1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Di Nicola MR, Crevani M, Avella I, Cerullo A, Dorne JLCM, Paolino G, Zattera C. A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins (Basel) 2024; 16:255. [PMID: 38922149 PMCID: PMC11209566 DOI: 10.3390/toxins16060255] [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: 04/30/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
The genus Vipera encompasses most species of medically significant venomous snakes of Europe, with Italy harbouring four of them. Envenomation by European vipers can result in severe consequences, but underreporting and the absence of standardised clinical protocols hinder effective snakebite management. This study provides an updated, detailed set of guidelines for the management and treatment of Vipera snakebite tailored for Italian clinicians. It includes taxonomic keys for snake identification, insights into viper venom composition, and recommendations for clinical management. Emphasis is placed on quick and reliable identification of medically relevant snake species, along with appropriate first aid measures. Criteria for antivenom administration are outlined, as well as indications on managing potential side effects. While the protocol is specific to Italy, its methodology can potentially be adapted for other European countries, depending on local resources. The promotion of comprehensive data collection and collaboration among Poison Control Centres is advocated to optimise envenomation management protocols and improve the reporting of epidemiological data concerning snakebite at the country level.
Collapse
Affiliation(s)
- Matteo Riccardo Di Nicola
- Unit of Dermatology and Cosmetology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Wildlife Health Ghent, Ghent University, 9820 Merelbeke, Belgium
- Asociación Herpetológica Española, Apartado de correos 191, 28911 Leganés, Spain
| | - Marta Crevani
- Poison Control Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Ignazio Avella
- Landes-Offensive zur Entwicklung Wissenschaftlich-ökonomischer Exzellenz-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
| | - Anna Cerullo
- Department of Veterinary Sciences, University of Turin, L.go Braccini 2, 10095 Grugliasco, Italy
| | - Jean-Lou C. M. Dorne
- Methodological and Scientific Support Unit, European Food Safety Authority, Via Carlo Magno 1A, 43100 Parma, Italy
| | - Giovanni Paolino
- Unit of Dermatology and Cosmetology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Zattera
- Unit of Emergency Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo University Hospital, University of Pavia, P.Le Golgi, 19, 27100 Pavia, Italy
| |
Collapse
|
4
|
Stazi M, Megighian A, D'Este G, Negro S, Ivanušec A, Lonati D, Pirazzini M, Križaj I, Montecucco C. An agonist of CXCR4 induces a rapid recovery from the neurotoxic effects of Vipera ammodytes and Vipera aspis venoms. J Neurochem 2024; 168:428-440. [PMID: 36912731 DOI: 10.1111/jnc.15803] [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: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/14/2023]
Abstract
People bitten by Alpine vipers are usually treated with antivenom antisera to prevent the noxious consequences caused by the injected venom. However, this treatment suffers from a number of drawbacks and additional therapies are necessary. The venoms of Vipera ammodytes and of Vipera aspis are neurotoxic and cause muscle paralysis by inducing neurodegeneration of motor axon terminals because they contain a presynaptic acting sPLA2 neurotoxin. We have recently found that any type of damage to motor axons is followed by the expression and activation of the intercellular signaling axis consisting of the CXCR4 receptor present on the membrane of the axon stump and of its ligand, the chemokine CXCL12 released by activated terminal Schwann cells. We show here that also V. ammodytes and V. aspis venoms cause the expression of the CXCL12-CXCR4 axis. We also show that a small molecule agonist of CXCR4, dubbed NUCC-390, induces a rapid regeneration of the motor axon terminal with functional recovery of the neuromuscular junction. These findings qualify NUCC-390 as a promising novel therapeutics capable of improving the recovery from the paralysis caused by the snakebite of the two neurotoxic Alpine vipers.
