51
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Presynaptic action of Bothriopsis bilineata smargadina (forest viper) venom in vitro. Toxicon 2011; 58:140-5. [DOI: 10.1016/j.toxicon.2011.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 11/18/2022]
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52
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Calvete JJ, Sanz L, Pérez A, Borges A, Vargas AM, Lomonte B, Angulo Y, Gutiérrez JM, Chalkidis HM, Mourão RH, Furtado MFD, Moura-Da-Silva AM. Snake population venomics and antivenomics of Bothrops atrox: Paedomorphism along its transamazonian dispersal and implications of geographic venom variability on snakebite management. J Proteomics 2011; 74:510-27. [DOI: 10.1016/j.jprot.2011.01.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 12/28/2010] [Accepted: 01/10/2011] [Indexed: 11/25/2022]
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53
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Rodrigues Sgrignolli L, Florido Mendes GE, Carlos CP, Burdmann EA. Acute Kidney Injury Caused by Bothrops Snake Venom. ACTA ACUST UNITED AC 2011; 119:c131-6; discussion c137. [DOI: 10.1159/000324228] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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54
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Segura A, Castillo M, Núñez V, Yarlequé A, Gonçalves L, Villalta M, Bonilla C, Herrera M, Vargas M, Fernández M, Yano M, Araújo H, Boller M, León P, Tintaya B, Sano-Martins I, Gómez A, Fernández G, Geoghegan P, Higashi H, León G, Gutiérrez J. Preclinical assessment of the neutralizing capacity of antivenoms produced in six Latin American countries against medically-relevant Bothrops snake venoms. Toxicon 2010; 56:980-9. [DOI: 10.1016/j.toxicon.2010.07.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
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55
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Gefen T, Pitcovski J, Vaya J, Khatib S, Krispel S, Heller ED, Gaberman E, Gorodetsky R, Aizenshtein E. Coated cross-species antibodies by mannosamine-biotin adduct confer protection against snake venom without eliciting humoral immune response. Vaccine 2010; 28:8197-202. [PMID: 20875497 DOI: 10.1016/j.vaccine.2010.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/10/2010] [Indexed: 10/19/2022]
Abstract
Passive immunization with cross-species antibodies triggers the patient's immune response, thereby preventing repeated treatment. Mannosamine-biotin adduct (MBA) has been described as a masking agent for immunogenic reduction and here, the immunogenicity and biological activity of MBA-coated horse anti-viper venom (hsIgG) were compared to those of uncoated or PEGylated hsIgG. In in vitro tests, hsIgG binding was not affected by MBA conjugation. The immune response to hsIgG-MBA was about 8-fold and 32-fold lower than to PEG-coated and uncoated hsIgG, respectively. In vivo, hsIgG-MBA showed efficient venom-neutralization activity. We thus demonstrate the feasibility of using MBA as a masking agent for passive immunization with cross-species antibodies.
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Affiliation(s)
- Tal Gefen
- MIGAL - Galilee Technology Center, P.O. Box 831, Kiryat Shmona 11016, Israel
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56
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González-Andrade F, Chippaux JP. Snake bite envenomation in Ecuador. Trans R Soc Trop Med Hyg 2010; 104:588-91. [DOI: 10.1016/j.trstmh.2010.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 05/18/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022] Open
