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Shumway D, Pho K, Andrews N, Greene S. Transient Hematotoxicity After Emerald Horned Pitviper (Ophryacus smaragdinus) Envenomation: A Case Report. J Emerg Med 2024; 66:e601-e605. [PMID: 38702243 DOI: 10.1016/j.jemermed.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/11/2023] [Accepted: 01/06/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND A minority of snake envenomations in the United States involve non-native snakes. In this report, we describe what we believe is the first documented human envenoming from an emerald horned pitviper, Ophryacus smaragdinus. CASE REPORT A previously healthy 36-year-old woman was bitten on her left index finger by a captive emerald horned pitviper she was medicating at work. Swelling to the entire hand was present on emergency department arrival. She had no systemic symptoms and her initial laboratory studies were unremarkable. The affected limb was elevated. We administered five vials of Antivipmyn TRIⓇ (Bioclon), which specifically lists Ophryacus among the envenomations for which it is indicated. She developed pruritus and was treated with IV diphenhydramine and famotidine. Her swelling improved, but her repeat laboratory studies were notable for a platelet count of 102 K/µL and a fibrinogen level of 116 mg/dL. She declined additional antivenom because of the previous allergic reaction. She was admitted for further monitoring and pain control. Subsequent laboratory tests were better, but a small hemorrhagic bleb developed at the bite site. She was discharged the next day and followed up as an outpatient. Her swelling had resolved, her bleb had healed, and her laboratory studies continued to improve. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians may be required to treat bites from non-native snakes. Many of these bites will warrant treatment with non-U.S. Food and Drug Administration-approved antivenoms. Consultation with a regional poison center or medical toxicologist may be necessary to procure the proper antivenom.
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Affiliation(s)
- Devin Shumway
- Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas
| | - Karen Pho
- Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas
| | - Nichole Andrews
- Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas
| | - Spencer Greene
- Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas
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Mohanty CR, Radhakrishnan RV, Shaji IM, Singh N, Das S. Ultrasound-guided selective peripheral nerve block for the snakebite pain management in the emergency department: Our experience. Turk J Emerg Med 2024; 24:122-125. [PMID: 38766415 PMCID: PMC11100579 DOI: 10.4103/2452-2473.366855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/03/2023] Open
Abstract
Envenomation from snakebites (SBs) is a significant public health hazard globally. The venomous SB is associated with moderate-to-severe pain. Weak opioids such as tramadol or acetaminophen are commonly used for pain management but often provide inadequate analgesia. We hereby report our experience of using ultrasound-guided selective superficial peroneal, sural, and saphenous nerve blocks for pain management following SBs in nine patients. The selective peripheral nerve blocks are achieved with a small amount of local anesthesia and without loss of motor functions.
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Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Subhasree Das
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Cherif MS, Keita M, Dahal P, Guilavogui T, Beavogui AH, Diassy L, Conde M, Touré A, Delamou A. Neglected tropical diseases in Republic of Guinea: disease endemicity, case burden and the road towards the 2030 target. Int Health 2023; 15:490-504. [PMID: 37232124 PMCID: PMC10472893 DOI: 10.1093/inthealth/ihad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/02/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
Neglected tropical diseases (NTDs) predominantly affect vulnerable and marginalized populations in tropical and subtropical areas and globally affect more than one billion people. In Guinea, the burden of NTDs is estimated to be >7.5 disability-adjusted life years per million inhabitants. Currently the Guinea NTDs master plan (2017-2020) has identified eight diseases as public health problems: onchocerciasis, lymphatic filariasis, trachoma, schistosomiasis and soil-transmitted helminthiasis, leprosy, human African trypanosomiasis and Buruli ulcer. In this review we discuss the past and the current case burden of the priority NTDs in Guinea, highlight the major milestones and discuss current and future areas of focus for achieving the 2030 target outlined by the World Health Organization.
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Affiliation(s)
- Mahamoud Sama Cherif
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Direction Regionale de la Santé de Faranah, Ministère de la santé et de l'hygiène publique, Faranah, Guinea
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Mory Keita
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Timothé Guilavogui
- Management and Programmes Coordination, Ministry of Health, Conakry, Guinea
| | - Abdoul Habib Beavogui
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
| | - Lamine Diassy
- World Health Organization, Guinea office, Landreah, Corniche Nord, Boîte postale 817, Conakry, Guinea
| | - Mohamed Conde
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Abdoulaye Touré
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Institut National de Santé Publique, Ministère de la Santé et de l'Hygiène Publique, Conakry, Guinea
| | - Alexandre Delamou
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
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Abstract
Context: Heloderma bites are rare and generally mild, but a few cases can be life threatening. Methods: Description of Heloderma bite was searched in medical literature. Discussion: We present a synthesis of clinical and biomedical effects of envenomation by Heloderma sp. based on 22 well identified cases described in medical literature. Three life-threatening syndromes, concomitant or not, may be involved: (a) angioedema which can lead to respiratory tract obstruction, (b) significant fluid losses due to diarrhea, vomiting and sweating, associated with hypokalemia and sometimes metabolic acidosis, and (c) atrioventricular conduction disorders simulating cardiac ischemia. Conclusion: Heloderma bite are quite rare and generally mild. However, few severe cases may require emergency resuscitation. There is no antivenom, and the treatment is only symptomatic and supportive.
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Affiliation(s)
- Jean-Philippe Chippaux
- CRT, Institut Pasteur, Paris, France.,MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Karim Amri
- Snakebite institute of Latin America, Belize, USA
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