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Munshi H, Gavhande M, Bhad G, Mohanty B, Dash JP, Madavi K, Bansode M, Mohapatra A, Mahale SD, Pati S, Sachdeva G, Bawaskar HS, Gajbhiye R. Prevention & management of snakebite envenomation: A qualitative study on perspectives & practices in Maharashtra & Odisha. Indian J Med Res 2024; 159:356-368. [PMID: 39361800 PMCID: PMC11414789 DOI: 10.25259/ijmr_1566_23] [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: 03/14/2024] [Indexed: 10/05/2024] Open
Abstract
Background & objectives Snakebite envenoming (SBE) is a major public health concern, with India bearing the highest global burden of SBE-related deaths. SBE is concentrated in rural and tribal regions of India, where the knowledge, attitude and behaviour of the dwelling communities largely influence mortality and morbidity. Understanding these factors is crucial to designing effective SBE prevention and management strategies. The present study's objective was to document the perspectives of community members and practices in selected blocks of Maharashtra and Odisha States regarding SBE prevention, first aid and health-seeking behaviour. Methods Between March and April 2022, 28 focus group discussions (FGDs) were conducted. Study sites included Shahapur block in Thane district, Aheri block in Gadchiroli district of Maharashtra, and Khordha block in Khordha district, Kasipur block in Rayagada district of Odisha. Separate FGDs were held for males (n=14) and females (n=14), involving about 8-16 participants above 18 yr. All discussions were audio recorded, and a grounded theory approach was employed to identify key themes from the translated transcripts. Results The findings of this study revealed a variety of perspectives and practices determining the SBE burden at the study sites. The findings included insufficient knowledge about snake species and their nature of toxicity, use of non-scientific first aid techniques, inaccessible health care and reliance on traditional healers, non-utilization of prevention methods, varied cultural beliefs and practices, and differential treatments based on gender. The findings have been collated in two simplistic frameworks; barriers to effective prevention and barriers to effective management. Interpretation & conclusions SBE burden results from a complex interplay between socioeconomic, cultural, and demographic factors, necessitating a collaborative inter-sectoral effort for adequate control. Through crucial regional inputs and the barriers to prevention and management models, this study provides critical insights and priority intervention areas to strengthen India's upcoming National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in all high-burden States.
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Affiliation(s)
| | | | | | | | | | - Kanna Madavi
- Sub District Hospital Aheri, Government of Maharashtra, Maharashtra, India
| | - Manohar Bansode
- Sub District Hospital Shahapur, Government of Maharashtra, Maharashtra, India
| | | | | | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Geetanjali Sachdeva
- ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
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2
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Paolino G, Di Nicola MR, Ballouard JM, Bonnet X, Damm M, Le Roux G, Lüddecke T, Marini D, Weinstein SA, Avella I. A review of bites by non-front-fanged snakes (NFFS) of Europe. Toxicon 2024:108116. [PMID: 39368556 DOI: 10.1016/j.toxicon.2024.108116] [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: 09/09/2024] [Revised: 09/26/2024] [Accepted: 10/01/2024] [Indexed: 10/07/2024]
Abstract
Non-front-fanged snakes (NFFS) have long been overlooked by snake venom research, likely due to most of them being considered non-medically relevant for humans. The paucity of information about composition and activities of NFFS venoms and oral secretions makes it difficult to assess whether a given species can inflict medically significant bites. Here, we provide a review of the information currently available about the symptoms/signs elicited by bites from European NFFS, aiming to offer a foundation for understanding the threat they pose in terms of snakebite. Despite an overall limited amount of available data for most of the considered taxa, the genus Malpolon is notable for its capacity to cause local and systemic envenoming, including neurotoxic symptoms. Bites by other genera like, Hemorrhois, Hierophis, Natrix, Platyceps, Telescopus, and Zamenis are mainly associated with local symptoms, but the extent of their medical significance remains unclear. Our findings suggest that, although bites from European NFFS generally cause only mild effects, the potential occurrence of systemic effects from some species cannot be ruled out. Considering the above, any bite by European NFFS should receive professional medical evaluation in order to ensure patient safety and appropriate management, as well as detailed documentation facilitating construction of an accurate medical risk profile for the species.
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Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Matteo R Di Nicola
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Via Bologna 148, 10154 Turin, Italy.
| | - Jean-Marie Ballouard
- CRCC Centre for Research and Conservation of Chelonians, SOPTOM, Var, Routes du Luc 1065, 83660 Carnoules, France
| | - Xavier Bonnet
- CEBC, UMR-7372, CNRS-Université de La Rochelle, 79360 Villiers en Bois, France
| | - Maik Damm
- Institute for Insect Biotechnology, Justus Liebig University of Giessen, Heinrich-Buff Ring 26-32, 35392, Giessen, Germany; Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology, Ohlebergsweg 12, 35392, Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325, Frankfurt, Germany
| | - Gaël Le Roux
- Centre Antipoison et Toxicovigilance Grand Ouest, Centre Hospitalo-Universitaire d'Angers, Rue Larrey 4, 49933, Angers, France
| | - Tim Lüddecke
- Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology, Ohlebergsweg 12, 35392, Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325, Frankfurt, Germany
| | - Daniele Marini
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy; Department of Organismal Biology, Evolutionary Biology Centre, Uppsala University, Norbyvägen 18A, 752 36, Uppsala, Sweden
| | - Scott A Weinstein
- Young Adult Institute, 220 E. 42nd St., 8th Floor, NY, 10017, USA; Premier HealthCare, 227 E. 41st St., 8th Floor, NY, 10017, USA
| | - Ignazio Avella
- Institute for Insect Biotechnology, Justus Liebig University of Giessen, Heinrich-Buff Ring 26-32, 35392, Giessen, Germany; Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology, Ohlebergsweg 12, 35392, Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325, Frankfurt, Germany
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3
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Avella I, Schulte L, Hurka S, Damm M, Eichberg J, Schiffmann S, Henke M, Timm T, Lochnit G, Hardes K, Vilcinskas A, Lüddecke T. Proteogenomics-guided functional venomics resolves the toxin arsenal and activity of Deinagkistrodon acutus venom. Int J Biol Macromol 2024; 278:135041. [PMID: 39182889 DOI: 10.1016/j.ijbiomac.2024.135041] [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: 07/21/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
Snakebite primarily impacts rural communities of Africa, Asia, and Latin America. The sharp-nosed viper (Deinagkistrodon acutus) is among the snakes of highest medical importance in Asia. Despite various studies on its venom using modern venomics techniques, a comprehensive understanding of composition and function of this species' venom remains lacking. We combined proteogenomics with extensive bioactivity profiling to present the first genome-level catalogue of D. acutus venom proteins and their exochemistry. Our analysis identified an unusually simple venom containing 45 components from 20 distinct protein families. Relative toxin abundances indicate that C-type lectin and C-type lectin-related protein (CTL), snake venom metalloproteinase (svMP), snake venom serine protease (svSP), and phospholipase A2 (PLA2) constitute 90 % of the venom. Bioassays targeting key aspects of viperid envenomation showed considerable concentration-dependent cytotoxicity, particularly in kidney and lung cells, and potent protease and PLA2 activity. Factor Xa and thrombin activities were minor, and no plasmin activity was observed. Effects on haemolysis, intracellular calcium (Ca2+) release, and nitric oxide (NO) synthesis were negligible. Our analysis provides the first holistic genome-based overview of the toxin arsenal of D. acutus, predicting the molecular and functional basis of its life-threatening effects, and opens novel avenues for treating envenomation by this highly dangerous snake.
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Affiliation(s)
- Ignazio Avella
- Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; Institute for Insect Biotechnology, Justus Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany.
| | - Lennart Schulte
- Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; Institute for Insect Biotechnology, Justus Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany
| | - Sabine Hurka
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; BMBF Junior Research Group in Bioeconomy (BioKreativ) "SymBioÖkonomie", Ohlebergsweg 12, 35392 Giessen, Germany
| | - Maik Damm
- Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; Institute for Insect Biotechnology, Justus Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany
| | - Johanna Eichberg
- Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; BMBF Junior Research Group in Infection Research "ASCRIBE", Ohlebergsweg 12, 35392 Giessen, Germany
| | - Susanne Schiffmann
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), 60596 Frankfurt am Main, Germany
| | - Marina Henke
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), 60596 Frankfurt am Main, Germany
| | - Thomas Timm
- Protein Analytics, Institute of Biochemistry, Faculty of Medicine, Justus Liebig University Giessen, Friedrichstrasse 24, 35392 Giessen, Germany
| | - Günther Lochnit
- Protein Analytics, Institute of Biochemistry, Faculty of Medicine, Justus Liebig University Giessen, Friedrichstrasse 24, 35392 Giessen, Germany
| | - Kornelia Hardes
- LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; BMBF Junior Research Group in Infection Research "ASCRIBE", Ohlebergsweg 12, 35392 Giessen, Germany
| | - Andreas Vilcinskas
- Institute for Insect Biotechnology, Justus Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany
| | - Tim Lüddecke
- Animal Venomics Lab, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany; LOEWE Centre for Translational Biodiversity Genomics (LOEWE-TBG), Natural Product Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany; Branch for Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Ohlebergsweg 12, 35392 Giessen, Germany.