Collapse
Affiliation(s)
- M Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - A Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - G D'Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - S Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - A Ivanušec
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Doctoral School, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - D Lonati
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - M Pirazzini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - I Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - C Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- National Research Council, Institute of Neuroscience, Padova, Italy
| |
Collapse
|
5
|
Paolino G, Pampena R, Di Nicola MR. Snakebites in children: Also a European occurrence. Toxicon 2023; 236:107344. [PMID: 37949245 DOI: 10.1016/j.toxicon.2023.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Giovanni Paolino
- Unità di Dermatologia e Cosmetologia, IRCCS Ospedale San Raffaele, Milan, Italy; Unità di Dermatologia Clinica, Università Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Pampena
- Unità di Dermatologia e Cosmetologia, IRCCS Ospedale San Raffaele, Milan, Italy
| | | |
Collapse
|
6
|
Larréché S, Bousquet A, da Silva L, Planelles A, Ksas R, Mérens A, Chippaux JP. Antibiotic susceptibility of cultivable microbiota from the oral cavity of captive Bothrops atrox and Bothrops lanceolatus: Implications for the treatment of snakebite-associated infections in the French departments of America. Infect Dis Now 2023; 53:104721. [PMID: 37196810 DOI: 10.1016/j.idnow.2023.104721] [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: 03/10/2023] [Revised: 04/11/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Secondary infection is a frequent complication after bites by Bothrops atroxin French Guiana or B. lanceolatus in Martinique. Knowledge of the bacteria present in snake mouths is a valuable aid for determining probabilistic antibiotherapy after Bothrops bite. The objectives of this study were to describe the cultivable bacteria of the oral microbiota of the specimens of B. atrox and B. lanceolatus kept in captivity, and to study their susceptibility to antibiotics. METHODS Fifteen B. atrox and 15 B. lanceolatus were sampled. Bacterial cultures were performed and each morphotype on plates was identified using MALDI-TOF mass spectrometry. Antibiotic susceptibility was studied using the agar disk diffusion method, with possible determination of the MICs. RESULTS One hundred and twenty-two isolates were identified: 52 isolates and 13 species in B. atrox, 70 isolates and 23 species in B. lanceolatus. The main species were Providencia rettgeri, Morganella morganii, Pseudomonas aeruginosa, Staphylococcus xylosus, and Paeniclostridium sordellii (only in B. lanceolatus mouths). For B. atrox, 96% of isolates were susceptible to piperacillin/tazobactam, cefepime, imipenem and meropenem, 94% to ciprofloxacin and 76% to cefotaxime and ceftriaxone. For B. lanceolatus, 97% of isolates were susceptible to meropenem, 96% to cefepime, 93% to imipenem and piperacillin/tazobactam, 80% to ciprofloxacin, and 75% to cefotaxime and ceftriaxone. Many isolates were resistant towards amoxicillin/clavulanate. CONCLUSION Among currently recommended antibiotics, cefepime and piperacillin/tazobactam seem more suitable than cefotaxime or ceftriaxone in the event of a Bothrops bite. Ciprofloxacin may also be considered for B. atrox.
Collapse
Affiliation(s)
- S Larréché
- Department of Medical Biology, Bégin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France; INSERM, UMRS-1144, Paris Cité University, 4 avenue de l'Observatoire, 75006 Paris, France.
| | - A Bousquet
- Department of Medical Biology, Bégin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - L da Silva
- Department of Medical Biology, Bégin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - A Planelles
- Venomworld, 28 rue Paul-Henri Spaak, 77400 Saint-Thibault-des-Vignes, France
| | - R Ksas
- Venomworld, 28 rue Paul-Henri Spaak, 77400 Saint-Thibault-des-Vignes, France
| | - A Mérens
- Department of Medical Biology, Bégin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France; French Military Medical Academy, 1 place Alphonse Laveran, 75005 Paris, France
| | - J-P Chippaux
- UMR216-MERIT, Paris Cité University, 4 avenue de l'Observatoire, 75006 Paris, France
| |
Collapse
|
7
|
Hsu JY, Chiang SO, Yang CC, Hsieh TW, Chung CJ, Mao YC. Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002-2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database. PLoS Negl Trop Dis 2023; 17:e0011376. [PMID: 37289739 DOI: 10.1371/journal.pntd.0011376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. METHODS AND RESULTS This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18-64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. CONCLUSIONS Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention.