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Abubakar IS, Abubakar SB, Habib AG, Nasidi A, Durfa N, Yusuf PO, Larnyang S, Garnvwa J, Sokomba E, Salako L, Theakston RDG, Juszczak E, Alder N, Warrell DA. Randomised controlled double-blind non-inferiority trial of two antivenoms for saw-scaled or carpet viper (Echis ocellatus) envenoming in Nigeria. PLoS Negl Trop Dis 2010; 4:e767. [PMID: 20668549 PMCID: PMC2910709 DOI: 10.1371/journal.pntd.0000767] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/16/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In West Africa, envenoming by saw-scaled or carpet vipers (Echis ocellatus) causes great morbidity and mortality, but there is a crisis in supply of effective and affordable antivenom (ISRCTN01257358). METHODS In a randomised, double-blind, controlled, non-inferiority trial, "EchiTAb Plus-ICP" (ET-Plus) equine antivenom made by Instituto Clodomiro Picado was compared to "EchiTAb G" (ET-G) ovine antivenom made by MicroPharm, which is the standard of care in Nigeria and was developed from the original EchiTAb-Fab introduced in 1998. Both are caprylic acid purified whole IgG antivenoms. ET-G is monospecific for Echis ocellatus antivenom (initial dose 1 vial) and ET-Plus is polyspecific for E. ocellatus, Naja nigricollis and Bitis arietans (initial dose 3 vials). Both had been screened by pre-clinical and preliminary clinical dose-finding and safety studies. Patients who presented with incoagulable blood, indicative of systemic envenoming by E. ocellatus, were recruited in Kaltungo, north-eastern Nigeria. Those eligible and consenting were randomly allocated with equal probability to receive ET-Plus or ET-G. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by a simple whole blood clotting test repeated 6, 12, 18, 24 and 48 hr after treatment. Secondary (safety) outcomes were the incidences of anaphylactic, pyrogenic and late serum sickness-type antivenom reactions. FINDINGS Initial doses permanently restored blood coagulability at 6 hours in 161/194 (83.0%) of ET-Plus and 156/206 (75.7%) of ET-G treated patients (Relative Risk [RR] 1.10 one-sided 95% CI lower limit 1.01; P = 0.05). ET-Plus caused early reactions on more occasions than did ET-G [50/194 (25.8%) and 39/206 (18.9%) respectively RR (1.36 one-sided 95% CI 1.86 upper limit; P = 0.06). These reactions were classified as severe in 21 (10.8%) and 11 (5.3%) of patients, respectively. CONCLUSION At these doses, ET-Plus was slightly more effective but ET-G was slightly safer. Both are recommended for treating E. ocellatus envenoming in Nigeria. TRIAL REGISTRATION Current Controlled Trials ISRCTN01257358.
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Affiliation(s)
- Isa S. Abubakar
- Department of Community Medicine, Bayero University of Kano, Kano, Nigeria
| | | | | | | | - Nandul Durfa
- Special Projects Unit, Federal Ministry of Health, Abuja, Nigeria
| | - Peter O. Yusuf
- Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - John Garnvwa
- Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elijah Sokomba
- Department of Pharmacology, University of Jos, Jos, Nigeria
| | - Lateef Salako
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - R. David G Theakston
- Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ed Juszczak
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicola Alder
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - David A. Warrell
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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58
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Methodology of clinical studies dealing with the treatment of envenomation. Toxicon 2010; 55:1195-212. [DOI: 10.1016/j.toxicon.2010.02.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 02/05/2010] [Accepted: 02/18/2010] [Indexed: 01/22/2023]
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59
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Abstract
Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Its public health importance has been largely ignored by medical science. Snake venoms are rich in protein and peptide toxins that have specificity for a wide range of tissue receptors, making them clinically challenging and scientifically fascinating, especially for drug design. Although the full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. Preventive efforts should be aimed towards education of affected communities to use proper footwear and to reduce the risk of contact with snakes to a minimum through understanding of snakes' behaviour. To treat envenoming, the production and clinical use of antivenom must be improved. Increased collaboration between clinicians, epidemiologists, and laboratory toxinologists should enhance the understanding and treatment of envenoming.
