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Suárez JA, Urriola M, Moreno-Botello MM, Naranjo-Lara L, Gundacker N, Ascanio LC, Olivo-Freites C, Paniz-Mondolfi A. Colubrid snake envenomation: Erythrolamprus bizona "false coral" snakebite - clinical aspects and importance of identifying mimics. Am J Emerg Med 2024:S0735-6757(24)00458-3. [PMID: 39289053 DOI: 10.1016/j.ajem.2024.09.018] [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: 07/30/2024] [Revised: 09/06/2024] [Accepted: 09/08/2024] [Indexed: 09/19/2024] Open
Abstract
Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona, commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status.
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Affiliation(s)
- Jose Antonio Suárez
- Sistema Nacional de Investigación-SENACYT, Panamá; Bella Vista, Manuel E. Batista y Ave. Jose De Fabrega, Panama City, Panama Province, Panama; Infectotrópico, SA, Panamá
| | - Mario Urriola
- Serpentario Maravillas Tropicales, Valle de Antón, Panamá
| | | | - Laura Naranjo-Lara
- Sistema Nacional de Investigación-SENACYT, Panamá; Infectotrópico, SA, Panamá
| | - Nathan Gundacker
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Luis C Ascanio
- Department of Pathology, Molecular, and Cell-based medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-based medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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2
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Leppänen V, Mykkänen A. Suspected envenomation by the common European adder (Vipera berus berus) in 28 horses in Finland. J Equine Vet Sci 2024; 140:105145. [PMID: 38960009 DOI: 10.1016/j.jevs.2024.105145] [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: 04/03/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Vipera berus berus is the only venomous snake present in the Nordic countries and cases of envenomation in horses are reported during the warmer months. Little is known about the presentation, treatment and survival of horses with common European adder envenomation. Clinical and laboratory findings, treatment and outcome are reported for 28 horses admitted to Helsinki University Equine Hospital in 2008-2023 due to suspicion of snake bite. Eleven of these horses received antivenom treatment. Other common treatments included non-steroidal anti-inflammatories (22/28), antimicrobials (19/28), intravenous fluid therapy (11/28), corticosteroids (9/28) and local treatment (11/28). All horses survived until discharge. No difference was detected in the length of hospital stay between horses with moderate envenomation that had or had not received antivenom treatment. Horses with moderate envenomation are more likely to receive antivenom treatment and require longer hospital stay than horses with mild envenomation. Antivenom treatment is not associated with shorter hospital stay. Little evidence supports the use of corticosteroids and antibiotics in treatment of envenomation. Studies with larger numbers of animals are warranted to evaluate the effect of treatment, including administration of antivenom, on long-term outcome and survival from envenomation.
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Affiliation(s)
- V Leppänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Viikintie 47, University of Helsinki, 00014, Finland.
| | - A Mykkänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Viikintie 47, University of Helsinki, 00014, Finland
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3
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Gilliam LL. Snake Envenomation. Vet Clin North Am Equine Pract 2024; 40:133-150. [PMID: 37716857 DOI: 10.1016/j.cveq.2023.08.003] [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: 09/18/2023] Open
Abstract
Snakebite envenomation (SBE) in horses can have devastating outcomes. Tissue damage, cardiotoxicity, coagulopathy, and neurotoxicity can be concerns with SBE. Understanding the actions of venom components is important in developing a successful treatment plan. Antivenom is the mainstay of treatment. Long-term deleterious effects can occur including cardiac dysfunction and lameness.
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Affiliation(s)
- Lyndi L Gilliam
- College of Veterinary Medicine, Oklahoma State University, 2065 West Farm Road, Stillwater, OK 74078, USA.
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4
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Baumgartner K, Fishburn S, Mullins ME. Nonsteroidal Anti-Inflammatory Drugs Are Safe and Appropriate for the Treatment of Copperhead Envenomations. Wilderness Environ Med 2022; 33:361. [PMID: 35644736 DOI: 10.1016/j.wem.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin Baumgartner
- Division of Medical Toxicology, Washington University School of Medicine, St. Louis, MO
| | | | - Michael E Mullins
- Division of Medical Toxicology, Washington University School of Medicine, St. Louis, MO
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Nurminen I, Eskola V. Most adder bites in Finland's Lake District caused mild symptoms and severe poisoning was rare. Acta Paediatr 2022; 111:1638-1643. [PMID: 35531612 PMCID: PMC9546192 DOI: 10.1111/apa.16397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
AIM This study investigated the incidence, clinical picture and treatment of paediatric adder bites in Finland's Lake District. METHODS Data were retrospectively collected on all children aged 0-15 years who were bitten by adders from 2006 to 2015 and treated at Tampere University Hospital. The severity was evaluated with the five-level Poisoning Severity Score. RESULTS We found that 109 children were treated following an adder bite, which was an incidence of 13 per 100,000 children from 0 to 15. Of these, 75 were under 8 years of age, with a median age of 3.5 years, and 34 were 8-15 years, with a median age of 10.3 years. The gender distribution was similar in both ages. Younger children were more likely to be bitten in their yards at home, whereas older children were more likely to be bitten in a forest. Older children reported more pain than younger patients. Most children were bitten on a lower limb, with minor symptoms such as localised redness and swelling, and received conservative treatment. Antivenom treatment was rarely administered and then only in severe cases or if symptoms progressed. CONCLUSION Adder bites mostly caused mild symptoms, severe poisoning was rare and antivenom was rarely given.
