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Cheng X, Cao F, Zhong C, Wang M, Ye J, Liu Y, Zhang W, Yu F, Wu D, Wang X. Photoresponsive porous ZnO-based broad-spectrum venom first-aid treatment. Biomater Sci 2021; 9:4149-4158. [PMID: 33959736 DOI: 10.1039/d1bm00115a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A venomous snakebite is an emergency. However, antivenoms are rare and very similar, difficult to produce and preserve, and almost impossible to be used for emergency treatment. Therefore, it would be of great significance to develop convenient, efficient and broad-spectrum snake venom neutralizing nano-materials. In this study, inspired by boiled eggs, a new concept based on a ZnO complex (ZC) for the treatment of snake venoms is proposed. In vitro and in vivo experiments proved that ZC could widely adsorb biological (including snake) venoms and effectively reduce the concentration of toxic protein in the blood. More importantly, ZC could realize photothermal conversion under the stimulation of near-infrared (NIR) irradiation, resulting in protein hydrolyzation of venoms, thereby fundamentally prolonging survival time. In addition, ZC not only showed good biocompatibility, but also could inhibit bacterial reproduction, alleviate inflammation, and contribute to the healing of open wounds caused by biological venoms.
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Affiliation(s)
- Xinyan Cheng
- College of Chemistry, Nanchang University, Nanchang, Jiangxi 330088, China.
| | - Fei Cao
- The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Cailing Zhong
- School of Pharmacy, Nanchang University, Nanchang, Jiangxi 330088, China
| | - Manyu Wang
- The National Engineering Research Center for Bioengineering Drugs and the Technologies: Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, China
| | - Jing Ye
- The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yu Liu
- The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Wei Zhang
- College of Chemistry, Nanchang University, Nanchang, Jiangxi 330088, China.
| | - Fen Yu
- College of Chemistry, Nanchang University, Nanchang, Jiangxi 330088, China.
| | - Dan Wu
- School of Public Administration, Nanchang University, Nanchang, Jiangxi 330088, China.
| | - Xiaolei Wang
- College of Chemistry, Nanchang University, Nanchang, Jiangxi 330088, China. and The National Engineering Research Center for Bioengineering Drugs and the Technologies: Institute of Translational Medicine, Nanchang University, Nanchang, Jiangxi 330088, China
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Miyagi K, Shimoji N, Shimoji S, Tahara R, Uechi A, Tamaki I, Oshiro H, Komiyama A, Tedokon M, Hirai I. Comparison of species, virulence genes and clones of Aeromonas isolates from clinical specimens and well water in Okinawa Prefecture, Japan. J Appl Microbiol 2021; 131:1515-1530. [PMID: 33570830 DOI: 10.1111/jam.15038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
AIMS To reveal the sources of Aeromonas infection in Okinawa Prefecture of Japan, the species, virulence genes and clones of strains isolated from clinical specimens and well water were compared. METHODS AND RESULTS The properties of both isolates were investigated by sequencing of rpoD, detection of 10 virulence genes using PCR and genotyping with pulsed-field gel electrophoresis. In all, 68 clinical and 146 well water strains of Aeromonas were isolated and the main species were A. caviae, A. dhakensis, A. hydrophila and A. veronii biovar sobria. Aeromonas dhakensis possessed various virulence genes; however, A. caviae possessed only fla. The same or similar clones were distributed in certain areas of Okinawa and one clone had survived several months in the biliary system of two patients, respectively. CONCLUSION Although the same Aeromonas clone was not isolated from clinical and well water samples, our study revealed the detected patterns of virulence genes in both isolates, the distribution of identical/similar clones in the Okinawan environment and long-time survival in patient's organs. SIGNIFICANCE AND IMPACT OF THE STUDY We investigated the association between Aeromonas patients and well water exposure. This study provides the properties of species, virulence genes and clones of Aeromonas isolated from samples of these origins.
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Affiliation(s)
- K Miyagi
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - N Shimoji
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - S Shimoji
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.,Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - R Tahara
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - A Uechi
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan.,Division of Clinical Laboratory and Blood Transfusion, University Hospital of the Ryukyus, Okinawa, Japan
| | - I Tamaki
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - H Oshiro
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - A Komiyama
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - M Tedokon
- Department of Clinical Laboratory, Urasoe General Hospital, Okinawa, Japan
| | - I Hirai
- Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Yeh H, Gao SY, Lin CC. Wound Infections from Taiwan Cobra ( Naja atra) Bites: Determining Bacteriology, Antibiotic Susceptibility, and the Use of Antibiotics-A Cobra BITE Study. Toxins (Basel) 2021; 13:toxins13030183. [PMID: 33801318 PMCID: PMC7999477 DOI: 10.3390/toxins13030183] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
Wound necrosis and secondary infection are common complications after Naja atra bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report regardless of whether patients’ wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in the future for other Naja spp. bites.