Collapse
Affiliation(s)
- Jen-Yu Hsu
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- Office of Preventive Medicine, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-O Chiang
- ESTAT Statistical Consulting Co., Ltd., Taipei, Taiwan
| | - Chen-Chang Yang
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tan-Wen Hsieh
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yan-Chiao Mao
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
8
|
Avella I, Damm M, Freitas I, Wüster W, Lucchini N, Zuazo Ó, Süssmuth RD, Martínez-Freiría F. One Size Fits All-Venomics of the Iberian Adder ( Vipera seoanei, Lataste 1878) Reveals Low Levels of Venom Variation across Its Distributional Range. Toxins (Basel) 2023; 15:371. [PMID: 37368672 PMCID: PMC10301717 DOI: 10.3390/toxins15060371] [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: 04/29/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
European vipers (genus Vipera) are medically important snakes displaying considerable venom variation, occurring at different levels in this group. The presence of intraspecific venom variation, however, remains understudied in several Vipera species. Vipera seoanei is a venomous snake endemic to the northern Iberian Peninsula and south-western France, presenting notable phenotypic variation and inhabiting several diverse habitats across its range. We analysed the venoms of 49 adult specimens of V. seoanei from 20 localities across the species' Iberian distribution. We used a pool of all individual venoms to generate a V. seoanei venom reference proteome, produced SDS-PAGE profiles of all venom samples, and visualised patterns of variation using NMDS. By applying linear regression, we then assessed presence and nature of venom variation between localities, and investigated the effect of 14 predictors (biological, eco-geographic, genetic) on its occurrence. The venom comprised at least 12 different toxin families, of which five (i.e., PLA2, svSP, DI, snaclec, svMP) accounted for about 75% of the whole proteome. The comparative analyses of the SDS-PAGE venom profiles showed them to be remarkably similar across the sampled localities, suggesting low geographic variability. The regression analyses suggested significant effects of biological and habitat predictors on the little variation we detected across the analysed V. seoanei venoms. Other factors were also significantly associated with the presence/absence of individual bands in the SDS-PAGE profiles. The low levels of venom variability we detected within V. seoanei might be the result of a recent population expansion, or of processes other than directional positive selection.
Collapse
Affiliation(s)
- Ignazio Avella
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; (I.F.); (N.L.)
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4099-002 Porto, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - Maik Damm
- Institut für Chemie, Technische Universität Berlin, Straße des 17. Juni 124, 10623 Berlin, Germany; (M.D.)
| | - Inês Freitas
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; (I.F.); (N.L.)
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4099-002 Porto, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - Wolfgang Wüster
- Molecular Ecology and Evolution at Bangor, School of Natural Sciences, Bangor University, Bangor LL57 2UW, UK;
| | - Nahla Lucchini
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; (I.F.); (N.L.)
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4099-002 Porto, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - Óscar Zuazo
- Calle La Puebla 1, 26250 Santo Domingo de la Calzada, Spain
| | - Roderich D. Süssmuth
- Institut für Chemie, Technische Universität Berlin, Straße des 17. Juni 124, 10623 Berlin, Germany; (M.D.)
| | - Fernando Martínez-Freiría
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal; (I.F.); (N.L.)
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| |
Collapse
|
9
|
Paolino G, Di Nicola MR, Avella I, Mercuri SR. Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management. Life (Basel) 2023; 13:1228. [PMID: 37374011 DOI: 10.3390/life13061228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them.
