AVS was infused in the ambulance when the patient was being carried to Kolkata.

 

MYTHS:

1)There is one interesting myth about the bite of this kalach snake . In Bengali it is " Chatle Chiti , Kamrele Borah "( চাটলে চিতি , কামড়ালে বোড়া") That means if the snake has licked only it is a Chiti snake and if it has bitten then it is a Viper snake. Now we can easily explain this rural myth . Actually the painless and markless bite of common krait has made it to believe that the snake does not bite , but lick only. this is not true.

2) In Birbhum and Burdwan districts of West Bengal India this Common Krait snake is known as " Domna Chiti" They say ,"যদি কাটে ডোমনা ডেকে আন বামনা", this means , if a C. Krait snake has bitten,  you have the only option to call a Brahmin . This signifies sure death . Though our doctors like Sreejita Bhowmic , Dr Md. Rafik and Dr Moumita Mondal had already proved that , Common Krait bite cases can also be cured , many a times the cases are becoming fatal due to  late diagnosis only.

LICK SWEAT ?

One peculiarity of this Kalach snake is that , frequently they are found in the bed of a person sleeping on the open floor. One common belief is that, the snake comes to lick sweat. This is not proved. Some authority is of the opinion that , the snake has affinity to the warmth of human body , so they come to the bed. 

Any way , open floor beds in the rural areas should be avoided to prevent this snake bite.  Other preventive aspects of snake bite is detailed in the book " 50000 Deaths and a Snake bite fanatic".

 

TREATMENT

Rapid infusion of 10 vials of Indian Poly valent  AVS  at the onset of ptosis ( drooping of eye lids) is the only treatment . See and down load the most simple Flow Chart for Snake bite management in the photogallery.

   See treatment regim for all Indian snakes at SLIDE No : 28 & 29 in the photo gallery of  htttp://www.50000snake.webs.comwww.50000snake.webs.com

 http://www.searo.who.int/LinkFiles/SDE_mgmt_snake-bite.pdf

CONVULSION IN KRAIT BITE

Though in scientific literature review we see that  convulsion is a rare sign of Krait bite ; it was a very common feature in case of Krait bite patients of the Sundarban area of the South 24-Paraganas district of West Bengal state of India. In case of our first patient ( Tapan Bag ) convulsions started before respiratory failure.

In a publication of the " Juktibadi Sanaskritik Sanstha " of Canning ,South 24-Paraganas we see that  in last 20 years dozons of Krait bite patients were treated at the Canning Sub Divisional Hospital . All the patients presented with Convulsion and most of them with pain abdomen. 

Most probably time after bite is the main factor to get different signs. In case of Tapan Bag earliest symptom was sore throat ; then came ptosis. Convulsions came about three hours after ptosis. In case of the lady patient treated by Dr Rafiq at Debra Rural Hospital presenting symptom was pain abdomen , then came ptosis . See was given AVS at the stage of ptosis , so see did not deteriorate . As the Sundarban area of West Bengal is the worst in position for communication ; all most all the krait bite patients were brought to canning hospital very late. Definitely the painless bite in the open floor bed was a contributing factor for the late hospital attendance.

 All the Krait bite patients of canning hospital were treated with AVS only ; Convulsions subsided first , then other symptoms. 

PAIN ABDOMEN IN KRAIT BITE

Pain Abdomen is a very common presenting symptom in  case of Common Krait bite victims. There are several case reports in the recently published " Snake Bite Help Line " book by Canning Juktibadi Sanaskritik Sanastha. 

 Very recently Dr Rafik of Debra  Rural Hospital of West Midnapur district of West Bengal had miraculously saved life of one Sunil Hembram , 23 yrs Male patient who presented purely with pain abdomen. He was admitted into the DRH in the early morning of 25th May 2010. There was no history of any bite ; the patient was treated by other doctors for 24 hours for pain abdomen . On 26th morning Dr Rafik ( rafik.debra@gmail.com) first noted PTOSIS in the patient . And he suspected it to be a case of Krait bite . The patient was treated with 10 vials of AVS and survived. 

   So , PTOSIS may come even after 24 hrs of Common Krait bite .  And AVS at the onset of Ptosis is life saving in a case of Common Krait bite.

 

PRESENTING IN PARALYSIS

One Patient named Zakir Hossain Sardar , 21 yrs , male from Belegachi Village of P.S: Baruipur , Dist : South 24-Paraganas , West Bengal was brought to the Canning Subdivisional Hospital at 8 AM on 29th May 2010.The patient was confused and had signs like hemiperesis of Rt. side of body. The patient had ptosis. On interrogation the Emergency Medical Officer , Dr. Ujjal Halder ( 9433353269) got some positive history to suggest a Kalach ( Common Krait ) bite. The patient was treated by Dr Halder with IV infusion of 15 vials of Indian Poly Valent AVS and survived. 

What was the history from the patient's relatives ? There was no history of any bite. Most relevant history was open floor bed in the previous night. Sudden pain abdomen broke the sleep of the patient . Then there was vomiting for one time only . Whole body ache and blurring of vision came latter on in that order. 

