What seemed at first like an ordinary snakebite in Assam, India, quickly became a neurological emergency. Within hours, a tea-garden worker lost motor function after being bitten on the foot by a snake she and her co-workers described as completely white.
Here's what to know
The bite happened around 11:30 a.m. on September 16 while she worked in a tea garden in Assam's Sivasagar district, according to Northeast Now. She reached Demow Community Health Centre about 50 minutes later, and the injury initially seemed minor, as staff noted neither major swelling nor an obvious fang mark.
Even when shown photos of venomous snakes found in Assam, she repeatedly identified the animal as white. The situation shifted around 1:40 p.m., when a health worker noticed drooping eyelids and double vision, both signs pointing toward neurotoxic envenomation.
Treatment started with 20 vials of polyvalent anti-snake venom, along with neostigmine and glycopyrrolate. When her ptosis still did not improve after five maintenance doses, the team began to suspect presynaptic neurotoxicity involving a Bungarus species.
More background
Part of what made the case so dangerous was how mild the bite looked at the beginning. There was little swelling and no obvious fang mark, even as a life-threatening neurological reaction was developing.
As her neurological decline continued, the team discontinued anticholinesterase treatment because they believed the venom was acting presynaptically.
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She appears to have stepped on the snake while working in the tea garden. That kind of overlap between people and wildlife often leads to dangerous encounters.
What's being done?
By about 3:30 p.m., Demow CHC had intubated the patient despite not having mechanical ventilation on site.
Because no ventilator was available there, the medical team used an Ambu bag throughout the ambulance transfer to a collaborating private intensive-care facility. By about 5 p.m., after reaching the ICU, she was in complete flaccid paralysis and needed mechanical ventilation.
Her recovery unfolded step by step: she came off the breathing tube around 30 hours after the bite, her swallowing difficulty had resolved by the fourth day, and by the eighth day her drooping eyelids and abnormal pupil responses had completely recovered.
She was discharged on September 22 with no residual neurological deficit.
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