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Affiliation(s)
- Heng Yeh
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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4
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Lin CC, Chen YC, Goh ZNL, Seak CK, Seak JCY, Shi-Ying G, Seak CJ. Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics-A BITE Study. Toxins (Basel) 2020; 12:toxins12090575. [PMID: 32906845 PMCID: PMC7551380 DOI: 10.3390/toxins12090575] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022] Open
Abstract
Snakebites from Taiwan habus (Protobothrops mucrosquamatus) and green bamboo vipers (Viridovipera stejnegeri) account for two-thirds of all venomous snakebites in Taiwan. While there has been ongoing optimization of antivenin therapy, the proper management of superimposed bacterial wound infections is not well studied. In this Bacteriology of Infections in Taiwanese snake Envenomation (BITE) study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with snakebites from these two snakes. We further developed a BITE score to evaluate the probability of wound infections and guide antibiotic usage in this patient population. All snakebite victims who presented to the emergency departments of seven training and research hospitals and received at least one vial of freeze-dried hemorrhagic antivenin between January 2001 and January 2017 were identified. Patient biodata, laboratory investigation results, and treatment modalities were retrieved. We developed our BITE score via univariate and multiple logistic regression analyses. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the BITE score. Out of 8,295,497 emergency department visits, 726 patients presented with snakebites from a Taiwan habu or a green bamboo viper. The wound infection rate was 22.45%, with seven positive wound cultures, including six polymicrobial infections. Morganella morganii, Enterococcus spp., Bacteroides fragilis, and Aeromonas hydrophila were most frequently cultured. There were no positive blood cultures. A total of 33.0% (n = 106) of snakebite patients who received prophylactic antibiotics nevertheless developed wound infections, while 44.8% (n = 73) of wound infection patients were satisfactorily treated with one of the following antibiotics: amoxicillin/clavulanic acid, oxacillin, cefazolin, and ampicillin/sulbactam. With the addition of gentamicin, the success of antibiotic therapy increased by up to 66.54%. The prognostic factors for the secondary bacterial infection of snakebites were white blood cell counts, the neutrophil lymphocyte ratio, and the need for hospital admission. The area under the ROC curve for the BITE score was 0.839. At the optimal cut-off point of 5, the BITE score had a 79.58% accuracy, 82.31% sensitivity, and 79.71% specificity when predicting infection in snakebite patients. Our BITE score may help with antibiotic stewardship by guiding appropriate antibiotic use in patients presenting with snakebites. It may also be employed in further studies into antibiotic prophylaxis in snakebite patients for the prevention of superimposed bacterial wound infections.
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Affiliation(s)
- Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yen-Chia Chen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Zhong Ning Leonard Goh
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Joanna Chen-Yeen Seak
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
| | - Gao Shi-Ying
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
- Correspondence:
| | - SPOT Investigators
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-C.L.); (G.S.-Y.); (S.I.)
- Sarawak General Hospital, Kuching, Sarawak 93586, Malaysia; (Z.N.L.G.); (C.-K.S.); (J.C.-Y.S.)
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
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Devos M, Sainte-Rose V, Kallel H, Mayence C, Ouedraogo H, Djossou F, Demar M, Couppié P, Blaizot R. Skin and soft-tissue infections associated with Aeromonas species in French Guiana: an 11-year retrospective study. J Eur Acad Dermatol Venereol 2020; 34:e414-e416. [PMID: 32176375 PMCID: PMC7496744 DOI: 10.1111/jdv.16365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M Devos
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - V Sainte-Rose
- Laboratory of Bacteriology, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - H Kallel
- Intensive Care Unit, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - C Mayence
- Intensive Care Unit, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - H Ouedraogo
- Orthopaedics Department, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - F Djossou
- Infectious Diseases Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - M Demar
- Laboratory of Bacteriology, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - P Couppié
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - R Blaizot
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
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Heckmann X, Lambert V, Mion G, Ehrhardt A, Marty C, Perotti F, Carod JF, Jolivet A, Boels D, Lehida Andi I, Larréché S. Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana. Clin Toxicol (Phila) 2020; 59:193-199. [PMID: 32609546 DOI: 10.1080/15563650.2020.1786108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn Tri TM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. METHODS This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL-1. The antivenom group included patients receiving Antivipmyn Tri TM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. RESULTS 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. CONCLUSION Antivipmyn Tri TM as currently used did not show any benefit in recovery from coagulopathy.