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L Mitchell C, Smelski G, Schmid K, Roland M, Christenberry M, D Ellingson K, Brooks DE, Komatsu K, Dudley S, Shirazi F, Cullen TA. Characterization of patients with a snakebite presenting to healthcare facilities and reported to poison and drug information centers-Arizona, 2017-2021. Clin Toxicol (Phila) 2024:1-8. [PMID: 39316835 DOI: 10.1080/15563650.2024.2402937] [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: 03/05/2024] [Revised: 08/27/2024] [Accepted: 09/05/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Envenomation after a North American rattlesnake (Crotalus spp. and Sistrusus spp.) bite is associated with substantial morbidity. Arizona reports the highest number of rattlesnake envenomations annually in the United States. We evaluated the performance of poison and drug information centers for snakebite surveillance, compared with the hospital and emergency department discharge database. We used both datasets to improve the characterization of epidemiology, healthcare costs, and clinical effects of snakebite envenomations in Arizona. METHODS We identified patients with a snakebite during 2017-2021 using Arizona hospital and emergency department discharge data and snakebite consults with two regional Arizona poison centers. Patients were matched using name and birthdate. The performance of poison center data for snakebite surveillance was evaluated using the percentage of snakebite patients in hospital and emergency department discharge data that consulted with poison centers. Patient demographics, healthcare characteristics, clinical effects, and context of snakebite events were described using both datasets. RESULTS In total, 1,288 patients with a snakebite were identified using the Arizona hospital and emergency department discharge data, which resulted in 953 (74%) consultations with poison centers. The median age of patients was 48 years (IQR 28-62 years), and they were predominantly male (66%), White (90%), and non-Hispanic (84%). The median billed charges were US$ 84,880 (IQR US$ 13,286-US$ 168,043); the median duration of a healthcare stay was 34 h (IQR 13-48 h), and 29% of patients were transferred between healthcare facilities. Among 953 consulted poison center calls for a snakebite, a median of 14 vials of antivenom was administered per patient; 375 (60%) bites occurred near the home, and 345 (43%) patients were bitten on a lower extremity. One death was identified. DISCUSSION Snakebites in Arizona can cause severe morbidity and require extensive healthcare resources for treatment. Poison centers are valuable for monitoring venomous snakebites in Arizona. CONCLUSIONS Using hospital and emergency department discharge data with poison center records can improve public health surveillance data regarding snakebite epidemiology and human-snake interaction information and be used to tailor interventions to increase awareness of snake encounters and prevent snakebites.
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Affiliation(s)
- Cedar L Mitchell
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kim Schmid
- Banner Poison and Drug Information Center, Phoenix, AZ, USA
| | - Maureen Roland
- Banner Poison and Drug Information Center, Phoenix, AZ, USA
| | | | - Katherine D Ellingson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckermann College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | | | - Steven Dudley
- Arizona Poison and Drug Information Center, Tucson, AZ, USA
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5
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Bhaumik S, Beri D, Santra V, Gopalakrishnan M, Faiz MA, Williamson PR, Clarke M, Sharma SK, Jagnoor J. Core outcome set for intervention research on snakebite envenomation in South Asia. Inj Prev 2024:ip-2023-045155. [PMID: 39266207 DOI: 10.1136/ip-2023-045155] [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: 10/24/2023] [Accepted: 07/18/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND The 2019 WHO strategy to reduce snakebite burden emphasises the need for fostering research on snakebite treatments. A core outcome set (COS) is a consensus minimal list of outcomes that should be measured in research on a particular condition. We aimed to develop a COS for snakebite research in South Asia, the region with the highest burden. METHODS We used data from a systematic review of outcomes to develop a long list of outcomes which were rated in two rounds of online Delphi survey with healthcare providers, patients and the public, and potential COS users to develop a COS for intervention research on snakebite treatments in South Asia for five intervention groups. Subsequently, meetings, consultations and workshops were organised to reach further consensus. We defined the consensus criteria a priori. RESULTS Overall, 72 and 61 people, including patients and the public, participated in round I and round II of the Delphi, respectively. Consensus COSs (including definition and time points) were developed for interventions that prevent adverse reaction to snake antivenom (three outcomes), specifically manage neurotoxic manifestations (five outcomes), specifically manage haematological manifestations (five outcomes) and those that act against snake venom (seven) outcomes. A priori criteria for inclusion in COS were not met for COS on interventions for management of the bitten part. CONCLUSION The COS contributes to improving research efficiency by standardising outcome measurement in South Asia. It also provides methodological insights for future development of COS, beyond snakebite.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health India, New Delhi, India
- Meta-research and Evidence Synthesis Unit, George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Deepti Beri
- The George Institute for Global Health India, New Delhi, India
| | - Vishal Santra
- Society for Nature Conservation, Research and Community Engagement, Hooghly, West Bengal, India
| | - Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jagnoor Jagnoor
- Injury Division, George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Edge RJ, Marriott AE, Stars EL, Patel RN, Wilkinson MC, King LDW, Slagboom J, Tan CH, Ratanabanangkoon K, Draper SJ, Ainsworth S. Plug and play virus-like particles for the generation of anti-toxin antibodies. Toxicon X 2024; 23:100204. [PMID: 39280983 PMCID: PMC11401359 DOI: 10.1016/j.toxcx.2024.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/08/2024] [Accepted: 08/18/2024] [Indexed: 09/18/2024] Open
Abstract
Snakebite is a major global health concern, for which antivenom remains the only approved treatment to neutralise the harmful effects of the toxins. However, some medically important toxins are poorly immunogenic, resulting in reduced efficacy of the final product. Boosting the immunogenicity of these toxins in the commercial antivenom immunising mixtures could be an effective strategy to improve the final dose efficacy, and displaying snake antigens on Virus-like particles (VLPs) is one method for this. However, despite some applications in the field of snakebite, VLPs have yet to be explored in methods that could be practical at an antivenom manufacturing scale. Here we describe the utilisation of a "plug and play" VLP system to display immunogenic linear peptide epitopes from three finger toxins (3FTxs) and generate anti-toxin antibodies. Rabbits were immunised with VLPs displaying individual consensus linear epitopes and their antibody responses were characterised by immunoassay. Of the three experimental consensus sequences, two produced antibodies capable of recognising the consensus peptides, whilst only one of these could also recognise native whole toxins. Further characterisation of antibodies raised against this peptide demonstrated a sub-class specific response, and that these were able to elicit partially neutralising antibody responses, resulting in increased survival times in a murine snakebite envenoming model.
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Affiliation(s)
- Rebecca J Edge
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, United Kingdom
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Amy E Marriott
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, United Kingdom
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Emma L Stars
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Rohit N Patel
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Mark C Wilkinson
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Lloyd D W King
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, Oxford, OX1 3QU, United Kingdom
- Kavli Institute for Nanoscience Discovery, University of Oxford, Dorothy Crowfoot Hodgkin Building, Oxford, OX1 3QU, United Kingdom
| | - Julien Slagboom
- Amsterdam Institute of Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081HV, the Netherlands
| | - Choo Hock Tan
- School of Medicine, College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, 300, Taiwan
- Institute of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, 300, Taiwan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kavi Ratanabanangkoon
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Simon J Draper
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, Oxford, OX1 3QU, United Kingdom
- Kavli Institute for Nanoscience Discovery, University of Oxford, Dorothy Crowfoot Hodgkin Building, Oxford, OX1 3QU, United Kingdom
| | - Stuart Ainsworth
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, United Kingdom
- Centre for Snakebite Research and Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
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7
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Damm M, Karış M, Petras D, Nalbantsoy A, Göçmen B, Süssmuth RD. Venomics and Peptidomics of Palearctic Vipers: A Clade-Wide Analysis of Seven Taxa of the Genera Vipera, Montivipera, Macrovipera, and Daboia across Türkiye. J Proteome Res 2024; 23:3524-3541. [PMID: 38980134 PMCID: PMC11301686 DOI: 10.1021/acs.jproteome.4c00171] [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: 03/04/2024] [Revised: 05/21/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024]
Abstract
Snake venom variations are a crucial factor to understand the consequences of snakebite envenoming worldwide, and therefore it is important to know about toxin composition alterations between taxa. Palearctic vipers of the genera Vipera, Montivipera, Macrovipera, and Daboia have high medical impacts across the Old World. One hotspot for their occurrence and diversity is Türkiye, located on the border between continents, but many of their venoms remain still understudied. Here, we present the venom compositions of seven Turkish viper taxa. By complementary mass spectrometry-based bottom-up and top-down workflows, the venom profiles were investigated on proteomics and peptidomics level. This study includes the first venom descriptions of Vipera berus barani, Vipera darevskii, Montivipera bulgardaghica albizona, and Montivipera xanthina, as well as the first snake venomics profiles of Turkish Macrovipera lebetinus obtusa, and Daboia palaestinae, including an in-depth reanalysis of M. bulgardaghica bulgardaghica venom. Additionally, we identified the modular consensus sequence pEXW(PZ)1-2P(EI)/(KV)PPLE for bradykinin-potentiating peptides in viper venoms. For better insights into variations and potential impacts of medical significance, the venoms were compared against other Palearctic viper proteomes, including the first genus-wide Montivipera venom comparison. This will help the risk assessment of snakebite envenoming by these vipers and aid in predicting the venoms' pathophysiology and clinical treatments.