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Affiliation(s)
- Iiris Nurminen
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Vesa Eskola
- Faculty of Medicine and Health Technology, Tampere Center for Child, Adolescent and Maternal Health Research Tampere University and University Hospital Tampere Finland
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6
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Masri A, Berg KJ, Paul-Murphy J, Guzman DSM. Crotalid Polyvalent F(ab)2 Antivenom Treatment in a Red-Tailed Hawk (Buteo jamaicensis). J Avian Med Surg 2022; 36:63-69. [DOI: 10.1647/21-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mullins ME, Schwarz ES, Liss DB, Baumgartner KT, Devgun JM. How Should Native Crotalid Envenomation Be Managed in the Emergency Department? J Emerg Med 2022; 62:131-132. [PMID: 35090730 DOI: 10.1016/j.jemermed.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Michael E Mullins
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri.
| | - Evan S Schwarz
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - David B Liss
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Kevin T Baumgartner
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Jason M Devgun
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Villca-Corani H, Nieto-Ariza B, León R, Rocabado JA, Chippaux JP, Urra FA. First reports of envenoming by South American water snakes Helicops angulatus and Hydrops triangularis from Bolivian Amazon: A one-year prospective study of non-front-fanged colubroid snakebites. Toxicon 2021; 202:53-59. [PMID: 34562494 DOI: 10.1016/j.toxicon.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Although snakebite incidence is underestimated in Bolivia, the Amazon region presents the highest incidence of these accidents. The local effects of bites by some non-front-fanged colubroid (NFFC) snakes are usually confused with that of viperids, resulting in the improper use of antivenoms and medications. Since there is scarce information on clinical treatment and management of NFFC bites from Bolivian Amazon, we conducted a prospective study of NFFC snakebites by reviewing the records of patients admitted with a snakebite diagnosis at Hospital Central Ivirgarzama, Bolivia. Snakebites were recorded for 12 months (December 2019-November 2020), including information about the sex and age of the patient, snakebite date, and treatment. Eight (5.7 %) of 152 patients were bitten by NFFC Helicops angulatus, Hydrops triangularis, and Erythrolamprus sp. Our results showed that 5/7 patients had prolonged clotting time and INR, as well as local edema and mild pain, suggesting systemic envenoming. Previously non-documented mild coagulopathy was observed for H. angulatus and H. triangularis bites. In some cases, incorrect first-aid measures, and inappropriate use of bothropic/lachesic antivenom were administrated. All the patients received supportive therapy and antihistamine drugs. Unsupported use of non-evidence-based treatments for snakebites such as corticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and prophylactic antibiotic prescription were recorded. In conclusion, we describe the first formally documented snakebite cases produced by NFFC from Bolivia, highlighting the urgent need for training of the medical team in the snake identification, clinical management of snakebite, and the existence of a human-snake conflict involving NFFC species.
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Affiliation(s)
- Huber Villca-Corani
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile.
| | - Beatriz Nieto-Ariza
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - Raúl León
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - José A Rocabado
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia
| | - Jean-Philippe Chippaux
- Proyecto Pucarara, Hospital Central Ivirgarzama, Red de Salud 4, Cochabamba, Bolivia; CRT, Institut Pasteur, MERIT, Institut de Recherche pour le Développement et Université de Paris, Paris, France; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile
| | - Félix A Urra
- Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, Santiago, 7800003, Chile; Network for Snake Venom Research and Drug Discovery, Santiago, 7800003, Chile.