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Affiliation(s)
- Xavier Heckmann
- Department of Emergency, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana.,French Red Cross, Cayenne, French Guiana
| | - Véronique Lambert
- Department of Obstetrics and Gynaecology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Georges Mion
- Department of Anaesthesiology, Cochin Hospital, Paris, France
| | | | | | - Frédérique Perotti
- Department of Pharmacy, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Jean-François Carod
- Department of Medical Biology, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Anne Jolivet
- Department of Public Health, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - David Boels
- Poison Control Center, Angers University Hospital, Angers, France
| | - Ibrahim Lehida Andi
- Department of Anaesthesiology and Reanimation, Western Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Sébastien Larréché
- Department of Medical Biology, Bégin Military Teaching Hospital, Saint-Mandé, France
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Urra FA, Miranda-Calle AB, Araya-Maturana R. Philodryas (Serpentes: Dipsadidae) Envenomation, a Neglected Issue in Chile. Toxins (Basel) 2019; 11:E697. [PMID: 31795440 PMCID: PMC6950111 DOI: 10.3390/toxins11120697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022] Open
Abstract
Snakebite envenomation is considered a neglected tropical disease, although it also occurs outside the tropics. In this work, we analyzed the literature on Philodryas species in Chile (Philodryaschamissonis, P.simonsii, and P.tachymenoides) from 1834 to 2019, searching for epidemiological, clinical, and molecular aspects of envenomation. Ninety-one percent of the studies found regarded taxonomy, ecology, and natural history, suggesting that snakebites and venom toxins are a neglected issue in Chile. All snakebite cases reported and toxicological studies concerned the species Philodryaschamissonis. Using 185 distributional records from the literature and museum collections for this species, we show for the first time that the reported snakebite cases correlate with human population density, occurring in the Valparaiso and Metropolitan regions in Central Chile. The reduced number of snakebite cases, which were previously considered as having a low incidence in Chile, may be a consequence of under-reported cases, probably due to the inadequate publication or scarce research on this issue. Absence of information about official pharmacological treatment, post-envenoming sequels, clinical management of particular patient groups (e.g., with non-communicable diseases, pregnant women, and the elderly) was also detected. In conclusion, despite having over 185 years of literature on Chilean snakes, knowledge on the envenomation of Philodryas genus remains scarce, seriously affecting adequate medical handling during an ophidic accident. This review highlights the need to develop deep research in this area and urgent improvements to the management of this disease in Chile.
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Affiliation(s)
- Félix A. Urra
- Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Independencia 1027, Casilla 7, Santiago 7800003, Chile
- Network for Snake Venom Research and Drug Discovery, Santiago 7800003, Chile;
| | | | - Ramiro Araya-Maturana
- Network for Snake Venom Research and Drug Discovery, Santiago 7800003, Chile;
- Instituto de Química de Recursos Naturales, Universidad de Talca, Casilla 747, Talca 3460000, Chile
- Programa de Investigación Asociativa en Cáncer Gástrico, Universidad de Talca, Casilla 747, Talca 3460000, Chile
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Kallel H, Mayence C, Houcke S, Mathien C, Mehdaoui H, Gutiérrez JM, Megarbane B, Hommel D, Resiere D. Severe snakebite envenomation in French Guiana: When antivenom is not available. Toxicon 2018; 146:87-90. [PMID: 29621529 DOI: 10.1016/j.toxicon.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/20/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
Abstract
In French Guiana, Bothrops atrox, Bothrops brazili, Bothrops bilineatus, Lachesis muta and Micrurus sp are responsible for most cases of snakebite envenomation. The clinical features in patients suffering from envenomations by viperid snakes involve local tissue damage and systemic manifestations, such as hemorrhage, coagulopathies and hemodynamic instability. We report a severe case of envenomation in a patient bitten by a large unidentified pit viper in French Guiana. Due to lack of antivenom, the patient only received symptomatic management. Severe manifestations of local and systemic envenomation developed, and the patient needed multiple debridement procedures and ultimately required a transfemoral amputation. In addition, Aeromonas hydrophila was cultivated from the affected tissue, suggesting that infection contributed to necrotizing fasciitis. This case highlights the clinical features of a severe viperid snakebite envenomation, and illustrates the urgent need to ensure accessibility of effective and safe polyvalent viperid antivenom in French Guiana.