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Affiliation(s)
- Maik Damm
- Institut
für Chemie, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- LOEWE-Centre
for Translational Biodiversity Genomics, Senckenberganlage 25, 60325 Frankfurt am Main, Germany
- Institute
for Insect Biotechnology, Justus-Liebig
University Giessen, Heinrich-Buff-Ring
26-32, 35392 Gießen, Germany
| | - Mert Karış
- Program
of Laboratory Technology, Department of Chemistry and Chemical Process
Technologies, Acıgöl Vocational School of Technical Sciences, Nevşehir Hacı Bektaş Veli University, Acıgöl, 50140 Nevşehir, Türkiye
| | - Daniel Petras
- Department
of Biochemistry, University of California
Riverside, 169 Aberdeen
Dr, Riverside, California 92507, United States
- Interfaculty
Institute of Microbiology and Infection Medicine, University of Tuebingen, Auf der Morgenstelle 24, 72076 Tuebingen, Germany
| | - Ayse Nalbantsoy
- Department
of Bioengineering, Faculty of Engineering, Ege University, Bornova, 35100 Izmir, Türkiye
| | - Bayram Göçmen
- Zoology
Section, Department of Biology, Faculty of Science, Ege University, Bornova, 35100 Izmir, Türkiye
| | - Roderich D. Süssmuth
- Institut
für Chemie, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
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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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9
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Hao W, Lv C, Song X, He L, Wang J, Hu Y, Chen Y, Gan Y, Yan S, Han X. Vulnerability factors of snake bite patients in China. BMC Public Health 2024; 24:1704. [PMID: 38926898 PMCID: PMC11200872 DOI: 10.1186/s12889-024-19169-3] [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: 10/26/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To analyze the vulnerability factors of snakebite patients in China. METHODS Multi-stage random sampling was used as the main sampling method and snowball sampling as the auxiliary sampling method. The knowledge, attitude and behavior of snakebite among Chinese residents were investigated. Non-parametric test was used to compare the percentage differences in residents' knowledge, attitude and behavior of snakebite, and generalized linear regression analysis was used to analyze the influencing factors, and the vulnerability factors of snakebite patients were comprehensively analyzed. RESULTS A total of 6338 subjects were included in this study, of which 68.4% were males, and 58.6% were farmers, workers and service personnel. The median total score of knowledge, attitude, and behavior was 26 (22,36). The patients who were improperly treated after injury were ligation proximal to the affected area (23.43%), squeezing (21.82%), and oral and suction wounds (8.74%). Did not go to hospital due to poverty (1351 cases) and did not receive antivenom (2068 cases). There were 21.32% and 32.63%, respectively. Among 4270 patients injected with antivenom 30.7% were vaccinated within 2 h. Among the patients who went to the hospital for treatment (4987), 75.0% arrived at the hospital within 6 h; Among the 4,761 patients who made emergency calls, 37.4% were treated within 0.5 h. CONCLUSIONS Snakebite patients in China have weak knowledge about snakebite, low awareness of medical treatment, lack of correct prevention and emergency treatment measures, dependence on folk remedies, poor housing and so on. In addition, there are low availability of antivenoms and unreasonable distribution of medical resources in some areas of China. Multisectoral and multidisciplinary cooperation should be developed to prevent and control snakebites in order to reduce the burden caused by snakebites.
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Affiliation(s)
- Wenjie Hao
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Lanfen He
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Juntao Wang
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Yanlan Hu
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Yu Chen
- School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou, Hainan, China.
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China.
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, The First Affiliated Hospital, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan, China.
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10
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Torres SV, Valle MB, Mackessy SP, Menzies SK, Casewell NR, Ahmadi S, Burlet NJ, Muratspahić E, Sappington I, Overath MD, Rivera-de-Torre E, Ledergerber J, Laustsen AH, Boddum K, Bera AK, Kang A, Brackenbrough E, Cardoso IA, Crittenden EP, Edge RJ, Decarreau J, Ragotte RJ, Pillai AS, Abedi M, Han HL, Gerben SR, Murray A, Skotheim R, Stuart L, Stewart L, Fryer TJA, Jenkins TP, Baker D. De novo designed proteins neutralize lethal snake venom toxins. RESEARCH SQUARE 2024:rs.3.rs-4402792. [PMID: 38798548 PMCID: PMC11118692 DOI: 10.21203/rs.3.rs-4402792/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Snakebite envenoming remains a devastating and neglected tropical disease, claiming over 100,000 lives annually and causing severe complications and long-lasting disabilities for many more1,2. Three-finger toxins (3FTx) are highly toxic components of elapid snake venoms that can cause diverse pathologies, including severe tissue damage3 and inhibition of nicotinic acetylcholine receptors (nAChRs) resulting in life-threatening neurotoxicity4. Currently, the only available treatments for snakebite consist of polyclonal antibodies derived from the plasma of immunized animals, which have high cost and limited efficacy against 3FTxs5,6,7. Here, we use deep learning methods to de novo design proteins to bind short- and long-chain α-neurotoxins and cytotoxins from the 3FTx family. With limited experimental screening, we obtain protein designs with remarkable thermal stability, high binding affinity, and near-atomic level agreement with the computational models. The designed proteins effectively neutralize all three 3FTx sub-families in vitro and protect mice from a lethal neurotoxin challenge. Such potent, stable, and readily manufacturable toxin-neutralizing proteins could provide the basis for safer, cost-effective, and widely accessible next-generation antivenom therapeutics. Beyond snakebite, our computational design methodology should help democratize therapeutic discovery, particularly in resource-limited settings, by substantially reducing costs and resource requirements for development of therapies to neglected tropical diseases.
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Affiliation(s)
- Susana Vázquez Torres
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Graduate Program in Biological Physics, Structure and Design, University of Washington, Seattle, WA 98105, USA
| | - Melisa Benard Valle
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Stephen P. Mackessy
- Department of Biological Sciences, University of Northern Colorado, Greeley, CO, 80639, USA
| | - Stefanie K. Menzies
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Biomedical & Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom LA1 4YG8
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nick J. Burlet
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Edin Muratspahić
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Isaac Sappington
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Graduate Program in Biological Physics, Structure and Design, University of Washington, Seattle, WA 98105, USA
| | - Max D. Overath
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Esperanza Rivera-de-Torre
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jann Ledergerber
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kim Boddum
- Sophion Bioscience, DK-2750 Ballerup, Denmark
| | - Asim K. Bera
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Alex Kang
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Evans Brackenbrough
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Iara A. Cardoso
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Edouard P. Crittenden
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Rebecca J. Edge
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, United Kingdom
| | - Justin Decarreau
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Robert J. Ragotte
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Arvind S. Pillai
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Mohamad Abedi
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Hannah L. Han
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Stacey R. Gerben
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Analisa Murray
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Rebecca Skotheim
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Lynda Stuart
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Lance Stewart
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - Thomas J. A. Fryer
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- Media Lab, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, 02139, MA, USA
| | - Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - David Baker
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA 98105,USA
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Ralph R, Sharma D, Jain R, Balachandran A, Chiang YW, S R G. Protobothrops jerdonii (Jerdon's pit viper) and Protobothrops himalayanus (Himalayan lance-headed pit viper) bites: Clinical report on envenomings from North-East India, managed through remote consultation by a national-level Poison control center. Toxicon 2024; 242:107704. [PMID: 38565396 DOI: 10.1016/j.toxicon.2024.107704] [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: 02/05/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Members of the genus Protobothrops are amongst the more than twenty-eight range-restricted Indian pit viper species. Their bites and envenomings are rarely documented from India. Pit viper envenomings can be challenging to treat in the Indian setting, since available antivenoms do not satisfactorily neutralize their venoms. Herein, we present the first Indian reports on bites and envenoming by Protobothrops jerdonii and Protobothrops himalayanus resulting in local effects, coagulopathy and acute kidney injury in the case of the former and possible mild, isolated coagulopathy in the case of the latter; and discuss management-related challenges in the context of absent specific antivenoms.