Collapse
Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Unit of Clinical Dermatology, Università Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Matteo Riccardo Di Nicola
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Asociación Herpetológica Española, Apartado de Correos 191, 28911 Leganés, Spain
| | - Ignazio Avella
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4099-002 Porto, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - Santo Raffaele Mercuri
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| |
Collapse
|
10
|
A Viper bite in an urban area : A case report. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1191161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Envenomous viper snakes are not natural inhabitants of Istanbul, Turkey. The city is crowded and lacks an appropriate area for wild
life. Viper snakes are mostly found in southern and middle rural Anatolia in Turkey. To our knowledge, viper bites have not been
reported in our urban area previously. Here, we report a envenomous snakebite case, treated with polyvalent antivenom successfully.
The snake was identified as Vipera Pontica, by the National Poisons Center.
Collapse
|
11
|
Siigur J, Siigur E. Biochemistry and toxicology of proteins and peptides purified from the venom of Vipera berus berus. Toxicon X 2022; 15:100131. [PMID: 35769869 PMCID: PMC9234072 DOI: 10.1016/j.toxcx.2022.100131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 12/19/2022] Open
Abstract
The isolation and characterization of individual snake venom components is important for a deeper understanding of the pathophysiology of envenomation and for improving the therapeutic procedures of patients. It also opens possibilities for the discovery of novel toxins that might be useful as tools for understanding cellular and molecular processes. The variable venom composition, toxicological and immunological properties of the common vipers (Vipera berus berus) have been reviewed. The combination of venom gland transcriptomics, bottom-up and top-down proteomics enabled comparison of common viper venom proteomes from multiple individuals. V. b. berus venom contains proteins and peptides belonging to 10–15 toxin families: snake venom metalloproteinase, phospholipases A2 (PLA2), snake venom serine proteinase, aspartic protease, L-amino acid oxidase (LAAO), hyaluronidase, 5′-nucleotidase, glutaminyl-peptide cyclotransferase, disintegrin, C-type lectin (snaclec), nerve growth factor, Kunitz type serine protease inhibitor, snake venom vascular endothelial growth factor, cysteine-rich secretory protein, bradykinin potentiating peptide, natriuretic peptides. PLA2 and LAAO from V. b. berus venom produce more pronounced cytotoxic effects in cancer cells than normal cells, via induction of apoptosis, cell cycle arrest and suppression of proliferation. Proteomic data of V. b. berus venoms from different parts of Russia and Slovakian Republic have been compared with analogous data for Vipera nikolskii venom. Proteomic studies demonstrated quantitative differences in the composition of V. b. berus venom from different geographical regions. Differences in the venom composition of V. berus were mainly driven by the age, sex, habitat and diet of the snakes. The venom variability of V. berus results in a loss of antivenom efficacy against snakebites. The effectiveness of antibodies is discussed. This review presents an overview with a special focus on different toxins that have been isolated and characterized from the venoms of V. b. berus. Their main biochemical properties and toxic actions are described. Vipera berus berus venom composition is variable among different populations. Venom contains about 15 protein/peptide families. It disturbs blood coagulation inducing pro- or anticoagulant effects. Venom contains different types of blood factor X activators. PLA2 and L-amino acid oxidase produce cytotoxic effects in cancer cells.
Collapse
|
12
|
Bites by Non-Native Reptiles in France: Species, Circumstances and Outcome. Toxins (Basel) 2022; 14:toxins14080570. [PMID: 36006232 PMCID: PMC9412768 DOI: 10.3390/toxins14080570] [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] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to make an exhaustive assessment of circumstances of bites by exotic reptiles bred in France. A retrospective observational study was conducted in all the reported cases from 2000 to 2020 in French poison control centers (PCCs). Two hundred and eighteen cases of bites were recorded. The sex ratio (M/F) of the patients was 1.79 and the mean age of the patients was 29.0 ± 15.8 years. Twenty-two cases (10.1%) occurred during the deep night. One hundred and eighty-six bites (85.7%) occurred in a private context; however, there were more cases of high severity when it occurred in a professional setting (60.0% vs. 11.2%, p < 0.01). The feeding/nursing activity accounted for 54.7% cases. Forty-three species of snake were identified; 28 were considered venomous. There were no deaths among the patients in the study. Most of the cases (85.8%) were of mild severity. All of the patients bitten by a venomous reptile were hospitalized: 10 patients received an antivenom; and 2 required surgery. Bites occurred at home and by a small number of popular non-venomous reptile species (pythons and boas, colubrids). These occurred mainly when handling the animals. The rare envenomations were mainly by Asian and American crotalids, followed by elapids. One-third of them were treated with antivenom when available.
