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Alshalah A, Williams DJ, Ferrario A. From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region. PLoS Negl Trop Dis 2024; 18:e0012200. [PMID: 39083539 PMCID: PMC11335162 DOI: 10.1371/journal.pntd.0012200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 08/20/2024] [Accepted: 05/07/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. METHODOLOGY/PRINCIPAL FINDINGS The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. CONCLUSION/SIGNIFICANCE Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.
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Affiliation(s)
- Ali Alshalah
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - David J. Williams
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Alessandra Ferrario
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
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2
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Jenkins TP, Ahmadi S, Bittenbinder MA, Stewart TK, Akgun DE, Hale M, Nasrabadi NN, Wolff DS, Vonk FJ, Kool J, Laustsen AH. Terrestrial venomous animals, the envenomings they cause, and treatment perspectives in the Middle East and North Africa. PLoS Negl Trop Dis 2021; 15:e0009880. [PMID: 34855751 PMCID: PMC8638997 DOI: 10.1371/journal.pntd.0009880] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel-binding toxins and potassium channel-binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.
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Affiliation(s)
- Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Matyas A. Bittenbinder
- Naturalis Biodiversity Center, Leiden, the Netherlands
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), Amsterdam, the Netherlands
| | - Trenton K. Stewart
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Dilber E. Akgun
- Department of Biomedical Engineering, Faculty of Engineering and Architecture, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Melissa Hale
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nafiseh N. Nasrabadi
- Pharmaceutical Sciences Research Centre, Student Research Commitee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Venomous Animals and Antivenom Production, Razi Vaccine, and Serum Research Institute, Karaj, Iran
| | - Darian S. Wolff
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Freek J. Vonk
- Naturalis Biodiversity Center, Leiden, the Netherlands
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Kool
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), Amsterdam, the Netherlands
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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3
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Abdeldayem A, Alanazi AA, Aljabri JN, Abid I. Challenges in the Management of an Echis coloratus Adult Snakebite Victim at a Tertiary Care Hospital: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931532. [PMID: 34103465 PMCID: PMC8197442 DOI: 10.12659/ajcr.931532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 18-year-old Final Diagnosis: Snakebite envenomation Symptoms: Coagulopathy Medication:— Clinical Procedure: Anti snake venom Specialty: General and Internal Medicine • Toxicology • Tropical Medicine
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Affiliation(s)
- Ahmed Abdeldayem
- In-Charge Drug and Poison Information Center, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alhanouf Ayed Alanazi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Internal Medicine Department, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia
| | - Jawaher N Aljabri
- Internal Medicine Department, National guard health Affairs, Al Madinah Al Monawara, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ijaz Abid
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Internal Medicine Department, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia
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4
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Al-Sadoon MK, Fahad Albeshr M, Ahamad Paray B, Rahman Al-Mfarij A. Envenomation and the bite rate by venomous snakes in the kingdom of Saudi Arabia over the period (2015-2018). Saudi J Biol Sci 2021; 28:582-586. [PMID: 33424343 PMCID: PMC7783841 DOI: 10.1016/j.sjbs.2020.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/02/2022] Open
Abstract
Snakebite being medical emergency and known cause for increased mortality needs assessment and treatment on high-priority bases, even in patients of snakebite who appear fine initially. The current retrospective study presents the snake bites in Saudi Arabia from 2015 to 2018 reported by General Administration of Statistics and Information, Ministry of Health, Kingdom of Saudi Arabia. The data presented in the current study, was extracted, analyzed, and reported after getting ethical approval from institutional committee. Totally, 14,679 cases of snakebites were reported during the four-year study period, with a higher prevalence in males (80%) in their productive age. Most patients were within the age group between 25 and 44 followed by 44 to 64 years. The majority of snakebite affected inhabitants were reported from farms of the rural areas, commonly during night hours of spring and summer seasons when snakes are very active. Only 36 (0.24%) patients out of 14,679 were reported dead and 14,643 (99.63%) were discharged after the treatment. Awareness among the general public should be encouraged and early diagnosis and usage of proper snake antivenoms could be life-saving. The delay in appropriate treatment can lead to significant morbidity and mortality.