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Affiliation(s)
- Ravikar Ralph
- Poison Control Center, Department of Medicine, Christian Medical College (CMC), Vellore, Tamil Nadu, 632004, India.
| | - Deepak Sharma
- 181 Military Hospital, Tenga, Arunachal Pradesh, 790116, India
| | - Rohit Jain
- 327 Field Hospital, Chungthang, North Sikkim, India
| | - Amith Balachandran
- Poison Control Center, Department of Medicine, CMC Vellore, Tamil Nadu, 632004, India
| | - Yu-Wei Chiang
- Department of Medical Research, Taipei Veterans General Hospital, 112, Taiwan; Department of Biology and Anatomy, National Defense Medical Centre, Taipei City, 11490, Taiwan; Foundation for Poison Control, Taiwan
| | - Ganesh S R
- Kalinga Foundation, Agumbe, Shivamogha, Karnataka, 577411, India
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12
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Rodrigo C, Gnanathasan A. Lack of controlled studies on snakebite prevention: a rapid review. Trans R Soc Trop Med Hyg 2024; 118:247-252. [PMID: 38088196 DOI: 10.1093/trstmh/trad088] [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: 07/04/2023] [Revised: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 04/07/2024] Open
Abstract
Globally, snakebites cause an estimated 80 000-140 000 deaths annually. While there are evidence-based recommendations for managing snakebite victims, recommendations on the prevention of snakebites are limited to expert opinions. We conducted a rapid review to summarise evidence from human studies with a control group on preventing snakebites. Searching PubMed, Web of Science, Scopus, CINAHL and EMBASE with inclusive search terms without language or time limits only yielded three eligible studies (one case control study and two prospective controlled clinical studies), highlighting a knowledge gap. Two studies in Nepal by the same group showed that health education of stakeholders and sleeping under a bednet can significantly reduce snakebite incidence (p<0.05), but these observations are not confirmed elsewhere, and because of the high risk of bias the certainty of evidence was low. The third study from Sri Lanka, which assessed if sleeping above ground would prevent snakebites, had inconclusive results. This demonstrates an urgent need for studies with a control group to guide evidence-based recommendations for snakebite prevention. Potential interventions tested can range from low-cost measures such as wearing appropriate footwear in resource-limited settings to testing the efficacy of chemical, biological (e.g. rodent control) or device-based methods and community-supported platforms tracking snakebite sightings with real-time geolocation data in highly resourced settings.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Biomedical Sciences, UNSW, Sydney, NSW 2052, Australia
| | - Ariaranee Gnanathasan
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 00800, Sri Lanka
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13
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Pannu AK, Chand D, Bhalla A, Dhibar DP. Efficacy of a low dose of antivenom for severe neuroparalysis in Bungarus caeruleus (common krait) envenomation: a pilot study. Toxicol Res (Camb) 2024; 13:tfae023. [PMID: 38450179 PMCID: PMC10913380 DOI: 10.1093/toxres/tfae023] [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: 08/29/2023] [Revised: 12/26/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Despite the widespread use of antivenom for the treatment of snakebite envenoming in the Indian subcontinent, the ideal dose of antivenom has been a point of contention. Low-dose regimens can economize on a scarce resource in low- and middle-income countries. This study assessed the effectiveness of a low-dose (10 vials) antivenom regimen compared to the usual 20 vials in patients with krait bite neuroparalysis requiring mechanical ventilation. Methods This study was a prospective controlled pilot study conducted in a tertiary-care hospital in north India. Participants were eligible if they were ≥12 years old, had krait bite neurotoxicity, showed severe paralysis requiring mechanical ventilation, and had access to antivenom therapy within 24 h of the bite. The primary outcome was the duration of mechanical ventilation, and the secondary outcomes were the length of hospital stay and in-hospital survival. Results Fifteen patients received 10 vials of antivenom, and 25 received 20 vials. The two treatment groups had similar baseline demographics, clinical and laboratory features, snakebite severity scores, and median time from snakebite to initiation of antivenom therapy. The low-dose regimen was as effective as the standard dose concerning the median duration of mechanical ventilation (41 h vs. 55 h, P = 0.094), the median length of stay (78 h vs. 85.5 h, P = 0.360), and in-hospital deaths (1 vs. 3, P = 1.000). The incidence of ventilator-associated pneumonia was similar between the two groups (1 vs 3, P = 1.000). Conclusion A low dose of antivenom effectively treats patients with severe krait bite neuroparalysis.
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Affiliation(s)
- Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4 Floor, F Block, Nehru Hospital, Chandigarh 160012, India
| | - Duni Chand
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4 Floor, F Block, Nehru Hospital, Chandigarh 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4 Floor, F Block, Nehru Hospital, Chandigarh 160012, India
| | - Deba Prasad Dhibar
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4 Floor, F Block, Nehru Hospital, Chandigarh 160012, India
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14
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Davi SD, Lumeka A, Hildebrandt TR, Endamne LR, Otchague C, Okwu DG, Artus R, Hunstig F, Manego RZ, Blessmann J, Kremsner PG, Lell B, Mombo-Ngoma G, Agnandji ST, Ramharter M, Kreuels B. Assessing the Incidence of Snakebites in Rural Gabon-A Community-Based, Cross-Sectional Pilot Survey. Trop Med Infect Dis 2024; 9:68. [PMID: 38668529 PMCID: PMC11053831 DOI: 10.3390/tropicalmed9040068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Snakebite envenoming (SBE) is a neglected tropical disease (NTD). Community-based studies from sub-Saharan Africa are urgently required as data on the incidence are scarce. This study aimed to determine the lifetime prevalence of snakebites in rural Gabon by preparing the conduct of a larger regional survey. A cross-sectional community-based epidemiological survey in Sindara, Ngounie province, was conducted. Households were interviewed about the history of snakebites of household members to calculate lifetime prevalence. In addition, the average annual incidence rate per 100,000 over the last 5 years was calculated. A total of 771 inhabitants were enrolled, of which 5 (0.65%; 95% confidence interval (95% CI: 0.2-1.5%)) were victims of snakebites. Over the past 5 years, annual incidence was 77 bites per 100,000 (95% CI: 0-620). This study provides a first rough estimate of the incidence of SBE from rural central Gabon, demonstrating the importance of this NTD. Key Contribution: The estimated annual incidence of snakebites found was 77 per 100,000. Snakebites occurred mainly during agricultural activities.
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Affiliation(s)
- Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
| | - Anita Lumeka
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Teite Rebecca Hildebrandt
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Lilian Rene Endamne
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
| | - Cedric Otchague
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Dearie Glory Okwu
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Rica Artus
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Friederike Hunstig
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Jörg Blessmann
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, 72016 Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- Research Group Drug Implementation, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
| | - Michael Ramharter
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany; (S.D.D.); (T.R.H.)
- Centre de Recherches Médicales de Lambaréné, Lambarene BP 242, Gabon; (A.L.); (C.O.); (G.M.-N.); (S.T.A.)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
| | - Benno Kreuels
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel-Riems, 20359 Hamburg, Germany
- Research Group Snakebite Envenoming, Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany (J.B.)
- Division for Tropical Diseases, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
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Lim ASS, Tan KY, Tan CH. Immunoreactivity and neutralization efficacy of Pakistani Viper Antivenom (PVAV) against venoms of Saw-scaled Vipers (Echis carinatus subspp.) and Western Russell's Vipers (Daboia russelii) from the Indian subcontinent. Acta Trop 2024; 250:107099. [PMID: 38097152 DOI: 10.1016/j.actatropica.2023.107099] [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: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/31/2023]
Abstract
Snakebite envenoming (SBE) is a priority Neglected Tropical Disease listed by the World Health Organization. South Asia is heavily affected, and virtually all countries in the region import polyvalent antivenom products from India for clinical use. The imported antivenoms, however, have suboptimal effectiveness due to geographical venom variation. Recently, a domestic bivalent product, named Pakistani Viper Antivenom (PVAV) has been developed specifically for Pakistani vipers, Echis carinatus sochureki and Daboia russelii. As a bivalent viperid antivenom, it is unknown yet if PVAV exhibits higher immunological binding and neutralization activities against viper venoms from distant locales compared with polyvalent antivenoms manufactured in India. This study thus examined the preclinical efficacy of PVAV against venoms of Western Russell's Vipers and Saw-scaled Viper subspecies from selected locales in the Indian subcontinent. PVAV generally outperformed the commonly used VINS polyvalent antivenom (VPAV, manufactured in India) in binding toward venoms, and showed superior or comparable neutralization efficacy against the venom procoagulant and hemorrhagic effects of Saw-scaled Vipers as well as Russell's Vipers from Pakistan and Sri Lanka. Based on normalized potency values, PVAV is far more potent than VPAV in neutralizing the lethality of all viper venoms, except that of the Indian Russell's Viper. The study shows conserved antigenicity of toxins responsible for major toxicity across these viperid venoms, and suggests the feasible production of a viper-specific antivenom with higher potency and broader geographical utility for the region.