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Affiliation(s)
- Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, French Guiana.
| | - Claire Mayence
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | | | - Cyrille Mathien
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - Hossein Mehdaoui
- Intensive Care Unit, Fort de France University Hospital, Martinique
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS 1144, Paris-Diderot University, Paris, France
| | - Didier Hommel
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - Dabor Resiere
- Intensive Care Unit, Fort de France University Hospital, Martinique
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9
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Sachett JAG, da Silva IM, Alves EC, Oliveira SS, Sampaio VS, do Vale FF, Romero GAS, dos Santos MC, Marques HO, Colombini M, da Silva AMM, Wen FH, Lacerda MVG, Monteiro WM, Ferreira LCL. Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: A randomized controlled clinical trial. PLoS Negl Trop Dis 2017; 11:e0005745. [PMID: 28692641 PMCID: PMC5519217 DOI: 10.1371/journal.pntd.0005745] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 06/24/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Secondary bacterial infections from snakebites contribute to the high complication rates that can lead to permanent function loss and disabilities. Although common in endemic areas, routine empirical prophylactic use of antibiotics aiming to prevent secondary infection lacks a clearly defined policy. The aim of this work was to estimate the efficacy of amoxicillin clavulanate for reducing the secondary infection incidence in patients bitten by Bothrops snakes, and, secondarily, identify risk factors for secondary infections from snakebites in the Western Brazilian Amazon. METHODS AND FINDINGS This was an open-label, two-arm individually randomized superiority trial to prevent secondary infection from Bothrops snakebites. The antibiotic chosen for this clinical trial was oral amoxicillin clavulanate per seven days compared to no intervention. A total of 345 patients were assessed for eligibility in the study period. From this total, 187 accomplished the inclusion criteria and were randomized, 93 in the interventional group and 94 in the untreated control group. All randomized participants completed the 7 days follow-up period. Enzyme immunoassay confirmed Bothrops envenoming diagnosis in all participants. Primary outcome was defined as secondary infection (abscess and/or cellulitis) until day 7 after admission. Secondary infection incidence until 7 days after admission was 35.5% in the intervention group and 44.1% in the control group [RR = 0.80 (95%CI = 0.56 to 1.15; p = 0.235)]. Survival analysis demonstrated that the time from patient admission to the onset of secondary infection was not different between amoxicillin clavulanate treated and control group (Log-rank = 2.23; p = 0.789).Secondary infections incidence in 7 days of follow-up was independently associated to fibrinogen >400 mg/dL [AOR = 4.78 (95%CI = 2.17 to 10.55; p<0.001)], alanine transaminase >44 IU/L [AOR = 2.52 (95%CI = 1.06 to 5.98; p = 0.037)], C-reactive protein >6.5 mg/L [AOR = 2.98 (95%CI = 1.40 to 6.35; p = 0.005)], moderate pain [AOR = 24.30 (95%CI = 4.69 to 125.84; p<0.001)] and moderate snakebites [AOR = 2.43 (95%CI = 1.07 to 5.50; p = 0.034)]. CONCLUSIONS/SIGNIFICANCE Preemptive amoxicillin clavulanate was not effective for preventing secondary infections from Bothrops snakebites. Laboratorial markers, such as high fibrinogen, alanine transaminase and C-reactive protein levels, and severity clinical grading of snakebites, may help to accurately diagnose secondary infections. TRIAL REGISTRATION Brazilian Clinical Trials Registry (ReBec): RBR-3h33wy; UTN Number: U1111-1169-1005.