Collapse
|
13
|
Blasco Mariño R, Soteras Martínez I, Hernandez Roca AI, Zafren K. Isolated Ptosis Following a Vipera aspis Bite. Wilderness Environ Med 2022; 33:245-247. [PMID: 35367125 DOI: 10.1016/j.wem.2022.02.007] [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: 10/05/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022]
Abstract
In Spain, snakebites are uncommon medical emergencies that cause barely 100 hospitalizations annually. Most of the venomous bites are by snakes of the Viperidae family. Venom from Vipera snakes is reported to have cytotoxic and hematotoxic effects, and neurological effects have also been described. Ptosis (cranial nerve III palsy) is the most common sign, although any cranial nerve can be affected. We describe isolated ptosis, which was very likely after a Vipera aspis bite in the East Catalonian Pyrenees. No antivenom was administered. The ptosis resolved spontaneously within 10 h. Although neurologic findings are usually mild, they indicate a moderate or severe envenomation. Treating snakebites can be challenging for clinicians, especially when there are uncommon clinical manifestations. A toxicologist at a poison center should be consulted to help guide management. Development of local protocols may provide clinical support.
Collapse
Affiliation(s)
- Robert Blasco Mariño
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain.
| | - Iñigo Soteras Martínez
- Department of Medical Science, Faculty of Medicine, University of Girona, Girona, Spain; Department of Emergency, Cerdanya Hospital, Puigcerdà, Spain; Sistema Emergències Mèdiques (SEM), Catalonia, Spain
| | | | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska; Department of Emergency Medicine, Stanford University Medical Center, Stanford, California; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| |
Collapse
|
14
|
Harjen HJ, Hellum M, Rørtveit R, Oscarson M, Anfinsen KP, Moldal ER, Solbak S, Kanse SM, Henriksson CE. Persistent hypercoagulability in dogs envenomated by the European adder (Vipera berus berus). PLoS One 2022; 17:e0263238. [PMID: 35180240 PMCID: PMC8856559 DOI: 10.1371/journal.pone.0263238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Envenomation by the European adder, Vipera berus berus (Vbb), is a medical emergency. The overall in vivo haemostatic effects of pro- and anticoagulant components in Vbb venom, and the downstream effects of cellular injury and systemic inflammation, are unclear. Objectives To longitudinally describe the global coagulation status of dogs after Vbb envenomation and compare to healthy controls. A secondary aim was to investigate differences between dogs treated with and without antivenom. Methods Citrated plasma was collected at presentation, 12 hours (h), 24 h, 36 h and 15 days after bite from 28 dogs envenomated by Vbb, and from 28 healthy controls at a single timepoint. Thrombin generation (initiated with and without exogenous phospholipids and tissue factor), thrombin-antithrombin (TAT)-complexes and the procoagulant activity of phosphatidylserine (PS)-expressing extracellular vesicles (EVs), expressed as PS-equivalents, were measured. Results At presentation the envenomated dogs were hypercoagulable compared to controls, measured as increased thrombin generation, TAT-complexes and PS-equivalents. The hypercoagulability decreased gradually but compared to controls thrombin generation and PS-equivalents were still increased at day 15. The discrepancy in peak thrombin between envenomated dogs and controls was greater when the measurement was phospholipid-dependent, indicating that PS-positive EVs contribute to hypercoagulability. Lag time was shorter in non-antivenom treated dogs, compared to antivenom treated dogs <24 h after envenomation. Conclusions Hypercoagulability was measured in dogs up to 15 days after Vbb envenomation. Dogs treated with antivenom may be less hypercoagulable than their non-antivenom treated counterparts. Thrombin generation is a promising diagnostic and monitoring tool for Vbb envenomation.