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Affiliation(s)
- Andy Shing Seng Lim
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Kae Yi Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Sørensen CV, Fernández J, Adams AC, Wildenauer HHK, Schoffelen S, Ledsgaard L, Pucca MB, Fiebig M, Cerni FA, Tulika T, Voldborg BG, Karatt-Vellatt A, Morth JP, Ljungars A, Grav LM, Lomonte B, Laustsen AH. Antibody-dependent enhancement of toxicity of myotoxin II from Bothrops asper. Nat Commun 2024; 15:173. [PMID: 38228619 PMCID: PMC10791742 DOI: 10.1038/s41467-023-42624-5] [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: 06/13/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Improved therapies are needed against snakebite envenoming, which kills and permanently disables thousands of people each year. Recently developed neutralizing monoclonal antibodies against several snake toxins have shown promise in preclinical rodent models. Here, we use phage display technology to discover a human monoclonal antibody and show that this antibody causes antibody-dependent enhancement of toxicity (ADET) of myotoxin II from the venomous pit viper, Bothrops asper, in a mouse model of envenoming that mimics a snakebite. While clinical ADET related to snake venom has not yet been reported in humans, this report of ADET of a toxin from the animal kingdom highlights the necessity of assessing even well-known antibody formats in representative preclinical models to evaluate their therapeutic utility against toxins or venoms. This is essential to avoid potential deleterious effects as exemplified in the present study.
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Affiliation(s)
- Christoffer V Sørensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Julián Fernández
- Instituto Clodomiro Picado, Facultad de Microbiologia, Universidad de Costa Rica, San Jose, Costa Rica
| | - Anna Christina Adams
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Helen H K Wildenauer
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Sanne Schoffelen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Line Ledsgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista, BR-69310-000, Brazil
| | - Michael Fiebig
- Absolute Antibody Ltd, Wilton Centre, Redcar, Cleveland, TS10 4RF, UK
| | - Felipe A Cerni
- Postgraduate Program in Tropical Medicine, University of the State of Amazonas, Manaus, BR-69040-000, Brazil
| | - Tulika Tulika
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Bjørn G Voldborg
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | | | - J Preben Morth
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Anne Ljungars
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Lise M Grav
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark
| | - Bruno Lomonte
- Instituto Clodomiro Picado, Facultad de Microbiologia, Universidad de Costa Rica, San Jose, Costa Rica.
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kongens Lyngby, Denmark.
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Lai R, Yan S, Wang S, Yang S, Yan Z, Lan P, Wang Y, Li Q, Wang J, Wang W, Ma Y, Liang Z, Zhang J, Zhou N, Han X, Zhang X, Zhang M, Zhao X, Zhang G, Zhu H, Yu X, Lyu C. The Chinese guideline for management of snakebites. World J Emerg Med 2024; 15:333-355. [PMID: 39290598 PMCID: PMC11402871 DOI: 10.5847/wjem.j.1920-8642.2024.076] [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: 06/06/2024] [Accepted: 08/08/2024] [Indexed: 09/19/2024] Open
Abstract
In 2009, the World Health Organization included snakebite on the list of neglected tropical diseases, acknowledging it as a common occupational hazard for farmers, plantation workers, and others, causing tens of thousands of deaths and chronic physical disabilities every year. This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims. These recommendations are based on clinical experience and clinical research evidence. This guideline focuses on the following topics: snake venom, clinical manifestations, auxiliary examination, diagnosis, treatments, and prevention.
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Affiliation(s)
- Rongde Lai
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou 571199, China
| | - Shijun Wang
- Surgery Department of Traditional Chinese Medicine, the Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China
| | - Shuqing Yang
- Emergency Department, Chongqing University Central Hospital/Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Zhangren Yan
- Department of Surgery of Traditional Chinese Medicine, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330006, China
| | - Pin Lan
- Department of Emergency Medicine, the Fifth Affiliated Hospital of Wenzhou Medical University/Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui 323000, China
| | - Yonggao Wang
- General Surgery Department, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Qi Li
- Emergency Department, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - Jinlong Wang
- Emergency Department, Chongqing University Fuling Hospital, Chongqing University, Chongqing 408000, China
| | - Wei Wang
- Emergency Department, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yuefeng Ma
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zijing Liang
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianfeng Zhang
- Emergency Department , Wuming Hospital of Guangxi Medical University, Nanning 530021, China
| | - Ning Zhou
- Emergency Department, Central People's Hospital of Zhanjiang, Zhanjiang 524037, China
| | - Xiaotong Han
- Emergency Department, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Xinchao Zhang
- Emergency Department, National Geriatrics Center of Beijing Hospital, Beijing 100020, China
| | - Mao Zhang
- Emergency Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiaodong Zhao
- Emergency Department, the Fourth Medical Center of the PLA General Hospital, Beijing 100048, China
| | - Guoqiang Zhang
- Emergency Department, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, BeiJing 100730, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, BeiJing 100730, China
| | - Chuanzhu Lyu
- Emergency Department, Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital, Chengdu 610072, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou 571199, China
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18
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Abad Ribeiro AB, Santoro ML, Duarte MR, Virgulino CC, de Oliveira GSS, França FODS. Hemoperitoneum after a Bothrops snakebite: Case report. Toxicon 2024; 237:107350. [PMID: 38016581 DOI: 10.1016/j.toxicon.2023.107350] [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: 08/09/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.
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Affiliation(s)
| | - Marcelo Larami Santoro
- Biotério Central and Escola Superior do Instituto Butantan (ESIB), Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcelo Ribeiro Duarte
- Laboratório de Coleções Zoológicas, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Cristiana Cruz Virgulino
- Hospital Vital Brazil, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Gerson Sobrinho Salvador de Oliveira
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Oscar de Siqueira França
- Núcleo de Medicina Tropical, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Laboratório de Imunologia (LIM48), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
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19
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Yang Q, Gao Y, Fu W, Ma S. Impact of tourniquet use on severity of snakebite envenoming in Chongqing, China: a single-center retrospective study. J Int Med Res 2024; 52:3000605231225540. [PMID: 38258738 PMCID: PMC10807319 DOI: 10.1177/03000605231225540] [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: 10/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To identify risk factors associated with snakebite severity and determine whether tourniquet use can affect the severity and outcome of snakebites. METHODS The clinical data of patients who sustained limb snakebites from 1 March 2021 to 31 October 2022 were reviewed. The patients were divided into three groups according to snakebite severity: mild (517 cases), moderate (112 cases), and severe (8 cases). We compared the clinical data of mild versus moderate to severe snakebites. Multivariate logistic regression was used to determine the independent risk factors for moderate to severe snakebites. RESULTS The study involved 637 patients. There were statistically significant differences in age, tourniquet use, onset time, white blood cell increase, platelet decrease, creatine kinase (CK) increase, activated partial thromboplastin time shortening, and length of stay between patients with mild snakebites and those with moderate to severe snakebites. Multivariate logistic regression analysis showed that age, tourniquet use, and CK increase were independent risk factors for moderate to severe snakebites. CONCLUSION The overall severity of snakebites in Chongqing is mild, and the prognosis is good. Age, tourniquet use, and CK increase are independent risk factors for the severity of snakebites. We do not recommend tourniquet use after snakebites in Chongqing.
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Affiliation(s)
- Qian Yang
- Qian Yang, Department of General Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), 1 Health Road, YuZhong District, Chongqing 400014, China.
| | | | | | - Shaying Ma
- Department of General Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing, China
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20
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Munshi H, Gajbhiye RK. Empowering Health care Systems and Communities for Snakebite Envenoming Control in India. Asia Pac J Public Health 2023; 35:535-537. [PMID: 37846023 DOI: 10.1177/10105395231206032] [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] [Indexed: 10/18/2023]
Abstract
Snakebite envenoming (SBE) is a global health challenge, predominantly affecting economically disadvantaged regions. India contributes significantly to global snakebite mortality. Since 2013, the Indian Council of Medical Research (ICMR) has spearheaded efforts to combat SBE. A multi-sectoral engagement in the snakebite research projects and inputs from communities, traditional healers, and the health system have led to the creation of an Information Education and Communication (IEC) material suite, including management flowchart, information booklets, posters, and brochures, all available in local languages. These resources were broadly disseminated in high-burden regions in Maharashtra and Odisha, resulting in an approximately 10% increase in case reporting within a year. This holistic approach, engaging diverse stakeholders and addressing multiple facets of SBE, offers promise for alleviating the snakebite burden, not only in India but also in other low- and middle-income countries across South Asia, Africa, and South America, holding potential for broader positive global impact.
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Affiliation(s)
- Hrishikesh Munshi
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - Rahul K Gajbhiye
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
- Model Rural Health Research Unit (MRHRU), Vani, India
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21
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da Silva WRGB, de Siqueira Santos L, Lira D, de Oliveira Luna KP, Fook SML, Alves RRN. Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country. PLoS Negl Trop Dis 2023; 17:e0011708. [PMID: 37856557 PMCID: PMC10617728 DOI: 10.1371/journal.pntd.0011708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/31/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming.