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Affiliation(s)
- David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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60
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Neutralization of Bothrops asper venom by antibodies, natural products and synthetic drugs: Contributions to understanding snakebite envenomings and their treatment. Toxicon 2009; 54:1012-28. [DOI: 10.1016/j.toxicon.2009.03.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/10/2009] [Accepted: 03/17/2009] [Indexed: 11/24/2022]
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61
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Gutiérrez JM, Williams D, Fan HW, Warrell DA. Snakebite envenoming from a global perspective: Towards an integrated approach. Toxicon 2009; 56:1223-35. [PMID: 19951718 DOI: 10.1016/j.toxicon.2009.11.020] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/11/2009] [Accepted: 11/24/2009] [Indexed: 11/29/2022]
Abstract
Snakebite envenoming is a neglected public health challenge of compelling importance in many regions of the world, particularly sub-Saharan Africa, Asia, Latin America and Papua-New Guinea. Addressing the problem of snakebite effectively demands an integrated multifocal approach, targeting complex problems and involving many participants. It must comprise: (a) Acquisition of reliable information on the incidence and mortality attributable to snakebite envenoming, and the number of people left with permanent sequelae. (b) Improvements in production of effective and safe antivenoms, through strategies aimed at strengthening the technological capacity of antivenom manufacturing laboratories. (c) Increasing the capacity of low-income countries to produce specific immunogens(snake venoms) locally, and to perform their own quality control of antivenoms. (d) Commitments from regional producers to manufacture antivenoms for countries where antivenom production is not currently feasible. (e) Implementation of financial initiatives guaranteeing the acquisition of adequate volumes of antivenom at affordable prices in low-income countries. (f) Performance of collaborative studies on the safety and effectiveness of antivenoms assessed preclinically and by properly designed clinical trials. (g) Development of antivenom distribution programmes tailored to the real needs and epidemiological situations of rural areas in each country. (h) Permanent training programmes for health staff, particularly in rural areas where snakebites are frequent.(i) Implementation of programmes to support those people whose snakebites resulted in chronic disabilities. (j) Preventive and educational programmes at the community level, with the active involvement of local organizations and employing modern methods of health promotion. Such an integrated approach, currently being fostered by the Global Snake Bite Initiative of the International Society on Toxinology and by the World Health Organization, will help to alleviate the enormous burden of human suffering inflicted by snakebite envenoming.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, 1000 San José, Costa Rica.
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62
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Torrez PQ, Duarte MR, França FOS, Figueiredo L, Abati P, Campos LR, Pardal PPDO, Quiroga M, Mascheretti M, Boulos M. First report of an accident with the speckled forest pit viper (Bothriopsis taeniata) in Brazil. Rev Soc Bras Med Trop 2009; 42:342-4. [PMID: 19684987 DOI: 10.1590/s0037-86822009000300020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 04/29/2009] [Indexed: 11/22/2022] Open
Abstract
The first reported case of an accident with Bothriopsis taeniata in Brazil is described. The victim, a 43-year-old man, was bitten just above his right heel and presented a clinical condition compatible with mild Bothrops poisoning: local edema with hemorrhage at the bite site and pain, although without coagulopathy.
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63
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Apparent marked reduction in early antivenom reactions compared to historical controls: Was it prophylaxis or method of administration? Toxicon 2009; 54:779-83. [DOI: 10.1016/j.toxicon.2009.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/31/2009] [Accepted: 06/02/2009] [Indexed: 11/20/2022]
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64
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Núñez V, Cid P, Sanz L, De La Torre P, Angulo Y, Lomonte B, Gutiérrez JM, Calvete JJ. Snake venomics and antivenomics of Bothrops atrox venoms from Colombia and the Amazon regions of Brazil, Perú and Ecuador suggest the occurrence of geographic variation of venom phenotype by a trend towards paedomorphism. J Proteomics 2009; 73:57-78. [DOI: 10.1016/j.jprot.2009.07.013] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 01/28/2023]
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65
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Isbister GK. Antivenom efficacy or effectiveness: the Australian experience. Toxicology 2009; 268:148-54. [PMID: 19782716 DOI: 10.1016/j.tox.2009.09.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/19/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
Abstract
Despite widespread use of antivenoms, many questions remain about their effectiveness in the clinical setting. The almost universal acceptance of their value is based mainly on in vitro studies, animal studies and human observational studies. Numerous examples exist where they demonstrate clear benefit, such as consumption coagulopathy in viper envenoming, prevention of neurotoxicity in Australasian elapid bites, systemic effects in scorpion and funnel-web spider envenoming. There are also concerns about the quality and efficacy of some antivenoms. However, it is important not to confuse the efficacy of antivenom, defined as its ability to bind and neutralise venom-mediated effects under ideal conditions, and the effectiveness of antivenom, defined as its ability to reverse or prevent envenoming in human cases. There are numerous potential reasons for antivenom failure in human envenoming, of which antivenom inefficacy is only one. Other important reasons include venom-mediated effects being irreversible, antivenom being unable to reach the site of toxin-mediated injury, or the rapidity of onset of venom-mediated effects. A number of recent studies in Australia bring into question the effectiveness of some antivenoms, including snake antivenom for coagulopathy, redback spider and box jellyfish antivenoms. Despite brown snake antivenom being able to neutralise venom induced clotting in vitro, use of the antivenom in human envenoming does not appear to change the time course of coagulopathy. However, it is important that apparent antivenom ineffectiveness in specific cases is correctly interpreted and does not lead to a universal belief that antivenom is ineffective. It should rather encourage further studies to investigate the underlying pathophysiology of envenoming, the pharmacokinetics of venoms and antivenoms, and ultimately the effectiveness of antivenom based on snake type, clinical effects and timing of administration.