LADY HOUSE STAFF DIAGNOSED

This was a case of typical presentation of Kalach snake bite . Pintu Naskar , 35 yrs, Male of Mousal village , near Kolkata Leather Complex , of South 24-Paraganas district of  Paschimbanga attended the emergency of N R S Medical College , Kolkata on 14th August 2011 in the early morning . Pintu gave a history of something bitten him from out side the bed net of his floor bed. He was suffering from pain abdomen only when he came to the hospital. Pintu was kept in observation and discharged at 10.00 AM. He was admitted at the Calcutta National Medical College & Hospital , in Male paying Bed No. 227 , at 12.10 PM. There also he got treatment for pain abdomen at first. In the evening Pintu complained of Dysphagia ( difficulty in swallowing ) and drooping of eye lids. Now he was diagnosed to be a case of Neurotoxic Snakebite by one lady House Staff ( Dr . Sreejita Bhowmick) . Pintu was infused with 10 vials of Indian Poly- valent AVS ; and was cured.   See the page 15 of a publication by Raptacos, Brett & Co. Mumbai. 

4.5 Yrs Boy with pain in Throat

Once again a miraculous save by Dr Rafik of Debra Rural Hospital ( 9434005487). 4.5 Yrs boy admitted in gasping condition at about 6 PM to day ( 15th Sept 2012) , saved by  AVS infusion , no history of any bite. History of floor bed , early morning sore throat , boy  went to school also , returned with sickness. Bilateral ptosis started at about  4 PM. Congratulate Rafik for saving this mysterious case of  Common Krait bite. 

Pain in Throat in C K Bite Patient of Alipurduar  S D Hospital:

    Senior physician of Alipurduar S D Hospital of Jalpaiguri district in West Bengal presented an interesting case of Common Krait bite in a symposium held in that hospital on 22nd July, 2013.

 

    This was a middle aged tribal male patient admitted under the ENT surgeon of that hospital with complaints of pain in throat only. On the next day the patient was referred to Dr Judhisthir Das, physician of that hospital as the patient developed “Bilateral Ptosis”. Dr Das diagnosed it to be a case of C K bite and infused 10 vials of Indian Poly-valent ASV, and the patient was cured. We are grateful to Dr Das for presenting such an interesting case of C K Bite. 

19 Yrs Male Patient Saved at Haringhata BPHC of WB.

        This is a 19yrs old male patient, presented at Haringhata BPHC of Nadia District of West Bengal, in the early morning on 7th August 2013. Presenting complaints were Pain abdomen since 3 AM, along with Vomiting and pain in throat. The lady Medical Officer on duty, Dr Moumita Mondal got “ Bilateral Ptosis” on examination. Yes, with a history of “Floor Bed”. No History of any Snakebite. The patient was infused with 10 vials of Indian Poly-valent ASV; Inj. Atropine and Neostigmine was also given. The patient was referred to  Kalyani J N Medical College for assisted ventilation if necessary. No ventillatory support was needed. Patient was completely cured. We congratulate Dr M Mondal for a successful diagnosis of a Common Krait bite. 

C K Bite case like Diphtheria :

Got another Heavenly gift:

 

My student Dr Achintya Chakraborty, now House Staff at the dept of Medicine, CNMC&H , Kolkata has done a miraculous diagnosis and saved a life of a 14 yrs old girl ( from Basanti, South 24- Paraganas). This patient was admitted at CNMC& H on 12th Sept night with severe pain abdomen and sore throat. She was admitted by the EMO with a suspicion of Diphtheria. But Achintya could diagnose it to be a case of Common Krait bite with the finding of Bilateral Ptosis. There was no history of any bite, nor a H/O floor bed. She slept on a low cot without a bed net. The patient dramatically improved after ASV infusion, discharged from hospital today ( 17.9.2013).

Important Contact Numbers :

Dr Samarendranath Roy : 7278728524. and 9830479696.

Snakebite Helpline Number : 9635995476. 

Canning Hospital Patient 

See this patient of Canning S D Hospital . This case was presented at a Workshop held there on 5.10.2013. This patient was bitten in her bed at about 1.00 AM , the snake was inside her bed net. Her son killed the snake , and ignored the bite. Patient started sufferinf from some symptoms since 4 AM ; then only they started for hospital. They reached the Hospital at 6.00 AM . Dr Samarendranath Roy ( 7278728524) saved her by infusing ASV only.  http://youtu.be/nU21t4UWMgg http://youtu.be/nU21t4UWMgg

PTOSIS PICTURES : 

IGNORANCE & CONTROVERSY:

 

Dr Sikdar of Jangipara BPHC of Hoogly district of WB, India got a typical Common krait bite patient presenting with Gastro Intestinal symptoms in the early morning today ( 24.6.2014). Dr Sikdar tried his best with ASV infusion and Atropine & Neostigmine injections. As the patient ( Ranajit Malik , 16yrs , Male) was in paradoxical respiration , Dr Sikdar was bound to transfer the pt. to MCK ( the most prestigious Medical College in the Eastern region ). Unfortunately the patient died before reaching MCK. 
Patient party was seriously agitated by a “ most irresponsible and nonsense comment” of a doctor ( we would be happy to know if he was a junior doctor ), that it was not at all a case of Snakebite. Doctors of Jangipara were about to be manhandled and hospital was to be demolished by the agitated patient party. 
Fortunately enough, Post mortem report from the MCK revealed it to be a “ Neurotoxic Snakebite “ . And , last but not the list, reminds us great teaching of great Doctor Himmat Saluba Bawaskar , “ One Common Krait Snake was recovered from the room where the patient slept in the previous night”. 
I know , most of our teachers of Medical Colleges are “ NOT INTERESTED to teach Snakebite” ; But may we expect that, they would teach their juniors , “ Not to give any adverse comment on any patient treated by his fellow colleague working in the rural health centers”?

 

New Video of Kalach ( Common Krait)

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