Management of snake bite during third trimester of pregnancy with coagulopathy and delivery of a live baby in resource-limited setting in Nepal: a case report.

We reported a case of snakebite in an 18-year-old woman, Gravida 2 Para 1+0 in the third trimester of pregnancy who presented with pain and swelling over the left hand and forearm and vaginal spotting. The laboratory investigations revealed coagulopathy attributed to green pit viper envenomation. On the fourth day of admission, the patient developed sudden abdominal pain and massive per vaginal bleeding with haemorrhagic shock, most likely abruptio placentae. In Nepal, no anti-snake venom has been developed for green pit-viper. So, she was managed conservatively, including blood transfusion, and delivered a single live female baby without any foetal complications. The patient was discharged along with the baby after 8 days of hospitalization. This case demonstrated that vigilant observation and appropriate resuscitation with fluids and blood products could save mother and baby in pit viper envenomation cases in settings where specific anti-snake venom is unavailable.

Dengue and malaria coinfection: the first case report in Nepal.

A 21-year-old male from Nepal, with a history of travel to Mumbai 2 months ago, presented with fever with chills and rigors, vomiting and multiple joint pain for 1 week. Clinical examination was noteworthy for tachycardia, hypotension and positive tourniquet test. Lab reports showed NS1-Ag positive, thrombocytopenia, lymphocytosis, transaminesemia, hyperbilirubinemia, increased urea and creatinine. He was treated for severe dengue. His laboratory parameters started improving; however, he had fever with chills and rigors daily and persistent vomiting. Repeat peripheral smear for Malaria showed schizonts and trophozoites of Plasmodium vivax. He recovered following treatment with IV fluids and injection artesunate. The presence of fever even in a critical phase of dengue, the typical rise of temperature daily, and jaundice gave a clue of coinfection with Malaria. On follow-up, after 2 weeks, he had no symptoms, and all the laboratory parameters were normal.

Dengue and Scrub Typhus Coinfection in a Patient Presenting with Febrile Illness.

Dengue fever and scrub typhus are common causes of acute febrile illness of unclear origin in Asia. Though coinfections of many vector-borne diseases have been described, articles on dengue and scrub typhus coinfection are distinctly limited. In case of coinfection with dengue and scrub typhus, vigilant monitoring of vitals, platelets transfusion, and timely treatment with doxycycline are necessary. High degree of suspicion has to be made for coinfection in a patient presenting with febrile illness with thrombocytopenia and deranged laboratory parameters in postmonsoon season in endemic regions in Asia.