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Affiliation(s)
- Geoffrey K Isbister
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
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66
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Otero-Patiño R. Epidemiological, clinical and therapeutic aspects of Bothrops asper bites. Toxicon 2009; 54:998-1011. [PMID: 19591857 DOI: 10.1016/j.toxicon.2009.07.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/29/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
Bothrops asper inflicts the majority of snakebites in Central America and in the northern regions of South America, mostly affecting young agricultural workers in rural settings. This species is capable of provoking severe envenomings associated with local and systemic manifestations. The main clinical features are: local edema, ecchymoses, blisters, dermonecrosis, myonecrosis, defibrinogenation, thrombocytopenia, systemic bleeding, hypotension and renal alterations. In addition, soft-tissue infection, acute renal failure, compartmental syndrome, central nervous system hemorrhage and, in pregnant women, abortion, fetal wastage and abruptio placentae have been described as complications. Intravenous administration of antivenom constitutes the mainstay in the therapy. Antivenoms composed of either whole IgG or F(ab')(2) fragments, manufactured in Brazil, Colombia, Costa Rica and Mexico, have been tested in controlled clinical trials, and rational protocols for antivenom administration have been developed. In addition to antivenom therapy, a number of ancillary interventions are recommended in the treatment of B. asper bites.
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67
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Stability of equine IgG antivenoms obtained by caprylic acid precipitation: Towards a liquid formulation stable at tropical room temperature. Toxicon 2009; 53:609-15. [DOI: 10.1016/j.toxicon.2009.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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68
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Chotenimitkhun R, Rojnuckarin P. Systemic antivenom and skin necrosis after green pit viper bites. Clin Toxicol (Phila) 2009; 46:122-5. [DOI: 10.1080/15563650701266826] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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69
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Manock SR, Suarez G, Graham D, Avila-Aguero ML, Warrell DA. Neurotoxic envenoming by South American coral snake (Micrurus lemniscatus helleri): case report from eastern Ecuador and review. Trans R Soc Trop Med Hyg 2008; 102:1127-32. [DOI: 10.1016/j.trstmh.2008.03.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 11/30/2022] Open
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70
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Zychar BC, Castro NC, Marcelino JR, Gonçalves LRC. Phenol used as a preservative in Bothrops antivenom induces impairment in leukocyte–endothelial interactions. Toxicon 2008; 51:1151-7. [DOI: 10.1016/j.toxicon.2008.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/19/2007] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
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71
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Bucaretchi F, Hyslop S, Mello SM, Vieira RJ. Bothrops snakebite on the head: case report and review of the literature. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2008; 101:733-43. [PMID: 18028735 DOI: 10.1179/136485907x241370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A previously healthy, 21-year-old female was admitted 5 h after being bitten in the occipital region by a pitviper presumed to be Bothrops jararaca. Physical examination revealed marked cranial and facial oedema extending to the neck and dorsum, bilateral eyelid ecchymosis, and local conjunctival and gingival bleeding. The patient was alert and complained of mild, local pain and nausea. There were no signs of neurological involvement. The main laboratory findings on admission included incoagulable blood, a platelet count of 4000/microl, and an ELISA-estimated serum venom concentration of 62.6 ng/ml. Sequential serum creatinine, urea nitrogen, sodium and potassium concentrations were normal. The case was classified as severe and, after the intravenous administration of ranitidine, chlorpheniramine and hydrocortisone, the intravenous infusion of 12 vials of undiluted bothropic equine antivenom [F(ab)(2); 10 ml/vial] was initiated. The antivenom infusion was halted after 10 vials because the patient developed a severe early reaction, although this was successfully treated with subcutaneous adrenaline and intravenous hydrocortisone. Platelet replacement (seven units) was performed and 24 h after the antivenom infusion, normal results in blood-coagulation tests and an increase in the platelet count (to 100,000/microl) were observed. No circulating venom was detected in blood samples collected 6, 12, 24 or 48 h post-admission. The patient was discharged after 4 days, with clinical improvement and no signs of local infection, and subsequent follow-up revealed no sequelae.
