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Senthilkumaran S, Patel K, Rajan E, Vijayakumar P, Miller SW, Rucavado A, Gilabadi S, Sonavane M, Richards NJ, Williams J, Williams HF, Trim SA, Thirumalaikolundusubramanian P, Gutiérrez JM, Vaiyapuri S. Peripheral Arterial Thrombosis following Russell's Viper Bites. TH OPEN 2023; 7:e168-e183. [PMID: 37333023 PMCID: PMC10276757 DOI: 10.1055/s-0043-1769625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/05/2023] [Indexed: 06/20/2023] Open
Abstract
Envenomings by Russell's viper ( Daboia russelii ), a species of high medical importance in India and other Asian countries, commonly result in hemorrhage, coagulopathies, necrosis, and acute kidney injury. Although bleeding complications are frequently reported following viper envenomings, thrombotic events occur rarely (reported only in coronary and carotid arteries) with serious consequences. For the first time, we report three serious cases of peripheral arterial thrombosis following Russell's viper bites and their diagnostic, clinical management, and mechanistic insights. These patients developed occlusive thrombi in their peripheral arteries and symptoms despite antivenom treatment. In addition to clinical features, computed tomography angiography was used to diagnose arterial thrombosis and ascertain its precise locations. They were treated using thrombectomy or amputation in one case that presented with gangrenous digits. Mechanistic insights into the pathology through investigations revealed the procoagulant actions of Russell's viper venom in standard clotting tests as well as in rotational thromboelastometry analysis. Notably, Russell's viper venom inhibited agonist-induced platelet activation. The procoagulant effects of Russell's viper venom were inhibited by a matrix metalloprotease inhibitor, marimastat, although a phospholipase A 2 inhibitor (varespladib) did not show any inhibitory effects. Russell's viper venom induced pulmonary thrombosis when injected intravenously in mice and thrombi in the microvasculature and affected skeletal muscle when administered locally. These data emphasize the significance of peripheral arterial thrombosis in snakebite victims and provide awareness, mechanisms, and robust strategies for clinicians to tackle this issue in patients.
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Affiliation(s)
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | | | | | - Stephen W. Miller
- The Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Alexandra Rucavado
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Soheil Gilabadi
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Medha Sonavane
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | | | | | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Bernasconi L, Schicchi A, Pirozzolo R, Negrini V, Scaravaggi G, Lonati D, Petrolini VM, Locatelli CA. Coronary thrombosis after European adder bite in a patient on dual antiplatelet therapy: A case report. Toxicon 2022; 220:106961. [DOI: 10.1016/j.toxicon.2022.106961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]
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Pirasath S, Gajan D, Guruparan M, Murugananthan A, Gnanathasan A. Saw-scaled viper envenoming complicated with acute myocardial infarction. SAGE Open Med Case Rep 2021; 9:2050313X211007705. [PMID: 33953917 PMCID: PMC8042544 DOI: 10.1177/2050313x211007705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
The saw-scaled viper (Echis carinatus) is considered to be a venomous snake which is especially seen in Northern Sri Lanka. Systemic manifestations are rare and reported complications include coagulopathy and renal impairment. The cardiac toxicity following snakebites is rare and cardiac involvement following the saw-scaled viper bites is extremely rare. Here, we describe a patient with acute myocardial infarction following systemic envenoming by saw-scaled viper in Northern Sri Lanka, which was successfully managed per ward protocol following national guidelines.
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Affiliation(s)
| | - Dilani Gajan
- District General Hospital, Kilinochchi, Sri Lanka
| | | | - Arumugam Murugananthan
- Department of Parasitology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Ariaranee Gnanathasan
- National Hospital of Sri Lanka and Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Fatal Rattlesnake Envenomation in Northernmost Brazilian Amazon: A Case Report and Literature Overview. REPORTS 2020. [DOI: 10.3390/reports3020009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Snakebite envenomations are classified as Category A Neglected Tropical Diseases by the World Health Organization. In Brazil, 405 snake species are distributed among 11 families, with the genera Bothrops and Crotalus being the most studied and main responsible for severe and lethal envenomations. In the country, Crotalus genus (i.e., rattlesnakes) is represented by Crotalus durissus species, showing seven different subspecies distributed along the country, including Crotalus durissus ruruima, which inhabits Roraima, the Brazilian nothermost state from Amazon forest. Here, we report a fatal case of a severe envenomation following a rattlesnake bite. The patient presented classic crotalic neurological signs and symptoms such as ptosis, drooling of saliva, sluggishness, macroscopic hematuria, and oliguria, which evolved to acute kidney failure (AKF) and hemodynamic instability. Although the patient was treated with the specific antivenom therapy, the severe envenomation resulted in three cardiac arrests and death of the victim in less than 38 h. This study discusses the causes of the patient death, the features of rattlesnake venom-induced AKF, and shows evidences that the Brazilian crotalic antivenom should be improved to treat rattlesnake envenomations caused by C. d. ruruima venom in Roraima state.
