Clinical Characteristics and Outcomes of Asian Coral Snake Bites in Thailand: A Retrospective Cohort Study

Abstract

Asian coral snakes are distributed throughout Southeast Asia, including Thailand, but clinical data on their envenomation remain limited. Using a 10-year retrospective dataset from the Ramathibodi Poison Center, we investigated the epidemiology, clinical characteristics, management, and outcomes of Asian coral snake envenomation in Thailand. Patient demographics, clinical and laboratory data, treatments, and outcomes were analyzed descriptively. Fifty-two patients were included. Sinomicrurus macclellandi was the most frequently reported species. Most bites occurred during the rainy season and involved the lower extremities. Clinical manifestations were predominantly mild and localized. No cases of systemic neurotoxicity, bulbar weakness, respiratory compromise, or death were observed. Laboratory results were generally within normal limits. Two patients developed anaphylaxis, which resolved with standard emergency treatment, while two experienced severe pain. Calliophis intestinalis lineata was associated with a higher proportion of tachycardia at presentation and longer hospitalization. No patients required mechanical ventilation or antivenom therapy. Supportive care and short-term hospital observation are generally sufficient in confirmed cases. The median duration of hospitalization was 1–3 day. Local manifestations were the predominant clinical findings following Asian coral snake envenomation in Thailand, and systemic neurotoxicity was not observed. These findings differ from reports of Micrurus envenomation, which primarily involve New World coral snakes, whereas the species implicated in Thailand belong to Old World genera.