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Affiliation(s)
- F Bucaretchi
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), CP 6111, 13083-970, Campinas, SP, Brazil.
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72
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73
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Antivenom Therapy for Crotaline Snakebites: Has the Poison Control Center Provided Effective Guidelines? J Formos Med Assoc 2007; 106:1057-62. [DOI: 10.1016/s0929-6646(08)60084-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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74
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Benítez JA, Rifakis PM, Vargas JA, Cabaniel G, Rodríguez-Morales AJ. Trends in Fatal Snakebites in Venezuela, 1995–2002☆. Wilderness Environ Med 2007; 18:209-13. [PMID: 17896844 DOI: 10.1580/06-weme-br-076r.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There have been few studies evaluating snakebite mortality in Venezuela and South America. In this study we evaluate trends in fatal snakebites occurring in Venezuela between 1995 and 2002. METHODS Epidemiological data for this study were retrieved from the records of the Ministry of Health of Venezuela. Using these data, we analyzed the impact of snakebites in Venezuela during the study period. RESULTS During the study period, there were 266 reports of death due to snakebite; 79.7% were males, and 20.3% were females (P < .01). Annual mean deaths numbered 33 per year. Of total deaths, 24.1% occurred in victims 55-70 years old. Deaths in young children (<5 years old) accounted for 7.1% of the total. Mortality rate by age showed an age-dependent rate, with higher rates in older ages (P = .038). CONCLUSION Snake envenomations are an important cause of injury and deaths in Venezuela as in many American countries. Surveillance of envenomations is essential for establishing guidelines, planning therapeutic supplies, and training medical staff on snakebite treatment, as well as assessing risk zones for travelers.
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Affiliation(s)
- Jesús A Benítez
- Direction of Environmental Health, Ministry of Health, Maracay, Venezuela
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75
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Williams DJ, Jensen SD, Nimorakiotakis B, Müller R, Winkel KD. Antivenom use, premedication and early adverse reactions in the management of snake bites in rural Papua New Guinea. Toxicon 2007; 49:780-92. [PMID: 17210167 DOI: 10.1016/j.toxicon.2006.11.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine antivenom use, premedication, early adverse reactions and patient outcomes after snake bite in rural Papua New Guinea. DESIGN Retrospective chart analysis of all admissions for snake bite with documented antivenom use at 11 rural health facilities from January 1994 to June 2004. No formal protocol was followed and there was no attempt at randomisation or blinding of prophylaxis. RESULTS Antivenom use was documented in 136/1881 (7.2%) snake bite admissions and most (121/136: 88.9%) received a single vial. CSL Polyvalent antivenom was administered to 112/136 (82.4%). One hundred and eleven patients (81.6%) happened to have been given premedication with adrenaline and/or promethazine and/or hydrocortisone. Early adverse reactions were reported in 25 patients (18.4%) including 23 treated with polyvalent antivenom. Intravenous test doses of antivenom were given to 32 patients, none of whom had a positive test result. Subsequent adverse reactions occurred in 9 of these 32 (28.1%) patients. One death may have been attributable to anaphylaxis after polyvalent antivenom. Reaction rates were significantly (p < or = 0.005) lower in adrenaline premedicated patients (7.7%) compared to patients premedicated without adrenaline (28.3%) and unpremedicated patients (28.0%). Adrenaline premedication caused no detectable changes in vital signs. The case fatality rate was 9.6% (13/136 patients). CONCLUSIONS Polyvalent antivenom is the main treatment for envenomation in rural health centres, and early adverse reactions are common. Adrenaline premedication appears to significantly reduce acute adverse reaction rates. Premedication with promethazine and/or hydrocortisone without adrenaline did not reduce early adverse reactions.