Collapse
Affiliation(s)
- Hannah J. Harjen
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- * E-mail:
| | - Marit Hellum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Runa Rørtveit
- Faculty of Veterinary Medicine, Department of Preclinical Sciences and Pathology, Norwegian University of Life Sciences, Oslo, Norway
| | | | - Kristin P. Anfinsen
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Elena R. Moldal
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Susanna Solbak
- Anicura Dyresykehus Oslo, Oslo, Norway
- Anicura Jeløy Dyresykehus, Moss, Norway
| | - Sandip M. Kanse
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Carola E. Henriksson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
15
|
Review of the Mechanisms of Snake Venom Induced Pain: It's All about Location, Location, Location. Int J Mol Sci 2022; 23:ijms23042128. [PMID: 35216244 PMCID: PMC8879488 DOI: 10.3390/ijms23042128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Pain—acute, chronic and debilitating—is the most feared neurotoxicity resulting from a survivable venomous snake bite. The purpose of this review is to present in a novel paradigm what we know about the molecular mechanisms responsible for pain after envenomation. Progressing from known pain modulating peptides and enzymes, to tissue level interactions with venom resulting in pain, to organ system level pain syndromes, to geographical level distribution of pain syndromes, the present work demonstrates that understanding the mechanisms responsible for pain is dependent on “location, location, location”. It is our hope that this work can serve to inspire the molecular and epidemiologic investigations needed to better understand the neurotoxic mechanisms responsible for these snake venom mediated diverse pain syndromes and ultimately lead to agent specific treatments beyond anti-venom alone.
Collapse
|
16
|
Teodoro A, Gonçalves FJ, Oliveira H, Marques S. Venom of Viperidae: A Perspective of its Antibacterial and Antitumor
Potential. Curr Drug Targets 2022; 23:126-144. [DOI: 10.2174/1389450122666210811164517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 12/25/2022]
Abstract
:
The emergence of multi-drug resistant bacteria and limitations on cancer treatment represent
two important challenges in modern medicine. Biological compounds have been explored with
a particular focus on venoms. Although they can be lethal or cause considerable damage to humans,
venom is also a source rich in components with high therapeutic potential.
:
Viperidae family is one of the most emblematic venomous snake families and several studies highlighted
the antibacterial and antitumor potential of viper toxins. According to the literature, these
activities are mainly associated to five protein families - svLAAO, Disintegrins, PLA2, SVMPs and
C-type lectins- that act through different mechanisms leading to the inhibition of the growth of bacteria,
as well as, cytotoxic effects and inhibition of metastasis process. In this review, we provide
an overview of the venom toxins produced by species belonging to the Viperidae family, exploring
their roles during the envenoming and their pharmacological properties, in order to demonstrate its
antibacterial and antitumor potential.
Collapse
Affiliation(s)
- André Teodoro
- Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fernando J.M. Gonçalves
- Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
- CESAM- Centre for Environmental and
Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Helena Oliveira
- Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
- CESAM- Centre for Environmental and
Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sérgio Marques
- Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
- CESAM- Centre for Environmental and
Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
| |
Collapse
|
17
|
Damm M, Hempel BF, Süssmuth RD. Old World Vipers-A Review about Snake Venom Proteomics of Viperinae and Their Variations. Toxins (Basel) 2021; 13:toxins13060427. [PMID: 34204565 PMCID: PMC8235416 DOI: 10.3390/toxins13060427] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
Fine-tuned by millions of years of evolution, snake venoms have frightened but also fascinated humanity and nowadays they constitute potential resources for drug development, therapeutics and antivenoms. The continuous progress of mass spectrometry techniques and latest advances in proteomics workflows enabled toxinologists to decipher venoms by modern omics technologies, so-called ‘venomics’. A tremendous upsurge reporting on snake venom proteomes could be observed. Within this review we focus on the highly venomous and widely distributed subfamily of Viperinae (Serpentes: Viperidae). A detailed public literature database search was performed (2003–2020) and we extensively reviewed all compositional venom studies of the so-called Old-World Vipers. In total, 54 studies resulted in 89 venom proteomes. The Viperinae venoms are dominated by four major, four secondary, six minor and several rare toxin families and peptides, respectively. The multitude of different venomics approaches complicates the comparison of venom composition datasets and therefore we differentiated between non-quantitative and three groups of quantitative workflows. The resulting direct comparisons within these groups show remarkable differences on the intra- and interspecies level across genera with a focus on regional differences. In summary, the present compilation is the first comprehensive up-to-date database on Viperinae venom proteomes and differentiating between analytical methods and workflows.
