Abstract

Background Snakebite envenoming (SBE) remains a major neglected tropical disease in Sudan. Venom-induced consumption coagulopathy (VICC) is the most frequent and fatal systemic complication, particularly following envenoming by hemotoxic Echis species. Robust clinical data on VICC in Sudan are limited.

Methods We conducted a prospective hospital-based cohort study at Sinja Teaching Hospital, Sennar state, Sudan, from March to September 2022. All patients admitted with SBE were enrolled. VICC was diagnosed using the 20-minute whole blood clotting test (WBCT20) and laboratory coagulation assays. Clinical features, laboratory abnormalities, management, and outcomes were recorded until discharge or death.

Results Among 119 patients with SBE (mean age 34.5 ± 9 years; 79.8% male), VICC developed in 96 (80.7%). Echis spp. were implicated in 86.6% of cases based on patient recognition. Spontaneous systemic bleeding occurred in 88.5% of VICC patients, and life-threatening hemorrhage in 30.2%, most commonly intracerebral hemorrhage. Acute kidney injury occurred in 36.5% of VICC cases. WBCT20 was positive in all VICC patients and showed high diagnostic sensitivity. Despite administration of fresh frozen plasma, mortality among VICC patients was 30.2%. All paediatric patients died.

Conclusions VICC was highly prevalent and associated with severe hemorrhage, acute kidney injury, and high mortality in this snakebite-endemic region of Sudan. Supportive therapy alone was insufficient to prevent fatal outcomes, reflecting delayed presentation and the absence of effective Echis-specific antivenom. Improved access to species-appropriate antivenom, early referral, and adherence to evidence-based management are critical to reducing snakebite-related mortality in Sudan.

Author Summary Snakebite envenoming is a neglected tropical disease that disproportionately affects rural and agricultural communities in low-resource settings. In Sudan, snakebite remains a major but underreported cause of illness and death. One of its most serious complications is venom-induced consumption coagulopathy (VICC), a disturbance of blood clotting that can lead to severe bleeding and organ failure.

We studied all patients admitted with snakebite envenoming to a teaching hospital in southeastern Sudan over six months. More than 80% of patients developed VICC, most often following bites attributed to Echis species, which are common in this region. Many patients experienced spontaneous bleeding, and nearly one-third developed life-threatening hemorrhage, most frequently bleeding in the brain. Acute kidney injury was common. Despite supportive treatment, almost one-third of patients with VICC died, and all children in the study died.

Our findings highlight the severe and largely preventable burden of snakebite envenoming in this setting. Delayed presentation to hospital, reliance on traditional healers, and the lack of effective antivenom against locally prevalent snake species contributed to poor outcomes. This study highlights the urgent need to improve access to appropriate antivenom, strengthen health-care systems, and implement evidence-based management of snakebite envenoming to reduce avoidable deaths and disability in Sudan.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Sudan's Medical Specialization Board, Ministry of Health Sennar state, and Sinja Teaching Hospital's Ethical Committees.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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List of AbbreviationsAKIAcute Kidney InjuryAPTTActivated Partial Thromboplastin TimeFFPFresh Frozen PlasmaINRInternational Normalized RatioKDIGO criteriaKidney Disease: Improving Global Outcomes criteriaNTDsNeglected Tropical DiseasesPTProthrombin TimeVICCVenom-Induced Consumption CoagulopathyWBCT2020-min Whole Blood Clotting Test