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Affiliation(s)
- Weslley Ruan Guimarães Borges da Silva
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Bioinformatics, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas de Siqueira Santos
- Graduate Program in Geodetic Sciences and Geoinformation Technologies, Department of Cartographic Engineering, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Derick Lira
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Karla Patrícia de Oliveira Luna
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Science Teaching and Mathematics Education, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Cellular and Molecular Biology, Department of Molecular Biology, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Sayonara Maria Lia Fook
- Graduate Program in Public Health, Department of Pharmacy, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Rômulo Romeu Nóbrega Alves
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ethnobiology and Nature Conservation, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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22
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Salim A, Williams J, Abdel Wahab S, Adeshokan T, Almeida JR, Williams HF, Vaiyapuri R, Senthilkumaran S, Thirumalaikolundusubramanian P, Patel K, Baksh MF, Lewin MR, Vaiyapuri S. Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India. PLoS Negl Trop Dis 2023; 17:e0011699. [PMID: 37844081 PMCID: PMC10602377 DOI: 10.1371/journal.pntd.0011699] [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: 06/23/2023] [Revised: 10/26/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND India suffers ~58,000 annual deaths due to snakebites. The 'Big Four' snakes (Russell's viper, Indian cobra, common krait, and saw-scaled viper) that are responsible for most bites cause diverse clinical effects. Delayed treatment increases the risk of serious complications and treatment costs. Although government hospitals offer free treatment for snakebites in India, most patients opt for private healthcare, which is an out-of-pocket expense as they often lack health insurance coverage. This study aims to analyse snakebite treatment costs in private tertiary care hospitals in Tamil Nadu, India and identifies the key factors contributing to treatment costs. METHODOLOGY/PRINCIPAL FINDINGS The treatment cost details for 913 snakebite victims were collected from 10 private tertiary care hospitals across Tamil Nadu. The data were classified into hospital, pharmacy, investigation, and laboratory costs, and analysed to determine various factors that contribute to the costs. The results demonstrate that the average treatment costs vary widely for different snakes. The hospital and pharmacy costs are higher than investigation and laboratory costs for all snakebites. Notably, Russell's viper bites cost significantly more than the bites from other snakes. Overall, the type of snake, nature of complications, specialist treatments required, and arrival time to hospitals were identified as some of the key factors for higher treatment costs. CONCLUSIONS/SIGNIFICANCE These data demonstrate that ~80% of snakebite patients can be treated with INR 100,000 (~GBP 1000 or USD 1200) or less. This study emphasises the urgent need to improve rural medical care by providing appropriate training for healthcare professionals and essential resources to facilitate early assessment of patients, administer the initial dose of antivenom and refer the patients to tertiary care only when needed. Moreover, the outcome of this study forms a basis for developing appropriate policies to regulate snakebite treatment costs and provide affordable medical insurance for vulnerable communities.
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Affiliation(s)
- Anika Salim
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | - Tade Adeshokan
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - José R. Almeida
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | | | | | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - M. Fazil Baksh
- Department of Mathematics and Statistics, University of Reading, Reading, United Kingdom
| | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, California, United States of America
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23
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Kachhwaha A, Kumar A, Garg P, Sharma A, Garg MK, Gopalakrishnan M. Delayed Compression Paralysis Following an Iliopsoas Hematoma 30 Days After Saw-Scaled Viper (Echis carinatus sochureki) Envenoming: A Case Report. Wilderness Environ Med 2023; 34:366-371. [PMID: 37179190 DOI: 10.1016/j.wem.2023.03.005] [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: 11/15/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Abstract
Snakebite envenoming is a neglected tropical disease disproportionately affecting the rural and marginalized population in low-middle-income countries. The saw-scaled viper (Echis carinatus) is a clinically important snake that causes serious morbidity and mortality in the Indian subcontinent. Even though it is within the so-called big-four snakes against which polyvalent antivenom is available throughout India, reports of antivenom ineffectiveness are emerging in saw-scaled viper envenoming, especially around Jodhpur, Rajasthan, India. This case report highlights a patient with saw-scaled viper envenoming with an ineffective antivenom response complicated by acute kidney injury as well as local and systemic bleeding complications, which subsequently resulted in a pelvic hematoma that compressed the lumbosacral nerves, causing lower-limb weakness and sensory deficits. He was successfully managed with hematoma aspiration and supportive care. This case brings into focus the challenges of managing saw-scaled viper envenoming in this region with antivenom ineffectiveness, resulting in delayed and significant coagulopathy and its complications leading to prolonged hospital stay and morbidity. Our report spotlights less emphasized aspects of long-term morbidity in snakebite survivors, such as loss of working days and productivity. We also highlight the need for an organized system of long-term follow-up of snakebite survivors to screen for possible complications and manage them early.
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Affiliation(s)
- Arjun Kachhwaha
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Akhilesh Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Pawan Garg
- Department of Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankur Sharma
- Department of Anesthesiology and critical care, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra K Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Maya Gopalakrishnan
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India.
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24
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Schulte L, Damm M, Avella I, Uhrig L, Erkoc P, Schiffmann S, Fürst R, Timm T, Lochnit G, Vilcinskas A, Lüddecke T. Venomics of the milos viper ( Macrovipera schweizeri) unveils patterns of venom composition and exochemistry across blunt-nosed viper venoms. Front Mol Biosci 2023; 10:1254058. [PMID: 37719269 PMCID: PMC10500195 DOI: 10.3389/fmolb.2023.1254058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction: Snakebite is a neglected tropical disease and a globally important driver of death and morbidity. Vipers of the genus Macrovipera (Viperidae: Viperinae) are among the snakes of higher medical importance in the Old World. Despite the medical relevance of Macrovipera venoms, the knowledge regarding them is heterogeneously distributed with virtually all works conducted so far focusing on subspecies of Macrovipera lebetinus, while other species within the genus are largely overlooked. Here we present the first proteomic evaluation of the venom from the Greek endemic Milos viper (Macrovipera schweizeri). In line with clinical symptoms typically elicited by Macrovipera envenomations, Milos viper venom primarily comprises coagulotoxic and cytotoxic protein families, such as metalloproteinases (svMP) and serine proteases (svSP). Methods: We conducted comparative bioactivity assays on venoms from M. schweizeri and the M. lebetinus subspecies M. lebetinus cernovi, M. lebetinus obtusa, and M. lebetinus turanica, and showed that they all exhibit similarities in levels of cytotoxicity proteolytic activity, and inhibition of prokaryotic growth. Lastly, we compared Macrovipera venom profiles by 1D-SDS-PAGE and RP-HPLC, as well as our proteomic data with previously published Macrovipera venom proteomes. Results and discussion: The analyzes performed to reveal that a general venom profile seems to be conserved across blunt-nosed vipers, and that, M. schweizeri envenomations, similarly to those caused by other blunt-nosed vipers, are able to cause significant tissue damage. The present work represents an important starting point for the development of comparative studies across the full taxonomic range of the genus Macrovipera and can potentially help optimize the treatment of envenomations caused by M. schweizeri.
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Affiliation(s)
- Lennart Schulte
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
- Institute for Insect Biotechnology, Justus Liebig University Giessen, Giessen, Germany
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
| | - Maik Damm
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
| | - Ignazio Avella
- CIBIO, Research Centre in Biodiversity and Genetic Resources, InBIO Associated Laboratory, University Port, Porto, Portugal
- Department of Biology, Faculty of Sciences, University of Porto, Porto, Portugal
- CIBIO, BIOPOLIS Program in Genomics, Biodiversity and Land Planning, Vairão, Portugal
| | - Lilien Uhrig
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
| | - Pelin Erkoc
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
- Institute of Pharmaceutical Biology, Faculty of Biochemistry, Chemistry and Pharmacy, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Schiffmann
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Frankfurt, Germany
| | - Robert Fürst
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
- Institute of Pharmaceutical Biology, Faculty of Biochemistry, Chemistry and Pharmacy, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Timm
- Institute of Biochemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Günter Lochnit
- Institute of Biochemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Vilcinskas
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
- Institute for Insect Biotechnology, Justus Liebig University Giessen, Giessen, Germany
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
| | - Tim Lüddecke
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Giessen, Germany
- LOEWE-Centre for Translational Biodiversity Genomics, Frankfurt, Germany
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De Jesus R, Tratner AE, Madrid A, Rivera-Mondragón A, Navas GE, Lleonart R, Britton GB, Fernández PL. Body Temperature Drop as a Humane Endpoint in Snake Venom-Lethality Neutralization Tests. Toxins (Basel) 2023; 15:525. [PMID: 37755951 PMCID: PMC10535418 DOI: 10.3390/toxins15090525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Snake venom neutralization potency tests are required for quality control assessment by manufacturers and regulatory authorities. These assays require the use of large numbers of mice that manifest severe signs associated with pain and distress and long periods of suffering. Despite this, many animals make a full recovery; therefore, the observation of clinical signs as a predictor of animal death is highly subjective and could affect the accuracy of the results. The use of a more objective parameter such as body temperature measurement could help establish a humane endpoint that would contribute to significantly reducing the suffering of large numbers of animals. We determined the temperature drop in BALB/c mice exposed to the mixtures of Bothrops asper or Lachesis stenophrys venom and a polyvalent antivenom by using an infrared thermometer. Our data show that, based on the temperature change from baseline, it is possible to predict which animals will survive during the first 3 h after inoculation. The data provided in this study may contribute to future reductions in animal suffering, in concordance with general trends in the use of laboratory animals for the quality control of biologicals.