Collapse
Affiliation(s)
- Maik Damm
- Department of Chemistry, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany;
| | - Benjamin-Florian Hempel
- BIH Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, (BCRT), 10117 Berlin, Germany;
| | - Roderich D. Süssmuth
- Department of Chemistry, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany;
- Correspondence: ; Tel.: +49-(0)30-314-24205
| |
Collapse
|
18
|
Chowdhury A, Zdenek CN, Lewin MR, Carter R, Jagar T, Ostanek E, Harjen H, Aldridge M, Soria R, Haw G, Fry BG. Venom-Induced Blood Disturbances by Palearctic Viperid Snakes, and Their Relative Neutralization by Antivenoms and Enzyme-Inhibitors. Front Immunol 2021; 12:688802. [PMID: 34177943 PMCID: PMC8222980 DOI: 10.3389/fimmu.2021.688802] [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: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022] Open
Abstract
Palearctic vipers are medically significant snakes in the genera Daboia, Macrovipera, Montivipera, and Vipera which occur throughout Europe, Central Asia, Near and Middle East. While the ancestral condition is that of a small-bodied, lowland species, extensive diversification has occurred in body size, and niche specialization. Using 27 venom samples and a panel of in vitro coagulation assays, we evaluated the relative coagulotoxic potency of Palearctic viper venoms and compared their neutralization by three antivenoms (Insoserp Europe, VIPERFAV and ViperaTAb) and two metalloprotease inhibitors (prinomastat and DMPS). We show that variation in morphology parallels variation in the Factor X activating procoagulant toxicity, with the three convergent evolutions of larger body sizes (Daboia genus, Macrovipera genus, and Vipera ammodytes uniquely within the Vipera genus) were each accompanied by a significant increase in procoagulant potency. In contrast, the two convergent evolutions of high altitude specialization (the Montivipera genus and Vipera latastei uniquely within the Vipera genus) were each accompanied by a shift away from procoagulant action, with the Montivipera species being particularly potently anticoagulant. Inoserp Europe and VIPERFAV antivenoms were both effective against a broad range of Vipera species, with Inoserp able to neutralize additional species relative to VIPERFAV, reflective of its more complex antivenom immunization mixture. In contrast, ViperaTAb was extremely potent in neutralizing V. berus but, reflective of this being a monovalent antivenom, it was not effective against other Vipera species. The enzyme inhibitor prinomastat efficiently neutralized the metalloprotease-driven Factor X activation of the procoagulant venoms. In contrast, DMPS (2,3-dimercapto-1-propanesulfonic acid), which as been suggested as another potential treatment option in the absence of antivenom, DMPS failed against all venoms tested. Overall, our results highlight the evolutionary variations within Palearctic vipers and help to inform clinical management of viper envenomation.
Collapse
Affiliation(s)
- Abhinandan Chowdhury
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, Australia
- Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
| | - Christina N. Zdenek
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, Australia
| | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, CA, United States
- Ophirex, Inc., Corte Madera, CA, United States
| | | | | | | | - Hannah Harjen
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Ås, Norway
| | | | | | - Grace Haw
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, Australia
| | - Bryan G. Fry
- Venom Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, Australia
| |
Collapse
|
19
|
Marano M, Pisani M, Zampini G, Pontrelli G, Roversi M. Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach. Toxins (Basel) 2021; 13:toxins13050330. [PMID: 34063282 PMCID: PMC8170888 DOI: 10.3390/toxins13050330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.