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Ongprakobkul C, Jaigla P, Kositanurit W, Thanprasertsuk S. Sudden cardiac arrest and cerebral thrombosis due to bites by Russell’s viper ( Daboia siamensis). TOXICOLOGY COMMUNICATIONS 2019. [DOI: 10.1080/24734306.2019.1624012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Simpson CH, Richardson WH, Swartzentruber GS, Lloyd VJ. ST Segment Elevation Myocardial Infarction Following a Crotalus horridus Envenomation. Wilderness Environ Med 2018; 29:383-387. [DOI: 10.1016/j.wem.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 12/29/2022]
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Quan D, Zurcher K. Reversible atrial fibrillation following Crotalinae envenomation. J Venom Anim Toxins Incl Trop Dis 2017; 23:16. [PMID: 28331489 PMCID: PMC5359800 DOI: 10.1186/s40409-017-0108-9] [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: 08/08/2016] [Accepted: 03/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Cardiotoxicity is a documented complication of Crotalinae envenomation. Reported cardiac complications following snake envenomation have included acute myocardial infarction, electrocardiogram abnormalities and arrhythmias. Few reports exist describing arrhythmia induced by viper envenomation and to our knowledge none describe arrhythmia induced by Crotalinae envenomation. This report concerns the first known case of atrial fibrillation precipitated by rattlesnake bite. Case presentation A 73-year-old Caucasian man with a past medical history of hypertension, hyperlipidemia, type 1 diabetes mellitus, and a baseline first-degree atrioventricular block presented to the emergency department following a rattlesnake bite to his left lower leg. He developed pain and swelling in his left leg two-hour post-envenomation and subsequently received four vials of Crotalidae polyvalent immune fab (ovine). At three-hour post-envenomation following transfer to the intensive care unit, an electrocardiogram revealed new-onset atrial fibrillation. An amiodarone drip was started and the patient successfully converted to normal sinus rhythm approximately six hours after he was found to be in atrial fibrillation. A transthoracic echocardiogram revealed mild concentric left ventricular hypertrophy and an ejection fraction of 72%. He was discharged the following day with no hematological abnormalities and a baseline first-degree atrioventricular block. Conclusion This is the first documented case of reversible atrial fibrillation precipitated by Crotalinae envenomation. In patients with pertinent risk factors for developing atrial fibrillation, physicians should be aware of the potential for this arrhythmia. Direct toxic effects of venom or structural and electrophysiological cardiovascular abnormalities may predispose snakebite patients to arrhythmia, warranting extended and attentive cardiac monitoring.
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Affiliation(s)
- Dan Quan
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 East Roosevelt Road, Phoenix, AZ 85008 USA.,Department of Emergency Medicine, University of Arizona College of Medicine - Phoenix, 550 East Van Buren Street, Phoenix, AZ 85004 USA
| | - Kenneth Zurcher
- University of Arizona College of Medicine - Phoenix, 550 East Van Buren Street, Phoenix, AZ 85004 USA
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Kim OH, Lee JW, Kim HI, Cha K, Kim H, Lee KH, Hwang SO, Cha YS. Adverse Cardiovascular Events after a Venomous Snakebite in Korea. Yonsei Med J 2016; 57:512-7. [PMID: 26847308 PMCID: PMC4740548 DOI: 10.3349/ymj.2016.57.2.512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/20/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Although cardiac involvement is an infrequently recognized manifestation of venomous snakebites, little is known of the adverse cardiovascular events (ACVEs) arising as a result of snakebite in Korea. Accordingly, we studied the prevalence of ACVEs associated with venomous snakebites in Korea and compared the clinical features of patients with and without ACVEs. MATERIALS AND METHODS A retrospective review was conducted on 65 consecutive venomous snakebite cases diagnosed and treated at the emergency department of Wonju Severance Christian Hospital between May 2011 and October 2014. ACVEs were defined as the occurrence of at least one of the following: 1) myocardial injury, 2) shock, 3) ventricular dysrhythmia, or 4) cardiac arrest. RESULTS Nine (13.8%) of the 65 patients had ACVEs; myocardial injury (9 patients, 13.8%) included high sensitivity troponin I (hs-TnI) elevation (7 patients, 10.8%) or electrocardiogram (ECG) determined ischemic change (2 patients, 3.1%), and shock (2 patient, 3.1%). Neither ventricular dysrhythmia nor cardiac arrest was observed. The median of elevated hs-TnI levels observed in the present study were 0.063 ng/mL (maximum: 3.000 ng/mL) and there was no mortality in the ACVEs group. Underlying cardiac diseases were more common in the ACVEs group than in the non-ACVEs group (p=0.017). Regarding complications during hospitalization, 3 patients (5.4%) in the non-ACVEs group and 3 patients (33.3%) in the ACVEs group developed bleeding (p=0.031). CONCLUSION Significant proportion of the patients with venomous snakebite is associated with occurrence of ACVEs. Patients with ACVEs had more underlying cardiac disease and bleeding complication.