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Affiliation(s)
- Rosa De Jesus
- Bioterio, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City 0843-01103, Panama; (R.D.J.); (A.M.)
| | - Adam E. Tratner
- Florida State University, Republic of Panama Campus, City of Knowledge, Panama City 0843-01103, Panama;
- Centro de Neurociencias, INDICASAT AIP, City of Knowledge, Panama City 0843-01103, Panama
| | - Alanna Madrid
- Bioterio, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City 0843-01103, Panama; (R.D.J.); (A.M.)
| | - Andrés Rivera-Mondragón
- Instituto Especializado de Análisis (IEA), Universidad de Panamá, Panama City P.O. Box 3366, Panama; (A.R.-M.); (G.E.N.)
| | - Goy E. Navas
- Instituto Especializado de Análisis (IEA), Universidad de Panamá, Panama City P.O. Box 3366, Panama; (A.R.-M.); (G.E.N.)
| | - Ricardo Lleonart
- Centro de Biología Celular y Molecular de Enfermedades, INDICASAT AIP, City of Knowledge, Panama City 0843-01103, Panama;
| | - Gabrielle B. Britton
- Centro de Neurociencias, INDICASAT AIP, City of Knowledge, Panama City 0843-01103, Panama
| | - Patricia L. Fernández
- Centro de Biología Celular y Molecular de Enfermedades, INDICASAT AIP, City of Knowledge, Panama City 0843-01103, Panama;
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Vanuopadath M, Rajan K, Alangode A, Nair SS, Nair BG. The Need for Next-Generation Antivenom for Snakebite Envenomation in India. Toxins (Basel) 2023; 15:510. [PMID: 37624267 PMCID: PMC10467155 DOI: 10.3390/toxins15080510] [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: 05/20/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 08/26/2023] Open
Abstract
The limitations posed by currently available antivenoms have emphasized the need for alternative treatments to counteract snakebite envenomation. Even though exact epidemiological data are lacking, reports have indicated that most global snakebite deaths are reported in India. Among the many problems associated with snakebite envenomation, issues related to the availability of safer and more efficient antivenoms are of primary concern. Since India has the highest number of global snakebite deaths, efforts should be made to reduce the burden associated with snakebite envenoming. Alternative methods, including aptamers, camel antivenoms, phage display techniques for generating high-affinity antibodies and antibody fragments, small-molecule inhibitors, and natural products, are currently being investigated for their effectiveness. These alternative methods have shown promise in vitro, but their in vivo effectiveness should also be evaluated. In this review, the issues associated with Indian polyvalent antivenoms in neutralizing venom components from geographically distant species are discussed in detail. In a nutshell, this review gives an overview of the current drawbacks of using animal-derived antivenoms and several alternative strategies that are currently being widely explored.
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Affiliation(s)
| | | | | | | | - Bipin Gopalakrishnan Nair
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam 690 525, Kerala, India; (M.V.); (K.R.); (A.A.); (S.S.N.)
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Bhaumik S, Norton R, Jagnoor J. Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment. BMC PRIMARY CARE 2023; 24:160. [PMID: 37563556 PMCID: PMC10416377 DOI: 10.1186/s12875-023-02109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified 'health systems strengthening' as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey - 4), to assess structural capacity and continuum of snakebite care in primary health care system in India. METHODOLOGY We evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not. RESULTS No state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains. CONCLUSION Comprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
- Injury Division, The George Institute for Global Health, New Delhi, India.
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Pandey DP, Thapa NB. Analysis of News Media-Reported Snakebite Envenoming in Nepal during 2010-2022. PLoS Negl Trop Dis 2023; 17:e0011572. [PMID: 37639403 PMCID: PMC10491300 DOI: 10.1371/journal.pntd.0011572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/08/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Snakebite envenoming is a well-known medical emergency in the Terai of Nepal in particular. However, there is an epidemiological knowledge gap. The news media data available online provide substantial information on envenomings. Assessing this information can be a pristine approach for understanding snakebite epidemiology and conducting knowledge-based interventions. We firstly analyzed news media-reported quantitative information on conditions under which bites occur, treatment-seeking behavior of victims, and outcomes of snakebite envenomings in Nepal. METHODOLOGY/PRINCIPAL FINDINGS We analyzed 308 Nepalese snakebite envenomed cases reported in 199 news media articles published between 2010 and 2022 using descriptive statistics, Wilcoxon, and Chi-square tests to know why and how victims were bitten, their treatment-seeking behavior, and the outcomes. These envenomated cases known with substantial information represented 48 districts (mostly located in the Terai region) of Nepal. These envenomings mostly occurred in residential areas affecting children. Generally, envenomings among males and females were not significantly different. But, in residential areas, females were more envenomed than males. Further, victims' extremities were often exposed to venomous snakebites while their active status and these episodes often occurred at night while victims were passive during snakebites indoors and immediate surroundings of houses. Snakebite deaths were less among referred than non-referred cases, males than females, and while active than passive conditions of victims. CONCLUSION/SIGNIFICANCE The most of reported envenomed patients were children, and most envenomings were due to cobra bites. Consultation with traditional healers complicated snakebite management. In most cases, deaths that occur without medical interventions are a severe snakebite consequence in Nepal. Further, several deaths in urban areas and mountains and higher hills of Nepal suggest immediate need of snakebite management interventions in the most affected districts. Therefore, there is an urgent need to immediately admit Nepalese snakebite victims to nearby snakebite treatment centers without adopting non-recommended prehospital interventions. The strategies for preventing snakebite and controlling venom effects should also include hilly and mountain districts where snakebite-associated deaths are reported.
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Affiliation(s)
- Deb P. Pandey
- Department of Veterinary Microbiology and Parasitology, Agriculture and Forestry University, Rampur, Chitwan, Bagmati Province, Nepal
| | - Narayan B. Thapa
- Department of Pediatrics, Bharatpur Hospital, Bharatpur, Chitwan, Bagmati Province, Nepal
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Bhaumik S, Zwi AB, Norton R, Jagnoor J. How and why snakebite became a global health priority: a policy analysis. BMJ Glob Health 2023; 8:e011923. [PMID: 37604596 PMCID: PMC10445399 DOI: 10.1136/bmjgh-2023-011923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Snakebite was added to the WHO neglected tropical disease (NTD) list in 2017, followed by a World Health Assembly resolution in 2018, and an explicit global target being set to reduce the burden in 2019. We aimed to understand how and why snakebite became a global health priority. METHODS We conducted a policy case study, using in-depth interviews, and documents (peer-reviewed and grey literature) as data sources. We drew on Shiffman et al's framework on global health network to guide the analysis. RESULTS We conducted 20 interviews and examined 91 documents. The prioritisation of snakebite occurred in four phases: pre-crescendo, crescendo, de-crescendo and re-crescendo. The core snakebite network consisted of academics, which expanded during the re-crescendo phase to include civil society organisations and state actors. The involvement of diverse stakeholders led to better understanding of WHO processes. The use of intersecting and layered issue framing, framing solutions around snake antivenoms, in a background of cross-cultural fascination and fear of snakes enabled prioritisation in the re-crescendo phase. Ebbs and flows in legitimacy of the network and reluctant acceptance of snakebite within the NTD community are challenges. CONCLUSION Our analyses imply a fragile placement of snakebite in the global agenda. We identify two challenges, which needs to be overcome. The study highlights the need to review the WHO criteria for classifying diseases as NTD. We propose that future prioritisation analysis should consider identifying temporal patterns, as well as integrating legitimacy dimensions, as in our study.