Collapse
Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Giuseppe Pontrelli
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Roversi
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Correspondence:
| |
Collapse
|
20
|
Mao YC, Chuang HN, Shih CH, Hsieh HH, Jiang YH, Chiang LC, Lin WL, Hsiao TH, Liu PY. An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota. PLoS Negl Trop Dis 2021; 15:e0009331. [PMID: 33857127 PMCID: PMC8078740 DOI: 10.1371/journal.pntd.0009331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/27/2021] [Accepted: 03/25/2021] [Indexed: 01/11/2023] Open
Abstract
Naja atra is a major venomous snake found in Taiwan. The bite of this snake causes extensive wound necrosis or necrotizing soft tissue infection. Conventional microbial culture-based techniques may fail to identify potential human pathogens and render antibiotics ineffective in the management of wound infection. Therefore, we evaluated 16S Sanger sequencing and next-generation sequencing (NGS) to identify bacterial species in the oropharynx of N. atra. Using conventional microbial culture methods and the VITEK 2 system, we isolated nine species from snakebite wounds. On the basis of the 16S Sanger sequencing of bacterial clones from agar plates, we identified 18 bacterial species in the oropharynx of N. atra, including Morganella morganii, Proteus vulgaris, and Proteus mirabilis, which were also present in the infected bite wound. Using NGS of 16S metagenomics, we uncovered more than 286 bacterial species in the oropharynx of N. atra. In addition, the bacterial species identified using 16S Sanger sequencing accounted for only 2% of those identified through NGS of 16S metagenomics. The bacterial microbiota of the oropharynx of N. atra were modeled better using NGS of 16S metagenomics compared to microbial culture-based techniques. Stenotrophomonas maltophilia, Acinetobacter baumannii, and Proteus penneri were also identified in the NGS of 16S metagenomics. Understanding the bacterial microbiota that are native to the oropharynx of N. atra, in addition to the bite wound, may have additional therapeutic implications regarding empiric antibiotic selection for managing N. atra bites. Naja atra bites induce extensive wound necrotizing soft tissue infections in a substantial proportion of patients. Empiric antibiotic administration in snakebite patients is a common practice, but clinical reports indicate that this treatment was ineffective in preventing secondary infection given that the microbiota of the infected wound and oropharynx of the culprit snake were not properly established. In this study, only 9 species were detected in cobra bites using a conventional microbial culture method and the VITEK 2 system, whereas 18 species were detected in the cobra oropharynx using microbial culture-based 16S Sanger sequencing. Among these, Morganella morganii, Proteus vulgaris, and Proteus mirabilis were identified as common bacteria. Compared to microbial culture-based 16S Sanger sequencing, NGS-based 16S metagenomic sequencing detected more than 286 bacterial species. Stenotrophomonas maltophilia, Acinetobacter baumannii, and Proteus penneri only appeared with 16S metagenomic sequencing. These results suggest that NGS-based 16S metagenomic sequencing is a better tool for uncovering the bacterial microbiota of the N. atra oropharynx, which may help in developing a proper therapeutic strategy for patients with N. atra bites.
Collapse
Affiliation(s)
- Yan-Chiao Mao
- Department of Emergency Medicine, Division of Clinical Toxicology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Medicine, Division of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Ni Chuang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Precision Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Hung Shih
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Precision Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Han-Hsueh Hsieh
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Precision Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Han Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Liao-Chun Chiang
- Department of Emergency Medicine, Division of Clinical Toxicology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Medicine, Division of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan
| | - Wen-Loung Lin
- Taichung Wildlife Conservation Group, Taichung, Taiwan
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Precision Medicine Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
- * E-mail: (T-HH); (P-YL)
| | - Po-Yu Liu
- Department of Internal Medicine, Division of Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- * E-mail: (T-HH); (P-YL)
| |
Collapse
|