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Affiliation(s)
- Oh Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Joon Woo Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyung Il Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyoungchul Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kang Hyun Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
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Gupta PN, Thomas J, Francis PK, Shylaja SV. +Ophitoxaemia and myocardial infarction--the issues during primary angioplasty: a review. BMJ Case Rep 2014; 2014:bcr-2013-201912. [PMID: 25342187 DOI: 10.1136/bcr-2013-201912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
'The Big four' are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
| | - Jinesh Thomas
- Department of Cardiology, Medical College Hospital, Trivandrum, Kerala, India
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Acute MI in a stented patient following snake bite-possibility of stent thrombosis - a case report. Indian Heart J 2013; 65:327-30. [PMID: 23809391 DOI: 10.1016/j.ihj.2013.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 12/12/2022] Open
Abstract
Acute myocardial infarction following snake bite is rare with few reported cases in literature. A 60-year-old male underwent uneventful stenting to a critical stenosis in left anterior descending coronary artery in June 2012. A month later, he presented to the local hospital with history of snake bite. During admission he developed chest pain with ST-segment elevation in anterior leads consistent with stent thrombosis. He was successfully thrombolysed and his coronary angiogram 5 days later revealed patent stent with TIMI III flow and no evidence of thrombus.
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Niraj M, Jayaweera JL, Kumara IW, Tissera NW. Acute myocardial infarction following a Russell's viper bite: a case report. Int Arch Med 2013; 6:7. [PMID: 24499589 PMCID: PMC3605354 DOI: 10.1186/1755-7682-6-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 02/08/2013] [Indexed: 01/31/2023] Open
Abstract
Introduction Snake bite is a common and devastating environmental hazard, especially in rural areas of tropical countries. Acute myocardial infarction caused by snakebite has rarely been reported. To our knowledge we found only 10 cases of Myocardial infarction following a viper bite in English literature. Case presentation We report a case of inferior ST elevation myocardial infarction following a Russell’s viper bite in a 37 year old healthy Sri Lankan (South Asian) female with no past history of cardiac disease or cardiac risk factors who died 30 hours following the bite. Conclusion The course of events with respect to myocardium suggests a direct toxic effect of the venom on myocardial tissue or coronary vasoconstriction. Physicians should bear in mind the complications and devastating sequela of Myocardial infarction following Russell’s viper bite.
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Silva A, Pilapitiya S, Siribaddana S. Acute myocardial infarction following a possible direct intravenous bite of Russell's viper (Daboia russelli). BMC Res Notes 2012; 5:500. [PMID: 22971617 PMCID: PMC3490800 DOI: 10.1186/1756-0500-5-500] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Russell's viper (Daboia russelli) bites lead to high morbidity and mortality in South Asia. Although variety of clinical manifestations is reported in viper bite victims, myocardial ischemic events are rare. CASE PRESENTATION We report a unique case of inferior wall ST elevation myocardial infarction due to a Russell's viper bite over a vein with possible direct intravenous envenoming, in a young male with no past history or family history suggestive of ischemic cardiac disease, from Sri Lanka. In addition, the possible mechanisms of myocardial ischemia in snake bite victims are also briefly discussed. CONCLUSION Importance of the awareness of physicians on the rare, yet fatal manifestations of snake envenoming is highlighted.
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Affiliation(s)
- Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Senaka Pilapitiya
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
- Institute of Research and Development, Battaramulla, Sri Lanka
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Infant death after nose-horned viper (Vipera ammodytes ammodytes) bite in Croatia: A case report. Toxicon 2010; 56:1506-9. [PMID: 20813122 DOI: 10.1016/j.toxicon.2010.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 08/09/2010] [Accepted: 08/13/2010] [Indexed: 11/20/2022]
Abstract
A case of a 45-day-old male infant, bitten on the neck by nose-horned viper (Vipera ammodytes ammodytes), is reported. This episode occurred while the baby was on a picnic with his parents in a hill near a town in southern Croatia. In spite of immediate arrival at hospital, where antivenom was administrated and all the necessary treatment measures were carried out, the infant died 6 h following the bite. The cause of death was severe and progressive hyperkalaemia, massive intravascular haemolysis, severe coagulopathy and myocardial dysfunction.
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