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Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Anthony B Zwi
- School of Social Sciences, UNSW, Sydney, New South Wales, Australia
| | - Robyn Norton
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
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Li Y, Guan Z, Hu S, Huang Z, He D, Cheng X, Song T, Mo C, Xiao M, Huang Y, Wei Y, Zhou Y, Zhang X, Liao M. Glutamine ameliorates Bungarus multicinctus venom-induced lung and heart injury through HSP70: NF-κB p65 and P53/PUMA signaling pathways involved. J Venom Anim Toxins Incl Trop Dis 2023; 29:e20220080. [PMID: 37441002 PMCID: PMC10334810 DOI: 10.1590/1678-9199-jvatitd-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 07/15/2023] Open
Abstract
Background Bungarus multicinctus is one of the most dangerous venomous snakes prone to cardiopulmonary damage with extremely high mortality. In our previous work, we found that glutamine (Gln) and glutamine synthetase (GS) in pig serum were significantly reduced after Bungarus multicinctus bite. In the present study, to explore whether there is a link between the pathogenesis of cardiopulmonary injury and Gln metabolic changes induced by Bungarus multicinctus venom. We investigated the effect of Gln supplementation on the lung and heart function after snakebite. Methods We supplemented different concentrations of Gln to mice that were envenomated by Bungarus multicinctus to observe the biological behavior, survival rate, hematological and pathological changes. Gln was supplemented immediately or one hour after the venom injection, and then changes in Gln metabolism were analyzed. Subsequently, to further explore the protective mechanism of glutamine on tissue damage, we measured the expression of heat-shock protein70 (HSP70), NF-κB P65, P53/PUMA by western blotting and real-time polymerase in the lung and heart. Results Gln supplementation delayed the envenoming symptoms, reduced mortality, and alleviated the histopathological changes in the heart and lung of mice bitten by Bungarus multicinctus. Additionally, Gln increased the activity of glutamine synthetase (GS), glutamate dehydrogenase (GDH) and glutaminase (GLS) in serum. It also balanced the transporter SLC7A11 expression in heart and lung tissues. Bungarus multicinctus venom induced the NF-κB nuclear translocation in the lung, while the HO-1 expression was suppressed. At the same time, venom activated the P53/PUMA signaling pathway and the BAX expression in the heart. Gln treatment reversed the above phenomenon and increased HSP70 expression. Conclusion Gln alleviated the glutamine metabolism disorder and cardiopulmonary damage caused by Bungarus multicinctus venom. It may protect lungs and heart against venom by promoting the expression of HSP70, inhibiting the activation of NF-κB and P53/PUMA, thereby delaying the process of snake venom and reducing mortality. The present results indicate that Gln could be a potential treatment for Bungarus multicinctus bite.
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Affiliation(s)
- Yalan Li
- Guangxi Medical University, Nanning, PR China
| | - Zhezhe Guan
- Guangxi Medical University, Nanning, PR China
| | - Shaocong Hu
- Guangxi Medical University, Nanning, PR China
| | - Zhi Huang
- Guangxi Medical University, Nanning, PR China
| | - Dongling He
- The First Affiliated Hospital of Guangxi University of Chinese
Medicine, Nanning, PR China
| | | | - Tianlin Song
- Tongji University Cancer Center, Shanghai Tenth People’s Hospital,
Tongji University School of Medicine, Shanghai, PR China
| | - Caifeng Mo
- Guangxi Medical University, Nanning, PR China
| | - Manqi Xiao
- Guangxi Medical University, Nanning, PR China
| | - Yue Huang
- Guangxi Medical University, Nanning, PR China
| | - Yuanmei Wei
- Guangxi Medical University, Nanning, PR China
| | - Yi Zhou
- Guangxi Medical University, Nanning, PR China
| | | | - Ming Liao
- Guangxi Medical University, Nanning, PR China
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Sørensen CV, Ledsgaard L, Wildenauer HHK, Dahl CH, Ebersole TW, Bohn MF, Ljungars A, Jenkins TP, Laustsen AH. Cross-reactivity trends when selecting scFv antibodies against snake toxins using a phage display-based cross-panning strategy. Sci Rep 2023; 13:10181. [PMID: 37349546 PMCID: PMC10287648 DOI: 10.1038/s41598-023-37056-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
Antibodies with cross-reactive binding and broad toxin-neutralizing capabilities are advantageous for treating indications such as infectious diseases and animal envenomings. Such antibodies have been successfully selected against closely related antigens using phage display technology. However, the mechanisms driving antibody cross-reactivity typically remain to be elucidated. Therefore, we sought to explore how a previously reported phage display-based cross-panning strategy drives the selection of cross-reactive antibodies using seven different snake toxins belonging to three protein (sub-)families: phospholipases A2, long-chain α-neurotoxins, and short-chain α-neurotoxins. We showcase how cross-panning can increase the chances of discovering cross-reactive single-chain variable fragments (scFvs) from phage display campaigns. Further, we find that the feasibility of discovering cross-reactive antibodies using cross-panning cannot easily be predicted by analyzing the sequence, structural, or surface similarity of the antigens alone. However, when antigens share the (exact) same functions, this seems to increase the chances of selecting cross-reactive antibodies, which may possibly be due to the existence of structurally similar motifs on the antigens.
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Affiliation(s)
- Christoffer V Sørensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
| | - Line Ledsgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Helen H K Wildenauer
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Camilla H Dahl
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Tasja W Ebersole
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Markus-Frederik Bohn
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Anne Ljungars
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Timothy P Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
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Bhaumik S, Beri D, Zwi AB, Jagnoor J. Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study. Toxicon X 2023; 18:100157. [PMID: 37089517 PMCID: PMC10091724 DOI: 10.1016/j.toxcx.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March-May 2020; May-November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Anthony B. Zwi
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Injury Division, The George Institute for Global Health, New Delhi, India
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Gajbhiye RK, Munshi H, Bawaskar HS. National programme for prevention & control of snakebite in India: Key challenges & recommendations. Indian J Med Res 2023; 157:271-275. [PMID: 36926753 PMCID: PMC10438420 DOI: 10.4103/ijmr.ijmr_2424_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 03/17/2023] Open
Affiliation(s)
- Rahul K. Gajbhiye
- Department of Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Hrishikesh Munshi
- Department of Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
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Vaiyapuri S, Kadam P, Chandrasekharuni G, Oliveira IS, Senthilkumaran S, Salim A, Patel K, de Almeida Gonçalves Sachett J, Pucca MB. Multifaceted community health education programs as powerful tools to mitigate snakebite-induced deaths, disabilities, and socioeconomic burden. Toxicon X 2023; 17:100147. [PMID: 36632238 PMCID: PMC9827049 DOI: 10.1016/j.toxcx.2022.100147] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022] Open
Abstract
Snakebite envenoming (SBE) predominantly affects rural impoverished communities that have limited access to immediate healthcare. These communities often hold numerous myths/misbeliefs about snakes and SBE. Moreover, healthcare professionals who practice in rural regions often work in unstable situations with limited medical infrastructure and therefore, lack sufficient knowledge/experience and confidence in the clinical management of SBE. Due to the lack of reliable statistics on the true burden of SBE, developing health policies for this condition by relevant authorities may be difficult. Hence, it is critical to improve awareness about SBE among rural communities, healthcare professionals and health authorities using robust multifaceted community health education approaches. Here, we describe the design, development, implementation, and impact of distinctive community health education approaches that we used in India and Brazil. A wide range of educational tools including information leaflets, posters, pocket guides, learning materials for healthcare professionals and short/long video documentaries were developed in local languages and used to engage with target communities through direct assemblies as well as mass/traditional and social media. Notably, we used diverse methods to determine the impact of our programs in improving awareness, treatment-seeking behaviour, and clinical practice. The people-centred approaches that we used were inclusive and highly impactful in instigating fundamental changes in the management of SBE among rural communities. The resources and approaches presented in this article can be easily adapted for wider use in other countries in order to collectively reduce SBE-induced deaths, disabilities and socioeconomic ramifications.
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Affiliation(s)
| | | | | | - Isadora S. Oliveira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Anika Salim
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, RG6 6UB, UK
| | | | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
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Fortner R. The tale of snakebite's fleeting spotlight-and why it encapsulates all that's wrong with global health. BMJ 2023; 380:306. [PMID: 36849183 DOI: 10.1136/bmj.p306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Blessmann J, Hosemann D, Hunstig F, Kreuels B. Schlangenbissvergiftungen – Inzidenz, Giftwirkung, Erste Hilfe und Therapie. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2022. [DOI: 10.1055/a-1961-3731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ZUSAMMENFASSUNGMit jährlich geschätzten 81 000–138 000 Todesfällen sind Schlangenbissvergiftungen die tödlichste Erkrankung auf der WHO-Liste der vernachlässigten Tropenkrankheiten. Die meisten Schlangenbissvergiftungen treten in Asien und Afrika auf, vor allem in ländlichen Gebieten. Die Giftwirkung ist überwiegend hämatotoxisch oder neurotoxisch. Zudem verursachen Zytotoxine Schwellungen und Gewebsnekrosen. Zur spezifischen Therapie werden Antivenine eingesetzt, die meist aus Pferdeserum gewonnen werden. Der Zugang zu Antiveninen ist häufig nicht gewährleistet, vor allem in Ländern mit niedrigen und mittleren Einkommen. Neben der Aufklärung und praktischen Empfehlungen ist Armutsbekämpfung die beste Prävention. Um das WHO-Ziel einer Mortalitätsreduktion um 50 % bis 2030 zu erreichen, ist eine kostenlose Behandlung mit Antiveninen und eine Gesundheitsaufklärung der Bevölkerung zur Prävention essenziell.
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Affiliation(s)
- Jörg Blessmann
- Arbeitsgruppe Schlangenbissvergiftungen, Abteilung für Implementationsforschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
| | - Deborah Hosemann
- Arbeitsgruppe Schlangenbissvergiftungen, Abteilung für Implementationsforschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
| | - Friederike Hunstig
- Arbeitsgruppe Schlangenbissvergiftungen, Abteilung für Implementationsforschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
| | - Benno Kreuels
- Arbeitsgruppe Schlangenbissvergiftungen, Abteilung für Implementationsforschung, Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
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