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Affiliation(s)
- Jacqueline A. G. Sachett
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Iran Mendonça da Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Eliane Campos Alves
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Sâmella S. Oliveira
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S. Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Núcleo de Sistemas de Informação, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Fábio Francesconi do Vale
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | - Gustavo Adolfo Sierra Romero
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Marcelo Cordeiro dos Santos
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Hedylamar Oliveira Marques
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Manaus, Brazil
| | - Mônica Colombini
- Divisão de Desenvolvimento Científico, Instituto Butantan, São Paulo, Brazil
| | | | - Fan Hui Wen
- Divisão de Desenvolvimento Científico, Instituto Butantan, São Paulo, Brazil
| | - Marcus V. G. Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Wuelton M. Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Luiz C. L. Ferreira
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
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10
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Abba Y, Ilyasu YM, Noordin MM. Isolation and identification of bacterial populations of zoonotic importance from captive non-venomous snakes in Malaysia. Microb Pathog 2017; 108:49-54. [PMID: 28478198 DOI: 10.1016/j.micpath.2017.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Abstract
AIM Captivity of non-venomous snakes such as python and boa are common in zoos, aquariums and as pets in households. Poor captivity conditions expose these reptiles to numerous pathogens which may result in disease conditions. The purpose of this study was to investigate the common bacteria isolated from necropsied captive snakes in Malaysia over a five year period. MATERIALS AND METHODS A total of 27 snake carcasses presented for necropsy at the Universiti Putra Malaysia (UPM) were used in this survey. Samples were aseptically obtained at necropsy from different organs/tissues (lung, liver, heart, kindey, oesophagus, lymph node, stomach, spinal cord, spleen, intestine) and cultured onto 5% blood and McConkey agar, respectively. Gram staining, morphological evaluation and biochemical test such as oxidase, catalase and coagulase were used to tentatively identify the presumptive bacterial isolates. RESULTS Pythons had the highest number of cases (81.3%) followed by anaconda (14.8%) and boa (3.7%). Mixed infection accounted for 81.5% in all snakes and was highest in pythons (63%). However, single infection was only observed in pythons (18.5%). A total of 82.7%, 95.4% and 100% of the bacterial isolates from python, anaconda and boa, respectively were gram negative. Aeromonas spp was the most frequently isolated bacteria in pythons and anaconda with incidences of 25 (18%) and 8 (36.6%) with no difference (p > 0.05) in incidence, respectively, while Salmonella spp was the most frequently isolated in boa and significantly higher (p < 0.05) than in python and anaconda. Bacteria species were most frequently isolated from the kidney of pythons 35 (25.2%), intestines of anacondas 11 (50%) and stomach of boa 3 (30%). CONCLUSION This study showed that captive pythons harbored more bacterial species than anaconda or boa. Most of the bacterial species isolated from these snakes have public health importance and have been incriminated in human infections worldwide.
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Affiliation(s)
- Yusuf Abba
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400, Serdang, Selangor D.E, Malaysia; Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Maiduguri, PMB 1069, Maiduguri 600233, Borno State, Nigeria.
| | - Yusuf Maina Ilyasu
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400, Serdang, Selangor D.E, Malaysia.
| | - Mustapha Mohamed Noordin
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400, Serdang, Selangor D.E, Malaysia.
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11
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Cushing A, Pinborough M, Stanford M. Review of bacterial and fungal culture and sensitivity results from reptilian samples submitted to a UK laboratory. Vet Rec 2011; 169:390. [DOI: 10.1136/vr.d4636] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A. Cushing
- Birch Heath Veterinary Clinic; Birch Heath Road Tarporley Cheshire CW6 9UU UK
| | - M. Pinborough
- Pinmoore Animal Laboratory Services Limited; Birch Heath Road Tarporley Cheshire CW6 9UU UK
| | - M. Stanford
- Birch Heath Veterinary Clinic; Birch Heath Road Tarporley Cheshire CW6 9UU UK
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12
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Bucaretchi F, Herrera SR, Hyslop S, Baracat EC, Vieira RJ. Snakebites by Bothrops spp in children in Campinas, São Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2001; 43:329-33. [PMID: 11781603 DOI: 10.1590/s0036-46652001000600006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
From January, 1984 to March, 1999, 73 children under 15 y old (ages 1-14 y, median 9 y) were admitted after being bitten by snakes of the genus Bothrops. Twenty-six percent of the children were classified as mild envenoming, 50.7% as moderate envenoming and 20.6% as severe envenoming. Two patients (2.7%) showed no signs of envenoming. Most of the patients presented local manifestations, mainly edema (94.5%), pain (94.5%) ecchymosis (73.9%) and blisters (11%). Local and/or systemic bleeding was observed in 28.8% of the patients. Before antivenom (AV) administration, blood coagulation disorders were observed in 60.7% (incoagulable blood in 39.3%) of the 56 children that received AV only in our hospital. AV early reactions, most of which were considered mild, were observed in 44.6% of these cases (in 15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). The main clinical complications observed were local infection (15.1%), compartment syndrome (4.1%), gangrene (1.4%) and acute renal failure (1.4%). No deaths were recorded. There were no significant differences with regard to severity of envenoming versus the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75) or in the frequency of patients with AV early reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infection was significantly greater in severe cases (p < 0.001). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenoming (p = 0.04).
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Affiliation(s)
- F Bucaretchi
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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