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Affiliation(s)
- Mohammed K. Al-Sadoon
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Mohammed Fahad Albeshr
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Bilal Ahamad Paray
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdul Rahman Al-Mfarij
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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A New Group II Phospholipase A2 from Walterinnesia aegyptia Venom with Antimicrobial, Antifungal, and Cytotoxic Potential. Processes (Basel) 2020. [DOI: 10.3390/pr8121560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Many venomous species, especially snakes, contain a variety of secreted phospholipases A2 that contribute to venom toxicity and prey digestion. We characterized a novel highly toxic phospholipase A2 of group II, WaPLA2-II, from the snake venom of Saudi Walterinnesia aegyptia (W. aegyptia). The enzyme was purified using a reverse phase C18 column. It is a monomeric protein with a molecular weight of approximately 14 kDa and an NH2-terminal amino acid sequence exhibiting similarity to the PLA2 group II enzymes. WaPLA2-II, which contains 2.5% (w/w) glycosylation, reached a maximal specific activity of 1250 U/mg at pH 9.5 and 55 °C in the presence of Ca2+ and bile salts. WaPLA2-II was also highly stable over a large pH and temperature range. A strong correlation between antimicrobial and indirect hemolytic activities of WaPLA2 was observed. Additionally, WaPLA2-II was found to be significantly cytotoxic only on cancerous cells. However, chemical modification with para-Bromophenacyl bromide (p-BPB) inhibited WaPLA2-II enzymatic activity without affecting its antitumor effect, suggesting the presence of a separate ‘pharmacological site’ in snake venom phospholipase A2 via its receptor binding affinity. This enzyme is a candidate for applications including the treatment of phospholipid-rich industrial effluents and for the food production industry. Furthermore, it may represent a new therapeutic lead molecule for treating cancer and microbial infections.
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ALfaifi MS, ALOtaibi AE, AlQahtani SA, ALShahrani OA, ALSharani KM, ALbshabshi AO, ALZahrani HM, ALAli HE. Cobra snakebite mimicking brain death treated with a novel combination of polyvalent snake antivenom and anticholinesterase. Am J Emerg Med 2020; 38:2490.e5-2490.e7. [PMID: 32712238 DOI: 10.1016/j.ajem.2020.05.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/31/2020] [Accepted: 05/30/2020] [Indexed: 11/29/2022] Open
Abstract
In toxicology literature, snake bites were the second toxicology-relevant cause mimicking brain death. A 57-year-old woman with history of cobra snake bite. On examination, the brain stem reflexes were absent with Glasgow coma score of 3. The patient accomplished full neurological recovery after using a novel combination of Polyvalent Snake Antivenom (PSA) and anticholinesterases. This case highlights a unique presentation of cobra bite induced brain death mimicking. Thus, intensivist should exclude neuroparalytic effect of snakebite before considering withdrawal of ventilatory support or organ donation. Also, the life-threatening presentation of cobra envenomation mandates the use of higher doses of PSA to reverse the neuroparalytic toxicity. We should consider the rule of anticholinesterase as an adjunctive therapy to PSA in severe cobra envenomation.
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Affiliation(s)
- Musa S ALfaifi
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia.
| | - Atheer E ALOtaibi
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Saeed A AlQahtani
- Emergency Medicine Department and Clinical Toxicology Division, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ohood A ALShahrani
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Khalid M ALSharani
- Department of Emergency Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ali O ALbshabshi
- Department of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Hadi E ALAli
- Department of Emergency Medicine, Armed forces hospital southern region, Khamis Mushait, Saudi Arabia
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Khan A, Al-Kathiri WH, Balkhi B, Samrkandi O, Al-Khalifa MS, Asiri Y. The burden of bites and stings management: Experience of an academic hospital in the Kingdom of Saudi Arabia. Saudi Pharm J 2020; 28:1049-1054. [PMID: 32792849 PMCID: PMC7414059 DOI: 10.1016/j.jsps.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/03/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose The main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia. Methods A retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019. Results A total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR. Conclusion Bites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits.
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Affiliation(s)
- Anas Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waad H Al-Kathiri
- Department of Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomic Research Unit, King Saud University, Riyadh, Saudi Arabia
| | - Osama Samrkandi
- Department, Prince Sultan bin Abdulaziz College for EMS, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | - Yousef Asiri
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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8
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Amr ZS, Abu Baker MA, Warrell DA. Terrestrial venomous snakes and snakebites in the Arab countries of the Middle East. Toxicon 2020; 177:1-15. [DOI: 10.1016/j.toxicon.2020.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
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9
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Carné A, Fathinia B, Rastegar-Pouyani E. Molecular phylogeny of the Arabian Horned Viper, Cerastes gasperettii (Serpentes: Viperidae) in the Middle East. ZOOLOGY IN THE MIDDLE EAST 2020. [DOI: 10.1080/09397140.2020.1711622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Behzad Fathinia
- Department of Biology, Faculty of Science, Yasouj University, Yasouj, Iran
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