Snakebite poisoning causes between 81,000 and 138,000 deaths annually and leaves significant sequelae in another 400,000 people. It is a very common problem in some impoverished areas of the world that, like many others, does not receive the attention it deserves and barely has a place in global health programs.
Gabriel Alcoba, a pediatrician, neglected tropical diseases advisor for Doctors Without Borders (MSF), and snakebite expert, knows this well after years of working in the field in countries like South Sudan.
Not only is there a problem with access to medical care, explains Alcoba, who has too often seen patients arriving at his clinic many hours after being bitten with "tourniquets or incisions made by some healer." There are also difficulties in identifying the snake that caused the bite, which is essential to optimize available resources, apply the most suitable treatment, and avoid unnecessary allergic reactions that can result from the use of antivenoms.
To try to solve this problem, MSF has developed a tool with the University of Geneva (Switzerland) that, thanks to artificial intelligence, can help healthcare professionals identify the snake that bit their patient, determine if it is venomous, and act accordingly.
"Some snakes are very similar, and it can be easy to confuse a toxic one with a non-toxic one," says Alcoba, who until now relied on a photo album where he asked the patient or their companions to try to point out the animal that caused the bite. The volume contains cobras, mambas, vipers, or non-toxic snakes... "It's difficult to identify them. Some can mimic toxic ones, and mistakes are common," says the pediatrician.
Having information about the species is crucial to act, emphasizes the specialist, who believes that this software, whose pilot project is being tested in South Sudan, can help with more accurate identification.
With the help of an artificial intelligence program fed with over 380,000 snake images, the application can guide healthcare professionals in choosing the appropriate antivenom. Additionally, it can also help people who are not near a clinic.
Between January and July 2024, MSF reports having treated over 300 snakebite patients throughout South Sudan, one of the countries with one of the highest rates of snakebite admissions but which "has one of the lowest numbers of snake studies. That's why it was chosen to start the pilot project with the tool," explains Alcoba.
Currently, the project is in the phase of 'feeding' the tool with photographs taken by NGO teams in areas near two municipalities, Twic and Abyei. "For the most important vipers and cobras in the area, we know that we are achieving a very high level of accuracy," notes Alcoba, who emphasizes that "there is a great lack of data." In many regions, the species present in the area are not well known, basic information to know what they are dealing with.
There are clues that can guide healthcare professionals if a patient arrives in time for a consultation after a bite. For example, if the individual presents inflammation and hemorrhages, one must consider a hematotoxic syndrome, the reaction produced by the bite of some vipers. Other species of these snakes cause a lot of inflammation and necrosis, which can lead to amputation of the affected limb. And if muscular paralysis occurs, the signs point to a neurotoxic syndrome, caused by the bite of a mamba or some cobras. However, the initial symptoms are not always clear, and prescribing an antivenom when it is not necessary also carries risks since it is a product made from horse serum that can cause severe allergic reactions, among other side effects.
Furthermore, not knowing the snake's genus can also lead to unnecessary use of a lot of antivenom, a resource that is scarce, explains Alcoba. The price of antivenoms is a significant access barrier in impoverished countries that suffer the most from snakebites.
"Our goal is to have information on where the most dangerous snakes are to be prepared," says Alcoba, who has worked on creating the tool alongside Rafael Ruiz de Castañeda, who co-directs the One Health Unit at the University of Geneva.
Throughout his long career, Alcoba has vivid memories of cases, such as that of a young child who put his hand in a burrow and was bitten by a cobra. "His father went after the animal, tried to hit it with a stick, and the snake bit him. Unfortunately, we were able to save the child, but not the father," he recalls.
"I have seen many terrible cases like that. They happen daily," laments Alcoba, who emphasizes that to this day, this is a neglected tropical disease, associated only with remote areas, "but it is possible that with climate change, the problem will spread to other latitudes, as is happening with other diseases."