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Gerardo CJ, Silvius E, Schobel S, Eppensteiner JC, McGowan LM, Elster EA, Kirk AD, Limkakeng AT. Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming. Front Immunol 2021; 12:628113. [PMID: 33790901 PMCID: PMC8006329 DOI: 10.3389/fimmu.2021.628113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background The immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this study was to develop pre- and post-antivenom prognostic models comprised of clinical features and immunologic cytokine data that are associated with recovery from SBE. Materials and Methods We performed a prospective cohort study in an academic medical center emergency department. We enrolled consecutive patients with Crotalinae SBE and obtained serum samples based on previously described criteria for the Surgical Critical Care Initiative (SC2i)(ClinicalTrials.gov Identifier: NCT02182180). We assessed a standard set of clinical variables and measured 35 unique cytokines using Luminex Cytokine 35-Plex Human Panel pre- and post-antivenom administration. The Patient-Specific Functional Scale (PSFS), a well-validated patient-reported outcome of functional recovery, was assessed at 0, 7, 14, 21 and 28 days and the area under the patient curve (PSFS AUPC) determined. We performed Bayesian Belief Network (BBN) modeling to represent relationships with a diagram composed of nodes and arcs. Each node represents a cytokine or clinical feature and each arc represents a joint-probability distribution (JPD). Results Twenty-eight SBE patients were enrolled. Preliminary results from 24 patients with clinical data, 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (82%) with a mean age of 38.1 (SD ± 9.8) years. In the pre-antivenom model, the variables most closely associated with the PSFS AUPC are predominantly clinical features. In the post-antivenom model, cytokines are more fully incorporated into the model. The variables most closely associated with the PSFS AUPC are age, antihistamines, white blood cell count (WBC), HGF, CCL5 and VEGF. The most influential variables are age, antihistamines and EGF. Both the pre- and post-antivenom models perform well with AUCs of 0.87 and 0.90 respectively. Discussion Pre- and post-antivenom networks of cytokines and clinical features were associated with functional recovery measured by the PSFS AUPC over 28 days. With additional data, we can identify prognostic models using immunologic and clinical variables to predict recovery from SBE.
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Affiliation(s)
| | | | - Seth Schobel
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | | | - Lauren M McGowan
- Department of Surgery, Duke University, Durham, NC, United States
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Allan D Kirk
- Department of Surgery, Duke University, Durham, NC, United States
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Chuang PC, Chang KW, Cheng SY, Pan HY, Huang KC, Huang YT, Li CJ. Benefits of Early In-Hospital Antivenom Administration to Patients with Protobothrops mucrosquamatus Envenomation. Am J Trop Med Hyg 2021; 104:323-328. [PMID: 33146122 PMCID: PMC7790107 DOI: 10.4269/ajtmh.20-0659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/20/2020] [Indexed: 11/07/2022] Open
Abstract
Protobothrops mucrosquamatus is one of the common venomous snakes in Southeast Asia. This retrospective cohort study conducted in six medical institutions in Taiwan aimed to obtain information on the optimal management strategies for P. mucrosquamatus snakebite envenomation. Data were extracted from the Chang Gung Research Database from January 2006 to December 2016. The association between early antivenom administration and patient demographics, pain requiring treatment with analgesic injections, and hospital length of stay was analyzed. A total of 195 patients were enrolled; 130 were administered antivenom within 1 hour after emergency department arrival (early group), whereas 65 were treated later than 1 hour after arrival (late group). No in-hospital mortality was identified. The difference in surgical intervention rates between the early and late groups was statistically insignificant (P = 0.417). Compared with the early group, the late group showed a higher rate of antivenom skin test performance (46.9% versus 63.1%, respectively, P = 0.033), longer hospital stay (42 ± 62 hours versus 99 ± 70 hours, respectively, P = 0.016), and higher rate of incidences of pain requiring treatment with analgesic injections (29.2% versus 46.2%, respectively, P = 0.019). After adjusting for confounding factors, early antivenom administration was associated with decreased pain requiring treatment with analgesic injections (adjusted odds ratio: 0.51, 95% CI: 0.260-0.985). Antivenom administration within 1 hour of arrival was associated with a decreased likelihood of experiencing pain and hospital length of stay in patients with P. mucrosquamatus snakebites. Antivenom skin testing was associated with delays in antivenom administration.