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Affiliation(s)
- David J Williams
- School of Public Health and Tropical Medicine, James Cook University, Townsville, Qld, Australia.
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76
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Otero R, León G, Gutiérrez JM, Rojas G, Toro MF, Barona J, Rodríguez V, Díaz A, Núñez V, Quintana JC, Ayala S, Mosquera D, Conrado LL, Fernández D, Arroyo Y, Paniagua CA, López M, Ospina CE, Alzate C, Fernández J, Meza JJ, Silva JF, Ramírez P, Fabra PE, Ramírez E, Córdoba E, Arrieta AB, Warrell DA, Theakston RDG. Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without beta-propiolactone, in the treatment of Bothrops asper bites in Colombia. Trans R Soc Trop Med Hyg 2006; 100:1173-82. [PMID: 16698053 DOI: 10.1016/j.trstmh.2006.01.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/26/2005] [Accepted: 01/04/2006] [Indexed: 11/22/2022] Open
Abstract
The efficacy and safety of two whole IgG polyvalent antivenoms (A and B) were compared in a randomised, blinded clinical trial in 67 patients systemically envenomed by Bothrops asper in Colombia. Both antivenoms were fractionated by caprylic acid precipitation and had similar neutralising potencies, protein concentrations and aggregate contents. Antivenom B was additionally treated with beta-propiolactone to lower its anticomplementary activity. Analysing all treatment regimens together, there were no significant differences between the two antivenoms (A=34 patients; B=33 patients) in the time taken to reverse venom-induced bleeding and coagulopathy, to restore physiological fibrinogen concentrations and to clear serum venom antigenaemia. Blood coagulability was restored within 6-24 h in 97% of patients, all of whom had normal coagulation and plasma fibrinogen levels 48 h after the start of antivenom treatment. Two patients (3.0%) had recurrent coagulopathy and eight patients suffered recurrence of antigenaemia within 72 h of treatment. None of the dosage regimens of either antivenom used guaranteed resolution of venom-induced coagulopathy within 6 h, nor did they prevent recurrences. A further dose of antivenom at 6 h also did not guarantee resolution of coagulopathy within 12-24 h in all patients. The incidence of early adverse reactions (all mild) was similar for both antivenoms (15% and 24%; P>0.05).
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Affiliation(s)
- Rafael Otero
- Programa de Ofidismo/Escorpionismo, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, Morgan M. Clinical predictors of in-hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Trop Med Int Health 2006; 11:22-30. [PMID: 16398752 DOI: 10.1111/j.1365-3156.2005.01535.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the association between selected admission risk factors and in-hospital mortality in patients admitted with venomous snake bite to a rural tertiary care hospital in central India. METHODS Retrospective cohort study of patients aged 12 years or older admitted to a rural hospital in central India between January 2000 and December 2003 with venomous snake bites. The primary endpoint was in-hospital mortality. We used Cox proportional-hazards regression analysis to evaluate the association between risk factors (home-to-hospital distance, bite-to-hospital time, vomiting, neurotoxicity, urine albumin, serum creatinine concentration and whole-blood clotting time) and in-hospital mortality. RESULTS Two hundred and seventy-seven patients [mean age 32 (SD 12) years; 188 men (68%)] were admitted with venomous snake bite, 29 patients (11%) died. The probability of survival at day 7 was 83%. Vomiting [hazard ratio 6.51 (95% CI 1.94-21.77), P < or = 0.002], neurotoxicity [hazard ratio 3.15 (95% CI 1.45-6.83), P = 0.004] and admission serum creatinine concentration [hazard ratio 1.35 (95% CI 1.17-1.56), P < or = 0.001] were associated with higher risk of death in the adjusted analysis. CONCLUSIONS In our rural hospital setting, the overall mortality rate was 11 per 100 cases of snake bite. Vomiting, neurotoxicity and serum creatinine are significant predictors of mortality among inpatients with snake bite. These predictors can help clinicians assess prognosis of their patients more accurately and parsimoniously and also serve as useful signposts for clinical decision-making.
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Affiliation(s)
- Shriprakash Kalantri
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India.
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Affiliation(s)
- David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU. [corrected]
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