Anti-snake venom sera availability [26–28].

BackgroundSnake bite envenoming (SBE) is one neglected tropical disease that has not received the needed attention. The sequelae of burdensome disability and mortality impact the socioeconomic life of communities adversely with little documentation of SBE in health facility records in Ghana. This study details SBE and snake distribution, habits/habitats, type of venom expressed and clinical manifestations.MethodologyWe conducted a structured thematic desk review of peer reviewed papers, books and reports from repositories including PubMed, World Health Organization (WHO) and Women’s & Children’s Hospital (WCH) Clinical Toxinology Resources using bibliographic software EndNote and search engine Google Scholar with the following key words; snakes, medical importance, snake bites, venom and venom type, envenomation, symptoms and signs, vaccines, venom expenditure, strike behaviour and venom-metering + Ghana, West Africa, Africa, World. We also reviewed data from the District Health Information Management System (DHIMS) of the Ghana Health Service (GHS). Outcome variables were organized as follows: common name (s), species, habitat/habit, species-specific toxin, clinical manifestation, antivenom availability, WHO category.FindingsSnake bites and SBE were grouped by the activity of the expressed venom into neurotoxic, cardiotoxic, haemorrhagic, cytotoxic, myotoxic, nephrotoxic and procoagulants. Neurotoxic snake bites were largely due to elapids. Expressed venoms with cardiotoxic, haemorrhagic, nephrotoxic and procoagulant activities principally belonged to the family Viperidae. Snakes with venoms showing myotoxic activity were largely alien to Ghana and the West African sub-region. Venoms showing cytotoxic activity are expressed by a wide range of snakes though more prevalent among the Viperidae family. Snakes with neurotoxic and haemorrhagic venom activities are prevalent across all the agro-ecological zones in Ghana.Conclusion/SignificanceUnderstanding the characteristics of snakes and their venoms is useful in the management of SBE. The distribution of snakes by their expressed venoms across the agro-ecological zones is also instructive to species identification and diagnosis of SBE.

### 背景
蛇咬伤中毒（Snake bite envenoming, SBE）是一种被忽视的热带病，长期未获得应有的重视。沉重的残疾与死亡后遗症对社区社会经济生活造成严重负面影响，而加纳医疗机构的病例记录中关于SBE的记载极少。本研究详细阐述了SBE、蛇类分布、栖息习性、毒液类型及临床表现。

### 研究方法
本研究采用结构化主题案头综述法，对PubMed、世界卫生组织（World Health Organization, WHO）、妇女与儿童医院（Women’s & Children’s Hospital, WCH）临床毒理学资源库等馆藏的同行评议论文、书籍及报告进行梳理，使用文献管理软件EndNote与搜索引擎Google Scholar，以如下关键词开展检索：蛇类、医学重要性、蛇咬伤、毒液与毒液类型、中毒、症状与体征、疫苗、毒液释放、攻击行为、毒液计量+加纳、西非、非洲、全球。同时，本研究还调取了加纳卫生服务局（Ghana Health Service, GHS）的地区卫生信息管理系统（District Health Information Management System, DHIMS）数据。结局变量按以下类别进行整理：通用名称、物种、栖息环境/习性、物种特异性毒素、临床表现、抗蛇毒血清可及性、WHO分类。

### 研究结果
本研究将蛇咬伤与SBE按毒液活性分为神经毒性、心脏毒性、出血性、细胞毒性、肌毒性、肾毒性及促凝类。其中，神经毒性蛇咬伤主要由眼镜蛇科（Elapidae）蛇类所致；具有心脏毒性、出血性、肾毒性及促凝活性的毒液，主要归属于蝰科（Viperidae）。具有肌毒性毒液的蛇类大多未见于加纳及西非次区域。细胞毒性毒液可由多种蛇类分泌，但在蝰科中更为常见。兼具神经毒性与出血性毒液活性的蛇类，广泛分布于加纳所有农业生态区。

### 结论与意义
明晰蛇类及其毒液的特性，有助于SBE的临床管理。按毒液类型划分的蛇类在加纳农业生态区的分布特征，也可为SBE的物种鉴定与诊断提供重要参考。