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Affiliation(s)
- Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Kang-Wei Chang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shih-Yu Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Hsiu-Yung Pan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Kuo-Chen Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yii-Ting Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chao-Jui Li
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
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Cocchio C, Johnson J, Clifton S. Review of North American pit viper antivenoms. Am J Health Syst Pharm 2020; 77:175-187. [PMID: 31974558 DOI: 10.1093/ajhp/zxz278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE For the first time in nearly 20 years, 2 antigen-binding fragment (Fab) antivenoms are available to treat patients who incur North American pit viper snakebites: Crotalidae polyvalent immune Fab (ovine), or simply FabAV; and Crotalidae immune F(ab')2 (equine), or simply F(ab')2. Pharmacists are in a key position for the selection, dosing, reconstitution, administration, and monitoring of antivenom therapy; however, they encounter inconsistent exposure and experience with these drugs. Thus, an updated review of the literature is necessary. METHODS The search strategy and selection incorporated both controlled vocabulary terms and keywords to describe concepts relevant to the search. Retrieval was limited to literature published from 1997 to the present in English, Portuguese, or Spanish. RESULTS Given the paucity of available prospective literature, the authors elected to include all prospective evidence to best describe the role of antivenom. For the primary literature review, manuscripts were excluded if they were observational studies, conference abstracts, narrative or opinion articles, letters to the editor, or in-progress studies. CONCLUSION While there is limited evidence-based guidance on the superiority of F(ab')2 to FabAV, or vice versa, individual and regional considerations should contribute to formulary decisions. Pharmacists must play a role in the development of clinical pathways to ensure appropriate evaluation, supportive care, and antivenom procurement, administration, and monitoring.
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Affiliation(s)
| | - Jami Johnson
- Oklahoma Center for Poison and Drug Information, Oklahoma City, OK, and University of Oklahoma College of Pharmacy, Oklahoma City, OK
| | - Shari Clifton
- Reference & Instructional Services, Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Angarita-Sierra T, Montañez-Méndez A, Toro-Sánchez T, Rodríguez-Vargas A. A case of envenomation by the false fer-de-lance snake Leptodeira annulata (Linnaeus, 1758) in the department of La Guajira, Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2020; 40:20-26. [PMID: 32220160 PMCID: PMC7357383 DOI: 10.7705/biomedica.4773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
Envenomations by colubrid snakes in Colombia are poorly known, consequently, the clinical relevance of these species in snakebite accidents has been historically underestimated. Herein, we report the first case of envenomation by opisthoglyphous snakes in Colombia occurred under fieldwork conditions at the municipality of Distracción, in the department of La Guajira. A female biologist was bitten on the index finger knuckle of her right hand when she tried to handle a false fer-de-lance snake (Leptodeira annulata). Ten minutes after the snakebite, the patient started to have symptoms of mild local envenomation such as edema, itching, and pain in the wound. After 40 minutes, the edema reached its maximum extension covering the dorsal surface of the right hand and causing complete loss of mobility. The clinical treatment focused on pain and swelling control. No laboratory tests were performed. The patient showed good progress with the total regression of the edema 120 hours after the snake-bite accident and complete recovery of the movement of the limb in one week. Venomous bites of "non-venomous snakes" (opisthoglyphous colubrid snakes) must be considered as a significant public health problem because patients lose their work capability during hours or even days and they are forced to seek medical assistance to treat the envenomation manifestations.
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Affiliation(s)
- Teddy Angarita-Sierra
- Vicerrectoría de Investigación, Universidad Manuela Beltrán, Bogotá, D.C., Colombia; Yoluka ONG, Fundación de Investigación en Biodiversidad y Conservación, Bogotá, D.C., Colombia.
| | | | - Tatiana Toro-Sánchez
- Yoluka ONG, Fundación de Investigación en Biodiversidad y Conservación, Bogotá, D.C., Colombia.
| | - Ariadna Rodríguez-Vargas
- Grupo de Investigación en Proteínas, Departamento de Química, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
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Baumgartner KT, Fishburn SJ, Mullins ME. Current Management of Copperhead Snakebites in Missouri. MISSOURI MEDICINE 2019; 116:201-205. [PMID: 31527942 PMCID: PMC6690278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The past two decades have seen changes to the management of copperhead snakebites. We review the current use of antivenom, analgesics, and laboratory testing as well as the declining role of surgical management.
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Affiliation(s)
- Kevin T Baumgartner
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
| | - Steven J Fishburn
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
| | - Michael E Mullins
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
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Lavonas EJ, Gerardo CJ. Letter to the editor: "Safety of nonsteroidal anti-inflammatory drugs in copperhead snakebite patients" by Pham and Mullins, Clin Toxicol 2018 May 18. Clin Toxicol (Phila) 2018; 57:144-145. [PMID: 30306814 DOI: 10.1080/15563650.2018.1502445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eric J Lavonas
- a Department of Emergency Medicine and Rocky Mountain Poison and Drug Center , Denver Health , Denver , CO , USA.,b Department of Emergency Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Charles J Gerardo
- c Division of Emergency Medicine, Department of Surgery , Duke University School of Medicine , Raleigh , NC , USA
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